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Root Canal Gallery

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Root Canal Treatment & Apicectomy

Below you can see images of Root canal treatment, Apicectomy and Cyst enucleation carried out at Pearl dental clinic.

Please note the photos below contain images of blood and surgery, so please change the page if you don’t wish to see such images.


Case 1 – Complex root canal treatment

complex root canal treatment

The patient was referred to us with an unusual upper premolar with three root canals. Upper Premolars usually have one or two root canals and three canal premolars are very rare. Molar teeth usually have three canals and when a premolar is found to have three canals similar to molars, its known as a molarized premolar.

three canal premolar

Using a dental operating microscope our Specialist Endodontist used specialized equipment to find and clean all three root canals which were very narrow and would be very difficult to find without a dental microscope. If all three canals are not located and cleaned, there is a high chance of re-infection in future.


root canal treatment

The upper premolar root canal treatment was completed in one visit and the tooth was filled with a white filling. The patient was referred to the Specialist Periodontist for provision of gum disease treatment. The pain that the patient was having fully settled down.


Case 2 – Fractured endodontic instrument

fractured endodontic instrument

This patient was referred to our Endodontist after a file had fractured within his tooth during root canal treatment. Endodontic files have an approximately 5-10% chance of fracture during root canal treatment.

Fractured endodontic instrument removed

When a file fractures inside a canal, it can either be removed, bypassed or left in situ. Sometimes the file fractures so deep inside the canal that it has to be left in situ. In this case, the endodontic file was removed completely by our Endodontist using very fine ultrasonic instruments and dental microscope magnification.

fractured endodontic file removed

The fractured file can be seen above after it was removed. It was about 15mm long.

completed root canal treatment

The root canal treatment was completed over two visits and the tooth was filled with a white filling core. The tooth will now need a crown to reduce the risk of tooth fracture.


Case 3 – Dental Trauma

The gentleman below presented with his two upper incisor teeth which had been traumatized. Two upper incisors had suffered extrusion (moved completely out of their sockets) and were very loose. The central incisor had suffered root and crown fractures. The teeth were splinted with an orthodontic wire to stabilize them.

traumatized upper incisor

As a result of the trauma, the front teeth lost their vitality and tooth vitality was not re-established and pain and tooth mobility had arisen. The two upper incisors were root filled under microscope magnification over two visits. In the case of the upper central incisor, due to the presence of root fracture, the tooth was root filled upto the root fracture line. The fractured central incisor crown was restored with composite bonding. The two incisor teeth became firm once again and all symptoms ceased.

root filled front tooth

In more severe dental trauma cases, delaying dental treatment can result in root resorption arising which can result in the eventual loss of the tooth.


Case 4 – Redoing root canal treatment of upper front teeth

This lady wanted her upper front crowns changed to close the midline gap between her crowns. When changing dental crowns its important to ensure that the underlying root canal treatment is satisfactory and the foundations of the dental crowns are sound. In this case, the previous root canal treatments were suboptimal and there was chronic infection associated with the root of the upper left 1st incisor. To ensure success with the new crowns, we carried out root canal retreatment on both of the upper front teeth.

before root canal retreatment  after root canal treatment


Case 5 – Root canal treatment and Apicectomy

Before After Root Canal Treatment/ Apicectomy - Upper lateral incisor painThis patient presented complaining of pain from a discoloured upper right lateral incisor.
Before After Root Canal Treatment/ Apicectomy - Root Canal/ Apical Cyst X-rayX-ray taken showed failed root canal treatment and a large apical cyst around the tooth apex.
Before After Root Canal Treatment/ Apicectomy - Retreated root canal packet root fillingWe first retreated the root canal and placed a new well packed root filling. This ensures that the inside of the root canal is clean.
Before After Root Canal Treatment/ Apicectomy - Accessing cyst by raising gum flap We then raised a gum flap to have access to the cyst inside the bone at the end of the tooth root.
Before After Root Canal Treatment/ Apicectomy - Visible root apex after removing boneYou can now see the root apex once the bone around it is removed.
Before After Root Canal Treatment/ Apicectomy - Removing cyst around rootHere you can see the cyst being removed from around the root.
Before After Root Canal Treatment/ Apicectomy - Bone loss caused by cystYou Can now see the extent of bone loss caused by the cyst.
Before After Root Canal Treatment/ Apicectomy - Root apex removalThe very apex of the root is then removed.
Before After Root Canal Treatment/ Apicectomy - Sealing the root by MTA root fillingEnd of root MTA root filling material was placed to seal the very end of the root.
Before After Root Canal Treatment/ Apicectomy - Filling bony cavity by the cyst We placed bovine derived bone graft material known as (Bio-Oss) to fill in the bony cavity created by the cyst.
Before After Root Canal Treatment/ Apicectomy - Closing gum flap by restorable suturesThe gum flap was then closed with restorable sutures.
Before After Root Canal Treatment/ Apicectomy - Root filling, apicectomy, bone craft X-rayThe X-ray taken at the end shows the root filling, Apicectomy and bone graft.

As you can see from the above case, it is important not to allow a cyst to expand and damage more bone. If a root filling has failed, prompt treatment is critical in order to prevent cyst formation and bone loss.


Case 6 – Root Canal Treatment

Before After Root Canal Treatment - Decayed tooth X-rayThis patient presented with grossly decayed tooth with buccal cervical decay extending below the bone level.

Such deep decay would pose a serious problem for any dentist wishing to restore this tooth.

Before After Root Canal Treatment - Decayed tooth X-rayWe Initially thought about extracting this tooth and placing an Implant.

However due to medical problems, this patient only has 60% bone density.

Also this tooth was her only lower right molar tooth still present in her mouth.

Extracting this tooth would have left this patient with no posterior bite on that side.

Before After Root Canal Treatment - Decayed tooth filled/ crownedSo we root filled and crowned the tooth in order to save this tooth.

Note how deep the crown margin extends well below the bone level.

You can see a well packed root filling and a very good crown margin.

Before After Root Canal Treatment - Pain free visible crownThis is the crown visible in the mouth.

She did not suffer any pain during the procedure.

Case 7 – Failed Molar Root Canal Treatment

Before After Failed Molar Root Canal Treatment - Failed tooth root fillingThis patient presented with pain from his lower 1st molar.

The tooth had been root filled a few years ago but the root filling had failed.

Before After Failed Molar Root Canal Treatment - Rubber dam isolation canal treatment We did a re-root canal treatment with strict rubber dam isolation for a sterile field.

The canal lengths were measured with X-ray.

Before After Failed Molar Root Canal Treatment - Re-root filling after copious irrigation/ cleaning The tooth was re-root filled after copious irrigation and cleaning.

As root canal treatment makes the tooth more brittle, this tooth will need a crown to prevent fracture of the tooth.


Pearl Dental Clinic is open 7 days a week from 9am-10pm. You can book a root canal treatment or Apicectomy consultation by calling us on 0208 547 9997 or by emailing us or book an appointment online (available 24 hours/day)

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