Challenging Maxillary Canine Case

In this complex case, Dr. Bill Nudera takes on a severely carious maxillary canine with decay extending below the gingival tissue and dangerously close to the alveolar bone. Managing both the restorative and endodontic challenges required careful planning, advanced imaging, and innovative techniques.

From flap design and isolation strategies to a caries-directed endodontic access, Dr. Nudera demonstrates how to balance tissue management, root canal therapy, and restorative repair to preserve a tooth many might consider hopeless. Along the way, he shares practical pearls on achieving isolation, controlling heme in anticoagulated patients, and using the gutta-percha projection technique for predictable access and restoration.

The case also highlights an important postoperative complication—persistent bleeding due to the patient’s Warfarin use—and how to effectively identify and manage a liver clot without compromising healing.

This case is a powerful example of comprehensive endodontic problem-solving, blending surgical, restorative, and medical considerations to deliver a positive outcome for the patient.