http://www.australiandentalspecialists.com/

Dr Varayini Yoganathan, Suite 219/4 Columbia Court, Baulkham Hills (2026)

13/01/2026

Is any lesion truly ‘too big’ to save? 🧐

Many clinicians see a large periapical radiolucency and immediately think “surgery” or “extraction.” But the human body is remarkably resilient when we provide the right environment for healing.

This 58-year-old patient presented with a buccal abscess and a significant apical finding on CBCT. Between orthodontic aligners and a high-stress period, the tooth was under a lot of pressure.

The Approach:
• Multi-visit RCT: Giving the body time to respond.
• Calcium Hydroxide: Utilizing its antimicrobial efficacy to clear the infection between visits.
• Observation: We waited 3 months to assess bone infill before obturation.

The Result: 9 months later, the patient is completely asymptomatic, the abscess is gone, and we are seeing near-complete bone infill. 🦴

Clinical takeaway? Large lesion size is a risk factor, not a contraindication for non-surgical success. Swipe to see the 9-month healing! ➡️

CBCT dentalspecialist biologicdentistry

09/01/2026

Everything it’s cracked up to be!

The “pumpkin seed” crack is a classic endodontic emergency. This 47-year-old patient came to me for a second opinion after being told tooth 45 needed to come out and be replaced with an implant.

While extraction is sometimes necessary, this case demonstrates how using one of the swiss army knives in my office the Biolase allowed me to save this tooth.

The Strategy:
1️⃣ Precision Diagnostics: CBCT revealed the crack extended sub-gingivally, but the root system remained a prime candidate for RCT.
2️⃣ Laser Advantage: We used the Waterlase (Er,Cr:YSGG) for gingival recontouring. This allowed for better isolation and saved the patient from more invasive traditional crown lengthening later.
3️⃣ Structural Reinforcement: A pre-endodontic resin build-up was used to provide a coronal seal and improve fracture resistance from day one.

The Result: 7 months later, the patient is completely asymptomatic, the crown is placed, and the natural tooth is doing its job.

What’s your threshold for “hopeless”? Let’s discuss in the comments! 👇

07/01/2026

Is it worth saving a third molar? 🦷🤔

Many would opt for the forceps, but for this 55-year-old patient, tooth 38 was a critical functional unit, her last posterior contact in the quadrant.

This case highlights three pillars of modern endodontics:
1️⃣ Precision: Using CBCT to map a 3-canal system in a wisdom tooth.
2️⃣ Technology: Waterlase (Er,Cr:YSGG) laser-activated irrigation to ensure maximum disinfection in a single visit.
3️⃣ Patient Management: Utilizing IV sedation to navigate significant dental anxiety.

Swipe through to see the 48-month follow-up showing complete apical healing. Evidence shows that with proper access and restorability, these teeth have success rates comparable to any other molar.
💬 Do you tend to save functional third molars, or is extraction your go-to? Let’s talk in the comments!

29/12/2025

Not all cracked teeth are write offs ✍️

This 54-year-old patient presented with intense pressure sensitivity on tooth 46, the clinical picture was classic: Parafunctional habits + high work stress = a symptomatic crack. 📈

The Diagnostic Deep Dive:
CBCT revealed apical periodontitis, but here’s why I felt confident moving forward with treatment:
• Good horizontal bone levels.
• No deep isolated vertical defects.
• A favorable crack pattern (no extension across the distal marginal ridge initially).

The Management:
We opted for a single-visit RCT utilizing Laser Activated Irrigation to ensure maximum disinfection of the canal system, followed by a fiber-reinforced resin core to “splint” the tooth from within.

The 12-Month Reality Check:
Healing is evident on the recall radiograph, and the patient is completely asymptomatic. However, there’s a catch….he still hasn’t seen his GP for the final crown! 😱

While the endodontic “foundation” is now healthy, the structural integrity remains questionable. He has been gently reminded to see his dentist at his earliest convenience.

27/12/2025

Can we predictably save a tooth with a 20-year-old failing root canal and a buccal plate perforation? 🦷🔍

This 39-year-old patient presented with pain in tooth 22. The CBCT revealed a significant apical lesion that had actually perforated the buccal plate.

The Approach:
✅ Single-visit retreatment.
✅ Laser-activated irrigation (LAI) for deep activation.
✅ Achieving patency and a high-quality coronal seal.

