Caribbean Institute of Endodontics

21/05/2026

🦷 Every now and then you put your foot in your mouth with ill thought out comments.

This is one such case I treated Mrs. T. In 2009 who was 43 years old for two teeth, #2 and #12.

#12 was a lateral periodontal cyst and I retreated the tooth and performed surgery with bone graft and a membrane. She would come with an attendant, a former patient of mine, who was in his 70s and I treated him for 2 teeth as well, a year earlier in 2008.

So one day I asked her if he was her dad while he was in the room. Apparently he was her husband and Mr. T. was clearly upset.

Fast forward to this week Mrs T was in my schedule , 17 years later for a consult. Mr. T accompanied her, walked up 3 levels of stairs at 92, sharp as a thumb tack but with both the teeth that I treated missing. He could not tell why but simply said they went bad and he got them taken out.

Mrs T at age 60 has both her teeth doing very well. But she forgot what she came in to consult for and was struggling to make sense. Dementia setting in.

That’s the tale of 2 teeth in 2 patients with 2 different stories. Don’t know what you learn from this, but to say never assume things and you don’t know what’s in stock for you in life.

Ps: Single panel of teeth #13 & #14 are Mr. T
Rest are Mrs. T

~ Dr. Sashi Nallapati, B.D.S.

22/04/2026

🦷 12 year follow up of a retreat with crack

I wasn’t sure if this is going to last but no probings or furcal defect prompted me to retreat tooth 19 with big shapes. This 12 year follow up justifies the decision- the tooth is still doing great while everything is falling apart around it.

30/03/2026

🦷 I retreated tooth #30 in 2003

After obturation I noticed some GP going into the furcation. Never paid much mind to it.

In 2004 she came back with a big furcal blow out. I retreated the coronal part of the mesial canals with long term Caoh. I finished the case once the furcal perf was dry and there were signs of healing.

At 23 years from today’s follow up tooth is doing very well. 🥳 She changed the crown some years later.

With a Big access, PCD not so great, big canal preps, this should not have made past 20, but it did!

~ Dr. Sashi Nallapati, B.D.S

26/03/2026

External cervical resorption in same patient.
Tooth #11: 19 year Follow up
Tooth #6 : 8 year follow up

He saw an endodontist in 2007 in the Fort Lauderdale area who recommended extractions and referred him to an oral surgeon. The oral surgeon advised him to get a second opinion. He eventually ended up coming back home to see me.

19 years later he still has both his teeth.

~ Dr. Sashi Nallapati, B.D.S

26/03/2026

From 2009, patient is my referring dentist.

I decided to save this badly cracked tooth with crack extending mesial to distal over the pulp floor. 99.9% of endodontists will suggest an extraction. However, I decided to save it because she is a dentist and she can handle the failure if and when it happens.

Still waiting on that after 17 years!! 🔥

Intentional follow up from today

~ Dr. Sashi Nallapati, B.D.S

25/03/2026

📌 Rule of thumb: most teeth calcify from crown up.

When a tooth undergoes trauma, this can change to dystrophic calcification and the pulp can calcify at any level. Here is an example where the canal calcified mid root.

Tooth discolored and patient started to develop symptoms in 2006.

I treated this tooth with long shank munce burs and using the dentin map as described by Steven Neimzyck in his seminal paper in Endodontic Therapy journal in 2002. If you haven’t read it, you should. I met Steve at ESE 2019 in Vienna when we shared the podium on a session conducted by Ronaldo. I told him how amazing that article was and he offered to share the images in HD if I like. What a great guy.

20 year follow up attached.

23/03/2026

Dens Invaginatus:

In 2008 I did RCT and surgery with MTA retrofill and geristore to dome the root. This tooth tested vital to begin with and I planned on just treating the dens tract with an orthograde and surgical approach based on my past success with these case types.

However, there was a small communication between the dens pouch and the vital canal as you can see in the post-op image. The tooth became infected with a sinus tract and I had to do RCT in the main canal.

At 18 years, tooth remains asymptomatic and functional. Tissue response to geristore doesn’t look great. No intervention is planned as patient reports no issues.

Today I would not have done surgery and tried to manage the dens tract with long term caoh. If surgery became necessary, do not dome it with geristore. Tissue reaction to Geristore is not good, at least in my hands.

Overall, happy to see the tooth is surviving and doing well.

~ Dr. Sashi Nallapati, B.D.S

22/03/2026

Dr. David Rosenberg’s advocacy: May he Rest in peace.

This case was referred with an endodontic file broken past the apex and an unsuccessful attempt was made by the referring doctor to remove it. In the process the access was overenlarged.

I thought of Masseron trephines to open the tip more and use tube and core paste technique. The file end was too big to fit any tube over it.

Plan B: Ala Dr. Dave Rosenberg, Bypass with 8, 10, 15, 20 & 25 to apical third, intermittent low intensity ultrasonics (try not to break the file) and eventually braid 20 and 25 around the file head and pull it.

Patient seems to have severe delamination and cemental tears around 9 and 10. Painted a bleak picture and referred him to a periodontist.

~ Dr. Sashi Nallapati, B.D.S

01/07/2019

The International Academy of Endodontics extends a warm congratulations and welcome to our 2019 IAE Fellows, Dr. Bill Seddon, Dr. Kirk Huffaker, Dr. Robert Grover!!

29/06/2018

Wonderful to be at the IAE ( International Academy of Endodontics) annual meeting. Looking forward to a great meeting.

08/04/2018

My sentiments as well

I would like to thank the people of Aluro Health Care, and in particular Mark O'Brien, for organizing a great endodontic symposium in Auckland. It was an honour and a great pleasure to be a speaker in the most beautiful country in the world! In addition, I would like to thank our friend Dr. Venkat Canakapalli for hosting us in his hometown Tauranga!