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13/08/2025

✨ Case Spotlight: Navigating the Unexpected for #41 ✨

This patient was referred by a experienced colleague who had encountered a tough challenge: a previously started root canal on the lower incisor ( #41) that just wouldn’t gain patency. After two hours of persistent attempts, it became clear something was blocking the path. So they decided to refer.

Swipe to see what I found! 👉 The referral radiograph showed some apical canal obliteration, and our pre-op CBCT a separated instrument lodged in the mid-to-apical third. That little piece of metal was the culprit behind the blockage!

With careful technique, we managed to bypass the fragment from the lingual and flush it out during irrigation. Both Canals were shaped with X7 files. The canal was then shaped and obturated smoothly using bioceramic sealer + and gutta-percha, and a composite core was placed. ✨

At the 3-months patient returned for a different tooth, but was keen to see healing so I took a PA- we were thrilled to see about 80% healing of the periapical area—great progress on this tooth’s journey back to health.

Thanks for following along this endo adventure! Stay tuned for more cases. #ʜᴇᴀʟɪɴɢᴊᴏᴜʀɴᴇʏ

07/08/2025

🇮🇹 Grateful to be part of something special in Rome
Last month , I attended two days of collaboration, innovation, and connection at La Sapienza University for the KOL advisory meeting.

A heartfelt thank you to Prof. Gianluca Gambarini for the warm hospitality and for welcoming us into his beautiful home for an unforgettable evening overlooking the Eternal City.

Appreciative of the entire , , , , and teams for making this happen.

Excited for what’s coming next. ✨🦷

06/08/2025

Thermafil out… 🦷✨
This retreatment case involved the careful removal of Thermafil obturation using the braiding technique — a method where multiple fine hand files are twisted together to engage and remove carrier-based obturation material with minimal dentin loss.

Once cleared, we shaped these long, delicate canals to working length using X7 rotary files — all while respecting the very close relationship with the inferior alveolar nerve visible on imaging. CBCT revealed lesions on both the mesial and distal roots, making thorough disinfection critical for long-term healing.

The canals were then hydraulically obturated with bioceramic sealer and gutta-percha for an excellent seal, supporting periapical healing. A composite core was placed to restore coronal integrity.

➡️ Swipe right to see the CBCT and the full clinical journey!

09/04/2025

It’s been a crazy few weeks—first, at the Star of the South Conference , where I had the opportunity to lecture on resorption and retreatment. Then off to in Boston, where I was proud to be lecturing and leading hands-on workshops.

Grateful to be part of a profession that never stops evolving. From cutting-edge technologies to dynamic discussions on complex clinical strategies, AAE25 teeth was packed with energy, ideas, and inspiration.

A huge congratulations to one my mentors, Dr. Ken Hargreaves, on receiving the Edgar D. Coolidge Award—an honour so well deserved. Training under him in San Antonio was truly world-class, and his impact on endodontics (and on me personally) has been profound.

It was a joy reconnecting with former colleagues and friends—and meeting so many passionate endodontists from around the globe.

09/03/2025

Complex anatomy lower premolar

A CBCT evaluation revealed a challenging C-shaped canal on LL5 diagnosed with pulp necrosis and symptomatic apical periodontitis. We carefully treated the tooth using X7 files for shaping and Hi-Flow eaer to ensure thorough obturation of the complex canal system.

One-Year Follow-Up:
A new CBCT shows remarkable bony infill in the periapical region, indicating near-complete healing and demonstrating the effectiveness of precise 3D imaging, specialized endodontic instrumentation, and technique-sensitive obturation.

Key Points:
• Diagnosis: Pulp necrosis with symptomatic apical periodontitis, confirmed on CBCT. 2 POE identified.
• Instrumentation: X7 files handled the intricate C-shaped canal curvature. Irrigation activation .medical Ultra X.
• Sealing: Hi-Flow sealer
• Results: One-year post-op revealed near-total bony healing, emphasizing long-term success.

This case showcases how modern imaging and advanced endodontic techniques can overcome challenging anatomy and achieve a predictable healing outcome.

Would you scan this case based on the pre-op radiograph?

