Yasuhiko Kamura DDS

Yasuhiko Kamura DDS Diplomate of the American Board of Endodontics. Endodontist in Coppell, Tx
Accepting same day emerge Endodontist at Sigma Dental Specialist

Tooth #2: Pulp Necrosis/ Symptomatic Apical Periodontitis. Curved canals #歯科
04/10/2026

Tooth #2: Pulp Necrosis/ Symptomatic Apical Periodontitis. Curved canals

#歯科

I usually assess the difficulty of a curved canal based on where the curve is and the radius of curvature—the more apica...
04/08/2026

I usually assess the difficulty of a curved canal based on where the curve is and the radius of curvature—the more apical the curve, the harder it is, and the smaller the radius, the more challenging it becomes.
In this case, the canal had an apical curve with a small radius, so I considered it a complex case. It needed to be carefully negotiated, with patency maintained and instrumentation done very gently. Otherwise, it could easily be ledged.
I start with a 20/.08 or***ce opener to about 15 mm to enlarge the or***ce. Once I achieve patency, I keep a #10 hand file in play and use gentle up-and-down motions to manually develop a glide path.
Next, I take a 20/.06 file, but not to full working length—only up to just before the curvature. After that, I use a glide path file or sometimes a 15/.04 to complete the path to full length.
For final shaping, I usually finish at 20/.04 or 25/.04. I don’t routinely go larger than 25/.04 unless the canal is clearly loose or wide.

New bone formation in endodontic lesions occurs after successful root canal treatment or surgery, which eliminates bacte...
04/07/2026

New bone formation in endodontic lesions occurs after successful root canal treatment or surgery, which eliminates bacteria causing apical periodontitis. The body repairs lost alveolar bone, a process often visible via imaging after 6–12 months. Healing involves complex bone remodeling where osteoblasts replace inflammatory tissue, often leading to full regeneration of the periodontal ligament (PDL) and lamina dura.

#歯科

#28 – a tricky premolarMost mandibular first premolars have one canal.This one started as a single canal and trifurcate...
02/27/2026

#28 – a tricky premolar
Most mandibular first premolars have one canal.
This one started as a single canal and trifurcated at the mid-root.
Three canals in #28 are rare (~1–2%), but these teeth are notorious for missed anatomy.

CBCT made it clear — the trifurcation was confirmed and treatment planned safely.

Tasty gelato
02/12/2026

Tasty gelato

Another curved case.
01/28/2026

Another curved case.

Internal Resorption – Mechanism, Tx & PrognosisMechanism• Caused by chronic pulpal inflammation (trauma, deep caries, he...
01/27/2026

Internal Resorption – Mechanism, Tx & Prognosis

Mechanism
• Caused by chronic pulpal inflammation (trauma, deep caries, heat)
• Odontoclast-like cells resorb dentin from inside
• Continues while inflamed vital pulp remains
• Stops once pulp becomes necrotic

Treatment
No perforation:
• Conventional RCT
• Thorough disinfection
• Warm vertical / 3D obturation
With perforation:
• RCT + perforation repair
• Bioceramic material (MTA / BC RRM / Biodentine)
• CBCT for planning

Prognosis
No perforation: ✅ Excellent
With perforation: ⚠️ Guarded–fair
• Depends on size, location, seal, timing

With the unexpected days off due to the weather—an almost annual event in Texas—it was a good time to sit down and revie...
01/26/2026

With the unexpected days off due to the weather—an almost annual event in Texas—it was a good time to sit down and review some cases.
I usually assess the difficulty of a curved canal based on where the curve is and the radius of curvature—the more apical the curve, the harder it is, and the smaller the radius, the more challenging it becomes.
In this case, the canal had an apical curve with a small radius, so I considered it a complex case. It needed to be carefully negotiated, with patency maintained and instrumentation done very gently. Otherwise, it could easily be ledged.
My instrumentation sequence was as follows: I started with a 20/.08 or***ce opener to about 15 mm to enlarge the or***ce. Once patency was achieved, I kept a #10 hand file in play and used gentle up-and-down motions to manually develop a glide path.
Next, I used a 20/.06 file, but not to full working length—only up to just before the curvature. After that, I used a glide path file or sometimes a 15/.04 to complete the path to full length.
For final shaping, I usually finish at 20/.04 or 25/.04. I don’t routinely enlarge beyond 25/.04 unless the canal is clearly loose or wide.

