Instagram story viewer> @dr_bilal253> Posts

Dr Bilal Akbar

@dr_bilal253

1.9K

followers

9609

following

🦷 Root Canals | Fillings | Extractions
✨ Veneers | Crowns & Bridges | Smile Makeovers
📍 Pindi Dental Clinic, Rwp
👇 Book Appointment

POSTS STORIES REELS TAGGED

Case: Deep mesial caries with tooth #46

Patient presented with deep mesial decay on lower right first molar (46)
No history of spontaneous pain
Cold test showed normal response
No tenderness on palpation or percussion

Radiographically the decay was very close to the pulp but a layer of remaining dentin was still present

Treatment: Deep Margin Elevation (DME) was performed to elevate the deep mesial margin followed by a direct composite restoration with proper tight contact achieved

The patient was counseled in detail about the pros and cons, and the possibility of future endodontic treatment if symptoms develop. by @dr_bilal253

11

1

5 days ago

Radix Entomolaris - The Extra Root You Can't Miss.

Case: RCT of 46 Radix Entomolaris

Patient presented with deep distal caries on #46
History of pain long time ago
Cold test: No Response
Palpation / Percussion: Negative

*Diagnosis: Pulp Necrosis / 46
Treatment Advised: Root Canal Treatment

*CASE PROTOCOL:

1. Isolation & Foundation:Absolute isolation with Rubber Dam - the most important step. Complete caries removal followed by Pre-Endo Build-up to build the distal wall and create 4 walls for effective irrigation.

2. The Surprise:Pre-op radiograph revealed an extra root on the distal side - A Radix Entomolaris Located 4 canals - MB, ML, DB, DL.

3. Glide Path & Shaping:
Glide path:6k,8k,10K,15.03proglider
Shaping: ProTaper S1, S2, F1, F2
Recapitulation & Patency maintained throughout

4. Irrigation Protocol:
- Cerakemad 5.25% NaOCl after each file
- Sonic & Ultrasonic activation
- 17% EDTA to remove smear layer
- Cold saline as final rinse

5. Obturation:Cold Lateral Compaction
Appreciate the curves Inverted images show well-maintained apical curvature and some lateral canals filling at the apex thanks to sonic/ultrasonic activation & good irrigation protocol

*KEY TAKEAWAY:

1. Never skip the Pre-op X-ray from different angles this radix was visible on careful observation - a missed root = failed RCT
2. Mandibular molars can have a third root If it's on the lingual side it's Radix Entomolaris if on the buccal side it's Radix Paramolaris RP is rarer and often superimposed Always take 2-3 angled radiographs
Prevalence is 5-30% in Asian populations
3. Pre-Endo Build-up is NOT optional without 4 walls you can't have a proper reservoir for irrigation and disinfection.
4.Rubber Dam is Standard of Care not a luxury it protects the patient and improves your treatment outcome.

Anatomy is never what it seems Always look for the extra!

See you soon with another case.

Dr. Bilal Akbar
Pindi Dental Clinic, Rwp by @dr_bilal253

17

5

11 days ago

*CASE: #36 Asymptomatic Pulp Necrosis with Deep Mesial Caries

Patient reported deep decay on lower molar wanted a simple filling
No current pain

*Examination:
Cold Test: Negative
Palpation: Negative
Percussion: Negative
History: Pain in this tooth long time ago

*Diagnosis: Pulp Necrosis No PARL

Treatment Plan: Root Canal Treatment advised Patient agreed.

*Protocol:
1. Quadrant Isolation - Rubber Dam
2. Complete caries removal
3. Pre-Endo Buildup to rebuild missing mesial wall BEFORE endo
4. Located 3 Canals: 2 Mesial, 1 Distal
5. Files: Anyway Files
6. Irrigation: Cerakemad 5.25% NaOCl - copious irrigation with Sonic & Ultrasonic Activation
7. Preparation: Till F2
8. Obturation: Cold Lateral Compaction
9. Core Buildup: Flowable composite to seal pulp chamber + Packable composite till coronal aspect

Crown advised.

*KEY TAKEAWAY:
Not every deep caries without pain is vital!
A negative cold test with a history of past pain = Suspect necrosis. Always test before you fill. And Pre-Endo buildup is a game changer for isolation and avoiding leakage in badly broken teeth.

---
Dr. Bilal Akbar
Pindi Dental Clinic

.

