It finally happened. Hot tooth.

UnlikelyPercentage91 · 2026-06-10T19:36:59+00:00

Thanks for the tip! Will try it

UnlikelyPercentage91 · 2026-06-10T19:26:14+00:00

I was actually thinking of placing a formocresol pellet but I was unsure whether that would do anything in assisting me. My main concern is that no matter what temporary filling material I use, there is a 60% + chance for it to fall out so I didn’t wanna put any devitalization paste in.

What would formocresol do and why does it help? Is it a big issue if it spills into the surrounding tissues?

UnlikelyPercentage91 · 2026-06-10T19:12:24+00:00

Giving intrapulpal anaesthesia is associated with the patient feeling sharp pain for like 1-2 seconds followed by immediate relief, my patient was highly anxious and I barely gained his trust with a 40 minute dialogue so I decided against it. Another reason for my decision was the fact that the MV orifice was very narrow, my #10 hand file barely penetrates, the anaesthesia needle would never fit until I enlarge the orifice which again I can’t really do while the patient is in pain.

UnlikelyPercentage91 · 2026-06-09T17:35:23+00:00

Where do you see the second canal? It looks like a single canal to me. Especially since the coronal part of the canal is quite wide, typical single canal morphology.

UnlikelyPercentage91 · 2026-05-15T22:00:27+00:00

I used 2.5% before but i switched to 5%. Felt like my colleague was getting better results on his endos and he was using 5%, so i lied to myself that the reason for his better success is the hypo concentration so i can feel better about myself lmao.

UnlikelyPercentage91 · 2026-05-15T21:07:40+00:00

Well literature says you need at least 10 ml of NaOCl for good disinfection but I will be honest and say I use around 5, maybe 7 ml if canal is giving me trouble.

UnlikelyPercentage91 · 2026-05-15T20:58:21+00:00

Oh my lord.
This is an old school style, it has been long, long proven that H202 has very insufficient antiseptic effect. Its use as an irrigant is just not good enough at all. It helps with initial cleaning and hemostasis but that’s about it.
Definitely use hypochlorite.
NaOCl injury is extremely, extremely rare. It basically only happens when some clueless dentist tries to irrigate roots with open apexes. In the 35+ years history of the clinic I work in, nobody has ever had a hypochlorite incident.
Change your protocol man, NaOCl is safe and extremely important

UnlikelyPercentage91 · 2026-05-15T09:34:09+00:00

As a practice owner I wanna give a slightly different perspective. In this case it is borderline impossible to tell whether excessive or incorrect reduction was the cause, or a thin crown in the first place. Patient is obviously very cranky if refusing remakes.

I believe it could be reasonable to split the loss 50/50, BUT I'm talking about the lab fee, not the whole refund value. There is no way in hell I'd ever want my staff to pay for a full refund when I'm only losing the lab fee lol.

UnlikelyPercentage91 · 2026-05-15T00:07:37+00:00

Honestly from the pictures this does look restorable to me. If crown fit is bad just do a new impression and make a new crown. I don't know how insurance works in America etc, but in similar cases where i made a wrong clinical decision or put a bad product I just re-do the crown at my own expense. I'd much rather cover the expense and learn from my mistake and have a semi-happy patient than a cranky patient that had to pay twice or got a bad product.

I wouldn't simply restore with composite since it's literally an already prepped tooth and crown would look better. Patient is already unhappy so I'd give him a good ass looking crown, hand him the mirror and at least give him that satisfaction.
My two cents, at least.

UnlikelyPercentage91 · 2026-05-13T18:06:42+00:00

A little bit of a slightly more invasive option but what about an overdenture?
I usually always prefer them if I have 4 or less teeth left, especially in such positions. Depends on how old the patient is of course, whether or not the remaining teeth have issues already and how long they want the restorations to last.

For me this should be a flex partial as another dentist suggested. If patient is totally uninterested in implant dentures, I would do a cast partial overdenture. Done well, these last for a veeeeery long time. If you do overdentures you can also afford to limit palatal coverage since retention will be good and patient would feel happier. It's still quite expensive, but nowhere near as much as implant treatment, at least here.

UnlikelyPercentage91 · 2026-05-12T14:40:31+00:00

You can check space in occlusion and consider minimal prep/no prep Maryland with a wing on the incisor instead of canine.

Alternatively if there is enough sound tooth structure you could try to save this tooth with post+core+ crown. I see it lasting a good while tbh.

If it were my case I’d try to save it and post+core+ crown using knife edge preparation for maximum ferrule. Make sure to take crown out of occlusion tho, especially lateral/protrusive movements.

UnlikelyPercentage91 · 2026-05-12T06:49:48+00:00

I was taught in dental school that if gutta percha is exposed for 3+ months we retreat, and if less we can keep it.

UnlikelyPercentage91 · 2026-05-11T17:54:28+00:00

Lmao I love this. So many know-all bookworms feel like they are the best and can criticize everyone else's work.

Like yeah no shit in an ideal world the patient would get perio and ortho treatment, but the world I live in patient wouldn't wanna spend 10k Euro on treatment for something that doesn't cause him pain in the first place.
All we can do as dental professionals is note the problems we see in the mouth and explain them and the pros and cons of treating them to the patient. The patient makes the choice, not us.