RootCanalTherapy EndoMicroscopy EvidenceBasedDentistry HealingInProgress
Endodontics RootCanalTreatment MicroscopeDentistry LaserEndodontics DentalAnatomy EndodonticCase Biolase EndoMicroscope PeriapicalHealing BiologicalHealing RootCanalTherapy PrecisionDentistry EndodonticSuccess DentalExcellence RootCanalSpecialist TexasDentistry DallasDental DFW GarlandTX CoppellTX BoardCertified Endodontist 歯科 歯 Dentistry

Pulp necrosis with symptomatic apical periodontitis. The MB and DB canals were found to merge into a single canal in the...
01/25/2026

Pulp necrosis with symptomatic apical periodontitis. The MB and DB canals were found to merge into a single canal in the mid-third of the root. An MB2 canal was identified with a separate portal of exit. One-visit root canal therapy was performed.

EndoMicroscopy EvidenceBasedDentistry HealingInProgress
Endodontics RootCanalTreatment MicroscopeDentistry LaserEndodontics DentalAnatomy EndodonticCase Biolase EndoMicroscope PeriapicalHealing BiologicalHealing RootCanalTherapy PrecisionDentistry EndodonticSuccess DentalExcellence RootCanalSpecialist TexasDentistry DallasDental DFW GarlandTX CoppellTX BoardCertified Endodontist 歯科 歯 Dentistry

Silver Point Retreatment #19: Diagnosis: Previously treated tooth with asymptomatic apical periodontitis.Findings: Legac...
01/20/2026

Silver Point Retreatment

#19: Diagnosis: Previously treated tooth with asymptomatic apical periodontitis.
Findings: Legacy silver point obturation and a missed distobuccal (DB) canal confirmed on CBCT.
Silver points were commonly used in the mid-20th century, but studies have shown major limitations:
• Poor seal – smooth metal cannot adapt three-dimensionally to canal anatomy, leading to microleakage
• Corrosion – silver points degrade over time, releasing byproducts that contribute to inflammation
• Higher failure rates compared to modern gutta-percha and bioceramic obturation systems
• Missed anatomy – older techniques frequently left untreated canals, a leading cause of post-treatment apical periodontitis
Treatment:
Microscope-assisted ultrasonic troughing was first used to break the cement seal around the silver points. H-file engagement technique was then used for retrieval: a Hedström file was placed alongside each silver point, rotated slightly to engage the metal, and withdrawn coronally for conservative removal.
The missed DB canal was located, all canals were cleaned and disinfected, and the tooth was obturated.

RootCanalTherapy EndoMicroscopy EvidenceBasedDentistry HealingInProgress
Endodontics RootCanalTreatment MicroscopeDentistry LaserEndodontics DentalAnatomy EndodonticCase Biolase EndoMicroscope PeriapicalHealing BiologicalHealing RootCanalTherapy PrecisionDentistry EndodonticSuccess DentalExcellence RootCanalSpecialist TexasDentistry DallasDental DFW GarlandTX CoppellTX BoardCertified Endodontist 歯科 歯 Dentistry

Pre-operative imaging revealed a PARL associated with a lateral canal, clearly identified on CBCT.Post-operative radiogr...
01/08/2026

Pre-operative imaging revealed a PARL associated with a lateral canal, clearly identified on CBCT.

Post-operative radiographs demonstrate sealer pe*******on into the lateral canal, confirming cleaning, disinfection as much as possible, and obturation beyond the main canal system (even though it is sealer).
YSGG laser assisted

The patient will be re-evaluated in 6 months, with the expectation of complete healing.

EndoMicroscopy EvidenceBasedDentistry HealingInProgress
Endodontics RootCanalTreatment MicroscopeDentistry LaserEndodontics DentalAnatomy EndodonticCase Biolase EndoMicroscope PeriapicalHealing BiologicalHealing RootCanalTherapy PrecisionDentistry EndodonticSuccess DentalExcellence RootCanalSpecialist TexasDentistry DallasDental DFW GarlandTX CoppellTX BoardCertified Endodontist 歯科 歯 Dentistry

Before and after apicoectomy of a maxillary first molar with a large periapical radiolucency that was partially perforat...
12/19/2025

Before and after apicoectomy of a maxillary first molar with a large periapical radiolucency that was partially perforating into the sinus floor.
The post-operative image demonstrates stable bony healing. This regenerated bone will be beneficial for future implant placement if it becomes indicated.

EndodonticCase Biolase EndoMicroscope PeriapicalHealing BiologicalHealing RootCanalTherapy PrecisionDentistry EndodonticSuccess DentalExcellence RootCanalSpecialist TexasDentistry DallasDental DFW GarlandTX CoppellTX BoardCertified Endodontist 歯科 歯 Dentistry

Address

220 S Denton Tap Road, Suite 102
Coppell, TX
75078

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Wednesday 8am - 5pm
Thursday 8am - 5pm
Friday 8am - 3pm

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+14696196319

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