Today’s Cases


Pre-op Angulated

Pre-op Photo


MB1-MB2 isthmus, DB MTA

Calcium Sulfate Barrier

Five interrupted and one vertical matress sling



MB1-MB2 obturated


Case 3.
RCT #3






RCT #18


Pre-op (buccal IRM)

Post op


Another Molar Saved


Pre-op, thin dentin wall mesial to the post

Pre-op photo

MTA root end fillings including isthmus

Immediate Post-op

1 year recall

1 year recall


Surgical Cases


Immediate post op, Dynoblast and membrane

2 year follow up

2 year follow up

pre op

post op, MTA and calcium sulfate

1 year follow up

pre op

resin cement, post perforation

post reduced

repair with "Sequence" ceramic material

bone graft

immediate post op

4 months post op

tissues at 4 months


Apical Surgery – To Do or Not To Do

Pre-op #13

Root end preparation using ultrasonic instruments

MTA root-end fillings in buccal and palatal roots (no isthmus here, roots are separate here)

Immediate post-op #13

Follow-up 2 years

Follow-up 2 years

Pre-op #7, large periapical area

Flap raised, lesion was curretted out

MTA root-end filling

Immediate post-op, calcium sulfate barrier was placed into the surgical crypt.

Follow-up 3 years

Pre-op #30, sinus track traced

Immediate post-op #30

Follow-up 1 year


Palatal Root Apical Surgery

Apical microsurgery has changed drastically with the use of microscopes, ultrasonics and new root end filling materials. It is now possible to minimize the size of the osteotomies, preserve bone and have access to difficult to reach areas. There are also prospective clinical studies with long-term follow-ups using current surgical techniques and materials that show over 90% success in saving natural teeth using apical surgery option.


All roots were resected, root-end preparations were made using ultrasonic instruments and MTA root-end fillings were placed.

MTA in MB1, MB2, isthmus, and DB

MTA in the palatal root


5 days post-op at suture removal

18 months follow-op

At 18 months follow up, although radiographically there is no complete healing observed, the tooth is asymptomatic and functional.