London Endo Implants

London Endo Implants Specialist Dentistry
Advanced specialist dentistry including:
Root canal treatment
Microscopic surge

The one that 'nearly' got away...🀨Picked up by a conscientious treatment coordinator, I was asked to consult and possibl...
04/08/2022

The one that 'nearly' got away...🀨

Picked up by a conscientious treatment coordinator, I was asked to consult and possibly treat this patient. The tooth was destined for extraction as deemed by the implantologist after referral, but the patient was reluctant. So I said, let's give it a shot. No probing defects, sound periodontium and no mobility.

As always a pre-endodontic composite rebuild was required after dismantling, assessing for restorability and deeming the supragingival tooth structure to be of both good quality, ferrule and good volume (well over 30% - Al Nuaimi et Al. 2020). The old band within another automatrix band with some PTFE did the trick for the very deep distal margin here.

After that it was plain sailing ⛡️, access with a fully restored tooth, 3 canals located, 5.25% NaOCl and 17% EDTA chemomechanical debridment and sonic activation with my favoured Eddy tip. A fibre post was cemented 16mm into the distal canal and entombed with 4mm of occlusal composite to ensure no microleakage. I've asked the referring dentist to place a cuspal coverage restoration on this tooth and considering the depth and complexity of the distal margin, I've asked for this to be placed on top of my composite (prepping so far down will be impossible without microscopy and will destroy any remaining structure we have there)

Lessons? An endo save with some complex restorative which will hopefully ultimately lead ti a functional and biological sound tooth for many more years! And oh... the forceps are out down for another day 🀫

The beauty of the apical 1/3rdPre-endodontic composite rebuild for circumferential seal, converging MB1 and 2, DB and P ...
09/04/2021

The beauty of the apical 1/3rd
Pre-endodontic composite rebuild for circumferential seal, converging MB1 and 2, DB and P located, chemomechanical prep 5.25% sodium hypochlorite and 17% EDTA and sonic activation with VDW Eddy. Warm vertical compaction obturation and deep composite core.
Sometime Friday's do put a smile on your face 😊

The mythical Apical Delta... 🌊It's all about the 3 dimensional clean. We always aim to clean these accessories but somet...
10/03/2021

The mythical Apical Delta... 🌊

It's all about the 3 dimensional clean. We always aim to clean these accessories but sometimes it's very hard to fill them.

Well, today the heavens were kind, a perfect gift πŸ™

Cracked LL7, defective amalgam, fractured distal wall and DB cusp.

Protocol:
- As always, removal of restoration, assessment of restorability, pre-endodontic composite rebuild / ESSENTIAL
- Scouting with C-Pilot 6,8,10,12.5 especially in the distal, you can't see but can feel the different portals of exit
- 1:2 mesial canal configuration; I couldn't see the hidden ML canal from the central canal or***ce until I used very high magnification and removed some excess dentine in the mid 1/3rd of the mesial root
- 20:07 prep mesials and distal gauged to ISO 25
- Chemomechanical 3% sodium hypochlorite (stabilised) and 17% EDTA irrigation finished off with a shake of the VDW Eddy (sonic activation)
- Warm vertical compaction obturarion heated gutta-percha and epoxy resin sealer
- Deep dowelled composite core into all three canals and occlusal composite coverage

Advised cuspal coverage as soon as practically possible.

I may not be doing skinny .04 preps routinely just yet (as seems to be the trend) but I'm quietly confident the outcome of this one should be good and my dentine preservation was adequate. Let's see review at 6/12 and 12/12.

Beautiful anatomy present in 7's... 🀩A case of a preoperative CBCT showing nature at its best, treatment of an irreversi...
01/03/2021

Beautiful anatomy present in 7's... 🀩

A case of a preoperative CBCT showing nature at its best, treatment of an irreversible pulpitis associated with the 27, merging mesial canals in the apical 1/3rd and confluent MB and DB canals. Challenging anatomy... 😐

Chemomechanical prep, hypochlorite 3% EDTA 17% Eddy sonic activation and apices gauged and prepared to 25. Warm vertical compaction obturation heated GP epoxy sealer and composite core. GDP to restore with onlay as good circumferential tooth structure.

They key here, to not over-prepare and respect the anatomy πŸ’―

Always makes my day to treat such pretty teeth 😊

Implant vs Endo? Which will fail first? My money is on the implant one 😎A tricky way to end the week, a bit of internal ...
12/02/2021

Implant vs Endo? Which will fail first? My money is on the implant one 😎

A tricky way to end the week, a bit of internal inflammatory resorption, some hyperaemic tooth tissue, some apical calcification.

Well adapted gold crown kept in tact, 4 canals with apical confluence, chemomechanical prep WOG small and apical prep by hand to an apical gauge of 20 in the mesial and 25 in the distal; that'll put a smile on the faces of my colleagues north of the river πŸ™ƒ

Warm vertical compaction obturation and restored with composite core.

Happy valentines all!

Another year of Hands-On practical Endodontics for this years Distance Learning Masters in Endodontology course at King'...
09/02/2021

Another year of Hands-On practical Endodontics for this years Distance Learning Masters in Endodontology course at King's College London commences.

Always a pleasure to support our students in their progression and give tailored tips to enhance their day to day skill-set, based upon evidence based current research from our institute and beyond.

Numbers may have been reduced due to the pandemic (2 specialists for 1 student, wowzers!) but we look forward to welcoming the rest of the international cohort once things settle.

Back with a corker! Root end apical microsurgery of the UR5 and UR6.It's been a blessed past few months, and I've learnt...
28/11/2020

Back with a corker! Root end apical microsurgery of the UR5 and UR6.