#Endodontics #RootCanalTreatment #PulpNecrosis #MolarEndo RubberDam RubberDamIsolation PreEndoBuildup AnywayFiles ColdLateralCompaction UltrasonicActivation SonicActivation EndoCase DentalXray CompositeBuildup SaveYourTooth DentistryWorld DentalEducation PakistanDentist RawalpindiDentist IslamabadDentist PindiDentalClinic dr_bilal253 by @dr_bilal253

17

0

13 days ago

Isolation and Inversion by @dr_bilal253

3

0

13 days ago

Challenging RCT Upper Left 7 with Limited Mouth Opening & Complex Canal Anatomy

Patient presented with pain in upper left 7 and had stopped eating from that side of the mouth
No exaggerated response to cold test partially necrotic pulp
No pain on palpation percussion

The real challenge started with isolation - after 20 minutes of struggle and tearing 2 rubber dam sheets I was finally able to place the dam and proceed

*Case Details:
- Tooth: Upper Left 7
- MB canal: Moderate curvature
- DB canal: Acute curvature at the apical third
- Palatal canal: Relatively straight
- Canal preparation done using AnyWay files
- Negotiation of apical third of DB canal: Plenty of 6, 8, 10 K-files used to negotiate the acute apical curvature with patience
- Thorough irrigation and disinfection with Cerkamed 5.25% NaOCl
- Obturation done using single cone technique
- Core build-up done with composite on the same visit

*Takeaway:
When you have limited mouth opening + maxillary second molar + severe curvature, patience is your best file. Rubber dam isolation was difficult in this case but non-negotiable. by @dr_bilal253

9

5

15 days ago

I Will share how I did this stay tuned by @dr_bilal253

10

2

17 days ago

No caption Needed by @dr_bilal253

3

0

19 days ago

*𝐒𝐚𝐯𝐢𝐧𝐠 𝐚 𝐌𝐮𝐭𝐢𝐥𝐚𝐭𝐞𝐝 𝐭𝐨𝐨𝐭𝐡 🦷*

Tooth #17 - Badly broken, last standing molar. We needed to save it for prosthetic purposes. Patient can't afford implants, so we went the extra mile to save it.

*𝟏. 𝐂𝐚𝐬𝐞 𝐏𝐫𝐨𝐭𝐨𝐜𝐨𝐥*
Isolation first - Remember: No Dam, No Endo.
Removed all decay, located all canals including MB2.
Thorough disinfection with NaOCl 5.25%, dried canals and obturated.
Time to build it up! Placed a fiber post in the palatal root for added strength & support.
All cusps reduced and core build-up done.
Patient returning next week for bridge preparation.

*𝟐. 𝐓𝐚𝐤𝐞 𝐇𝐨𝐦𝐞 𝐌𝐞𝐬𝐬𝐚𝐠𝐞*
Don't rush to extract every broken-down tooth. With proper isolation, right protocol and prosthetic planning, even a mutilated molar can be saved to serve as a valuable abutment.

#endodontics #rct #fiberpost #corebuildup savethetooth molarendo dentistry isolation rubberdam by @dr_bilal253

31

9

20 days ago

𝟏. 𝐓𝐡𝐞 𝐎𝐧𝐞 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐓𝐡𝐚𝐭 𝐂𝐚𝐦𝐞 𝐁𝐚𝐜𝐤 𝐀𝐟𝐭𝐞𝐫 𝐬𝐢𝐱 𝐌𝐨𝐧𝐭𝐡𝐬
Challenging RCT | Limited Opening + Long Curvy Roots

A story of compliance and complexity

We started RCT on this lower molar 37 six months ago After the 1st visit the patient disappeared today he returned with no temporary filling extensive re decay due to food impaction

𝟐. 𝐓𝐡𝐞 𝐂𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞
Very limited mouth opening
Posterior most tooth
Long curvy mesial roots difficult to approach

𝟑. 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐏𝐫𝐨𝐭𝐨𝐜𝐨𝐥
Started from where we left off
Rubber dam applied
All caries removed completely
Missing distal wall built temporarily with liquid dam to create a 4 walled reservoir for irrigation
Thorough cleaning and shaping done with ProTaper Universal files
Copious irrigation with 5.25 percent NaOCl throughout
Dry canals achieved so we proceeded with obturation

Unfortunately could not capture more clinical pictures due to very limited mouth opening and posterior access but the radiographs speak for themselves

Swipe to appreciate the curve management and apical seal in these long mesial roots

𝟒. 𝐊𝐞𝐲 𝐓𝐚𝐤𝐞𝐚𝐰𝐚𝐲
Limited opening + Curvy canals + No wall = Don't panic Isolate Build the wall Clean thoroughly

