I may be biased as an endodontist, but I’ve seen 15 years of evidence that the power of endo to save teeth is astonishing. So many times, I’ve done root canal therapy on teeth that most other dentists would condemn. And as a result, those teeth have been saved.
How do I know? I have my patients come back for recalls, and I end up with maybe one or two teeth in a whole year that need a retreatment. (It does happen. You can never get that number down to zero, because this is a biological process, and sometimes bacteria slips back in through a new crack or some other issue.) But one or two a year is not too shabby, if I do say so myself!
So what gives endodontics this power to heal our teeth? A root canal gets rid of the infection and helps the patient restore their oral microbiome so that the conditions are right for their immune system to kick in. This is why I tell patients who ask about bacteria still being in their tooth after a RCT that the point isn’t to get rid of every bit of bacteria. The point is to get rid of the bad bugs so they can get back to balance and health, and decrease the bacterial load to a point that the patient’s immune system can be efficient and effective again.
I want to share some awesome tooth stories that illustrate the power of endo. Later, I’ll go into more depth with these tooth stories in future blog posts, but right now, I want to give you some cases that I hope inspire you.
Tooth Story 1
When I saw the sinus mucosal thickening in this particular case of a necrotic tooth, I was freaking mind-blown. Take a look at these pre-op CBCT images.
Next, I went through my diagnostic protocol. The tooth did not respond to cold, and it was tender to percussion. So, the diagnosis was Necrotic Pulp with Symptomatic Apical Periodontitis.
As usual, I talked to the patient about their options, and we jointly decided to go ahead with the root canal. It went well—pretty straightforward, honestly.
And when I welcomed the patient back for their one-year follow-up, I was thrilled at what I saw in their imaging.
Compare the above image with this one here!
The healing of that tooth was really impressive. And best of all, the sinus membrane was restored to its original position.
Look at the before and after.
Okay, ready for another tooth story?
Tooth Story 2
MB2s. Love ‘em or hate ‘em. Most of us hate ‘em!
And there’s a good reason for that: They’re so commonly missed during root canals. I don’t think most dentists realize that they’re present 95% of the time! We have to assume that they’re there.
I admit that it takes a lot of precision and persistence to find them. That’s why this patient ended up in my practice with a failed root canal. Their previous provider had not treated the MB2 completely. I see this situation all too often, so I’m sharing this with you so you can be part of the solution.
This root canal looks pretty good on the radiograph, but the patient was having some intermittent pain, and her tooth would hurt when she would bite down. The diagnosis was Previously Treated and Symptomatic Apical Periodontitis #14.
The sagittal view of the CBCT shows a periapical radiolucency around the MB root, so my hunch right away was that there was an untreated MB2.
In the axial view, you can see a “faint canal” in the area of the MB2.
In the coronal view, you can see that perhaps there is some room lingual to the MB1 for another canal.
There’s a school of thought (even among many endodontists) that if canals are joining together, then it is not necessary to find them all.
But in my professional experience, this is playing with fire. Canals are all interconnected, so I always make it a practice to remove that old gutta percha and clean out the entire tooth during a retreatment.
So, I went ahead and proceeded with the retreatment, which went well.
I removed the gutta percha, fully disinfected the tooth and started to obturate the tooth again…
This was the final radiograph.
The patient returned a year later for their recall and it got me excited. They were healing really well.
A followup CBCT was also taken and the sagittal view shows that the lesion was healing.
The coronal view shows the independent MB2 canal with its own portal of exit.
And the axial slice shows the MB1 and MB2 nicely as well.
This was another successful tooth story for the books! I hope you can see the importance of persistence when it comes to finding hidden canals. They might be microscopic, but they can still harbor bacteria that can get your patient’s oral microbiome out of whack.
Remember the two cardinal rules of endodontics: 1) Find EVERY canal and 2) Get to the end of EVERY canal. This can be easier said than done, but it’s so crucial to having great outcomes.
Let’s explore another tooth story!
Tooth Story 3
One thing endodontics has taught me is to appreciate the intuitive intelligence of our bodies. For example, our bodies look for the pathway of least resistance. We see this in endo all the time. Think of water flowing in a stream. It always goes down, right? And if it hits a lot of rock, the water may carve a path of less resistance through some dirt on the side, widening and rerouting the stream.
I talk about the concept of “pathway of least resistance” in endo all the time, but I finally found a tooth story that demonstrates exactly what I mean! I was so excited when this one came in, because I wanted to share it with you.
Here’s a tooth story with a J-shaped radiolucency. It’s there because the tooth drained the infection out of the body and made the J-shaped radiolucency in the process. This is just what our bodies naturally do.
