I just got a Root canal this morning and let me tell you, I asked them to numb the hell outta me. When my Dr. got to 3:30 he wanted to make sure that i was 100% numb so he said he was touching the root of my tooth with one of his tools before he proceeds and asked me if i could feel anything. I said no and he said "Yay, Lets proceed". I asked prior to him working on me if he could tell me which steps he was on during my "operation" so I knew and could "follow" along in my mind, he didn't have a problem with that and was happy to keep me in the loop:-) After everything was good I asked him "was my roots infected or just inflamed?" and he told me that my roots were "pretty badly inflamed" and that's why i had soo much trouble with my tooth(hurting so bad). I was soo glad I got that procedure done, now all I have to do is cap my tooth and i'll be golden:-)
Marco I was a root canal virgin at 60 yrs old. I had two emergency root canals in March at the beginning of the pandemic because of complications - I am very unique in that I had three roots = 3 nerves = the 3rd wasn’t found on the 1st treatment resulting in recurring pain. Videos help to know what to expect as a suffer from Agoraphobia and leaving my home is one traumatic event on top of another and another! I have yet to return for the final permanent filling, build up for a crown and the crown placement!
Marco I have no TV, Couch, recliner, etc. I only have a table, some chairs, a desk and a bed. I’m living as they did in the Homesteading days when people didn’t have the luxury of a sitting room or a living room!
@@njk9989 what I meant was: you don't become a dental assistant by randomly watching canal diggings videos on RUclips. You might, if you're studying for it, and watching these kind of video on purpose. But not if you randomly do it in the middle of the night, while being an unemployed waiter which means you're life has nothing to see with dental practicing. As I said. So if you believe so, maybe you believe nice unrealistic stories which don't really happen. That's why I said you must not go outside a lot. And apparently I was right, as you've just confirmed to me
Everytime I have toothache and decide to go to dentist, I'm watching kind this video first. Wish my dentist good as dentist in this video. Always had bad experience with dentist.
The most difficult part usually is achieving WL and patency with hand files especially the last few mm. Step no 3 in this video. Please make a detailed video on this step as well. Thanks
@@AANasseh Its 2 years later, im in dental school now, and im getting ready to apply to endo programs in the near future. Time flies. Thank you for the great videos!
When you use 30, 25, 20 cycles, do you not recapitulate using handfiles? I thought it's important to recapitulate each time you switch a rotary instrument.
All hand files should have slight bends on them to help negotiate even on radiographically straight canals. The reason is a straight file tip will always catch on something while a curved tip may catch but on watch winding will bypass the catch. It is also unfair not comparing old single cone with Zoe sealer . Zoe is an incredibly well tested sealer standing the test of time of perhaps more than 50 years. The one study on bioceramic sealer I read showed a poorer seal than Zoe. I think it is un fair that books like pathways of the pulp critisised single cone. It works if you can get enough sealer in.
I'm afraid you're wrong on this issue. ZOE is soluble whereas BioCeramics are not. That's why you don't use ZOE for a retrofill but do use a BioCeramic for a retrofill. Pooling is an issue in one and not in the other. I hope it makes sense. Also, the issue of single cone with ZOE is a done deal. It was settled back in the 1960's that it doesn't work. So, you should not compare Hydraulic Condensation with ZOE single cone. It's apples and oranges. Watch this, it may explain a little better: ruclips.net/video/2s2gSh9xXs8/видео.html Regarding pre-bending files, yes, I agree it's better for the novice to prebend. Once you reach Jedi Master Level you know when to prebend and when it's not necessary!! ;) (Just kidding!!) :)
@@itszaldy9416 in my case yes as my adrenaline was counteracting the numbing effect of the local anesthetic. They had to give me 5 injections, the last one directly into my nerve in the tooth to fully numb the pain. After that no pain but it was a 3 hour ordeal.
@@Mcknockout777 I think he said it's so he doesn't have sealer mixed in there, but yeah, I just clean out the sealer with some cotton and bond to dentin.
what?? i was debating wheather I want to save my own tooth by doing a root canal or just have it pulled. I went with root canal. so far I am doing fine but further xray will confirm how things are.
Wave One is a different concept of instrumentation. Instead of crown down it's basic step back. So, after coronal flaring instrument the canal by hand to a size 15 (ideally 20) hand file, and then use your primary and final file to finish instrumentation. If you don't like hand instrumentation you have picked the wrong instrumentation system. But the Proglider helps a little. Good luck!
What a lovely approach! Thank you for sharing! Just to clarify, after you use the expiditor at 19mm, you don't use it at 22mm once length is confirmed with hand files? If not, what do you think of using the expiditor after the first cycle of 30 to 20 04. files? Wouldn't it be of value? As always, I thank you for the amazing quality content!
why not use more than one rubber stops , so that you can stop at the desired length. ? Initially when I started using rotary ,I used to go deep step by stap removing a stop at a time.
Excellent video. Is it better to place a layer of molten gp at the floor of the chamber rather than push it down the canals then put gic on top to in the canals ?
