Category Archives: Endodontics

Split tooth

split tooth

Split tooth or longitudinal tooth fracture of maxillary central incisor

split tooth

Radiograph of split tooth


1405129549 Textbook and Color Atlas of Traumatic Injuries to the Teeth 
Jens Andreasen
B009XQ343W Treatment of malocclusion of the teeth and fractures of the maxillae : Angle’s system 
Edward H. 1855-1930 Angle
B006FVPLT8 Treatment of malocclusion of the teeth and fractures of the maxillae: Angle’s system 
Edward H. Angle
0199670595 Teeth: A Very Short Introduction (Very Short Introductions) 
Peter S. Ungar
0723610347 Fractures of the Facial Skeleton, 1e 
Peter Banks FRCS(Edin) FDSRCS(Eng) FFDRCSI
0323079091 Minor Emergencies: Expert Consult – Online and Print, 3e 
Philip Buttaravoli MD FACEP
1490958797 Teeth For Life 
Maxim Babiner DMD
0323085490 Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, 10e 
Betty J. Ackley MSN EdS RN
3659190772 Re-attachment techniques for anterior fractured teeth: The fracture strength recovery of reattached anterior tooth fragment using different re-attachment techniques 
Abdul Mujeeb
B002KW52ZO Treatment of Malocculsion of the Teeth and Fractures of the Maxillæ 
Edward Hartley Angle

Complicated crown fracture

12 year old girl presented with broken incisal edge having history of fall 3 years before.clinical examination reveals complicated crown fracture. vitility tests reveals necrotic pulpal status



Another similar case picture

complicated crown fracture causes necrosis of pulp

Treatment options in Complicated crown root fracture (Case report article in PDF)  Archives of Orofacial Sciences (2009), 4(1): 25-28

Management of Horizontal and Multiple Crown-Root Fractures( case report in PDF) World journal of dentistry 2011

Guideline on Management of Acute Dental Trauma The American Academy of Pediatric Dentistry (AAPD)

Dental trauma guidelines 2011 International Association of Dental Traumatology (IADT)

Vertical root fracture Wikipedia

Traumatic dental injuries(soft tissue trauma)

A lecture in PDF by Bill Blood of Case Western Reserve University, Cleveland, Ohio

Classification of dental injuries

Scanned chapter from some unknown sports medicine book with comprehensive text and pictures.

Management of crown and root fractures

Article from ‘A Summary Journal of Advances in Dentistry and Oral Health Care’

Crown fractures in maxillary central incisors

Article published in Int. J. Odontostomat.(2008)

Complicated crown fracture images

From Google images

Functional-aesthetic treatment of crown fracture in anterior teeth with severe crowding

A case report published in RSBO by Diego Henrique et al.

Esthetic and endodontic management of a deep crown-root fracture of a maxillary central incisor

A case report published in Journal of oral science 2012 Tamotsu et al.

Aesthetic Management of Fractured Crown Segment: A Case report


Surgical Endodontics MCQs

Question no 1: the objective of incision and drainage are

  1. To evacuate exudates and purulence from a soft tissue swelling
  2. Incision for drainage increases discomfort
  3. Drainage through the soft tissue accomplished most effectively when swelling is firm and non- fluctuant
  4. Incision for drainage is always made horizontally into the swelling
  5. Incision of drainage speeds up healing process

Question 2: Peri apical surgery is indicated

  1. When there is persistent peri apical infection that cannot be resolved with non- surgical root canal re- treatment
  2. When there is true cyst
  3. Severe periodontal disease
  4. Irretrievable posts and root fillings and there removal would result in further damage to the root structure
  5. Unidentified cause of conventional root canal failure

Question 3: root end resection

  1. It removes the untreated apical portion of root
  2. It provides angled surface to prepare a root and cavity preparation
  3. It should be perpendicular to long axis of tooth
  4. It expose additional canals, apical deltas, or fractures
  5. It should be around 5 mm because most of additional canals are present in apical 5mm

Question 4: indication for root amputation or hemisection

  1. Preservation of strategically important roots and its accompanying crown
  2. Root fusion or proximity
  3. Untreatable roots with broken instruments, perforations, caries, resorption and calcified canals
  4. Severe periodontal disease
  5. Inability to complete root canal treatment on either half.