As I discovered with my diagnostic protocol, this tooth was necrotic (with a chronic apical abscess). The CBCT shows that J-shaped radiolucency a little more clearly….
I did the root canal, and here is my post-op radiograph.
And one year later, the patient came back for their followup and look and what we have here….BONE!!! It never ceases to amaze me that our bodies have an incredible superpower of regrowing bone. We just have to have patience, and we have to set them up for success through endodontic treatment.
I LOVE cases like these because they remind me to trust in what I do as a healer and endodontist. The recall shows the power of endodontics to give the body the conditions it needs to restore itself when you remove the bad bacteria. This is an immune system at work! You don’t need anything fancy, since this biological system is already built into us. Some people are very into biohacking—but this is even better, in my opinion. This is bioflow. (Like that new word that I coined?) There is no need to hack a system that is already working.
It’s our responsibility and honor to save our patient’s precious natural teeth. Extractions mean that the tooth is permanently gone, but root canals save the day! I’m asking you to trust the process, the human body, and your superpower to heal as a dentist.
Tooth Story 4
Some of my patients believe myths about root canals, saying that they’re toxic, or that they don’t work. To those patients, I say, “Only bad root canals don’t work.”
When done correctly and thoroughly, root canals are regenerative, and they heal our teeth and their infections.
Root canals preserve the precious, natural pearls that Mother Nature gave us, and they enable us to function the way that we were intended to—by chewing, breathing, smiling, talking, laughing, and digesting. They preserve the function of our jaw. We need our teeth!
As dentists, I’m asking us to reignite our belief in the importance of saving teeth. It’s our responsibility and honor to do this work, you know?
Here’s another tooth story I want to share with you. This one definitely deserves a deeper look soon, but I want to give you a sneak peek right now!
Take a look at the pre-operative radiographs. At first glance, you may not think that this tooth is that bad. Maybe the obturation is a bit short and maybe you don’t love the quality of the obturation.
I took a CBCT and found a little more to the story.
Do you see how inflamed that sinus membrane is? In fact, the floor of the sinus membrane has been resorbed by the infection.
When I went through my diagnostic protocol, I determined that the diagnosis for this tooth was Previously Treated and Symptomatic Apical Periodontitis.
The CBCT showed me even more information. We always assume that it is the MB2 that gets left untreated, but this time, it was the MB1 canal.
And the coronal view shows it nicely too….
I’m going to keep emphasizing on this, but that’s because it’s THAT important: The two cardinal rules of root canals MUST be followed every time. That’s how we get great outcomes and great healing for our patients!
Here are my post-op radiographs from the 1-year follow-up.
And the CBCT after one year is remarkable. The entire floor of the sinus has regenerated and the sinus membrane is back in its normal resting position.
I restored the freaking floor of the sinus, y’all! It looks even better in the coronal view and you can even appreciate the interconnection of the MB1 canal and the MB2 canal….
If this isn’t evidence of the power of endo, I don’t know what is.
I can’t wait to dive deeper into this tooth story in a future blog post.
Let’s do one more tooth story for this quick roundup.
Tooth Story 5
This patient had a big ol’ lesion. Take a look at this radiograph. That spot looks like a black hole in space, doesn’t it?! The diagnosis here was Previously Treated and Asymptomatic Apical Periodontitis #19.
The CBCT clearly outlines the lesion.
And the CBCT also shows us why the lesion is there in the first place (untreated canals).
A lot of dentists picked up on a myth somewhere along the way that big lesions don’t heal.
But this simply is not the case. Lesion size does NOT determine a tooth’s healing ability. I have seen truly enormous lesions be healed and massive bone loss be restored after a root canal. It’s about understanding the etiology of why a root canal is failing.
And by the way, the patients often don’t need any other treatment! A simple root canal really is all they need to restore their health.
Take a look at the post-op radiograph here.
There’s a little sealer puff, but don’t let it concern you. We don’t need to put too much emphasis on little things like that.
One year after treatment, the patient came back for us to see how he was healing…
The sealer puff has drifted away into the distance. And look at all that bone regrowth!
Please don’t let big lesions scare you, my friends. Give teeth a chance.
These days, I actually love treating teeth with big lesions, because they showcase the incredible healing ability of the human body.
It’s all about what’s going on inside that tooth. When those bugs and bad bacteria are allowed to thrive inside those canals, they cause havoc and bone loss. But the power of endo is the power to heal.
Do you believe in the human body’s natural ability to heal and regrow bone with proper endodontic treatment?
You will only attempt treatment if you A) believe that and B) feel competent and confident to do endo. (Remember, diagnosing pain is still endo, even if you refer out the treatment!)
Want to learn how to save more teeth like these? Check out E-School!
– Sonia