Old Harlow Referrals

The service is focused on achieving some key goals to assist you and your patients when it comes to root canal therapy

  • Assist you with difficult cases where successful endodontic treatment is challenging
  • Work with your patient in an informative way so the understand the process and intricacies of treatment
  • Return the patient to your care with enhanced probability of reliable outcomes in complex restorative cases.
  • Take the stress off you with difficult endodontics

To do this we employ the latest techniques, instruments and materials and of course highly skilled staff. In the case studies presented below Fernando has highlighted the latest research backing the protocols we follow to achieve predictable results for your patients. It is important in complex cases not to encounter any of the possible pit falls that can lead to problems. The cases highlight these possible difficulties and how they can be overcome.

C RCT + Fiber Post


Whilst undertaking root canal, having the tooth perfectly isolated with freshly prepared dentine, is a great opportunity to place bonded fibre or composite post and cores for future crown restoration (1, 2).

These are less likely to cause root fracture than indirect precious metal post cores (3) and leave the referring dentist a superb base for crown preparation.

The canal can be shaped with post preparation in mind to achieve the best long term results for your patients

Using the microscope magnification facilitates excellent surface preparation for bonding.

The use of pre-heated composites allows perfect adaptation of post material for best retention (4, 5)

Just ask on the referral form if you want a post prepared and fitted ready for your permanent crown restoration, or ask for more information

(1) Nicola S, Alberto FRiccardo MTAllegra CMassimo SCDamiano PMario AElio BEffects of fiber-glass-reinforced composite restorations on fracture resistance and failure mode of endodontically treated molars. J Dent. 2016 Oct;53:82-7

(2) Guldener KA, Lanzrein CLSiegrist Guldener BELang NPRamseier CASalvi GELong-term Clinical Outcomes of Endodontically Treated Teeth Restored with or without Fiber Post-retained Single-unit Restorations. J Endod. 2016 Dec 7 (Ahead of print)

(3) Bolla M, Muller-Bolla MBorg CLupi-Pegurier LLaplanche OLeforestier ERoot canal posts for the restoration of root filled teeth. Cochrane Database Syst Rev. 2016 Nov 28;11

(4) Magne P, Goldberg JEdelhoff DGüth JF. Composite Resin Core Buildups With and Without Post for the Restoration of Endodontically Treated Molars Without Ferrule. Oper Dent. 2016 Jan-Feb;41(1):64-75



A common difficulty in successful endodontics is a wide apical foramen especially in anterior teeth. This can lead to difficulties in obturation leading to failure.

Often these cases were treated by apicectomy and retrograde root filling, which was not the ideal for patient comfort and recovery. (1)

Now with the use of the microscope and techniques in MTA placement it is possible to treat these cases with an orthograde approach (2)

Here we have a wide foramen that has been successfully treated placing a 3-5mm MTA seal apically

Patient are much happier to have this approach of treatment in these complex cases.

(1) Del Fabbro M, Taschieri STestori TFrancetti LWeinstein RL. Surgical versus non-surgical endodontic re-treatment for periradicular lesions. Cochrane Database Syst Rev. 2007 Jul 18;(3)

(2) Kim USShin SJChang SWYoo HMOh TSPark DSIn vitro evaluation of bacterial leakage resistance of an ultrasonically placed mineral trioxide aggregate orthograde apical plug in teeth with wide open apexes: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Apr;107(4):e52-6.

Multiple difficulties



Sometime a tooth has many difficulties and pitfalls when it comes to root treatment, making the outcomes uncertain.

The case here has difficulties of access and isolation due to position and subgingival decay, a second mesio-buccal canal (often impossible to detect without a surgical microscope) and severe curvature of the roots.

A pre-endodontic tooth restoration has been done to avoid per and post operative leakage (1)

The use of a surgical microscope enhanced the search of  a  present fourth canal, hard to detect without magnification (2),    modern rotary  instruments (3, 4) along with the latest irrigants activation devices (5) and obturation methods (6), make success in these cases more achievable

Let us help with the complex underlying difficulties and return the patient to your care for the pleasure of the final restoration

(1) Heydrich RW. Pre-endodontic treatment restorations. A modification of the ‘donut’ technique. J Am Dent Assoc. 2005 May;136(5):641-2

(2) Buhrley LJBarrows MJBeGole EAWenckus CSEffect of magnification on locating the MB2 canal in maxillary molars. J Endod. 2002 Apr;28(4):324-7.

(3) Kiran SPrakash SSiddharth PRSaha SGeojan NERamachandran MComparative Evaluation of Smear Layer and Debris on the Canal Walls prepared with a Combination of Hand and Rotary ProTaper Technique using Scanning Electron Microscope. J Contemp Dent Pract. 2016 Jul 1;17(7):574-81.

(4) Cheung GSLiu CSA retrospective study of endodontic treatment outcome between nickel-titanium rotary and stainless steel hand filing techniques. J Endod. 2009 Jul;35(7):938-43.

(5) Duque JADuarte MACanali LCZancan RFVivan RRBernardes RABramante CM.Comparative Effectiveness of New Mechanical Irrigant Agitating Devices for Debris Removal from the Canal and Isthmus of Mesial Roots of Mandibular Molars. J Endod 2016 Dec (Ahead of print)

PM RCT Very Curved Roots 2



Some of you will, I know, will be quite comfortable with your duty of care in root canal cases, but if ever you feel it to be prudent to refer we are here to help out.
So let us help alleviate the worry and help you provide the best for your patients