Question no 5: root end cavity preparation

  1. Are now made with ultrasonic tips
  2. Preparation should be class one type in the apical portion of canal
  3. It should have a minimum depth of 3mm
  4. It should have a minimum depth of 5 mm
  5. The walls of the preparation will be slightly oblique with long axis of the root

Question 6: Thirty year old patients presented to you with chief complain of chewing. Radiographic examination reveals furcation caries and bone loss that has compromised the distal root. Which surgical procedure will be indicated for management?

  1. Bicuspidization
  2. Hemisection
  3. Apical surgery
  4. After root canal treatment, crown will be divided through the furcation
  5. Root amputation




    Question 1:

    1. true
    2. false
    3. false
    4. false
    5. true

Question 2

  1. true
  2. true
  3. false
  4. true
  5. false


    Question 3:


    1. true
    2. false
    3. true
    4. true
    5. false

Question 4

  1. true
  2. false
  3. true
  4. false
  5. false

Question 5:

a true

b. true

c. true

d. false

e. false

Question 6:

  1. false
  2. true
  3. false
  4. true
  5. false

Condensing osteitis


Radiograph showing radio-opacity associated with distal root of mandibular 1st molar. This bone production is because of reaction to carious infection. Tooth is irreversibly inflamed and treated with endodontic treatment.

Additional resources

A guide to common oral lesions

46 pages notes by UMKC School of Dentistry

Condensing osteitis in oral region

Case report

Pulp and Periapical

Presentation with pictures

Apical lesions

Notes by LSUHSC School of Dentistry

Radiographs of Condensing osteitis

Video on YouTube by Dr. In.Saini

Acute Apical Abcess/Periapical Abscess/Periredicular Abscess:

It’s one of the painful dental emergency results from extension of bacterial infection from dead pulp into the periapical tissues.

Acute Apical Abscess are of Two types

  1. Diffuse
  2. localized

Case 1:

This the Periapical radiograph of 21 year old female showing radiolucency associated with periapex of first premolar. Tooth was very tender on percussion and patient had extra-oral swelling on left side of face.

Extra-Oral swelling on left side of face due to spread of infection from maxillary first premolar

Case 2:

Diffuse extra-oral swelling This is the picture of a 32 year old female patient came to emergency with chief complain of severe pain and extra-oral swelling on right side of face. On examination maxillary canine was carious, tender to percussion and slight mobility was present

Arrow showing Periapical radiolucency associated with periapex of canine

Localized abscess

Localized abscess associated with maxillary 1st molar. Tooth was tender to percussion




  • Increase exposure to fluoride during tooth formation will lead to dental fluorosis.
  • Normal optimum level of water fluoride is upto 1ppm
  • Increasesd level of fluoride more then 1ppm will cause fluorosis
  • Clinically it appears as white opaque areas to brown discoloration and pitting of enamal
  • In severe cases hypomineralised enamel becomes very fragile and undergo surface damage
  • Management of dental fluorosis varies according to severity
  • In Mild cases micro and macro-abrasions and bleaching are treatment options
  • In moderate cases composite restoration and veneers are treatment options
  • In severe cases full crowns


Case 1

A female patient aged 21 came to conseravtive department with the chief complian of discolored upper central incisor.discoloration is present since her childhood. Clinically the discolration is of mild grade according to dean’s index

Mild grade fluorosis


Case no 2

23 year ol female with the chief complain of discoloration and tooth surface loss in upper anterior region.On examination mild to moderate grade fluorosis according to dean’s index

Mild to moderate grade fluorosis





Management with composite restoration

Broken / fractured endodontic instrument

Broken instrument is one of the procedural accidents that occurs during cleaning and shaping of root canal system.

Causes of broken instrument in root canal:

  1. Improper use of instrument
  2. Same instrument used for many times
  3. Excessive force applied to file during cleaning and shaping


    1. Lubrication of instrument with irrigating solution such as sodium hypochlorite or with lubricating agent EDTA (ethyl diamine tetra acetic acid)
    2. Instrument should be examined before use, if there is and untwisting in file which will be visible as shiny spot then it should be discarded
    3. Small no. of files must be discarded after single use.
    4. NiTi files do not show any sign of untwisting so they must be discarded before untwisting is seen


There are three methods of management

  1. Make an attempt to remove it
  2. Attempt to bypass it
  3. Fill and obdurate it.

This is the radiograph of 25 year old male presented with pain in lower right and left 1st incisors. The teeth had been endodontically treated 2 years before. Periapical radiograph showed inadequate filled canals and periapical radiolucency associated with lower right and left 1st and 2nd incisors and broken instrument in left lower 1st incisor.

