COME LIFT ME UP WHERE WE BELONG - SINUSES I have known and revised Part Deux

Wild Bill Cohen of St. Louis Mo

COME LIFT ME UP WHERE WE BELONG - SINUSES I have known and revised

Pathfiles by Castellucci et al

ROOT FRACTURE

Thirteen year recall - root fracture; sixteen year recall failure - implant

By Terry Pannkuk

Here’s a patient that returned today.  Free CBCT to see what was going on with #3 that I retreated in 1997.  There was a vertical fracture coursing into the MB2 root orifice a couple millimeters.  There was a 4mm sulcular defect associated with the area in 1997 and a 6mm one today.  The patient has been asymptomatic with no awareness of the tooth.  The #7 tooth that I treated in 1994 had been extracted and replaced for a reason the patient could not remember; probably split with a large post or microfracture propagated by the pin buildup.

A previous MB2 had been missed and chronic path had resulted in inflammatory root end resorption of the DB apex.  Note the semicircular radiolucency on the transverse section associated with the previously identified cracked root area. The radiolucency clearly disappeared at the 6mm level at the same depth it probed. 

 

Photography and the Microscope

 Hi folks :  I always smile when people challenge me on photography through the operating scope.  I can tell you that Carlos Murgel, Gary Carr, Chris Schaefer ( from Zeiss) and a few others have taught me a few tips over the years.  I have spent thousands of dollars and countless hours analyzing my photos and trying to improve them.  So when people assume that I havent tried things I smile.
Let me tell you that over the years I have had

1. Strobe flash with slides on a Contax SLR ( not digital) on the scope.
2. One chip analog video camera ( capture card)
3. Video captured from one chip to VCR
4. 3 chip digital Camcorder from Sony
5. 3 chip analog medical grade cube camera ( Sony and Panasonic)
6. 3 chip digital Sony cube camera
7. Sony HDR SR12 and Sony HDR HC7 high def video cam corders

Digital photography

1. Nikon 995
2. Nikon 5000 point and shoot cameras
3. Nikon D1
4. Nikon D2X
5. Nikon D300
6. Nikon D90 ( with 720 p video)
7. Canon T2i (with 1080 p video)

All of these I have had in addition to ring flashes including SB29 from Nikon, Sigma and Canon ring flashes and the R1 dual flash on the scope.
So I have spent oodles of time on these systems folks.  I OWN all of the above, all of them.
So let me tell you that when you want to try and cut corners - you can - but there will be a price and only you can determine that.
If you want decent photos and you are fairly good with cameras get a point and shoot camera but there is a price to pay.
If you want video and primarily use documentation for endo, and want something simple get a High def video camera ( try Sony or Panasonic)
If you want photography with an SLR, and want it to work in all situation and want restorative shots then get a DSLR ( I would suggest Canon T2i) but you may need a flash.
The flash will help you standardize your settings, it will also help you get more depth of field.
I mean honestly, the images taken with point and shoot cameras without a flash intraorally just for regular dentistry are not great so why when the scope robs light would you expect the to be better.
I know its costly, I know that its not easy.......that is true.  No one has to document but if  you want good photos through the scope like Carlos shows, like Jorg, Javier, and others show like Leandro....there is a price to pay both financially and in time.

Glenn van As

Apico Implantectomy

5 years ago this patient had multiple maxillary anterior implants.  When I saw her for consultation I thought she was a lawn dart victim.  I checked out #7 but findings were equivocal, the tooth tested vital. it was percussion sensitive but so was #6.  We decided to monitor.  I saw her a year later in 2005, similar symptoms, pulp still vital, but it wasn't as sensitive as a year earlier.  We decided to continue to monitor.  Here gingival tissues during this period were inflamed and she was being passed around from periodontist to periodontist and no one wanted to treat her except the original treating periodontist, but she didn't want to have him treat her (small wonder). She was extremely frustrated.  By 2007 she found a periodontist who did some grafting, her dentist placed some provisionals and she looked a lot better......only one problem she developed a fistula that traced to the #9 implant.  With all the goofing around with the #9 implant the internal threads had been stripped, the cover screw was presumed loose and the consensus opinion was that the internal implant space was communicating and contaminated.  Some suggested that I do an apico on it (only upside down and place MTA in the screw hole space and "put it to sleep".  It wasn't part of the restorative plan because of esthetics.  An implant supported bridge was the new final restorative plan.  I didn't think it would be a good thing to do and suggested that the new periodontist trephine it out and graft the area.  The compromise plan was for the periodontist to do the surgery and drill the coronal part of the implant down deeper eliminating the space area.  I thought that was a good plan and it was done.  A year later the area had healed, but her biting discomfort and sensitivity was isolated to #7.  I finally decided to treat it a year ago to rule out endo.  Of course she still has the same pain one year later. She had another graft performed about 3 months ago.  Tooth #7 is moderately percussion sensitive with normal probing depths.  

This woman is tired of being sliced and diced. Check out all the attached chronologic photos and radiographs.  Clearly the implant in the #8 site is probably close to the apex of #7. 

What would you do? 

An apicoectomy on the maxillary lateral that had its apex into the max central implant replacement.  I couldn’t apically resect the root too much away from the implant without severely shortening it, but I presume we got the root tip cut back enough from the implant to allow good debridement and clotting.  I’ll take another CT when I take the sutures out next week. Reverse-filled the root end with MTA polished and debrided the implant surface with Metronidizole gel where the root tip was in contact.