Endodontics Video Gallery by
Dr. Yacaman

Ok again I tell you the story about my patient. She is my mom, she fell on August 11th and when the patient falls so hard like she fell, all this was purple. She fractured this tooth that you wanted to see. It is the canine and now she has pain in all these areas, all these areas. When I saw the first time she had the fracture here, which is an oblique fracture, I will show you in an x-ray later. How do you know as a patient what to do? You have to wait 14 days after you fall and then you have to see your dentist, Endodontist and they have to do a testing again. So everything will be different and now I find out all these teeth are normal to cold and this is how we do the testing. Now we place the cold in the middle of the tooth and we wait for the patient to say if she feels it (doctor speaks in Spanish)

Ok she felt it? No. Then if your assistant is busy writing the data, then I ask the patient to do the suction by themselves because it is my mom! I am just kidding, usually my assistant does. Now – we go to the next tooth, she is normal and (doctor speaks Spanish) on Number 9 she is complaining of pain when I touch her. She is not giving me any response so I have to perceive that this tooth is not cracked. This is a C02 test which is 70 degrees below 0, we use it in the universities, not all the endodontic offices have it. Personally very stubborn, I want to have exactly by the book. At this point if she doesn’t feel anything with the cold (Doctor speaks in Spanish) the tooth could be necrotic which is interesting because this is the one she has more pain so we are doing a test in this area to see which one of the teeth are there and amazingly enough, the one with the fracture is still alive. She has pain even when I touch here, and she has pain (doctor speaks Spanish) in this one a little bit but I don’t know why the response to cold is negative.

That doesn’t mean you are going to do root canals or they have to do root canals on you, in the whole mouth. It just means that we have to wait again to do another testing. I don’t like to do root canals until I am sure that you are really going to need it, but that is the cold test and we will be back with the 2nd test which is bite test Percussion for the patient and etc. you will see it.

Where is your… so Maria was asking why the patient is having pain in this tooth when I touch it, when the accident was mainly in these teeth and I was talking to Maria that the referred pain can work from here to this tooth, but one thing that is interesting that I didn’t finish telling you Maria, is that I didn’t realize this tooth is on the other side, so referred pain from this cannot go to this side. Referred pain is only one side on the mouth. If you have pain on the back, that can go to the right and to the left but the mouth only refers to this side and the problem with this, having the pain and answering very little to cold means this tooth was hit also, and still it is alive, we are going to wait a couple of weeks and do an exam again.

Now we are going to put the second part which is the bite test. So we are going to ask the patient to bite, open and bite.

Ok, see so I didn’t even have to –close. Marie follow me. Marie is going to follow me and write the tooth number, tooth number 9, negative bite. Negative number 8. See how it’s amazing this. The endodontic test is fascinating so your Endodontist has to do step by step.

Mhmm open, open, bite, open, bite, open, bite, open, bite, open, open, bite, bite. Okay so we are going to go again. Ok she doesn’t have pain on almost 11 she has pain here. Then bite, so this is the worst. From 1 to 10 – so she has a positive 9 pains. We have to put three arrows up with the number 9. So your Endodontist has to see, if all of these teeth are important to compare because this is the only one who is giving her the pain. I thought this one was going to be the worst and no, I thought the fractured tooth was going to be the worst but now what is giving us the worst part is number 7, which on the x-ray is also showing a sign after all these weeks, about having a problem and a tooth coloration is darker. We are going to do the same test on the lower, but now we are going to go to the second, to the next test.

Now we are going to go to the 3rd test which is Percussion. Be sure your Endodontist, in my case I am a little exaggerated especially it is my mom. I go by quadrant but in this case where the accident was here and all this area was extremely purple, I have a picture, I will display it also for you guys, so I am testing the open and the lower but I am finishing with this step which is Percussion so we go again from the tooth and we are (doctor speaks in Spanish). Ok she has positive 8, Marie follow me, tooth number 9 – positive 8 tooth number 9. Level of pain is 8.

