Prime Endodontics

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Happy 4th of July from Prime Endodontics!

Our very own Dr.Cohenca will be speaking at PNDC tomorrow! Take a look at the next slide for lecture topics and times. We look forward to seeing you all there.

Lecturing at the Asociacion Argentina de Odontologia. Thanks for the kind invitation!

Happy St.Patricks day! ☘️ We are lucky to be working with all of you and thank you for trusting us with your patients care!
Hope everyone is enjoying some sunshine today ☘️☘️

Thank you to everyone for joining us last night for our study club. Special thank you to Dr.Franco Audia for the very informative lecture and to .us for providing us with food and drinks.
We hope to see you all at the next one!

I’m speaking at this May in Seattle! PNDC is a gem in the world of dental CE, with a lineup of amazing speakers in a gorgeous Pacific Northwest setting. I hope to see you at my sessions this spring in Seattle! Find me and register at wsda.org/speakers.

When he’s not caring for patients. Dr. Cohenca enjoys spending time giving back to the community he calls home.
Last week Dr.Cohenca and his wife Ruti spent the day volunteering with Habitat for Humanity.
Habitat works together with volunteers,families, local communities and global partners to provide affordable and safe homes to those in need. 🏡

Life is better with Girl scout cookies. Spreading some sunshine as springtime approaches us. We appreciate working with all of you 🍪 🌸

Happy Birthday Dr.Cohenca! Your Prime Endodontics family is wishing you a wonderful year ahead! 🥳

Wishing you all a Happy New Year! Cheers to new beginnings and an incredible year ahead 🎊

Invasive Cervical Root Resorption - The New Dental Epidemic?

The use of a CBCT to appropriately diagnose and treatment plan these cases is crucial. A CBCT provides vital information regarding the ECR size, location, circumferential spread, proximity to the root canal and if accessibility can be gained.

The above case Highlights a Surgical Resorption repair of tooth #8. As noted above the use of CBCT was integral in the treatment planning of this case.
Endodontic therapy was completed first followed by surgical repair and a 3 year follow up.

Happy thanksgiving to all of you! We are beyond grateful for our colleagues and the privilege of serving this community.

Happy Halloween from Prime Endo!
Wishing you a Spooktacular day 🕷️ 🎃

Case 2:
15-year-old girl was involved in a boat accident in June 2023 and referred to our office 2.5 months later.

Clinical and radiographic examination revealed:
Tooth #8 with evidence of 7-8mm intrusion and external inflammatory root resorption. In an attempt to restore esthetics, a composite build up was placed. No attempt of surgical or orthodontic repositioning was made.
Tooth #9 presents with uncomplicated crown fracture and mild extrusive luxation (based on photos provided by patient’s parent). The crown fracture has been restored with composite.

Diagnosis:
#8 Severe Intrusion with Pulp Necrosis and External Inflammatory root resorption.
#9 Pulp Necrosis with Symptomatic Apical Periodontitis

Tx Recommendations:
#8 - Immediate orthodontic extrusion (started same day) and endodontic therapy as soon clinically possible. At the time of examination, the palatal surface was almost completely sub-osseous. Coronal restoration of palatal access.
#9 - Endodontic therapy and coronal restoration of palatal access.


Treatment takeaways for teeth with complete root formation.
• Allow re-eruption without intervention if the tooth is intruded less than 3 mm. If no re- eruption within 8 week, reposition surgically and splint for 4 week with a passive and flexible splint. Alternatively, reposition orthodontically before ankylosis develops.
• If the tooth is intruded 3-7 mm, reposition surgically (preferably) or orthodontically
• If the tooth is intruded beyond 7mm, reposition surgically
• In teeth with complete root formation, the pulp almost always becomes necrotic. Root canal treatment should be started at 2 week or as soon as the position of the tooth allows, using a corticosteroid-antibiotic or calcium hydroxide as an intra-canal medication. The purpose of this treatment is to prevent the development of inflammatory (infection-related) external resorption. Comment below what some possible long term complications can be and what the long term prognosis is.

Proper management of Traumatic Dental Injuries (TDI) is of utmost importance requiring a multidisciplinary approach.

Within dental injuries, intrusive luxation and avulsion are considered the most severe, both for the pulp and periodontium. Today we will highlight two cases of severe intrusion.

Case 1:
A 9-year-old boy fell while playing soccer at school in February 2023. Patient presents to our office 6 months later after unsuccessful attempt of orthodontic extrusion of teeth #7 and #8 and with no endodontic intervention.

Clinical and Radiographic Examination revealed:
Tooth #8 is intruded about 9mm with the apex under the floor of the nostril. External Inflammatory root resorption is evident on teeth #7 and #8. Tooth #7 appears slightly intruded and laterally luxated. Tooth is currently ankylosed.

Diagnosis:
Tooth #7 History of intrusion with Pulp Necrosis and External inflammatory root resorption.
Tooth #8 Severe Intrusion with Pulp Necrosis and External Inflammatory root resorption.

Tx Recommendations:
#8 Surgical luxation and repositioning. Splint for retention.
#7 and #8 Endodontic therapy w/ Ca(OH)2 dressing to arrest existing root resorption, followed by MTA apexification and coronal restoration of palatal access.
Tooth #8 is expected to re-ankylosed in the new position and eventually might need to be decoronated and replaced in the future.

Wishing a Happy Birthday to our wonderful Associate Dr.Shahd Nawari!

AAE 2023. Mission accomplished. Provided a workshop and lectures together with my dear friend and student Cesar de Gregorio Cesar De Gregorio. Prime Endodontics Nestor Cohenca

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First meeting of this kind. Prime Endodontics always happy to help and support our community.