#Endodontics #RootCanalTreatment #CurvyCanals #LimitedMouthOpening #RubberDam ProTaperUniversal EndoLove SingleVisitEndo by @dr_bilal253

9

5

22 days ago

SIP with Deep Proximal Caries - RCT + Composite Build-up | 44, 45*

Case Details:
Patient presented with pain and sensitivity in lower right quadrant.
Clinical pics tell the story 👇

Pic 1 - Pre-op & Diagnosis:
Carious 44, 45 with food impaction.
Tests: Cold test - lingering response | Palpation - WNL | Percussion - WNL
Diagnosis: Symptomatic Irreversible Pulpitis (SIP) w.r.t 44, 45*
Treatment advised: RCT of both teeth

Pic 2 - Isolation is Everything:
No Dam, No Endo!
Isolated from 46 to 43 (4 teeth isolation) for better access, visualization and to manage deep subgingival margins.

Pic 3 - Caries Removal & Deep Margin Acquisition:
Complete caries removal under dam.
Floss tie used to retract gingiva and acquire deep proximal margins.

Pic 4 & 5 - Cleaning & Shaping Protocol:
Access + Glide path
Preparation: ProTaper Gold till F2
Irrigation: 5.25% NaOCl throughout preparation
Video - 3D Disinfection:
Activation of NaOCl with Sonic Activator for better penetration into lateral canals and isthmus.

Pic 6 & 7 - Prepared Canals & Margins:
Clean canals, clean and dry margins ready for restoration.

Pic 8 - Proximal Wall Build-up:
Restoration of proximal contacts for both 44, 45 using Tor Vm matrix system.

Pic 9 - Anatomy:
Adding some basic occlusal anatomy - function meets aesthetics.

Pic 10 onwards - Final Appreciation:
Post-op radiographs showing well-maintained proximal contacts and dense apical seal.

Isolation + Deep Margin Elevation + Thorough Disinfection = Predictable Endo-Resto.

See you soon with another case

#Endodontics #RootCanal #RubberDam #NoDamNoEndo #DentalIsolation DeepMarginElevation CompositeRestoration ProTaper EndoResto SonicActivation Dentistry ConservativeDentistry SIP DentalPhotography by @dr_bilal253

22

0

22 days ago

RCT OF LOWER MOLAR46 2 VISIT CASE

Swipe to see step by step

Pic 1 Visit 1
Patient reported with spontaneous pain pain to hot cold lingering pain Diagnosis Symptomatic irreversible pulpitis RCT advised and started
Pre Endo build up done first to get proper 4 walls access opening deroofing the chamber locating canals little bit scouting and closed for next visit You can see vital bleeding pulp

Pic 2 Visit 2 The most important step is
Isolation with rubber dam Remember No Dam No Endo
Clamp B2 isolated 4 teeth for better access and visualization Pre Endo build up still intact

Pic 3 4 and 5 Cleaning and Shaping
After thorough access refinement 3 canals located 2 Mesial 1 Distal
Thorough cleaning and shaping done using 5.25 percent Cerakemad Hypo and Edta and Normal Saline Filing with ProTaper Universal files
You can clearly see the isthmus and the canal orifices

Pic 6 Master Cone X ray
Master cone try in Looks fine cones reaching till apex with good tug back Ready for obturation

Pic 7 and 8 Obturation
Mesial canals with inward apical opening and distal canal Obturated with lateral condensation
Note big void in my build up visible here Dont worry will be redone before final restoration

Pic 9 and 10 For Anatomy Appreciation
Some negative inverted contrast to appreciate the apical anatomy and obturation better

Learning points:Pre endo build up plus Rubber dam plus Thorough irrigation equals Predictable Endo

What do you think about this case Comments welcome
See you with soon with another case
#endodontics #rct #rootcanal #rubberdam #isolation noDamNoEndo preendobuildup protaper endolove dentistry dentalcases conservativeDentistry rawalpindiDentist by @dr_bilal253

16

6

24 days ago

Endodontic Management of UL7 (27) with Limited Mouth Opening
Root canal treatment performed w.r.t Upper Left Second Molar (27).
Challenge:Curved roots + restricted mouth opening
Isolation achieved with modified rubber dam technique using W8A clamp and split dam method
Figure A: Post-obturation periapical radiograph showing dense obturation of buccal and palatal canals till apex.
Figure B: Inverted/contrast view for better appreciation of apical seal and canal morphology.

Case demonstrates that adequate isolation and apical seal is achievable even in difficult cases with proper technique by @dr_bilal253

11

2

a month ago