Histobacteriologic Conditions of the Apical Root Canal System and Periapical Tissues in Teeth Associated with Sinus Tracts

D. Ricucci et al, JOE 44:3 pp405-413, March 2018
Chronic apical abscess (chronic apical periodontitis) or what those of us who trained at Boston University under the legendary Dr. Herbert Schilder term a lesion of endodontic origin (LEO), is a variation of apical periodontitis caused by a root canal infection that has resulted in an …

Determining Pulpal Status – The Hot Test

In the November 2017 newsletter I talked about cold testing teeth to determine pulpal vitality.  The cold test is by far the most commonly employed of the pulp tests and for the most part the easiest to use.
The hot test, while used less frequently, is another important pulp vitality test.  As with cold testing …

Regenerative Potential of Carious Lesions – A Literature Review

It seems increasingly I have been approached by both patients and dental colleagues and asked to give an opinion regarding some aspect of regenerative dentistry; from regrowing pulp and dentin to 3D printing or growing a whole new tooth for the purpose of intention replantation.  This trending prevalence can be attributed directly to the increase …

Silver Point Endodontic Retreatment

The word “endodontic” comes from two Greek words meaning “inside” and “tooth”.  The first signs of human beings treating the “inside of the tooth” or the root canal system were believed to be around the second or third century B.C.  This notion is founded on the discovery of a skull found in Israel’s Negev Desert …

Perio-Endo: A Case Presentation

Dr, Jason Conn, DMD, CAGS, FRCD(C)

About Dr. Jason Conn, DMD, CAGS, FRCD(C)
Langley EndodonticsDr. Conn was born and raised in Langley. He completed a Bachelors in Chemistry at Simon Fraser University before receiving his DMD and Certificate of Advanced Graduate Study in Endodontics at Boston University where he wrote a …

Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-Control Study

Khalighinejad et al, JOE 43:10 pp1611-1614, October 2017
Preeclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (>140/90) and proteinuria amongst other symptoms.  This condition begins, by definition, after 20 weeks of pregnancy and is one of the most common causes of maternal fatalities, preterm birth, and reduced birth …

Spotting Canals

Dr. Conn discusses tips for a successful root canal treatment with the use of two-dimensional radiographs.
 

 
About Dr. Jason Conn, DMD, CAGS, FRCD(C)
Langley EndodonticsDr. Conn was born and raised in Langley. He completed a Bachelors in Chemistry at Simon Fraser University before receiving his DMD and Certificate of Advanced Graduate Study …

Determining Pulpal Status – The Cold Test

An accurate determination of the status of the pulp is a critical element in achieving the correct diagnosis and treatment plan.  How the pulp responds to a thermal challenge, both for a specific tooth and comparatively in relation to adjacent and opposing teeth, gives the dentist important information about the health of the pulp tissue.
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More Good Than Harm

The antibiotic class of drug has had a profound impact on the treatment and prevention of dental infections.  They have been so effective, cheap and readily available that last year there were five prescriptions written for every six people in the United States.  Canada ranked even higher in our disbursement with 23 million prescriptions …

Treatment Complexities of a Necrotic Tooth with an Immature Root Form

Endodontics has evolved dramatically over the last 50 years.  Dr. Herbert Schilder in the late 60’s established the principles of endodontic treatment that still govern our best treatment protocols today. He described the five tenets of ideal root canal preparation:

Continuously tapering cone from apex to coronal orifice
Decreasing cross-sectional diameters from orifice to …

Long-term Clinical Outcome of Teeth Obturated with Resilon

1. Barborka et al, JOE 43:4 April 2017, 556-560
The primary objective of root canal treatment is to eliminate the etiology of pulpal and periapical disease and promote tissue healing.  Following cleaning and shaping of the root canal system, the hopefully pristine endodontic environment needs to be filled and sealed, both apically and coronally, to …

Vital Pulp Therapy

Dr. Jason Conn discusses Vital Pulp Therapy in a case presentation on a nine year-old male patient . This treatment offers many advantages.
 

