417 Endodontics

Extra canals are always fun. They are hiding there surprisingly often. You just have to know where and how to look for them...

What a great looking recall on a lower molar with a large PARL! (XRs are pre-op, post-op, and 6 month recall). We work hard every day to perform high quality endodontic treatment and help people save their teeth, and it's always nice to see black and white evidence that we succeeded.

Here's a nice looking endodontic treatment from this morning. Nothing earth shattering, but relatively complex anatomy and a nice result.

Here's a couple nice, curvy #14's to start off 2021.

Here's a nice 2 year recall! I always love seeing healing like that!

Here's something unusual and interesting! This patient was asymptomatic and the lesion below was detected on routine radiographic evaluation. #27 responded WNL ...to cold, percussion and palpation. There is a mixed radiopaque/radiolucent lesion at the apex of this tooth. Let's make this a game and see who was paying attention in oral pathology! What is your differential diagnosis and what is our treatment plan? I'll give the answer below at the end of the day. {I'm going to add a little more info in response to the questions below - this patient was a 29-year-old hispanic female.}

After the week we've had working with a skeleton crew due to COVID, it feels good to show off a beautiful result from yesterday! With 3/5 staff out this week, we've been limping along, helping as many people as we can while prioritizing the safety of our staff and patients. Curves like this need no explanation. They take a lot of time, effort and skill to negotiate properly and they look great when they're done. Fortunately, we were able to get this beautiful result!

This was a complex case! The tooth presented with a large internal resorption defect that was non-perforating, and a necrotic pulp with a PARL. It also had a significant curve on the mesial root! Treatment involved cleaning out the resorptive defect as well as negotiating the curvature and treating the canals to length. Now we watch and hope to see nice healing over the next several months.

Wow! Check this tooth out! This one was a real challenge. Curvy and calcified. Those curves were no joke and we had to be cautious with every file. It took some elbow grease, but fortunately, we were able to get a great result! :)

This was a tough one! As you can see, there is no radiographic evidence of buccal canals whatsoever. In the cross section, we see evidence of the P canal and a root shape that indicates that there are most likely 3 buccal canals, MB, MB2 and DB. Reading the pulpal floor is an art that takes a long time to learn. It's all shades of gray; but the canals are typically hidden in the same places and you have to follow the shades of gray to find them. Fortunately, we were able to locate and treat all 4 canals and get a nice result.

Dental Visits Listed Among Health Appointments People Should Consider Keeping Despite The Pandemic The Washington Post (7/2, Searing) included dental visits in a list of five health practices that experts say you might want to reconsider delaying despite the coronavirus pandemic. Dental problems early on like very small decay in a tooth rarely have symptoms, so people often aren’t aware they have a problem until a dentist examines their teeth, said [Dr.] Chad Gehani, p...resident of the American Dental Association. Hence the recommended checkups and cleanings every three, six or 12 months, depending on the person’s oral health status, ‘to help spot dental health problems when treatment is effective and more affordable,’ he said. In addition, Dr. Rob Davidson, an emergency physician in West Michigan, shared in a video discussion on MSNBC (7/2) that he considers the risk of dental problems from delaying care greater than the risk of contracting the virus at the dentist. Information for the public on what to expect as dental offices reopen may be found on ADA’s consumer website MouthHealthy.org.

Here's a fun one from this week. There's two completely separate canals following that nice sharp curve on the MB root. Definitely not the easiest case we did this week, but fortunately it turned out looking beautiful.

Well that's good to know. "Study Finds Dental Offices Among Safest, Most Essential Businesses Amid COVID-19 Pandemic." The study, in the Proceedings of the National Academy of Science, identifies the businesses that have the best overall risk-benefit profiles when weighing important factors such as essential value to shoppers and the economy, as well as relative risk of contracting COVID-19or as one researcher put it, which businesses give us the most bang for our buck.

We treated this monster today. It was 28 mm long with calcified canals and multiple planes of curvature. Definitely took some elbow grease but we got a nice result!