It's been a blessed past few months, and I've learnt the hardest lesson yet (forget specialist training!), becoming a father. Work and life balance has never been more important and this case is a tribute to selecting the right cases and getting the balance right 😎

This patient was referred for assessment of failed root canal treatments of the UR5 and UR6. After lengthy discussion and CBCT evaluation, we suspected possible cystic involvement of the lesion UR5 (long standing) and decided dismantling was not an option (heavy fibre posts and cement).

A 3 sided mucoperiosteal papillae preservation flap was raised and we enlarged the already perforated buccal cortical plate with an osteotomy and selected to treat the MB root of the UR6 solely as this was the only root with a lesion (CBCT).

Root(s) resection, assessment for cracks (nil), found untreated MB2, and retroprep followed by retrofill with Biodentine (what was to hand and I've got great healing in the past with this).

Overall a satisfactory result, we await hopeful healing and will post follow up in due course. 🀞

Thoughts? What would you have done?

𝑫𝒐𝒏'𝒕 𝒆𝒙𝒕𝒓𝒂𝒄𝒕 𝒕𝒉𝒆 𝒄𝒆𝒏𝒕𝒓𝒂𝒍!This self referred patient wished to save the UL1 after being referred to an oral surgeon to e...
03/09/2020

𝑫𝒐𝒏'𝒕 𝒆𝒙𝒕𝒓𝒂𝒄𝒕 𝒕𝒉𝒆 𝒄𝒆𝒏𝒕𝒓𝒂𝒍!
This self referred patient wished to save the UL1 after being referred to an oral surgeon to extract the tooth.

A palatal sinus associated with the mid 1/3rd of the root was seen upon examination and a clear mid root mesial and apical radiolucencies were seen periapically. Due to the patients history of tennis coaching we referred for CBCT (Morita X800) to rule out trauma and a root fracture. Clearly, we see evidence on this high quality (4x4) scan that there was an associated lateral canal. With no pocketing or mobility and a necrotic pulp present, a diagnosis of a chronic apical periodontitis associated with a necrotic pulp of the UL1 was reached.

Usual access, chemomechanical debridment with sodium hypochlorite (3% stabilised) and 17% EDTA, and a warm vertical compaction obturarion with heated gutta percha and a sealer of AH plus.

Note the deep deep composite core, bonded subcrestally in level for a strong mechanical reinforcement and coronal seal. We just about managed to fill the lateral (not all the way but sometimes you win, sometimes you don't πŸ€·β€β™‚οΈ). As long as this lesion heals I'm not too concerned about the fancy horizontal white line πŸ˜‚. Let's keep an eye on 6/12 healing...

Lovely lateral...The power of ultrasonic activation never ceases to amaze. Key points here?1. Buccal swelling associated...
30/08/2020

Lovely lateral...

The power of ultrasonic activation never ceases to amaze. Key points here?
1. Buccal swelling associated with the mesial aspect of the UL1 root around the apical 1/3rd
2. Corresponding radiolucency radiographically
3. Copious irrigation if EDTA and Hypo
4. A warm vertical compaction obturarion with a very deep cone cut, leaving just 3mm apically before the backfill
5. Deep composite bonded core for integrity (note the flared pulp chamber - intentionally widened to clear deeply stained dentine from pulpal necrosis and an A1 composite shade)

We await healing at 6/12 and 12/12 review

"The deepest deep marginal elevation"This case really did have alot. The UR5 was unrestorable and needs extraction, the ...
30/08/2020

"The deepest deep marginal elevation"
This case really did have alot. The UR5 was unrestorable and needs extraction, the UR6 had to be salvaged and assessment revealed gross caries extending subgingivally and a 5mm distal pocket, where I could bone sound easily! (Kois 2000)

There was only one thing for it, the mother of all deep marginal elevations (Magne 2012). This was performed in 4 stages:
1) Gingivectomy and curretage of distal pocket (electrosurgery) and reduction in overhung margin on the mesial of the UR7
2) Triple packed matrix (band within a band within a band) with PTFE isolation and plenty of initial viscostat (no way Jose that you'd get a rubber dam on there πŸ˜’)
3) Initial 1mm composite distal rebuild on root dentine at crestal bone level
4) Removal of all matrix bands and replacement with new single matrix and further distal wall (full composite) rebuild

After 1.5 hours we were ready to root treat the tooth. Rubber dam placed with excellent coronal seal, 4 canals located, extensively resorped palatal root with a massive canal diameter and taper gauged at ISO 50, chemomechanical prep with sodium hypo and EDTA and warm vertical compaction obturarion, heated GP and AH Plus.
NOTE: composite bonded 8mm into the palatal canal for better retention and reinforcement of the core.

This one should heal and I'll be asking the referring dentist to place their distal crown margin on my composite and not to try and prepare the dentine of the distobuccal and palatal roots!

Stretching needing after this 3 hour monster πŸ™

New publication! Early view IEJ 8th June, 2020.https://onlinelibrary.wiley.com/doi/full/10.1111/iej.13322Behind all inte...
09/06/2020

New publication! Early view IEJ 8th June, 2020.

https://onlinelibrary.wiley.com/doi/full/10.1111/iej.13322

Behind all international publications lays years of planning, ex*****on and then analysis.

This paper marks my contribution to the world class team at King's College London to predict tooth survival of posterior root canal retreated teeth based upon volume of coronal tooth structure remaining.

A huge thank you to all involved in this important paper and the guidance and contribution shown by Dr Nassr Al-Nuaimi, Dr Shanon Patel and of course our Endodontic department lead Professor Francesco Mannocci.

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