The 12-month recall (swipe to see the CBCT!) shows incredible bone infill and a completely asymptomatic patient. It’s a powerful reminder that with the right protocol and Host/Infection dynamics we can save “hopeless” teeth.

Did you think this would heal without surgical intervention. Let’s discuss in the comments!👇

24/12/2025

Rules were made to be broken... especially for a bride-to-be! 👰🏻‍♀️🦷

The Story:
A 53-year-old patient came to see me with a painful tooth 22. With her wedding only a month away, the pressure was on. She loved her smile and didn’t want any “big aesthetic changes.”

The Dilemma:
The tooth was a peg lateral with a significant palatal build-up.
❌ Traditional Dogma: Always access from the palatal to “save” the aesthetics.
⚠️ The Reality: Accessing from the palatal would have required massive removal of tooth structure and created a nasty curve for my instruments to traverse.

The Solution:
We went facial. 🚀
By choosing a labial/facial access, we achieved:
1️⃣ Straight-line access (easier on the instruments, better cleaning).
2️⃣ Structural preservation (keeping the core of the tooth strong).
3️⃣ Predictable healing (as seen in the 48-month recall!).
With modern adhesive dentistry, the “aesthetic risk” of facial access is practically zero. The result? A pain-free bride and a tooth that is still going strong 4 years later.

Moral of the story: Treat the tooth, not the textbook.
What’s your stance? Are you still 100% Team Palatal, or do you let the anatomy guide your access? Let’s discuss below! 👇

21/12/2025

Swollen gums is not always perio ! 🦷✨

When this 23-year-old patient woke up with sudden pain and a swollen incisive papilla, she was understandably in distress. On first glance you could assume a simple gum infection but the history of orthodontic treatment and meticulous oral hygiene gave me reason to pause.

Using CBCT 3D imaging, we identified Invasive Cervical Resorption (ICR) on tooth 21. The “swelling” was actually vascular granulation tissue proliferating through the tooth and beyond the defect.

The Solution: We managed this entirely non-surgically through an internal approach:
✅ Cauterized the resorptive tissue (Laser + TCA + Ultrasonics).
✅ Restored the defect with Fuji II LC and Composite.
✅ Completed endodontic treatment.
Swipe to see the 1-month healing and the 24-month follow-up where the tooth remains healthy, stable, and asymptomatic.

I’ve seen some amazing ICR cases managed with a combination of surgical and orthograde endodontics, this situation was one where I wanted to avoid surgery due to the patients high aesthetic demands. Glad to get the outcome we did with only an internal approach

18/12/2025

Should you remove or bypass? 🧐

A 27-year-old male presented with a 5-year-old overseas crown and a persistent apical finding. CBCT imaging revealed the culprit: a separated instrument in the apical portion of the MB root

In endodontic retreatment, the goal is disinfection, not just removing the file at all costs. As noted by Terauchi et al. (2022), a fragment only affects the prognosis if it prevents us from cleaning the apical anatomy.

The Strategy:
✅ Single-visit retreatment.
✅ Focus on bypassing the instrument rather than aggressive retrieval.
✅ Preserve structural integrity by avoiding excessive dentine removal.

The Result:
12 months later, CBCT shows significant bone infill and a tooth that is now ready for a new crown by his general dentist.

Clinical Tip: Retrieval at all costs often leads to strip perforations or vertical root fractures. Know when to hold ‘em

16/12/2025

Sinusitis or a tooth infection?🕵🏽‍♀️

THE MYTH:
Patients (and many medical GPs) assume that sinus pain, congestion, and post-nasal drip are strictly issues for the ENT or family doctor. The teeth are often ignored if there is no specific “toothache.”

THE REALITY:
The floor of the maxillary sinus and the roots of the posterior teeth are intimate neighbors.
As seen in this case of Tooth 26, a necrotic tooth can pump bacteria directly into the sinus for months, masquerading as a chronic ENT issue.

THE STATS:
According to Craig et al. (2021), 25–40% of chronic maxillary sinusitis cases are odontogenic in origin.
That means up to 4 in 10 “sinus infections” will never heal with antibiotics alone because the source (the tooth) remains untreated.

THE CASE:
A 23-year-old female presented with chronic unilateral sinus pain, post-nasal drip, and a specific complaint of a constant “foul smell.”
Despite the massive apical lesion seen on the CBCT, she had no idea the infection was coming from her tooth.

