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Pierre Pizem Endodontics

Accueil
Canada
Westmount, QC
Pierre Pizem Endodontics

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Saving natural teeth with root canal treatments. Over 25 years of experience in complex root canal treatment

10/15/2026

Only two remaining walls. Twelve years of continued function.

This symptomatic maxillary first molar ( #26) presented with persistent inflammation following root canal treatment performed a year earlier.

Retreatment in 2014 required removal of the amalgam core and a long Flexi-Post from the palatal canal, removal of the previous gutta-percha, and location of the previously untreated MB2 canal.

Following cleaning and shaping, interim calcium hydroxide medication was placed before final obturation. The tooth was then restored with a cast post and core and a permanent crown.

**Only the distal and buccal walls remained. Despite this substantial loss of tooth structure, the restored tooth has withstood twelve years of masticatory forces and remains functional and asymptomatic.**

A reassuring long-term outcome illustrating the potential for preservation, even when little coronal tooth structure remains, with careful case selection, endodontic treatment, and definitive restoration.

10/13/2026

**When the canals are barely visible, planning matters.**

This maxillary first molar presented severe pulp canal calcification and indistinct canal pathways—a high-difficulty endodontic case.

The conventional radiographs revealed the challenge. CBCT added valuable three-dimensional information, showing residual canal spaces that were difficult to distinguish on the two-dimensional images and helping guide the search within the roots.

Finding these spaces is only the beginning. Negotiating narrow canals and establishing a reproducible glide path carry increased risks of perforation, ledging, instrument separation, and excessive dentin removal. CBCT helps inform the approach; careful clinical ex*****on remains essential.

An amalgam core now provides the foundation for the planned permanent crown, which will provide cuspal coverage. Endodontic treatment and the definitive restoration are successive steps toward the same goal: preserving a functional tooth.

The CBCT emphasis is consistent with the 2025 AAE/AAOMR statement supporting limited-field CBCT for identification and localization of calcified canals. [ScienceDirect](https://www.sciencedirect.com/science/article/pii/S0099239925005849?utm_source=chatgpt.com)

10/09/2026

This is not fantasy. This is the profound reality of time dilation a phenomenon that Einstein revealed to us through the mathematics of relativity. It asks us to contemplate something that challenges our deepest understanding of existence itself. When you travel at extreme velocities through space time itself bends and shifts around you. The faster you move the slower time passes for you compared to those who remain still on Earth. This is not metaphorical. This is physics. This is real.

For centuries humans believed time was absolute and unchanging for everyone everywhere simultaneously. Then Einstein showed us something breathtaking and humbling. Time is flexible. Time is negotiable. Time depends on speed and gravity in ways that defy our everyday intuition. A person traveling at near light speed experiences time differently than someone standing on solid ground. The universe operates by rules far stranger than we imagined when we were young and believed the world was simple.

Picture yourself at fifteen saying goodbye to your friends knowing something profound will separate you. You spend five years journeying through the vast cosmic expanse in your spacecraft experiencing only five years of aging. Meanwhile on Earth your companions live through fifty years of sunrises and sunsets. They experience fifty years of memories and changes and growth. You return to a world where everyone you loved has become elderly while you remain young. This temporal separation is perhaps one of the most poignant consequences of relativity.

Time dilation reveals something essential about the nature of reality itself. Speed and gravity warp the fabric of spacetime in ways that seem impossible yet are verified through countless scientific observations and experiments. This phenomenon teaches us that our perception of time's flow is not universal but depends entirely on our motion through space. Nothing in physics has more deeply shaken our sense of security and certainty than this realization.

This concept invites us into a meditation on connection and separation and the strange poetry of cosmic law. Time dilation stands as one of humanity's most profound discoveries about the universe. It whispers to us that reality is far more mysterious than our everyday experience suggests. In understanding how speed changes time we understand something sacred about existence itself. We are not separate from the cosmos. We are woven into it by forces we are only beginning to comprehend.

10/08/2026

🦷 **From a recommendation for extraction to a permanent crown.**

This maxillary left second molar ( #27), severely damaged by decay, had been deemed non-restorable by a clinic, which recommended extraction.

However, assessing the amount and distribution of the remaining sound tooth structure allowed us to consider preserving it.

Root canal treatment was performed, followed by an amalgam core buildup. Today, placement of the permanent crown completes this treatment sequence.

**Extensive destruction does not necessarily mean a tooth must be extracted.** The decision to preserve it relies on a careful assessment of restorability before beginning endodontic treatment.

This case illustrates an opportunity for tooth preservation. Follow-up will allow us to assess the long-term outcome.

09/30/2026

**A second opinion. Four years of preservation. A new bridge today.**

A furcation lesion, an accessory canal—and four years of tooth preservation.
This mandibular second molar ( #47), diagnosed with pulp necrosis and an acute apical abscess, had initially been considered fractured and non-restorable. Extraction followed by implant treatment at sites #46 and #47 was proposed.
The patient wished to explore whether her tooth could be preserved and consulted us for a second opinion.
The finding worth sharing was an accessory canal opening toward the furcation, corresponding to the area of extensive focal bone destruction. This pathway offered a possible explanation for the lesion: infection spreading from the necrotic root canal system into the surrounding periodontal tissues.
These presentations can be difficult to interpret. A substantial furcation lesion may raise concern for a root fracture, but an endodontic source is also worth considering. When the diagnosis remains uncertain, further assessment or an endodontic opinion may help clarify whether preservation is feasible before proceeding with extraction.
In this case, root canal treatment through the existing bridge abutment allowed us to retain both #47 and the bridge for four years. The postoperative radiograph shows the accessory canal extending toward the furcation.
Pulpitis subsequently developed in #45, the other abutment, requiring root canal treatment, a post, and a new bridge, which we cemented today—with #47 still serving as an abutment.
For me, this case is a useful reminder to keep an endodontic explanation in the differential diagnosis of a furcation lesion. Four years later, the tooth initially considered non-restorable remains part of the patient’s fixed restoration.

