Tuesday, February 19, 2013

CBCT as Aid In Removal of Separated File

Removal of a separated instrument is rarely a simple task.  The closer to the apex, the more difficult the removal.  In this case, tooth #19 had a separated instrument 6 yrs earlier. The tooth had become symptomatic and the patient was having extensive crown and bridge work done.

A CBCT was taken to evaluate the separation in 3D.  This image was very helpful because it told us the anatomy of the mesial root. It shows clearly that the mesial root is a single root, rather than two separate roots.  With this information, we can plan to remove some tooth structure between the MB and ML canals in our attempt to access and remove the separated instrument.  It also showed us that there were 2 separated instruments in the MB canal.  This information is crucial in our ability to remove the spearated instrument. (The radiographic imaging also warned us not to remove any dentin mesial to the prepared space to prevent root perforation)

This treatment can only be accomplished with the use of the dental operating microscope and use the of ultrasonic instrumentation.  Approximately 1 hour of treatment time was used in removing the separated instruments.

2 separated instruments

Final obturation.

Take home message from this case...

Always easier to prevent a separation than remove a separation.
Patients should be informed if an instrument separation occurs.
Advanced imaging (CBCT) provides valuable information that affects the course of treatment.
Microscopes are an indispensable tool in modern endodontic therapy.

Tuesday, February 5, 2013

Remembering James H.S. Simon DDS (1934-2013)

On Sunday, Feb 3, 2013, Dr. James H.S. Simon passed away. Dr. Simon was one of the pioneers of modern endodontics.  He dedicated his career to education and was truly an amazing teacher, mentor and friend.  I'm grateful for my association with Jim and the things he taught me about endodontics.

Dr. Simon (Chief) and his posse at Jackson Hole, WY - Oct 2012 meeting of American College of Endodontists.

The following bio was provided by Dr. Ilan Rotstein of USC.
Dr. Simon was born in 1934 in Boston. Between the ages of 14-18 he attended the Phillips Exeter Academy in New Hampshire, known for its excellence in education, and graduated from the Academy in 1953. Between the ages of 18-22 Dr. Simon attended Bowdoin College in Brunswick, Maine, where he majored in biology. He spent the next 4 years in Temple University School of Dentistry in Philadelphia obtaining his D.D.S degree. Following dental school Dr. Simon spent 2 years at Boston University School of Medicine where he studied oral pathology and endodontics with Henry Goldman, Kurt Thoma and Herb Schilder and received his certificate in endodontics. For the next 3 years he was engaged in a private practice in Quincy, Massachucetts, where he limited his practice to endodontics. After 3 years of private practice, Dr. Simon joined the Veteran’s Administration in White River, Vermont, treating endodontic cases and in addition serving as a research associate at Dartmouth Medical School in Hanover, New Hampshire.

In 1968 Dr. Simon joined the VA Medical Center in Long Beach, California, in order to start the first endodontic residency program there. For the next 32 years, Dr. Simon was the Director of the Endodontic Residency Program at the VA Long Beach where he mentored and trained more than 60 residents. This period of 32 years was the longest full-time teaching program under one director in the nation. During that period, Dr. Simon also held a part-time teaching position at USC School of Dentistry where he taught together with Al Frank, Dudley Glick, John Ingle and others. In 1974, he joined the faculty at Loma Linda School of Dentistry as part-time faculty. In July 2001, Dr. Simon was recruited to USC where he served as Professor of Clinical Dentistry and Director of the Advance Endodontics program. During that time he mentored and trained more than 110 advance endodontic students.

Dr. Simon was a Diplomate of the American Board of Endodontics, President of the College of Diplomates of the American Board of Endodontics, Director and President of the American Board of Endodontics, Fellow of the American College of Dentists and
Fellow of the International College of Dentists. He was member of many prestigious dental organizations and held leadership positions in the American Association of Endodontists. Dr. Simon published extensively in the dental and endodontic literature and in 2005 he received the Louis I. Grossman Award by the American Association of Endodontists. This most prestigious award is given to an author for cumulative publication of significant research studies that have made an extraordinary contribution to endodontics. Dr. Simon was an international authority in the field of endodontics and used to lecture extensively at universities and professional meetings in the United States and throughout the world.

Jim is survived by Helen, his wife of 53 years, his children Jeffrey, Linda and David, and his grandchildren Alexis, Morgan, Jake, Jordan and Jason.