Treatment of Recurrent Oral Herpes Labialis – What Works and What Doesn’t

Recurrent Herpes Labialis (RHL) is a commonly occurring condition. It is estimated there are 100 million outbreaks of cold sores in North America each year. Reports suggest 80% of people have antibodies against herpes simplex virus indicating some form of exposure to the virus.
Following a primary infection with either herpes simplex virus-1 (HSV1) or …

Cervical Resorption 2

Dr. Jason Conn Part 2 Video on Cervical Resorption.
Diagnosis: Cervical resorption with sulcular communication, asymptomatic irreversible pulpitis.

Horizontal Root Fractures: To Treat or Not to Treat, That is the Question! But What is the Answer?

It is not uncommon to see people with fractures to anterior teeth, usually as a result of a traumatic incident. A blow to the teeth can result in a crown fracture, partial or complete avulsion, a fracture to the root or some combination. These incidents create a lot of angst for both the patient, their …

Root Canal Completion Survival of Endodontically Treated Teeth

Journal of Endodontics, 42:11, 1598-1603, 2016 I. Pratt et al
The goal of most dentists is to have people, their patients, keep their natural dentition for their entire lifetime. In North America, organized dentistry has made incredible strides helping people keep their teeth, even through the era of high sugar, fast foods. The vast majority …

Cervical Resorption

Dr. Jason Conn discusses a case study in a video.

Irrigation: You Can Clean What You Can’t See

Endodontic irrigation is the second leg of chemo-mechanical cleaning and shaping of the root canal system (RCS).  Both mechanical shaping of the canals and chemical disinfection of the shaped canals are critical to a successful endodontic protocol and a comfortable patient outcome.  Mechanical shaping of the canals was described by Dr. Herbert Schilder in his …

Asymptomatic Menace

Returning from an endodontic symposium last month, there was a lot of talk around external cervical resorption (ECR) and its management. The etiology and predisposing factors still remain partly shrouded which tends to confound many of us as clinicians in the realm of diagnosis and treatment. Shannon Patel et al. (J Endod 2009;35:616-625) did an …

Is it or Isn’t it?

This patient was referred to our Langley Endodontics office earlier this year for evaluation, diagnosis, and treatment as needed, for tooth #11.
The patient was asymptomatic at the time of their visit to their dentist for routine maintenance.  A history of trauma to the maxillary central incisors with some minor chipping of the incisal edges …

Tips & Tricks – Access

As we celebrate Canadian New Year’s (Labour day) by heading back to school, I was reminded by my UBC students about the intricacies of access cavity preparation. While textbooks teach the generalized shape of preparations and roughly how many canals we should be looking for, a very common question I will encounter is, “So what …

Treatment Preferences for Toothache Among Working Poor Canadians

Journal of Endodontics, 41:12, 1985-1990, 2015 A. Azarpazhooh, C. Quinonez
Patient autonomy has received more emphasis in the last 20 years as we, in Dentistry, have moved from an authoritative to collaborative model of clinical decision making.  The Canadian Dental Association’s Patient Charter of Rights, not to mention the legal profession, has clearly described the …

A New Look at a Classical Treatment Option

There are many instances when a vertical root fracture dictates a hopeless prognosis resulting in extraction, but this need not always be the case.  Though less popular and less aggressively pursued in the age of implants, root amputations can still serve as an effective treatment option.  This option can be used to ‘transition’ a patient …

How to Prevent Local Anesthetic Overdose

I recently attended a course, hosted by the Fraser Valley Dental Society, on medical emergencies in the dental office. One of the many topics we covered was local anesthetic (LA) emergencies. It was clear from speaking with other attendees and the questions that arose with our speaker, Dr. David Isen, that most were a bit …

A New Age in Endodontics

In January of this year the editor of the Journal of Endodontics, Dr. Ken Hargraves, announced the addition of a new category in the journal. Citing that 50% of the top 20 referenced articles in the last 5 years all came from the same topic, Dr. Hargreaves declared that Regenerative Endodontics will have its own …

Mid Mesial Canals – The Black Sheep of the Lower Molar Root Canal System!

New to our newsletters this year is the Case Report.  As an Endodontist, I see a wide variety of interesting cases that are rarely seen by the general dentist. Our goal with these case reports is to share some of these more unusual and interesting cases with our dental community.
 
