Dr. Amr Ibrahim

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Dr. Amr Ibrahim Microscopic Comprehensive Dentist

Severely Curved LL7 | Challenging Anatomy, Controlled ApproachA referred case presented with a symptomatic lower left se...
07/09/2026

Severely Curved LL7 | Challenging Anatomy, Controlled Approach

A referred case presented with a symptomatic lower left second molar (LL7).

The tooth had limited accessibility, an elderly patient, and a severe double curvature, making negotiation and shaping particularly challenging.

CBCT revealed:
• Mesial canals: 1–2–1 configuration with severe curvature
• Distal canal: one canal with a lateral opening

Considering the anatomy, the initial priority was safe negotiation and establishment of a reproducible glide path.

Manual files were used sequentially:
06 → 08 → 10 → 15

Once a safe pathway was established, a Zarc Glide Path 15 was used to reach full working length.

Final shaping was completed using Super File 35/.04.

Obturation was performed using bioceramic sealer and gutta-percha.

In severely curved canals, the goal isn’t to force the system to the anatomy —
it’s to understand the anatomy and let the protocol adapt to it.

Safe negotiation. Controlled shaping. Predictable obturation.

Direct or indirect?In this case, I chose direct—not because indirect wasn’t an option, but because it wasn’t necessary.A...
20/08/2026

Direct or indirect?

In this case, I chose direct—not because indirect wasn’t an option, but because it wasn’t necessary.

After removing the old amalgam and recurrent caries under magnification, IDS was performed, followed by EverX for structural reinforcement and direct composite restoration.

Preserve what is sound. Reinforce what is compromised. Restore only what is necessary.

Quick Rehab💫Missed MB2. Persistent symptoms.Under the microscope, the MB2 was successfully negotiated, confirming a sepa...
11/08/2026

Quick Rehab💫

Missed MB2. Persistent symptoms.

Under the microscope, the MB2 was successfully negotiated, confirming a separate canal with a separate portal of exit.

Complete removal of the old obturation, meticulous shaping, and obturation with bioceramic sealer & gutta-percha.

Vertical preparation.
Zirconia crown.
Direct composite rehabilitation of the adjacent premolars.

Retreatment of an Upper Second Premolar with a Missed CanalA challenging root canal retreatment case where the initial t...
03/08/2026

Retreatment of an Upper Second Premolar with a Missed Canal

A challenging root canal retreatment case where the initial treatment revealed only two canals, both short-obturated.

CBCT revealed a third canal in the coronal portion that had not been negotiated, while the remaining canal was heavily calcified.

Under the microscope:

* Gutta-percha removal
* Careful negotiation of the calcified canal
* Successful patency achievement
* Complete cleaning and shaping
* Obturation with bioceramic sealer + gutta-percha

The tooth was then reinforced using EverX as a dentin-replacement material, providing additional structural support. The final restoration was completed using a Bioclear matrix, achieving a broad, well-contoured contact and a highly polished surface.

Missed canals can change the entire prognosis.

Direct vs. Indirect.The key isn’t choosing one over the other—it’s making the right decision in the right place.Lower le...
12/07/2026

Direct vs. Indirect.

The key isn’t choosing one over the other—it’s making the right decision in the right place.

Lower left 7: Indirect overlay for long-term structural protection.Lower left 6: Direct composite overlay with a minimally invasive approach.

Different restorations. Same philosophy: preserve, reinforce, and respect the remaining tooth structure.

Check the final X-ray in the last slide.





Root Canal Retreatment of a Calcified Lower First Molar 🔬Microscopia Protocol:• Remove restoration• Pre-endodontic build...
01/07/2026

Root Canal Retreatment of a Calcified Lower First Molar 🔬

Microscopia Protocol:
• Remove restoration
• Pre-endodontic build-up
• Remove gutta-percha completely
• Negotiate canals with manual file systems
• Shape canals with rotary files
• Use one rotary system for retreatment and another for final shaping of the remaining canals
• Activate irrigation• Place apical plugs where indicated
• Obturate with bioceramic sealer and warm backfill
• Build up the core
• Vertical preparation
• Restore with a zirconia crown

A disciplined, systematic protocol can transform even the most complex retreatment cases into durable, long-term success.

Precision in protocol. Confidence in outcome. 🔬

Complex retreatment case under magnification 🔬Patient referred to our clinic complaining of pain on biting and persisten...
07/05/2026

Complex retreatment case under magnification 🔬

Patient referred to our clinic complaining of pain on biting and persistent discomfort in lower left quadrant.

Clinical examination showed:
• Inflamed gingival tissues
• Detached interdental papilla
• Tenderness to percussion

CBCT revealed:
• Broken file in MB canal
• Short obturation
• Missed canals
• Deep apical split in distal canal of lower 6
• calcification in lower 7 after failed retreatment attempt

Treatment performed following Microscopia protocol:
✔ Removal of old restorations
✔ Pre-endo build-up
✔ Old GP removal
✔ Cleaning and shaping
✔ Intracanal medication phase
✔ Broken file retrieval using E6 ultrasonic tip from Woodpecker
✔ MTA apical plug + warm GP backfill obturation
✔ Core build-up in the same visit

Further zirconia crown fabrication will be done later.

Predictable protocol. Predictable outcome. 🔬

Failed RCT? Not the end. It’s a second chance. 🔬Maxillary lateral incisor with apical radiolucency + defective restorati...
05/05/2026

Failed RCT? Not the end. It’s a second chance. 🔬

Maxillary lateral incisor with apical radiolucency + defective restoration.

What went wrong?
• Short obturation
• Coronal leakage
• Persistent infection

Retreatment Strategy:
✔️ Removal of old restoration & caries (verified with detector dye)
✔️ Gutta-percha removal + canal renegotiation
✔️ Active irrigation for deep disinfection
✔️ MTA apical plug for predictable apical seal
✔️ Backfill obturation

Coronal Reinforcement is key:
Fiber-reinforced composite (Ribbond – wallpapering technique)
→ Stress distribution
→ Crack resistance
→ Enhanced bonding

Outcome:
• Pain resolved
• Improved structural integrity
• Predictable long-term success

Predictable protocol. Predictable outcome. 🔬

—
📍

Quick MOD composite restoration under magnification 🔬Every detail matters — from isolation to final anatomy.Saving pulp....
02/05/2026

Quick MOD composite restoration under magnification 🔬
Every detail matters — from isolation to final anatomy.
Saving pulp. Preserving biology.

Predictable approach. Predictable outcome.Lower left 6 with a poorly sealed old PFM crown, presenting with pain on bitin...
28/04/2026

Predictable approach. Predictable outcome.

Lower left 6 with a poorly sealed old PFM crown, presenting with pain on biting.
Failed RCT with a broken file in the MB curved canal and calcified canal.

Refined retreatment protocol:
retrieval • disinfection • apical & coronal seal

Executed under standards.

Obturation done with Apical Plug and Backfill GP.

Finalized with vertical preparation and zirconia crown—
restoring seal, form, and gingival harmony.

Last image showing the post-operative result.✨





Address

Alexandria

Opening Hours

Monday 10am - 10pm
Tuesday 10am - 10pm
Wednesday 10am - 10pm
Thursday 10am - 10pm
Saturday 10am - 10pm
Sunday 10am - 10pm

Telephone

+201124439938

Website

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