Endo Addict

14/04/2026

Mastering difficult anatomy requires more than skill—𝔦𝔱 𝔯𝔢𝔮𝔲𝔦𝔯𝔢𝔰 𝔞 𝔯𝔢𝔩𝔦𝔞𝔟𝔩𝔢 𝔭𝔯𝔬𝔱𝔬𝔠𝔬𝔩

Hyperalgesic patient, 28 mm molar, three MB canals and curved anatomy.
Following a structured shaping protocol allowed predictable navigation of the canals and safe preparation to working length.

From canal negotiation → shaping → cone fit → obturation → coronal seal, every step matters.

𝓐 𝓹𝓻𝓸𝓽𝓸𝓬𝓸𝓵 𝓽𝓱𝓪𝓽 𝓷𝓮𝓿𝓮𝓻 𝓵𝓮𝓽𝓼 𝓶𝓮 𝓭𝓸𝔀𝓷

07/04/2026

Single Vs Multiple visits endodontics

Criteria for Case Selection

1. Competence of the clinician:
Clinician should be able to perform all steps of root canal in single visit without compromising quality of the treatment
2 .Positive patient acceptance:
Patient should be cooperative for SVE. Uncooperative patients and patients with TMJ problems, limited mouth opening should be avoided for SVE.
3. Absence of anatomical interferences:
Anatomical problems like presence of fine, curved or calcified canals require more than usual time for the treatment and thus should be treated in multiple visits rather than a single visit
4. Accessibility:
Teeth for single visit should have an optimal accessibility and visibility
5. Availability of sufficient time to complete the case:
Both clinicians as well as patients should have sufficient time for SVE
6. Pulp status:
Vital teeth are better candidate for SVE than nonvital teeth because of less chances of flare-ups
7. Clinical symptoms:
‣ Teeth with acute alveolar abscess should not be treated by single visit.
‣ But teeth with sinus tract are good candidate for SVE because the presence of sinus acts as
safety valve and prevents buildup of pressure, so these teeth seldom show flare-ups

Factors to Consider..
- Pulp and peri-apical condition
- The complexity of the root canal system
- Probability of procedural difficulties
- The clinician's skills
- Time available
- The patient's systemic health
- Severity of symptoms
- Level of anxiety

Biological Considerations:

๏ Regardless of the number of appointments, effective bacteriologic disinfection of the root canal system is critical.
๏ It is possible that total elimination of bacteria may not be absolutely necessary for healing.
๏ A high level of clinical success can be achieved by:
✓ Maximal reduction of bacteria
✓ Effective root canal filling
✓ A timely satisfactory coronal restoration

Single-Visit Root Canal Treatment
* Pros:
✓ Reduction in the total duration of treatment together with cost-effectiveness.
✓ Eliminates the need of the clinician to re-familiarize the canal anatomy at the next visit,
✓ Better patient acceptance.
✓ Reduction of the inter-appointment infection risks.
✓ No risk of flare-up promoted by the leakage of the temporary seal between appointments.
✓ Materials needed for separate visits are saved.

* ConS:
😥 Flare-ups cannot be easily treated by opening the tooth for draining.
😥 Long appointments may be tiring to the clinician.
😥 Uncomfortable for some patients that cannot keep their mouth open for a long time.

27/03/2026

A 28-year-old patient walked into the clinic… not because of pain — but because of fear.

He had already been scheduled for apical surgery.
For him, it felt like the only option left.

But something didn’t sit right.

So he walked away… searching for another opinion — hoping, somehow, there was still a way to save his tooth without going surgical.

What he came with wasn’t a simple case.

Tooth #24 had already been through a failed endodontic attempt.
Two separated instruments were left behind — one buried deep in the apical third, the other trapped in the middle of the canal.

And as if that wasn’t enough…
An attempt to bypass the file had ended with a root perforation.

A case many would consider… already lost.

Yet despite all this, the patient’s only request was clear:

“Just… don’t let it end in surgery.”

🧠 The Challenge
- Two separated instruments in the same canal
- Apical lesion with cortical bone involvement
- Root perforation
- Open tooth contaminated with debris
- Patient reluctant for surgical intervention

🎯 The Plan

Instead of jumping to surgery, we chose a conservative approach:

- Retrieve what can be retrieved
- Bypass what cannot
- Seal the perforation
- Give biology a chance to heal

⚙️ The Ex*****on

Under magnification:

✔️ The coronal separated instrument was successfully retrieved using ultrasonics
✔️ The apical fragment was carefully bypassed
✔️ Full chemo-mechanical preparation completed
✔️ Perforation sealed using bioceramic material
✔️ Obturation done with warm vertical compaction + bioceramic sealer
✔️ Final restoration with fiber post & composite - case referred to make cuspal coverage restoration

⏳ The Outcome

No surgery. No extraction. No complications.