In mid-January 2016, a …

The Benefits of Isolation

An often overlooked area of root canal treatment is proper isolation and the myriad of benefits that come from it.  While it is true that a good rubber dam will prevent contamination of your working field and prevent irrigants from disturbing your patient, additional benefits include assistance in locating canals, preventing iatrogenic misadventures, and allowing …

Histological Changes within Dental Pulps in Teeth with Moderate-to-Severe Chronic Periodontitis

International Endodontic Journal, 48, 95-102, 2015 L. Wan et al
The inter-relationship of periodontal and endodontic diseases has been a subject of speculation because of the close connections between the periodontium and pulp tissue in embryonic origin, anatomy, and function. The literature concerning this relationship has been contradictory across the years. The reasons …

Association between Chronic Apical Periodontitis and Low Birth Weight Preterm Births

The literature contains a number of studies showing association between chronic apical periodontitis (CAP) and systemic health issues such as diabetes and cardiovascular diseases. Research from the field of periodontics has suggested that periodontitis in pregnancy is a risk factor for low birth weight and preterm birth (LBWPB).
…

Biocompatible Though Unretrievable

I have received a few calls and emails recently asking about sealers, particularly the “new” EndoSequence® BC Sealer. It has been marketed as “a revolutionary premixed bioceramic sealer which chemically bonds to both dentin and our bioceramic points.” So should you use it? Will it make your endodontic therapy better? And is it …

The Cracked Tooth: Histopathologic and Histobacteriologic Aspects

In the 1970’s in North America, dentists were faced with a huge onslaught of patients with periodontal disease and caries. The large cohort baby boomers grew up in the 25 cent coke and a chocolate bar era and their dental health reflected it. Organized dentistry responded to this challenge with massive public education …

Incidence of Middle Mesial Canals in Mandibular Molars After Guided Troughing Under High Magnifaction: An In Vivo Investigation

Disinfection of the root canal system is the primary goal of endodontic treatment. Schilder coined the term root canal system in the 1960’s to acknowledge the complexity of endodontic treatment. During tooth development, Hetrwig’s epithelial root sheath directs the formation of the root. Dentinogenesis results in the axial thickening of the root …

The Endodontic Red Herring

The idiom “red herring” is used to refer to something that misleads or detracts from the actual or otherwise important issue.  In the dental office, a red herring is a set of signs and symptoms which can confuse or obfuscate the diagnosis resulting in a course of treatment which does not address the patient’s chief …

Influence of Ferrule, Post System, and Length on Biomechanical Behavior of Endodontically Treated Anterior Teeth

Endodontically treated anterior teeth are always of concern to the restorative dentist and endodontist alike.  Anterior teeth are the most likely teeth to be affected by both accidental trauma and parafunctional occlusal forces.  Anterior teeth which are biomechanically compromised, whether through caries, trauma, or injudicious endodontic access are often restored, following endodontic treatment, with  post and …

Healing Outcomes After Obturation With Resilon or Gutta Percha

Endodontic treatment has three objectives: remove bacteria and bacterial by-products from the root canal system; prevent bacterial re-contamination from the oral environment; and entomb any remaining viable bacteria within the system.

The classic endodontic triad of cleaning, shaping, and obturation have predictably achieved these goals over the years. For 50 years obturation …

Investigation of Cultivable Bacteria Isolated from Longstanding Retreatment-Resistant Lesions of Teeth with Apical Periodontitis

Lesions of endodontic origin (LEO), as described by Schilder in the 1960 or more conventionally called chronic apical periodontitis, are the bane of both the general dentist and Endodontist.  The Toronto Study: Phase II, done by Friedman et al, JOE 2004, looked at the success rate of endodontic retreatment.  Friedman’s group found a retreatment success rate …

What Can I Expect When I See An Endodontist? Part 3 – First Office Visit

Welcome Doctor.  Whether this is your patient’s first visit to our office or they are returning, rest assured we are very pleased you and your patient have chosen Langley Endodontics for their endodontic care.  Our goal is to make this the best dental experience your patient has ever had.
As most patients who come into …

What Can I Expect When I See an Endodontist? Part 3 – First Office Visit.