8 Marie – come and see the teeth that I am working please. This is tooth number 1, ok so this will be the level of pain Marie will be number 10 and number 8, number 8. Tooth number 10 is the level of pain. Ok so I am comparing because she can be exaggerating a little bit because patients get scared, and it is my mom. Hard to treat family you know. Trying to distract her attention so she can’t concentrate. See, so it only makes sense because she has the widening of the, it means it shows inflammation on the crown of the roots and around the root, patients don’t know why they need a PDL but it means a semi inflammation and then in the accident she fractured this tooth, Dr. Bridget tried to place a Prosthodontist that is we are working together and he tried to accommodate the patient at the beginning , just until we wait for which is going to be the final treatment plan but as you see, ok she has positive A. Now she is asking me to rest, and if I don’t listen imagine it is my mom. So I have to listen. (doctor speaks in Spanish) See she is complaining about the same level on all the teeth so in this case, I mean all this area is still inflamed. The only one that I am very sure of a problem is this, but the rest I cannot take into consideration, the results of today with Percussion. We have to wait until it is more healing and do it again to have a more accurate diagnosis and that is what your dentist is going to do for you.

Now Senorita, (Doctor speaks in Spanish) we are doing to do the last test which is palpation, kind of the last one, we have to use a clinical judgment you have to look at the x-ray that Maria my business manager is taking the video today and she is going to place pictures today at the end, but we are talking about palpation so you very delicately, grab very gently – the doctor has to do that. Very gentle so you can differentiate where the pain. You can do this test yourself, and then you can compare with your dentist what he is doing and look at this area, if there is any pain so when the impact was there – So here is another problem. My mom is a heavy grinder and clencher and if she is not using her snore guard that she has already – or her night guard, what she is doing is aggravating everything which makes the diagnosis more difficult.

So now we go slow, okay mama? No. (Doctor speaks in Spanish) See how it is interesting she doesn’t have pain here but then we go here, look at this, this is fascinating for me you are going to see alter the oblique fracture in this tooth in the canine, but if we go a little bit here, then she has pain. She is asking me if I have my nails long, I will show you my nails – nobody at the office is allowed to have long nails except if you have any enamel placed on top, any colors because if you do this, my staff doesn’t do it, I do the patient, but still you need to be without nails to check these very delicate.

No pain, ok? Ok so number 6, number 7, no? Ok, number 8 and 9 she does have, but the thing she was saying is that she was having pain here so watch that maybe she forgot about this pain. See? So with the patient you start, you have to be very careful of her responses. She is like oh my God I have pain here it is a level from 1 to 10 – 8, and then she comes now and I am pressing really hard, harder than before and now she doesn’t feel anything? Now (Doctor speaks in Spanish) that is why I like to repeat the test. Mama? See now she doesn’t have pain in number 9, number 8, number 7, number 6. Okay mama, she feels like I am pinching her. See now she doesn’t complain about this area. Ok so we have 6 and 7, positive on palpation number 8 and the last one quickly we do a probing test for the patient and I am checking if she doesn’t have any and of course she is killing me because she thinks I am poking her. This is only to make sure, if there is any fracture in a different way, so I do that on the lingual and I am making an assessment and later on probably in a week or two I will bring the patient and I do the same testing here and I mean in this case, it is my mom but then with a regular patient that is what I do I wait 2, 3 weeks after the accident I go over to the testing, we analyze x-rays, all the symptoms and then we make a decision. Which tooth is going to need a root canal treatment and what is the level of root resorbtion after the trauma. Is the resorbtion coming up soon? When shown on the x-ray? Normally we see in the future a topic, very interesting that is called Root Reception and we are going to go over it, but root reception is caused by these type of traumas. This is my mom, I am very grateful that she is here and the next test I am going to do the same all over on the lower. Thank you for your attention if you have any questions doesn’t forget to contact us at (310) 248-2336 or you can send a messenger through our Facebook, I guess in YouTube I don’t have experience or you can – on the website also you can send messages. Thank you!

American Association of Endodontists – specialists in saving teeth.

Teeth that have had root canal treatment can last a lifetime but occasionally a root canal treated tooth does not heal properly. It can become painful or diseased. Months or years after the original treatment. When that happens an additional procedure called endodontic retreatment can help save your tooth. There are many reasons why a tooth may not heal. The tooth may have root canals that are narrow, curved or branched and are difficult to clean. The tooth may have extra root canals that were not located during the initial procedure. Sometimes a cavity forms or a fracture occurs – exposing the tooth to new infection. Retreatments are often complex and most are performed by dental specialists called Endodontists. Endodontists have advanced training in root canal treatment – they are experts in saving your natural teeth using state of the art technologies like microscopes and digital imaging to treat you quickly and comfortably. Here is how the endodontic retreatment process works – first the Endodontist numbs the area and makes a small opening in the crown of the tooth to access the pulp chamber, after removing materials placed in the root canals during the first procedure – the Endodontist looks for additional canals or new infection. The Endodontists then removes any infection cleans and shapes the canals, and places new filling materials in the roots – the Endodontist may fill the opening in the crown to protect the tooth or send you back to your dentist.