09/29/2026

Today’s challenge: a 26 mm calcified mandibular second molar.

Tooth 47 | Diagnosis: irreversible pulpitis

Second-molar position, length greater than 25 mm, and poorly discernible canal paths placed this case in the AAE high-difficulty category.

In this case, additional dentin had to be removed to establish a reproducible glide path and adequately prepare and debride the apical third.

All three canals were negotiated and prepared with a size #30 master apical file reaching the apical terminus.

Why aim for #30? My goal is to create enough apical space for effective cleaning and irrigation. Locating a canal and passing a small file to length are essential first steps, but they do not, by themselves, provide the space needed for thorough apical preparation. The final size must still respect each canal’s anatomy.

$Does a fractured root necessarily mean losing the entire tooth?In this maxillary left first molar ( #26), 3D imaging rev...$

09/27/2026

Does a fractured root necessarily mean losing the entire tooth?

In this maxillary left first molar ( #26), 3D imaging revealed a fractured fragment of the distobuccal root. The goal was to preserve the tooth while addressing the affected root.

Treatment involved root canal therapy, an amalgam core buildup, removal of the fractured root fragment, and placement of a crown. A follow-up radiograph from February 2026 shows the tooth still in place, several years after the initial treatment.

Root resection is an established tooth-preserving option that may be overlooked in the era of implants. In carefully selected cases, it can offer a favorable outcome.

Alkahtany’s 2021 case report describes a maxillary left first molar that remained functional five years after amputation of its distobuccal root. **The indication was different:** that root had a perforation, whereas the root in my case was fractured. The shared lesson is that a problem confined to one root does not always require extraction of the entire molar. The condition of the remaining roots, bone support, and restorability all matter.

📚 Alkahtany M. *Saving a Natural Tooth in the Implant Era: A Case Report on Noninvasive Surgical Root Amputation.* J Contemp Dent Pract. 2021;22(8):947–950.

09/21/2026

External apical root resorption — 11-year successful outcome
This mandibular first molar was diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis, with external apical resorption affecting the distal root.
Root canal treatment was completed in 2015 using gutta-percha and Pulp Canal Sealer EWT—without a bioceramic sealer.
An amalgam core build-up was placed at the same appointment and successfully withstood the occlusal load for five years before the tooth received cuspal coverage in 2020.
At the 11-year follow-up, the tooth remains asymptomatic, functional and radiographically stable.
Long-term success does not depend on the latest material alone. Appropriate case management, effective disinfection, sound obturation and a durable coronal restoration remain fundamental.

09/16/2026

**Pericervical dentin preservation—but at what cost?**

The initial access cavity of this symptomatic mandibular first molar appeared adequate. During retreatment, however, restrictive cervical dentin had to be removed to improve radicular access.

In long, narrow or curved canals, controlled pre-enlargement—called **radicular access**—may require removing internal dentinal triangles and other coronal interferences. In this case, additional dentin removal was necessary to establish a reproducible glide path and adequately prepare and debride the apical third.

A small-taper NiTi system cannot compensate for inadequate radicular access or an unestablished glide path.

**Dentin removal does not automatically translate into a measurable reduction in fracture resistance.** In da Silva et al.’s laboratory study on mandibular incisors, all instrumented groups lost cervical dentin, but only the Gates-Glidden group showed significantly lower fracture resistance; the NiTi preflaring groups did not differ significantly from the instrumented control. This finding is protocol-specific—not proof of equivalent clinical survival—but adds an important nuance. [da Silva et al., 2020](https://doi.org/10.1186/s12903-020-1050-8)

Reeh, Messer and Douglas reported that endodontic procedures alone reduced relative tooth stiffness by approximately **5%**, whereas loss of marginal ridges had a substantially greater effect. Their study did not compare 4% and 6% tapers or establish their effects on tooth survival.

**Preserve pericervical dentin whenever possible—but not at the expense of safe instrumentation, irrigation and apical disinfection. The goal is biologically adequate treatment with controlled, purposeful dentin removal.**

*Reeh ES, Messer HH, Douglas WH. J Endod. 1989;15:512–516.*

09/09/2026

Tooth #27 deemed “non-restorable”: look before you condemn
This maxillary second molar was considered non-restorable at another clinic because of extensive carious destruction. The cavity was also invaded by proliferative gingival tissue, making it difficult to assess the remaining tooth structure.
After removal of the proliferative gingival tissue and complete caries excavation under the operating microscope, enough sound tooth structure remained to preserve the tooth.
Root canal treatment was completed, followed by a Nayyar amalgam core build-up. The tooth can now receive its definitive cuspal-coverage restoration.
This case reminds us that severe coronal destruction does not necessarily make a tooth hopeless. Restorability is sometimes best determined only after complete caries removal and careful inspection of the remaining walls.
Before condemning a tooth, first determine what can still be preserved.

Adresse

5025 Sherbrooke Street W Suite 330A
Westmount, QC
H4A1S9

Heures d'ouverture

Lundi	8:30am - 4:30pm
Mardi	8:30am - 4:30pm
Mercredi	8:30am - 4:30pm
Jeudi	8:30am - 4:30pm
Vendredi	8:30am - 4:30pm

Site Web

https://www.endomontreal.com/

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