Cabinet d'endodontie - Docteur Romain Gabriel

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Cabinet d'endodontie - Docteur Romain Gabriel

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Retrouvez le Docteur GABRIEL Romain au sein de son cabinet dentaire à Paris. Le cabinet pratique de

02/10/2026

MANAGEMENT of a « THROUGH - AND - THROUGH » periapical lesion…

The main challenge in this case is achieving complete bone healing : cells from the lamina propria of the overlying mucosa compete with osteogenic cells to repopulate the defect, which often leads to incomplete healing with fibrous scar tissue.

Debridement of the granulation tissue and soft tissue dissection were performed using an Erbium:YAG laser.
A deep retrograde preparation was then carried out in the unobturated apical segment of the root canal.

Two resorbable membranes were placed beneath the gingival mucosa, one on the buccal cortical plate and one on the palatal cortical plate. They stabilize the blood clot within the bony crypt, prevent lamina propria cells from colonizing the defect, and support the proper development of the different tissues (bone and soft tissue) and of new blood vessels.

At the 6-month follow-up, the tooth demonstrated favorable periapical healing, confirming the success of the surgical procedure.

16/09/2026

YOU MUST TRUST ENDO !

Radio 1 — PRE OP
Class I carious lesion with major enamel-dentin destruction. Peri-apical and peri-radicular demineralization extending to the furcation. A tooth that seemed compromised.

Radio 2 — INTER- APPOINTMENT Ca(OH)₂ DRESSING
Canal shaping and debridement with Erbium:YAG laser, followed by an intracanal calcium hydroxide dressing. Alkaline pH → antibacterial action + unfavorable environment for clastic cells.

Ca(OH)₂ has limited pe*******on into dentinal tubules and biofilms, and some microorganisms show relative resistance to it — it complements irrigation and shaping, it doesn’t replace them. This is exactly why laser-activated irrigation with water and sodium hypochlorite offers a clear advantage in optimizing intracanal cleaning and disinfection.

Calcium hydroxide was used as an inter-appointment intracanal dressing, followed by Er:YAG laser-assisted disinfection.

Radio 3 — POST OP 1 month later
One month after calcium hydroxide placement, obturation was performed with a calcium silicate–based sealer using the single-cone technique.

27/02/2026

Tooth extraction was contraindicated because of the risk of medication-related osteonecrosis of the jaw (MRONJ).

A corono-radicular crack was detected along the distal wall of the crown extending apically into the distolingual root. The crack appeared to terminate at the middle third of the distolingual root.

Immediate Post Endodontic Dentin Sealing (IPDS):
- Clearfil AP-X composite for post endodontic dentin sealing
- EverX Flow in the access cavity to reinforce structurally the tooth and to limit crack propagation. The embedded fibers can bridge and deflect cracks, thereby preventing their further extension.
(Garoushi 2013; Lassila; Oksanen, Vallittu, Fráter.)
- Filtek One Bulk Fill Universal composite for occlusal sealing.

Endodontic treatment was carried out using a minimally invasive approach, including conservative canal preparation with low-taper rotary instruments (3–4%), three-dimensional erbium:YAG laser–assisted disinfection, and obturation with a calcium silicate–based sealer. The tooth was left in slight infraocclusion, and circumferential cuspal coverage was subsequently provided by the patient’s referring dentist.

28/12/2025

Patient, 29 years old, referred for treatment of a chronic abscess – Tooth 2.1

Traumatic dental injury occurred at 5 years old, resulting in the avulsion of tooth 6.1 and impaction of tooth 2.1. Subsequent orthodontic treatment allowed for partial dental realignment. Fourteen years later, attention is drawn to the cone-beam (CBCT) findings:
Thinning of the root canal wall,
Loss of continuity on both sides of the tooth,
Extended bone loss up to the floor of the nasal cavity.

The primary objective of our combined approach is both the preservation of the affected tooth and the promotion of tissue healing and regeneration.

1/ Orthograde Approach
Temporary intracanal medication — calcium hydroxide dressing, renewed. Maintained for 3 weeks
Definitive root canal obturation — Biodentine® obturation to strengthen the root canal system. However, root canal sealing remained incomplete due to its atypical anatomy.

2/ Retrograde & Complementary Approach
Granulation tissue debridement and soft tissue dissection performed using an Erbium:YAG laser
Retrograde preparation in depth within the labial portion of the root canal, corresponding to the segment not obturated during the initial orthograde procedure.

In complex clinical situations, adjunctive endodontic surgery is mandatory and must be fully integrated into a comprehensive treatment strategy. This combined orthograde and retrograde approach allowed for optimal debridement, sealing of the root canal system, and favorable conditions for periapical healing.

🤞🏼At +7 months follow-up: bone healing process in progress,
👍🏼 At +17 months follow-up: bone healing process well established, visible osseous trabeculations and a distinct lamina dura

16/11/2025

Importance of long-term radiographic follow-up. The periapical bone regeneration must be carefully monitored over time.
Late failures are most often associated with secondary bacterial contamination, frequently resulting from a loss of coronal seal integrity rather than procedural insufficiency.