You and your Endodontist should discuss whether retreatment is the right option to save your tooth. Advances in dental technology are constantly emerging and techniques maybe available now that were not when you first had your root canal procedure. Sometimes a tooth can’t be retreated. In these cases, your Endodontist may recommend endodontic surgery. Surgery can be done through the gum to remove the infected tip of the tooth’s root and allow the bone to heal. Occasionally neither retreatment or surgery is possible and the tooth may need to be removed. It is important to have a conversation with your Endodontist to determine the best option for you. Nothing looks, feels or functions like your natural teeth. Talk to your Endodontist about retreatment or other options to save your smile.

For more information go to www.aae.org

Nothing looks feels or functions like your natural teeth, and with the right care, your smile can last a lifetime, but problems like decay disease or injury can threaten teeth and ruin smiles. Thanks to advances in treatment and technology, many teeth can be saved. One way a tooth can be saved is with a procedure called root canal treatment, also known as endodontic treatment. Endodontics is a specialized area of Dentistry focused on treating disease or injury to the dental pulp, endodontists are dental specialists with advanced training in root canal treatment. They are experts in saving your natural teeth using state-of-the-art technologies, like microscopes and digital imaging to treat you quickly and comfortably. Let’s take a step by step look at a modern root canal procedure. Here is a healthy tooth. Inside the tooth under the white enamel is a hard tissue called dentin. Inside the dentin is a soft tissue called pulp. The pulp contains the tooths nerves and blood vessels. It extends from the crown of the tooth into the roots of your teeth. If the pulp becomes inflamed or infected your endodontist will remove it relieving your pain or discomfort. Here’s how root canal treatment works. First your endodontist will numb the tooth so that you won’t feel anything during the procedure. A small shield isolates the tooth keeping it dry and clean. An opening is made through the crown of the tooth and into the pulp chamber fluid is put in the canals to kill any bacteria and help rinse out debris. Then the pulp is removed. Using small instruments, the endodontist carefully cleans and shapes the canals. After the space is cleaned and shaped, the endodontist fills and seals the root canals in most cases a temporary filling is placed to close the opening until you see your dentist. After your endodontist is finished, you must return to your dentist to have your tooth properly restored with a filling or crown. That protects the tooth and is important to ensure the success of your root canal treatment. A tooth that has had root canal treatment often lasts a lifetime, so you keep smiling with confidence.