THE SOLUTION:
We didn’t treat the sinus; we treated the infected tooth.
✅ Single-visit endodontic treatment.
✅ Locating and disinfecting all 4 canals (including the MB2).
✅ Sealing the pathway of infection.

THE OUTCOME:
Swipe to the slide 5 to see the 6-month review.

The buccal dental abscess resolved in two weeks. By 6 months, the bone had refilled, and the sinus membrane had healed completely.

Takeaway: Unilateral sinus symptoms + A “foul smell” = worth a dental examination with vitality testing of posterior teeth and CBCT.

12/12/2025

It takes TWO to tango 💃🏽🕺🏽

THE MYTH:
Mandibular incisors are often viewed as the “simplest” teeth for endodontic treatment. They are small, straight, and up the front. What’s so hard?

THE REALITY:
Anatomy doesn’t care about our assumptions. As seen in this case of Tooth 41, lower incisors frequently hide a dark secret: a second canal (lingual) hidden deep under the cingulum.

THE STATS:
According to Martins et al. (2023), 21.9% of mandibular central incisors and 26% of laterals contain an additional lingual canal.
That means 1 in 4 lower incisors has the potential to fail if you don’t look for the second partner.

THE CASE:
A 17-year-old female presented with pain and swelling at site 41 following childhood trauma.
The CBCT confirmed what the naked eye might miss: Two canals and a big apical finding.

THE SOLUTION:
Finding the “second dancer” in this tango required:
✅ CBCT imaging to map the anatomy.
✅ High magnification (Microscope) to locate the lingual or***ce.
✅ Extending the access lingually (without compromising structural integrity).

THE OUTCOME:
Swipe to the end. Near complete healing at the 6-month review.

Takeaway: If you have a lower central in the book, consider CBCT to assess the anatomy prior to commencing treatment.

10/12/2025

The sun should never set on pus. ☀️🚫

Antibiotics alone are not the cure. But they sure can help the situation.

THE CASE:
A 65 year old male presented with a severe right-sided facial swelling.
The infection was aggressive he had trismus (limited opening) and the swelling was firm and painful.

THE TRAP:
It is tempting to prescribe antibiotics and hope the swelling goes down. But in cases of fluctuant swelling or systemic involvement, hope is not a strategy. Source control is.

THE PROTOCOL:
We didn’t rush the root canal. We managed the emergency first:
1️⃣ Immediate Incision & Drainage (I&D): To release the pressure and purulence.
2️⃣ Antibiotics: A course of Amoxicillin and Metronidazole to manage the systemic spread.
3️⃣ The Wait: We allowed time for the trismus to resolve.
4️⃣ The Cure: Once the patient could open comfortably, we performed single-visit endodontic treatment to remove the necrotic source.

THE OUTCOME:
Swipe to the end. At the 6-month review, the bone is healing beautifully, and the patient is symptom-free.

THE LESSON:
As Ellison (2009) states, the primary treatment for dentoalveolar infections is drainage and removal of the source. Antibiotics are just the adjunct.

08/12/2025

I watched a documentary that said root canals are bad...😟

Yesterday, I spoke about the myths surrounding endodontics. Today, I want to show you how that conversation plays out in real life.

THE CASE:
A 45-year-old female presented with pain at tooth 21.
She had a history of trauma (netball injury) and she had watched the ‘Root Cause’ documentary. She was anxious, skeptical, and price conscientious. She asked me
“Can you GUARANTEE this will work?”

THE REALITY:
The CBCT showed an apical lesion perforating the buccal plate.
My answer to her was honest: “No. In dentistry, there are no guarantees. Only probabilities.”

THE MANAGEMENT:
✅ Thorough informed consent (discussing success rates vs. failure risks & also alternative options
✅ Management of expectations (endodontic healing takes time).
✅ Single-visit endodontic treatment

THE OUTCOME:
Swipe to Slide 6.
At the 1-year review, the patient is pain-free, the lesion has healed significantly, and she has a new confidence in root canals.

THE TAKEAWAY:
I cannot promise 100% healing. But I can promise 100% effort, honesty, and precision.

Dr Varayini Yoganathan

13/01/2026

09/01/2026

07/01/2026

29/12/2025

27/12/2025

24/12/2025

21/12/2025

18/12/2025

16/12/2025

12/12/2025

10/12/2025

08/12/2025

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