🦷 #17 — Apical periodontitis associated with chronic maxillary sinusitis.
Erbium:YAG laser-assisted gingivectomy, followed by pre-endodontic dentin sealing using Clearfil™ AP-X composite, and orthograde Er:YAG laser-assisted endodontic retreatment.
🦷 #36–37 — Management of a centimetric periradicular lesion initially referred by a maxillofacial surgeon.
The treatment plan focused on preserving the affected teeth while promoting bone regeneration to the greatest possible extent.
Calcium hydroxide was used as an inter-appointment intracanal dressing, followed by Er:YAG laser-assisted disinfection and obturation with a calcium silicate–based sealer using the single-cone technique.
At the 8-month follow-up, radiographic examination demonstrated a clear and favorable trend toward bone healing.
🦷 #46 — Surgical retrograde endodontic retreatment involving the removal of foreign bodies from the periapical region and across the apical foramen.
Comprehensive debridement and retro-filling of both mesial and distal canals were performed under magnification.
🦷 #31 — Management of an extensive periapical lesion displacing tooth #41.
Calcium hydroxide was used as an inter-appointment intracanal dressing, followed by Er:YAG laser-assisted disinfection and obturation with a calcium silicate–based sealer.
🦷 #14-15-16 — Routine endodontic management consisting of the treatment of an acute apical abscess and retreatment of the adjacent teeth.
Er:YAG laser-assisted disinfection and obturation with a calcium silicate–based sealer were performed using the single-cone technique.

Bibliography :
1. Ørstavik D. International Endodontic Journal. 1996
2. Ray HA, Trope M. International Endodontic Journal. 1995

28/09/2025

40-year-old patient referred for the management of acute apical periodontitis affecting the mandibular first molar (tooth #36).

A surgical endodontic retreatment was undertaken.

During the procedure, a fractured instrument was successfully removed via a surgical approach.
Comprehensive canal debridement was performed using an Er:YAG laser, followed by instrumentation and obturation of the isthmuses interconnecting the root canals. Each canal was subsequently cleaned and obturated. An antibacterial sealer was applied to optimize disinfection and sealing.

At the 24-month follow-up, the tooth demonstrated favorable periapical healing, confirming the success of the surgical retreatment 🍾🥂

19/09/2025

3-Day Workshop and Advanced Courses focused on Endodontic Microsurgery.

Comprehensive clinical and scientific guidance, accompanied by Jean-Yves Cochet, one of the pioneers of microsurgery, bringing exceptional depth and expertise to the training.

Huge thanks to Dr. Karine Chazaud and Sandra for their valuable assistance 🫶🏻

07/06/2025

NEWLY GRADUATED – 2024/2025 ENDODONTIC PROGRAM - PARIS

Two intense days of orthograde & retrograde endodontics, led with expertise by Dr. Jean-Yves Cochet.

A full clinical immersion: live protocols, Erbium-YAG laser-assisted techniques, and hands-on sessions under the microscope.

A special thank you to Sandra and our amazing group of participants — engaged, curious, and eager to learn. It was a true pleasure to share this experience with you.

Level 2 – Practical session & diploma ceremony (+ birthday surprise 🎂) 🙏🏼

Powered by the support of our amazing partners,
THANK YOU !!

31/12/2024

As the year comes to a close, we would like to thank you for the trust you have placed in us throughout 2024.

Our endodontic practice is in constant motion, always seeking new innovations to provide you with more precise, effective, and comfortable care for our patients.

Excellence and your satisfaction are our mission. In 2025, our “mantra” will remain the same. We are proud to offer you high-quality care, with special attention to our patients.

We would also like to express our heartfelt thanks to our dedicated team, and especially to my assistant, Mrs. PETROVIC, for her unwavering support and commitment.

A huge thank you for your trust, and we wish you our best wishes for the end of the year.

13/10/2024

🚧 CHALLENGING CASE
Removal of Two Fractured Instruments from the Mesiolingual Canal of Tooth #3.6

🤒The patient referred after several unsuccessful attempts to remove one then two broken files.
⚠️During prior treatments, two rotary NiTi instruments fractured in the mesiolingual canal, significantly complicating the endodontic procedure.

📚Instrument separation in narrow, curved canals, particularly within the apical third (Wu J, Lei G, Yan M, et al.).
In this case, torsional stress was the likely cause of file fracture.

🥷🏼To resolve this complication, Erbium YAG laser was employed to activate the irrigation solutions and facilitate fragment removal. 🚿The laser’s ability to enhance the activation of EDTA and other irrigants contributed to improved debris clearance, aiding in the exposure and removal of the fractured instruments. This approach also provided superior cleaning of the canal space and enhanced visualization, critical for accessing the broken files.

📚A. Lloyd, J. P. Uhles, D. J. Clement, and F. Garci-Godoy, “Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: A pilot study,” J Endod, vol. 40, no. 4, pp. 584–587, 2014, doi: 10.1016/j.joen.2013.10.040.

🧼Using the Erbium YAG laser, the coronal portions of the two fractured files were exposed. The laser’s precision enabled the creation of an optimal access path for retrieval, and both fragments were successfully extracted.

🧱Subsequently, the canal was obturated using the cold vertical compaction technique with bioceramic (BC) sealers to ensure a hermetic and durable seal.

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75017

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