05/03/2025

A Peek at My ASI Cart Setup 🦷

As an endodontist, precision and efficiency are everything. ASI carts are designed to optimize workflow, reduce clutter, and enhance ergonomics—all while integrating the technology we rely on for successful treatments.

This is my 3rd cart I’ve used, and here’s what I love in these carts:
• Integrated NaOCl & EDTA – Having solutions on tap reduces the need to juggle multiple syringes and speeds up irrigation.
• Ultrasonic Options – My previous cart had two ultrasonic handpieces, which was a huge help during endodontic microsurgery (especially for retrograde prep).
• Electric High-Low Speed Motors – Smooth, consistent torque and less noise make a big difference in both patient comfort and my own precision.
• Obturation Brackets – Convenient holders for warm obturation devices keep them close at hand, which helps maintain a steady workflow, especially during multi-canal cases.
• Microsuction Benefits – Built-in suction helps keep the field clear, critical for microsurgeries that demand a precise view.
• Streamlined Workflow – A tubeless design and a mobile cart mean everything’s within reach, making longer cases more manageable.

👉 Do you use an ASI cart in your practice? What features do you find most valuable? Let me know in the comments!

04/03/2025

A referring dentist entrusted me with their own mother’s care for root canal treatment on her lower right first molar (LR6). She had no pain, but a routine X-ray revealed a mesial root periapical radiolucency, and testing confirmed pulp necrosis with asymptomatic apical periodontitis.

🦷 Treatment Steps:
✅ Rubber dam isolation & access preparation
✅ Shaping with X7 files (25.04 mesial, 30.04 distal)) for conservative preparation
✅ Irrigation: NaOCl, EDTA, with ultrasonic activation
✅ Obturation: with warm vertical compaction
✅ Final coronal seal with composite

📸 Post-op X-rays confirmed well obturated canals, and back to referring dentist for definitive crown. Healing is expected over time.

Honored to be trusted with a colleague’s family—one of the highest compliments in our field.

04/09/2024

Back for a Beautiful few weeks in Canada.
Great pleasure and honor to speak at the Canadian Academy of Endodontics .
Then fortunate to spend to time exploring such a beautiful country.

24/04/2024

Been a while since Ive posted a case. Work has been busy.

Case from today : Primary treatment on #3/16
85 year old patient !
Pre op pain 8/10 had restoration which was radiolucent placed some time ago.

Diagnosis :NP/SAP - necrotic pulp with
Symptomatic Apical Periodontitis

Single visit, Edge Endo X7 Utopia - .
Long roots -25mm
4 canals found- nice mb and mb2 anatomy
Obturation with BC Sealer.
Old restoration removed- matrix , aquacare .
Composite core placed back to dentist for crown.

16/10/2023

Happy World Endodontics Day!

Nice case to start the week
#36/ #19
Diagnosis :SIP/SAP- Symptomatic Irreversible pulpitis
Symptomatic Apical Periodontitis
Pre Endo build up,

Single visit, x7s 4%. 4 canals found- nice apical curves on mesialsanatomy.
Obturation with / bc sealer.
Re sealed access and back to dentist for cuspal coverage.

13/09/2023

Great ESE Conference in Helsinki! It was lovely to see so many familiar faces and friends from all over the world.
Great speaking for .
Excited for the next ESE in Paris!

30/11/2022

Nice routine Endo case.
Patient had #30/LR6 crowned a few years ago and recently had a bout of symptoms.
Clinically the tooth was percussion tender and non vital. No significant probing.
#30/ LR6 had a large periradicular radiolucency.

Diagnosis - Pulp Necrosis with Symptomatic Apical periodontitis.

Treatment: Root canal treatment #30 / LR6.

When I see a tooth that has a crown with very little restorative material I'm highly suspective of a fracture. Patients often forget the reason for there restorations.
Fortunately, there was no probing and on access and staining of the internal walls there was no visible fracture.
Canals were cleaned and shaped with X7 files 4% taper.

Bc sealer hi- flow and GP obturation.
Bc blue liner over GP and pulpal floor and back to Referring dentist for definitive restoration.

Discussion.....
1- Why do lesions develop this extensively before patient develop symptoms.
2- IF there was a crack extending to the distal or***ce how would it change your management.

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