Redmires Dental Care | Hunt & McGorrigan
Dental Professionals
Endodontic Referrals
Working with you for a healthy smile
Endodontic Case Studies
Our aim is to provide an endodontic referral service that displays the very highest levels of patient care. Our treatment strategies are based firmly on a research driven biological rationale of root canal therapy. There are no fixed single or multiple visit treatment strategies, each case is treated individually as required
We pride ourelves on providing a relaxed and caring environment for patients and where urgent management is required, no referral is necessary, please telephone for an express appointment.
We believe in developing close working relationships with all our referring dentists so should you wish to discuss a case prior to referral or just get some advice please don't hesitate to contact us. Please don't be surprised if we also contact you from time to time to discuss referral cases so that we can decide together how best to proceed. We will always keep you up to date with your patient's treatment status and a full clinical report will be provided upon completion of treatment.
Dr M. Jones
Primary Cases
Sclerosed Root Canals
Patient presented with a long history of pain and discomfort from the heavily restored UR7. The pulp chamber was almost completely sclerosed and the root canals were barely, if at all, visible on the preoperative radiograph. Four roots were also identified.
The sclerosed pulp chamber was managed with the aid of the operating microscope and ultrasonics. The root canal orifices were identified through ‘champagne bubbles’ elicited by the use of sodium hypochlorite.
The root canals were initially prepared with stainless steel handfiles and then finished with NiTi. The tooth was successfully treated and then restored by myself with a cuspal coverage amalgam.
Sclerosed Root Canals + Hypercementosis
This elderly patient presented with a lone standing LR7 that had undergone hypercementosis and sclerosis of the apical root thirds. The increased bone density around the apices also suggested long standing chronic inflammation.
This was the last functioning posterior tooth in this quadrant and the crown was designed to aid retention of the patients lower partial denture.
The tooth was successfully treated over three visits with the aid of the operating microscope and lots of small stainless / carbon steel hand files.
Cracked Tooth Syndrome
Patient reported a classic pain history that described cracked tooth symdrome, progressing on to reversible and then irreversible pulpitis and finally to chronic apical periodontitis. A mesial and distal crack was identified in the LL6.
The tooth was successfully root canal treated and then secured with an orthodontic band which alleviated the patients symptoms. The patient was then referred back to her GDP for placement of a cuspal coverage restoration to prevent further propagation of the crack.
Challenging Anatomy
Two canals in a LL4 that also merged apically. The acute entry into the lingual canal is not immediately apparent from the radiograph. Consequentially this case was prepared entirely with stainless steel handfiles. The tooth was restored by myself with an amalgam core at the patients request.
All content and images copyright Dr Michael Jones 2011©
Re-treatment Cases
Challenging Anatomy
The LL6 demonstrates fine / thin roots with sclerosis of the mesial root apically and an almost 90° curve in the apical third of the distal root. In addition both the two mesial and distal canals merged in the apical third complicating both instrumentation and obturation even further.
This case took quite some time to unblock the apical thirds and successfully negotiate the complex apical anatomy. The case was managed primarily with stainless steel hand-files and then finished with NiTi hand-files. Note the excellent healing response.
Fractured Instrument + Paste Removal
This patient had had pain on biting with the UL6 for over 10 years. Access was made through the existing crown. The root canals had been filled with a hard paste that was removed with the aid of ultrasonics. The fractured file in the palatal canal was visualised and removed with the Cancelier System™.
The tooth responded well to re-treatment and the patient is now pain free. The large apical foramen sizes created by the previous preparation in the mesial and distal canals were managed with a chloroform customized obturation technique.
Re-treatment through existing restorations
Pre-operatively we were concerned about the large furcal lesion on this UL6 and suspected a possible perforation in this area. Fortunately no perforation was apparent, the tooth was re-treated and dressed with calcium hydroxide for 4 weeks prior to obturation.
Emergency Management
Emergency referral of a teenage patient by their GDP after fracture of a gates glidden drill beyond the radiographic apex. The patient presented in pain with a large fluctuant buccal swelling.
The GDP‘s PA radiograph shows a large periapical lesion associated with the UR2, which also has an open apex. The lesion also involved the apex of the UR1.
The Gates Glidden drill was removed and the tooth chemomechanically debrided. Calcium hydroxide was placed for a total of 3 months, with the dressing changed at 1, 4 & 8 weeks due to apical wash out. By 3 months we had achieved a dry canal and the tooth was obturated with a chlorform customized GP technique, utilising a size 120 master cone.
Note the reduction in the size of the lesion and the evidence of boney infill within 3 months. The vitaility of the UR1 was monitored throughout treatment and successfully maintained.