Lateral chronic periodontitis

This case was referred to me for a re-root canal treatment of an upper left second premolar (25).

The tooth was presenting a lateral periodontitis which can indicate either a tooth fracture or an untreated lateral canal. 

For these kind of cases I always take a CBCT (3D x-ray) to ensure proper treatment planing and to obtain more information about the possible cause of the problem. I like to be very honest with all my patients and I always explain them the challenges of every case and the possible outcomes. 

The treatment was successful and, although a lateral canal wasn’t visible on the x-ray, it was likely the cause of the problem. A proper disinfection protocol and the use of advanced technologies and techniques are crucial for improving treatment success rates.

With the right experience, planning and tools complex cases are usually successful. I always recommend seeking out a specialist with experience to fix this kind of situations and to prevent further damage. The result may vary from patient to patient but it’s very predictable in the vast majority of cases. Let me save your tooth. 

Success is not final; failure is not fatal: It is the courage to continue that counts.

PhD. MSc. Dr. Pablo Salmeron at Dr. Roze & Associates.

Broken file retrieval on an upper second molar

This patient was referred to me for a re-root canal treatment of an upper left second molar (27). This tooth presented a broken instrument in the palatal canal. Due to the location of the tooth (the last one) and the location of the broken file at the apex, the treatment became an important challenge. For these types of cases, I always take a CBCT to properly plan the treatment.

value honesty with all my patients, and I always explain the challenges of each case and the possible outcomes to them. With the right experience, planning, and tools, complex cases are typically successful. My advice is always to seek out an experienced specialist to address these situations and prevent further damage.

While results may vary from patient to patient, they are highly predictable in the vast majority of cases.

Keep challenging yourself to think better, do better, and be better.

PhD. MSc. Dr. Pablo Salmeron at Dr. Roze & Associates.

Removal of silver points

This patient was referred to me for a re-root canal treatment of an upper left second premolar (15). The tooth was presenting a couple of metal post and a silver point obturation. Within the always difficulty of  re-root canal treatments, removal of metal posts and silver points are quite predictable with the proper skills. This tooth was already treated 2 times in the past so preserve as much natural tooth structure was very important. Every time that the tooth is root canal treated or re-treated adds another layer of difficulty for the next treatment making very challenging sometimes to fix what it was done 20 or 30 years ago. My advice is always to find the right specialist with experience to fix this kind of situations to avoid further damage. 

The obturation was done using bioceramic sealer and the treatment was completed in one session. The result may vary from patient to patient but it’s very predictable in the vast majority of cases. Let me save your tooth

Patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish.

PhD. MSc. Dr. Pablo Salmeron at Dr. Roze & Associates.

Vertical Root Fracture

In this post I’m going to talk about vertical fractures regarding a case I had a few months ago, the one on the right picture. This maxillary first premolar was ready to get a root canal therapy but presented a mesiodistally vertical coronal fracture that continued to the furca which divided the tooth in two roots, bucal and palatal. The tooth had an old restoration on the distal side that was not in occlusion and that probably let the fracture appear on the mesial area where you can see the line fracture. The tooth was also sensitive to vertical percussion and had some mobility, however, there wasn’t significant evidence or bone loss on the radiographic tests.

Most of the vertical fractures are due to excessive concentration of loading over some areas of the root canal. Studies have shown that the curvature of the root canal seems more important than the external morphology of the root, in terms of stress concentration, the remaining thin dentin increases the magnitude but not the direction of the stress generated by forces. In fact as thinner the mesiodistal dentin walls are, the concentration of forces on the lingual and bucal walls increase the risk of fracture in this direction contrary to what one might think at first, more dentin thickness the harder it is to break in that direction, well… it is not like that.

There are three factors that determine the distribution and direction of forces, a) the anatomy of the root canal, b) the anatomy of the root, c) the thickness of the dentin. The canal anatomy seems to be the most important factor determining the distribution of forces.

The vertical fractures most often occur in premolars, both maxillary and mandibular, followed by fractures on the mesial root of mandibular molars and central incisors.

One of the biggest problems we find in cases of vertical fractures is that they aren’t easy to diagnose. Most symptoms usually appear years after the fracture. We may well find, sensitivity to percussion and vertical palpation, presence of fistula, or a large and isolated periodontal pocket that doesn’t correspond to a general periodontitis. Radiologically we can observe a radiolucent area with horizontal bone loss along the affected root.

fractura verticalDiagnosis vertical fractures are a challenge for the dentist because the symptoms are similar to a failed root canal treatment and usually radiographic test doesn’t show evidence of a fracture clearly. Another problem in endodontically treated teeth is often the filling materials doesn’t allow us to see the fracture line on the radiograph as they’re in the same plane. Patients may experience anxiety to thinking that the endodontic treatment is not working when, in fact, the problem is a fracture prior or post to the root canal treatment.

PhD. MSc. Dr. Pablo Salmeron.

Microscope hands on course in your own practice

brochure hands on
I would like to introduce you this course I teach about the use of the microscope in your own practice. This course is recommended for those dentist who own a microscope (the brand doesn’t matter) and want to improve their technical skills with it.

The course takes place in your own practice with your own team and assistants, in your own space and with your own patients, so you will be able to maximize the use of the microscope making a pleasant working experience.

You can only treat what you see.

PhD. MSc. Dr. Pablo Salmeron.