At 9-month follow-up:
✅ Complete healing
✅ Patient symptom-free
✅ Tooth preserved

(Healing confirmed radiographically and clinically)

💡 The Message

Sometimes… it’s not about what’s broken.
It’s about how far you’re willing to go to save it.

👉 Even in complex cases with separated files and perforations,
non-surgical retreatment can still win — if done right.

21/03/2026

🚨 NEW VIDEO ALERT!

BPE | BEWE | Bitewing X-ray
All explained in a simple & clinical way

💡 Don’t miss it!

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12/03/2026

Management of an Overextended Root Canal Filling with Apical Resorption and Sinus Tract

A 35-year-old patient presented complaining of a gingival swelling above the upper right central incisor ( #11). The patient reported that when pressure was applied to the swelling, pus discharged from the gingiva and through the tooth.

Clinical Examination

- Tooth #11 was previously restored with recurrent caries.
- A localized gingival swelling extended from the free gingiva toward the marginal gingiva. (Green arrow )
- plaque and calculus deposits.
- Sinus tract detected extending between soft tissue and bone.
- No mobility.
- No pain on percussion, only slight discomfort.

Radiographic Assessment
Periapical radiograph and CBCT revealed:

- Previously treated root canal with approximately 3 mm overextended gutta-percha beyond the apex.
- Multiple voids between gutta-percha cones indicating poor obturation quality.
- Large periapical radiolucency.
- External inflammatory resorption on the mesial wall of the apical half of the root. (Yellow arrows )
- Significant enlargement of the apical foramen (bucco-palatal direction).
- No evidence of root fracture.

Treatment Plan

Non-surgical root canal retreatment with open apex management.

Treatment Procedure

First visit :
1.Removal of caries and previous restoration.
2. Rubber dam isolation.
3. Peri-endodontic build-up.
4. Removal of gutta-percha using a rotary retreatment system up to the apical third.
5. Apical gutta-percha removed using Hedström file #30.
To retrieve the overextended gutta-percha, the H-file was carefully allowed to extend about 1 mm beyond the apex to engage the material and pull it out without tearing.
6. chemo-mechanical preparation using manual K-files and H-files.
Endo XP-Shaper used to remove remaining sealer and infected dentin.
Irrigation protocol using 5% sodium hypochlorite and EDTA with ultrasonic activation.
7. non setting Calcium hydroxide used as intracanal medication for 4 weeks

Second visit:
1. under rubber dam isolation, Calcium hydroxide is removed
2. Irrigation using 5% sodium hypochlorite and using Xp-finisher to remove remnant of calcium hydroxide from canal walls
3- fabrication of custom made plugger using inverted taper 0.2 gutta percha cone size 80
4- MTA apical plug placed to manage the enlarged apex.
5. hydrated paper point placed above the MTA

third visit :
after 48 hours
Canal obturation using injected thermoplastic gutta-percha with resin sealer.
Final composite restoration.

Note :
Incision and drainage of the gingival swelling during the first visit.

Outcome
The case demonstrates that even complicated retreatment cases involving overextended obturation, apical resorption, and enlarged apical foramen can be successfully managed with proper disinfection and apical sealing using MTA.

26/02/2026

🦷 Beneath the Obvious, a Different Truth

This case walked in asking for a simple bridge replacement.

But it was never just about a bridge.

📌 Chief Complaint

The patient lost his old bridge on #17 and #15 six months ago and wanted new restoration.
Recently, he started experiencing pain in #14 with hot and cold fluids.

Medical history? Free.

🔎 Clinical Findings

#17 and #15: Severely decayed, only roots remaining
#14: Large distal recurrent caries under class II amalgam
Missing #16, #45, #46
Adequate attached gingiva

Radiographically:

#17 and #15 had very long roots
Short previous endodontic fillings
No coronal seal for long time
Surprisingly… no signs of apical periodontitis
Normal bone levels

At first glance, it looked hopeless.

But the roots were long.
The bone was stable.
The story was not over.

