Welcome to Julian Webber's blog where he muses on a range of topics including some of his most interesting cases,
stories from his travels, the latest from the clinic and news on our Saving Teeth Awareness Campaign.

If an endodontic problem is invisible to the human eye, as many are, the case is doomed to failure


I am grateful to Alpha Omega http://alphaomegauk.co.uk for asking me to carry out a live treatment recently. The picture above shows the treatment underway with myself and my nurse Paulette using the operating microscope. Watched by a handful of dentists, I explained what I do and answered questions; the experience prompted some helpful reflections. The patient in the chair had been referred to me by his dentist to treat infection and pain in an upper right molar. The referring dentist had opened the tooth up but decided that it was best treated by a specialist. What was I going to do? It wasn’t just me asking this question; a group of 7 observers were watching the procedure on a 50 inch plasma screen courtesy of my microscope which recorded the live action!


Numerous craze lines and a superficial fracture running from the front (mesial) to the back (distal) were visible on the surface of the tooth. This alerted me to the possibility that the tooth could be badly cracked or split and this could be the cause of the bone loss between the roots (furcation involvement) seen on the X-ray, leading to swelling in the cheek (buccal swelling)? After I cleaned out the root canals I spotted a fracture running from the mesial marginal ridge to the distal marginal ridge through the floor of the pulp chamber. This was clearly the root of the problem.


Could the patient’s dentist have diagnosed the fracture? The answer is no; only a clinician with an operating microscope could have seen this fracture. The limit of human vision is 0.2mm and anything less than this cannot be seen with a naked eye. I probably see a fracture across the of the  pulp chamber floor twice a month. It’s a sobering thought that outside of specialist practice, cases like this would be treated and fail. Thanks to the magnification, we avoid spending time and cost on a hopeless case.


Sadly this particular patient lost his tooth because it tooth was terminally fractured. But at least by cleaning out the canals and dressing the tooth I removed the discomfort and swelling, buying him time to talk to his dentist about the next step – a bridge or an implant.


The moral of my story is that without the correct imaging equipment problems can go undiagnosed. As clinicians we need to have an open mind and remember that the problem inside a tooth may not be visible to the human eye.And as a secondary thought, it’s always beneficial to open yourself up to the scrutiny of your colleagues. It really makes you think about what you do and why.

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