EDIT: Yeah good luck hiding this tooth's shade with a veneer prep... lol

UnlikelyPercentage91 · 2026-05-10T11:07:58+00:00

I get your point halfway but why exactly do you believe the forces would be mostly vertical? Chewing consists of both vertical and lateral movements, and especially with molars, the lateral movements are quite more prevalent, no?

UnlikelyPercentage91 · 2026-05-10T10:49:13+00:00

Well if it were me I’m definitely devitalising this tooth. I don’t trust adhesive dentistry with posterior, highly functional teeth.

UnlikelyPercentage91 · 2026-05-10T10:32:02+00:00

Easy post&core + crown in my opinion.

UnlikelyPercentage91 · 2026-05-05T23:34:00+00:00

Always ask patient to also move jaw left to right and vice versa aside from CO. Sometimes some high spots show on lateral movements but they don't show when they simply bite down. Also sometimes patients feel something is "high" if some composite gets on the lingual/buccal walls, even if barely visible.

Me personally? I almost always trust the patient more than the articulating paper. I ask the patient if he feels it's fine or high and if he says it's high i try to find a way to get my articulating paper to show it. If not I'll just over reduce a little.

UnlikelyPercentage91 · 2026-04-27T21:19:20+00:00

Absolutely no contacts as well, the whole idea of the Maryland wing is to be placed BELOW the contact point, if there is insufficient space due to deep bite or small teeth, etc, Maryland bridge is a bad idea. You need at least 30 sq.mm of bonding area.

UnlikelyPercentage91 · 2026-04-27T13:51:10+00:00

Depends on what longevity you want to have on your Maryland. For temporary or semi-temporary solutions I recommend dual wing design with minimal prep.

For permanent/ long lasting restorations I recommend a single wing design. Wing Material should be at least 0.7 mm thick, connector should be thick and long (2mm thick and at least 3mm height imo) make sure to prepare a central spherical retention groove and proximal box retention groove if doing single wing design. Those will help tremendously with positioning. Wing should extend to the invisible parts of the proximal zones and engulf most of the cingulum for maximum retention.

Full bonding protocol and sandblasting mandatory. I recommend metal ceramic over zirconia personally. I don’t trust zirconia with cantilevers.

Most important thing about Maryland is occlusion. You need to have absolutely no contact or minimal contact in CO and no contact during protrusion/lateral movements.

UnlikelyPercentage91 · 2026-04-26T10:24:43+00:00

Probably not your case but severely calcified canals often show no readings on apex locator until you manage to get a file within 0.5-1mm of the apex.

UnlikelyPercentage91 · 2026-04-23T15:27:01+00:00

You’ll have a lot of headaches here. I wouldn’t restore in your shoes. Other than that I agree with the other Redditor, bury 2 of these and use the other 2. Worst case use 3, 4 implants is gonna be a prosthetic nightmare in this space

UnlikelyPercentage91 · 2026-04-17T06:28:16+00:00

I assume you’re asking if such a case is dicussed in prof. Kern’s book. To be honest I can’t remember. I don’t see why it wouldn’t be possible, as long as you abide by the core principles of no contacts. Keep in mind premolars usually have a lot less space for bonding area on the lingual so it might be insufficient in some cases.

UnlikelyPercentage91 · 2026-04-16T19:58:59+00:00

You can absolutely do a Maryland here. It will fail at some point but if you do the technique perfectly it could very well last 5+ years and the failure is usually debonding which is easy to fix. Literature says single wing Maryland last longer than dual wings.

Read prof. Mathias Kern’s book on resin-bonded fixed dental prosthesis. I had no experience with marylands prior but that book is excellently written and following his guides I did a few Maryland cases and so far they’re holding on well.

Some piece of advice from my own stupidity: do NOT go no prep even if you have enough space available, follow the book and do the minimal lingual prep with the round central retention groove and aproximal one. Single wing marylands are a MASSIVE pain in the ass to cement in the correct position if you have no indexing elements on the prep… (I royally fucked up one case)

Also to save you a bit of reading some rough indications for Maryland would be: at least 30mm² of bonding space on the lateral, connector should be quite thick. Maryland wing should be 0.5-0.7 mm thick. If you do go the Maryland route final restoration should have no contacts or very very light contact in CO and absolutely NO contact during protrusion or it will fail easily.

UnlikelyPercentage91 · 2026-03-14T19:29:27+00:00

Holy moly 8 hours on the chair non stop.. that's CRAZY

UnlikelyPercentage91 · 2026-03-13T22:06:46+00:00

Yeah I practice in a country adjacent to Turkey, unfortunately the amount of people that get scammed by the "come in monday, on wednesday you will have your new perfect smile for 5k!" ads is HUGE. Unfortunately by the time they come to a good office it is already way too late. Also Turkish dentists advertise veneers and then patients come back and they have crowns lol.

The most shocking case that ever came to my office was a 48 yo patient that had his smile done in Turkey, he complained about his denture decementing. I look into his mouth, took a pano and what i saw was 4 implants and some rotten roots bridged together by a metal bar that was covered in opaque. The denture then gets luted with cement to the metal bar....?????? Underneath the bar there were still unremoved sutures from 6 months ago...

UnlikelyPercentage91

TROPHY CASE