Welcome.  Whether this is your first visit to our office or you are returning, rest assured we are very pleased you have chosen Langley Endodontics for your endodontic care.  Our goal is to make this the best dental experience you have ever had.
As most people who come into our office have an appointment, we …

Potential Correlation Between Statins and Pulp Chamber Calcification

Statins, such as Lipitor, Zocor, and Crestor, are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver.  255 million adults worldwide are prescribed statins to reduce the risks of cardiovascular disease and have revolutionized the treatment …

What Can I Expect When I See An Endodontist? Part 2 – First Contact

The first contact for your patient with our office depends entirely on the system you have created for a patient referral to an Endodontist.  Some dentists prefer to call our office directly and speak with one of our Patient Coordinators (PC).  Some prefer to email or fax over patient information and have our PC’s call …

What Can I Expect When I See An Endodontist? Part 2 – First Contact

The first contact for you, the patient, with our office, comes in different looks depending on your general dentist.  Some dentists prefer to call our office directly and speak with one of our Patient Coordinators (PC).  Some prefer to email or fax over your information and have our PC call you directly, and some dentists …

What Can I Expect When I See An Endodontist? Part 1 – The Vision

Most people are a little unsure of what to expect when they make an appointment to see a Root Canal Specialist (Endodontist).  The majority of people who see an Endodontist are referred by their general dentist.  General dental office varies in the type and quantity of information they provide for their patient prior to the …

How Do I Get To See An Endodontist When I Need A Root Canal?

Many times over the years I have been asked the question: “Do I need to see my general dentist first when I need a root canal or can I call you directly?”  Dentistry does not follow the same model as medicine.  With medical issues, MSP – Medical Services Plan of British Columbia – dictates that …

What Is An Endodontist?

Endodontist is a fancy name for a Root Canal Specialist.  An Endodontist’s training begins the same as all general dentists with a preparatory Bachelors degree, usually in the Sciences, followed by a four year degree in the Faculty of Dentistry.  A degree in Dental Medicine allows you to put Doctor in front of your name …

What Your Patients Can Expect When You Refer Them To Our Endodontic Office: Part 1 – The Vision

Most patients are a little unsure of what to expect when they make an appointment to see a root canal specialist. In our office we want your patients to feel that they have been referred for the best endodontic care possible.
This doesn’t happen by accident. It takes a lot of thought, planning and training. …

The Effect of Crown Design on the Potential to Develop a Vertical Root Fracture Following Endodontic Treatment

Patients often ask if a proposed endodontic treatment is guaranteed.  What they are meaning is will they be able to keep their tooth for the rest of their life.  Endodontic success studies have repeatedly shown that overall success rates are approximately 85% with tooth survival in the 98% range.  Most endodontic failures are related to …

The Effect of Early Coronal Enlargement on the Ability to Accurately Determine the True Size of the Apical Terminus

Dr. Herbert Schilder’s publications (1967’s Vertical Compaction of Warm Gutta Percha and 1972’s Cleaning and Shaping of the Root Canal System) have revolutionized the practice of endodontics, although they went widely unrecognized until the 1990s. We now have a good understanding of the complexity and interconnectedness of the root canal system …

Saving a Knocked-Out Tooth

Approximately one to three million permanent teeth are accidentally knocked out each year. Both adults and children are at risk.
With proper emergency action, a tooth that has been entirely knocked out of its socket often can be successfully replanted to last for years. Because of this, it is important to be prepared and …

Cracked Teeth

Today, people are extending the optimal health of their teeth thanks to advances in dental procedures. At the same time, people are also exposing their teeth to many more years of crack-inducing habits and stress. Cracked teeth are becoming increasingly more common, yet these teeth can often be saved if treated promptly.
 

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Bacterial Flora and Extraradicular Biofilm Associated with the Apical Segment of Teeth with Post-Treatment Apical Periodontitis

Many investigators (Nair, Sequeira) have demonstrated that most root canal failures are caused by viable bacteria and their by-products, which survive following endodontic treatment. Recent studies (Yang, Yu) have indicated that bacteria can migrate from an infected canal and colonize micro-resorptive areas in the external aspect of the root in proximity to the apical foramina. …