Here at 417 Endodontics, we are committed to protecting the health of our patients, our staff and the community. So, we have instituted a number of changes to our office, including extensive personal protective equipment and air purifiers. We may look a little different, but underneath all that, it's the same great, caring team here to help your patients.

These are confusing times, but one thing that's still for sure is that a cool endo case is still...a cool endo case! This emergency patient presented with a necrotic pulp and a sharply curving MB root. Using all the proper precautions at our disposal, we got him comfortable and a cool looking result too!

Colleagues and patients: As you may know, in response to the COVID-19 virus, President Trump, the American Dental Association and the Missouri Dental Association have all recommended that dental treatment be limited to emergencies only and all other treatment be postponed for 2-3 weeks. At 417 Endodontics, we are dedicated to the health and safety of our patients, staff, families, and the community at large. As such, we have made the decision to follow and abide with these re...commendations. Our offices will remain open to see any patient who presents with emergency dental pain. We will do our part to relieve the burden in hospital emergency rooms. However, all other non-emergency appointments are currently being rescheduled at this time. We ask for your patience and understanding during this difficult time. We have always taken the highest measures to ensure cleanliness and patient safety at our office. In addition to our standard protocols we are now taking some additional measures to help protect our patients and team members: 1. We are requesting anyone who has experienced fever, cough, shortness of breath or fatigue within the last 48 hours to reschedule their dental appointment and seek medical attention. We are also requesting that you reschedule if you or a family member has traveled outside the country within the last two weeks. 2. To limit the number of patients in our waiting area, we are asking patients to call the office and wait in your vehicle when you arrive. Please refrain from walking into the office until advised. A staff member will ask you some pre-screening questions over the phone and/or bring you paperwork/information to fill out. The staff member may also take your temperature at this time. 3. To further limit the number of patients in our waiting area, we are also requesting that, except for minors and patients with special needs, the scheduled patient comes into the office without companions. 4. When the room where you will be seen has been cleaned, disinfected, and set up, you will be called or a staff member will come out to escort you inside and straight to your room. 5. All high-touch areas (waiting area, restroom, doorknobs, etc.) will be routinely disinfected throughout the day We will continue to monitor the situation closely and will update you with any changes.. As always, we appreciate you trusting us with your health and will do our utmost to ensure we continue to earn that trust. 417 Endodontics

Wow! Look at that 90 degree curve on the distal! This is a great example of an anatomical feature that can make endodontic treatment more challenging. Curvature like this requires time, patience and skill to treat without ledging or separating an instrument. But it certainly looks cool once it's done!

It's been a while since I've posted, so here are a few interesting cases. These cases are very similar - all three involve mandibular molar retreatments where the initial treatment left a canal untreated. Obviously, finding and treating all canals is important to achieve the highest success rate, and leaving behind tissue and/or bacteria will eventually lead to problems. It can sometimes be challenging to locate calcified canals, and this is where experience, magnification, and CBCT scans are crucial aids in obtaining a good result.

Dental work can be stressful. So we do our best to go above and beyond to make it as easy as possible. We got a really nice review on google today letting us know that our efforts were appreciated. Thanks so much for the positive feedback! "For anyone who is terrified of the dentist, please read: I have been absolutely terrified of the dentist since I. Was a kid, so much so that I avoided going to the point that I eventually needed a root canal. To someone like me, a root ca...nal sounds like the absolute most horrible experience ever. I was so anxious about the idea that I almost called it off. After pushing myself hard to walk through the door, I eventually did it. 417 Endodontics has helped me to feel far less scared of the dentist, and I am more anxious than most. They were so amazing at listening to me talk about my fear and what I think causes it, they listened to my concerns and anxieties and took extra care to put those at ease. Not only was the Root Canal a breeze, it didn’t hurt in the slightest and the whole time the doctor constantly checked in to make sure I was doing ok. When I thought I could feel something he numbed me just a little more. I am floored by the experience and so grateful that I found them, they took away a chunk of my fear of the dentist and I can’t believe I’m saying this but I am actually looking forward to going back for the rest of the work I need done. I mean it, these people are incredible. Sincerely, Someone who used to HATE going to the dentist. Thank you all for helping me through those anxieties."