A root canal treatment has to be performed if the dental nerve technically called the dental pulp from the Latin Pulpa has died or is infected. The patient may or may not experience pain after pulp death. Some causes of pulp death include deep-seated caries, severe heat generation during tooth cutting, severe periodontitis or possibly chemicals used by the dentist for example white fillings called composites. The dead tooth can lead to acute even life-threatening complications at any time because the necrotic pulp tissue can cause acute infections called abscesses. The tooth is connected to the bone through numerous small canals at the end of the root. The objective of a root canal treatment is to completely remove the destroyed tissue which may also be infected with bacteria in some cases from the interior of a tooth. This way the infection is prevented from spreading to the bone. Since complete cleaning of the interior of a tooth is never 100% successful, the dentist attempts to close the pulp cavity in the root canals tightly with a special compound so that any remaining bacteria don’t have space to multiply. This means that absolute cleanliness and the sterile working environment are prerequisites for any root canal treatment. In order to create this environment in the oral cavity, it’s imperative that the dentist works with a rubber dam, because that’s the only way to prevent saliva from reaching the interior of a tooth. Saliva contains many different bacteria that can endanger the success of a root canal treatment. Furthermore, it’s important to work with sterile instruments. With the aid of sterile instruments, the dentist begins to clear and clean the interior of the tooth. Special solutions are used intermittently for irrigation in order to flush out tooth chips cell debris and bacteria. It’s important that all canals are reconditioned. Most teeth have several canals therefore a root canal specialist a so-called endodontic specialist always works with magnification, such as medical magnifying glasses or a microscope. The dental canal must be reconditioned all the way to the root apex. The length of the root is ascertained by means of x-rays and measuring aids. Only a well-conditioned tooth filled all the way to the root apex can be preserved permanently. If the tooth exudes a foul smell is painful or bleeds severely from within the canal should not be filled with the permanent material. In such cases medication is applied within the canal which is then tightly sealed for a few days. However, the temporary sealing material must be absolutely saliva proof because only then will it keep the tooth sealed for about one week. Another cleaning session must take place no longer than a week after the initial session. If this is not done bacteria from the saliva could enter the tooth and its canals necessitating a repeat of the entire previous procedure. Once the canals are clean and the tooth no longer causes any discomfort, the canals are tightly filled with a special compound creating a tight apical seal. The tooth crown should also be tightly sealed from the top in effect from the access opening because only then is it guaranteed that bacteria can no longer enter. On this x-ray of a tooth, you can see a good root canal treatment. The canals have been filled homogeneously and tightly down to the root apex. These filled canals are represented on the x-ray as a light strip within the interior of the tooth. Such a tooth is able to provide valuable service for an entire lifetime. Now we see an example of a tooth with a poorly performed root canal. The anterior root is not filled at all while the posterior root is only half filled. Such teeth can cause trouble even after many years and can lead to conditions like acute bone infection or abscesses. In this case a revision of the root canal treatment and/or tooth extraction becomes necessary. The only alternative to a root canal treatment is tooth extraction prevention is the best alternative. The risks involved in a root canal treatment include the following. Instrument breakage in the canal root canals overlooked by the dentist who leaves them unfilled perforation of the canal and the dental crown and over instrumentation with respective possible consequences such as maxillary sinusitis or bone inflammation.

Root canal therapy is a very common procedure. It has a reputation of being undesirable and painful but when done properly it is actually painless. Every tooth in your mouth is composed of a crown and a root. When a cavity or bacteria penetrates the tooth the root and its nerves become irritated. As a result the bacteria within the pulp cavity needs to be removed and cleaned in order to restore the tooth to its healthy state. Following the procedure the tooth is fragile and is consequently restored to a natural crown for a lifetime of durability. Root canals have a success rate of 95 percent or greater. Most root canals are diagnosed by patient’s sensitivities to a specific tooth. Be sure to consult your dentist if any symptoms or discomfort.

Does the thought of having a root canal make you cringe? Well you are not alone – an advanced specialist in microscopic Endodontics and microsurgery – Dr. Fanny Yacaman, shows us how to help personalize treatment and technology has really improved the health of her patients. An Endodontist is a specialist in the industry that diagnoses and treats the pulp or nerves as the patients calls it – the diseases and the surrounding tissues of the tooth. The patient will say I have a tooth ache or I have a tooth infection or my gums are swelling or I have pain with cod hot sweet or something with chewing would wake me up at night and I need to take pain medications to relive the pain or sometime the whole face is swelling and I have a pimple in my gums.

Root canal therapy has changed over the years; today procedures are virtually painless and more efficient – resulting in a more positive patient experience. My practice is extremely personalized – that is the key of a good treatment and this together with a use of the microscope in Endodontics the attest magnification and illumination with digital x-rays and instrumentation that we have now, this may facilitate the retreatment outcome. With the microscope now we can find tooth cracks that were impossible to see before and we can find extra canals it the same root however it is important to understand that faster doesn’t mean better there is nothing that will substitute a trained clinician and the time we take for each specific procedure the steps of a root canals as I mentioned in one procedure or 2 procedure – we need to have a good diagnosis and a biological and mechanical cleaning and a filling of the root canals – we must understand that nothing is better than keeping our own teeth – we have to remind our patients that our teeth are part of our mouth and our body – having good oral health will contribute towards our overall health towards our body. It is important that our patients also see their dentists 2 times a year, and after the root canal they must have restoration and of course brushing and flossing 3 times a day is extremely important to prevent future problems. I am always scared to go to the dentist and I usually have pains and I am never calm and Dr. Yacaman was very clam and soothing and I had a really nice experience with her. Dr. Fanny Yacaman knows that when it comes to your dental health you want the best endodontic treatment available.