🔹 Phase 1 – Surgical Crown Lengthening ( #17 & #15)

Full thickness flap.
Precise bone reduction.
2 mm ferrule achieved.
Careful recontouring and soft tissue repositioning.
Foundation before restoration.

🔹 Phase 2 – Non-Surgical Retreatment

Both #15 and #17 were non surgically retreated:
Old gutta-percha removal
Working length confirmed with apex locator
Rotary + hand instrumentation
5% NaOCl + EDTA with ultrasonic activation
Obturation using hydraulic / continuous wave techniques using Bioceramic sealer
Fiber posts + composite cores

🔹 The Unexpected Turn – #14

During RCT on #14, a file separated in the apical third of the palatal canal.

“Well… that escalated.”

Instead of panic:

Bypass achieved

WL re-established

Proper cleaning and shaping completed

Obturation with hydraulic condensation + bioceramic sealer

Crisis managed. Tooth saved.

🔹 Final Phase

Retreatment of #17 completed.
Three fiber posts placed.
4-unit full zirconia bridge fabricated.

From roots with no crown structure…
To stable, functional rehabilitation.

🧠 Lesson from This Case

What appeared hopeless…
Was only structurally compromised.

Sometimes the obvious diagnosis says “extract.”
But the deeper evaluation whispers, “restore.”

🦷 Endodontics is not about what you see first.
It’s about what you discover after you look deeper.

20/02/2026

🦷 When the Sea Can’t Wait… and the Apex Won’t Heal

A ship captain came to my clinic with urgency in his voice.

Pain in #12, radiating to the ala base of the nose.
Soft swelling buccally.
Pain on percussion.
A feeling of heaviness.

He had been on antibiotics for 9 days.
Slight improvement… but the pain never left.

Then came the history:

Eight years ago — same tooth.
Apical surgery.
Six months of treatment.
Occasional discomfort ever since.

Now he had only 3–4 weeks before sailing for months.
No access to dental care at sea.
Extraction was not an option.
Painkillers were not a solution.

And he is a heavy smoker.

Time was not on our side.

🔎 Clinical & Radiographic Findings

#12:

Large restoration

Tender to percussion

Buccal swelling

Periapical radiograph:

Previously resected apex

Large well-defined radiolucency

CBCT revealed the truth:

Inadequate root canal filling

Poor apical seal

Large bone defect

Palatal bone expansion

Buccal cortical destruction

#13 had poor RCT but no relation to the lesion.

The real problem was clear.

Phase 1 – Orthograde Retreatment

Rubber dam placed (no anesthesia needed).
Old gutta-percha removed using Gates Glidden + H-files.
Working length established with apex locator.
mechanical debridement.
30 minutes of ultrasonic-activated NaOCl 5% + EDTA.

Calcium hydroxide dressing for 2 weeks.

But after 2 weeks…

Still no dry canal.

few time left

The lesion was not surrendering.

Phase 2 – Surgical Intervention

The canal was obturated with MTA.
Composite core placed.

Then surgery:

Infraorbital nerve block.
Lübke-Ochsenbein flap
Careful soft tissue elevation.
Complete cystic lesion removal.
Bone curettage with surgical bur under saline irrigation.
Final saline rinse.
Flap repositioned.
Sutured with 6/0 polypropylene.

Post-op instructions:

Smoking cessation (at least during healing)

Cold application first 24 hours

Medications prescribed

Three days later…

The captain sailed.

Follow-up was done remotely through the ship’s medical officer.

8 Months Later

He returned.

No pain.
No swelling.
Radiographic signs of healing in #12.
#13 stable — no signs of failure.

🌊 Lesson from the Sea:

Even with modern endodontics…
Sometimes surgery is not optional.

And sometimes you are not just treating a tooth —
You are treating a deadline.

11/02/2026

Sometimes the obvious problem… isn’t the real problem.

A male patient was referred to me to retrieve or bypass a separated file located in one of the mesial canals of LL6.

Initially, the treating dentist decided to leave the fragment. However, persistent pus discharge continued over 6 visits, despite calcium hydroxide dressings. At this point, the decision was reconsidered, and the case was referred.

🔍 Diagnosis Phase

Radiographic and clinical assessment showed:

Separated file located ~ 2 mm coronal to apical foramen

Majority of the canal already cleaned and shaped

Distal canal → dry

This made me suspect… there is another hidden clue.