Gingivectomy for removal of subgingival caries/cervical caries extending subgingival

Gingivectomy procedure pictures

Preoperative picture of patient showing cervical caries extending subgingivally

Infiltration anesthesia was given for gingivectomy

Incision for removal of soft tissues

Incision starting from mesial marginal gingiva to distal marginal gingiva

After removal of soft tissue gingiva. subgingiva Caries are visible

Removal of caries

After removal of all soft caries leaving only hard and arrested caries

Application of retraction cord to stop bleeding

Application of 37% phosphoric acid

After washing and drying. Note white frosted appearance

Application of bonding agent

Light curing of bond

Application of composite resin- A2 shade

After Polymerization of composite resin

Postoperative view following composite placement

Dental Fistula: case reports with images

Dental Fistula/ Cutaneous Fistula of Dental Origin/ Suppurative Apical Periodontitis/ Apical Periodontitis With Fistula.

  • Dental fistula is a communication between the oral cavity and cutaneous surface of face
  • It is a squeal of infection from dental pulp that spread beyond the apex
  • Generally it is a painless condition because when drainage occurs, pressure relieves and symptoms disappear.
  • Chronic inflammation involves apical portion of tooth’s root.
  • Drainage mostly occur within oral cavity on facial or buccal side of alveolar ridge
  • Rarely occurs on cutaneous surface of face
  • Intraoral sinus tracts are common but extra oral fistula is not common.
  • Treatment involves complete debridement and obturation of root canal or Extraction.

Case 1:

This is the case of 10 year old patient with the chief complain of draining pustule from one month. Clinical examination reveals extraorally cutaneous draining fistula, intraorally grossly carious left mandibular 1st molar. Vitality test was negative. Radiographic findings are radiolucency associated with distal root of 1st molar and open apices. gutta percha point was used to trace the fistulas tract and was confirmed from radiograph it was associated with mandibular 1st molar. Diagnosis was chronic apical abscess or suppurative periodontitis with fistula.

Cutaneous draining fistula due to dental infection from mandibular 1st molar

Infection originated from mandibular 1st molar

Periapical radiograph: Arrow indicates radiolucency associated with distal root of madibular 1st molar. Red line showing immature root apex.

Case 2:

Cutaneous fistula healed with scarring

Infection from mandibuler 2nd molar causes cutaneous fistula

Additional resources

Treatment of Oroantral Fistula: Experience With 27 Cases

Cutaneous sinus tracts (or emerging sinus tracts) of odontogenic origin: a report of 3 cases

Nonsurgical therapy of mucosal and cutaneous fistulae

Diagnosis of cutaneous sinus tract in association with traumatic injuries to the teeth 2011

Rhinolithisasis as cause of oronasal fistula

A Note On Etiology, Clinical Features And Management Of Oroantral Fistula

Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: A case report  International Journal of Dental Research, 2 (1) (2014) 8-10


Autotransplantation Of Tooth

23 year old female was referred for dental treatment with the chief complain of pain in mandibular right 1st molar. Clinically the tooth was grossly carious. Periapical radiograph revealed coronal caries involving pulp and periapical radiolucency associated with mesial root of mandibular 1st molar. From the history of pain and examination it was confirmed that patient had irreversible pulpitis so root canal treatment was performed.during access cavity preparation iatrogenic furcation area gets perforated and tooth was difficult to treat and extraction was indicated.mandibular 3rd molar of same site was clinically and radiographically sound and decision was made to transplant 3rd molar in place of extracted 1st molar.

Periapical radiograph showing extensive coronal caries and periapical radiolucency associated with mesial root

Root canal treatment was performed

Radiograph of donor tooth (3rd molar)

Arrow indicating the tooth to be extracted

Elevation of gingival tissues with periosteal elevator

Sectioning of tooth into two for easy removal, to prevent trauma and to preserve buccal and lingual alveolar bone

Tooth was sectioned with fissure bur

Tooth sectioned into two

Radiograph showing sectioned tooth

Removal of granulation tissue from the recipients site

Extraction of donor tooth

Donor tooth

Root end cavity preparation of donor tooth

Root end filled with amalgam

Donor tooth transplanted in recipient’s site

transplanted was tooth stabilized with suture 3/0 silk that passed over the crown

Radiograph showing transplanted tooth

The tooth was stabilized with suture for 2 weeks

Root canal treatment of donor tooth was performed after 1 week

Radiograph of donor tooth taken at time of taranplantation

Radiograph of donor tooth after two month. Note the healing of periodontium around the tooth