Endodontic treatment of Geminated Canine

 An unusual presentation of a Canine (13) with periapical pathology showing an extra tooth structure on the mesial side.

On closer inspection, the pulp chambers seem connected. Since there is no missing tooth in the area, it looks like a case of Gemination.

After access opening, length determination of primary root is carried out.

Attempt is made to negotiate the additional root canal but the double curvature does not yield. The tooth  is unlikely to heal unless the additional root is endontically treated or resected.

Surgical intervention is planned. A flap is raised and the additional root resected. The resulting perforation is sealed off with GIC.

 Master cone placed.

Post Obturation radiograph. 

The bony defect is expected to fill up in time. 

To be reviewed in 3 & 6 months.....

On the MB2 trail

A carious exposed 16 requiring Endodontic treatment.

Initial working length determination using hand files.

Closer inspection of pulpal floor reveals another Mesiobuccal orifice. A faint canal can also be seen on radiograph.

The incidence of MB2 canal in Maxillary Ist & 2nd Molars is quite high and time should be devoted to to its location and treatment. 

Both MB canals have been located. It exibits a Type III  canal anatomy.

Post obturation radiograph .Protaper rotary files were used for canal preparation. 

Post obturation radiograph taken from another angle to see better separation of canals. 

Wrong turn !

A patient reports with symptoms of  pulpitis and apical periodontitis in 47. The tooth has a # filling.

 An obstruction is encountered in  the apical third of distal canal.

A precurved file and tactile feeling help negotiate a sharp distal bend in the apical third.

The distal canal is prepared by hand filing in the  apical third and Protaper rotary in coronal and middle third.

Mesial root has a Type II canal anatomy and is prepared with Protaper rotary files.

                                               

After final Obturation using 6% G.P.as master cone and lateral condensation technique.

Pegged for Crown

 A 26 yr. old girl is  unhappy with the dark shadows in between her front teeth. She wants crowns on  her peg laterals to fill up the gaps.

Minor preps are done on her laterals and impressions are sent for fabrication of 3M Lava crowns. 

3M Lava crowns on dental cast.

Crown after cementation with resin cement.

Final appearance after crown cementation.

Midline diastema closure is planned for Composite build-up.

Ceramic veneers

34 year old Female presents with generalized fluorosis and multiple restorations in posterior teeth. tooth # 35 is RC treated with a "gold" crown.

Patient wants 'caps on all teeth' to change her look. She also complains of sensitivity particularly in back teeth.

Clinical Assessment:


1. Fluorosis (Yellow- brown teeth).
2. Mild Attrition.
3. Inverse smile line.
4. Multiple restorations in Posterior teeth.
5. Sensitivity.

Treatment Plan:

1. Intentional RCT for posterior teeth and Lower Incisors followed by PFM Crowns.
2. Ceramic Veneers for Upper Anteriors.

PFM Crowns have been placed on 3 quadrants and crown preps can be seen in the first quadrant. The Crowns were placed one quadrant at a time.


The Lower anteriors have been prepared.


Occlusal view of Lower Anteriors after crown preparation.


After placement of Lower temporaries.

The Lower PFM Crowns.


Upper Veneer preparation has been done.


Upper anteriors with gingival cord in place to refine margins and before taking impressions.Lower PFM crowns have been cemented.


Upper temps in place.


E max veneers have been cemented.


The final visibility and smile line.

                     DIRECT COMPOSITE VENEERS

          23 yr./M with fluorosis  further compounded by gutkha stains. The stains are intrinsic in nature.

Preparation of 11 & 21 for veneering. All teeth from 13 to 23 were prepared in a similar fashion.

13 to 23 with direct composite veneers in place. 

                         ANTERIOR COMPOSITES

                     35 yr./M with deep abrasion/erosion lesion on 11. 21 is also affected.

a layer of Dycal followed by GIC has been applied.

The surface is etched.

Bonding agent is applied and cured.

after completion of final restoration. 21 has also been restored.

             # 11 & 21. teeth respond normally to vitality testing.

After restoration with composites.

                                A FINE LINE

26 yr./F with discolored composite (mesio-incisal) on 21 and a gap between 11 & 21.

21 after removal and re-restoration with composite. 11 was treated in a similar fashion.

                PERIAPICAL CYST

            15 yr./F with H/O trauma to anterior teeth and PA cyst in relation to 22. Non-vital 23.

Endodontic treatment carried out in 22 & 23. root end surgery was carried out and cyst enucleation done.

radiograph taken 1 yr. later shows complete healing of bone.

Occlusal radiograph shows complete bone healing around 22 & 23.

LOWER 1st MOLAR WITH 3 ROOTS (RADIX ENTOMOLARIS)

carious exposed 36 with 2 distinct distal roots(Radix Entomolaris)

post obturation radiograph.