I started ruling out vertical root fracture:

No deep narrow pocket (probing: 1–2.5 mm max)

No cracks under DOM

But one thing caught my attention:
➡ Large distance between mesial canal orifices
➡ Presence of an isthmus between them

That dark pathway raised suspicion.

⚡ The Hidden Room

Using ultrasonic tips, I started cleaning the isthmus…

And then —
A missed Mid-Mesial Canal was discovered, with its own separate pathway.

Was this the hidden bacterial reservoir causing the persistent pus?

Time would tell.

⏳ Next Visit (5 Days Later)

No pus.
Canals completely dry.

Performed:
✔ Final irrigation
✔ Obturation same visit
✔ Bioceramic sealer
✔ Hydraulic condensation technique
✔ Proper coronal seal

Patient referred back for cuspal coverage restoration.

📌 Important Note:
Separated file was left in place.
No retrieval. No bypass.
➡ Management relied on proper disinfection and irrigation.

🗓 3-Year Follow-Up

Patient returned for RCT on another tooth.

I rechecked #36.

Radiograph showed:
✨ Complete healing

Patient reported functional chewing on that side for 3 years.

🌑 Clinical Lesson:
Sometimes the tooth is a house… and the real problem is hidden in a secret room.

04/02/2026

Every great treatment starts with one thing…
🔍 A precise and complete diagnosis

I’m happy to share Part 5 of the Diagnosis Series, where we dive deep into:
🦷 Extraoral Examination
🦷 Intraoral Examination

This lecture is designed to simplify complex clinical assessment into a clear, practical, step-by-step approach you can apply directly in daily practice. From facial analysis and lymph node assessment to detailed intraoral evaluation — this session helps you see what others might miss.

Because in dentistry… the details make the difference.

🎥 Watch. Learn. Apply. Elevate your clinical thinking.

https://youtu.be/DTxt29v95gQ?si=wiaMLU7xh0IAn68p

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26/01/2026

Open Apex Management in a Traumatized Immature Tooth

📌 Case overview:
An 11-year-old female patient was referred with root canal access already opened for management of an open apex in the upper left central incisor.

🦷 History:
The patient had a history of dental trauma one year earlier, after falling from a swing, which resulted in a crown fracture.
The fractured tooth was restored with composite resin, however after one year the patient developed pain in the anterior region.
According to the referring dentist, the tooth was non-vital.

📸 Radiographic findings:
Periapical radiograph revealed widening of the periodontal ligament space at the apical area, consistent with apical pathology in an immature tooth.

🔬 Treatment protocol:

✔️ Rubber dam isolation
✔️ Mechanical preparation using manual K-files, followed by Endo-Shaper and finisher rotary files, with special care due to thin dentinal walls
✔️ Chemical disinfection using 5% sodium hypochlorite and EDTA, with ultrasonic activation
✔️ Fabrication of a custom-made MTA condenser using an inverted size 80 gutta-percha cone
✔️ Placement of MTA apical plug to achieve an artificial apical barrier
✔️ Canal obturation using warm condensation of flowable injected gutta-percha with resin sealer
✔️ Final coronal restoration with composite resin

📝 Additional consideration:

The patient was advised to seek ENT and orthodontic consultation due to the presence of deep bite, protruded anterior teeth, and mouth breathing, which may increase the risk of trauma and compromise long-term outcomes.

18/01/2026

🦷 Diagnosis Series – Part 4 is OUT NOW! 🎥🔥

Diagnosis doesn’t start in the mouth — it starts with the history.

In Part 4 of the Diagnosis Series, we dive deep into:
🔹 Family History – genetic & shared lifestyle risks
🔹 Social History – habits, behaviors, and real-life factors affecting oral health
🔹 Dental History – the foundation of safe diagnosis and treatment planning

This episode explains why history-taking is not a formality, but a powerful diagnostic tool that shapes risk assessment, clinical decisions, and patient outcomes.

If you’re a dentist, student, or preparing for exams, this lecture will change the way you look at diagnosis.

▶️ Watch now
👍 Like
🔁 Share with your colleagues
💬 Comment with questions or topics you want next

More parts are coming… stay tuned! 🚀

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06/01/2026

🚀 Hey Friends – Third Episode Is LIVE on Endo Addict: Medical History (Part 2)

Don’t underestimate the medical history—one smart question can flip your endo plan 180°.
In this video: the must-ask questions before you start, and the traps that silently ruin diagnosis.

🎬 Watch now
Let your diagnosis lead your hands 🦷🔥
Knowledge addiction continues!

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