Never want to put GP on the chamber floor as GP is probably the worst filling material around. Would be better off putting a resin ionomer, an glass ionomer, or pretty much anything else on the floor of the chamber rather than gutta percha that has zero bonding ability and is porous! Cheers!
@@AANasseh thanks for reply on 13:41 when floor of chamber lined is that later cut back at some point prior to filling or is there set criteria when it's done ?
@@bestporridge Frankly, this is an older video. If given the option, I would not line the floor with GP any more. The GIC or Liner would do a much better job of sealing the floor than Gutta Percha. I should have made that point. Thanks you for bringing it up! :)
Depends how hard it is to get down. But pretty much in most molars. Easy cases I would go straight to the .05 or .04. The key is the SSC motion. Cheers!
Hi Dr Ali, thank you for an informative video! I’m a dental student in Australia and we’re taught to work from smaller files up to our target maf in the apical zone. What’s the advantage of repeated cycles of larger to smaller files with the initial few cycles unable to reach full length, as opposed to a technique where we prep to length with 15 then 20 then 25 then 30? Thank you doctor!
I have another video on Crown Down vs. Step Back that explains this reasoning; but to make a long story short doing crown down (large to small) will extrude less debris and provide a more accurate working length. IMO, it also reduces the odds of procedural errors. You just have to learn how to use crown Down so you can improve the odds of your success.
How can U do a root canal on an upper back molar with a giant hard post that can not B drilled? If the post is blocking the root canal the end needs to get to to do the of the root (THE distal) I believe it is called? This would B the 2nd root canal surgery on the same tooth. It had a root canal over 10 years ago. Any ideas how to do the the troth canal so I don't have to ave no tooth pulled?? There must B an end doc who can get passed the giant post to get to the distal root. Know any end doctor doctor what can do the tough surgery I refesure to pull the tooth.
It's often possible to do that but you need to see a proper specialist in your area. If not, go to a dental school and see a senior post doctoral fellow or even a faculty. But 90% of the time it's possible. Just need to see someone with experience who can get it out. But a specialist will assess the risk of how much tooth structure is remaining after it's removed. Because it could potentially weaken the root too much in which while you've removed it your tooth may be weaker or break in function soon thereafter. Someone has to assess that risk for you. Good luck!
Always thought dental was an interesting career, I looking to get into George Brown in Toronto after the lock down is over, any advice for a fresh mind going into this program? How difficult is this line of work for an average IQ type? Thanks in advance, cheers.
I'm an average IQ type with a A+ work ethic. Third year dental student now and It's a lot of never ending hard work, exams, and self doubt. but worth it at the end as a secure job in any economy and there is so much you can do in the field. Let me know if you need any more advice.
What would you have done if the case was necrotic? I'd be afraid to leave the apex at such a small apical size but also afraid to go up in size in a tooth with freaky anatomy, exhibiting severe curvatures and apical impediments. It's one of those Endo conundrums...
That’s why we try to gauge the canal and not necessarily increase to a cookie cutter size solution in all cases. For that small of a canal the smaller size is enough. But that same size would not be enough for larger cases. Gauging the apex hells with the decision that’s case based and customized to each root.
@@AANasseh thank you dr. Al, I definitely am not talking about cookie cutter shaping, and I always gauging the apical diameter with 02. niti files, but I was commenting on the effective apical size that would allow NaOcl to do its thing. As you taught us, scraping the walls is only one part of the chemo-mechanical equation, and there are many opinions regarding what apical prep size (and what taper) allows for complete desinfection.
@@michaellupu2080 Based on studies by Christine Sedgely and others a size 30 is all that's needed to get the irrigation going to the end. But not all cases can be worked out to a size 30 (curvature, etc.) So, a size 25/04 can sometimes be substituted as long as enough irrigation is done. Keep in mind that every time you take a file to the apex you're taking NaClO down with you. Also, you can prepare to a size 25/04 and take a size 30/02 file to finish the apex to a larger size. Then you fill with a 25 cone with a larger sealer ring at the apex. As long as the sealer is a stable sealer like BC, then it wouldn't be a problem. That's one solutions too.
@@AANasseh You're phenomenal! Thank you for taking the time! I remember that 30 02. approach; I might use it for an upcoming case that is at least as complex as the one you showcased, but it is purulent (draining upon access) and exhibits a sinus tract. Apart from the FKG race/endosequence 02, do you have any other 02. file recommendation? The market is not providing a lot of options..
LOL! Thanks. Regarding the tooth. No, not a file. It's sealer streak. That's why it looks thin. The cone doesn't go all the way to the end and the apical hook is filled with radiopaque sealer. Cheers.
Thank you for this kind video but there's no way in hell I will get another root canal I kind of forgot how much it suck the last time so I will be kindly removing that m***********out for good but I must say your job is a work of art
It's a very helpful and informative topic. Very systematic and It almost answered my questions. The only thing I like to know is to where we could purchase the equipment. It's been years I really like to know which system I could use in my daily practice without questions behind my mind and worries of breakages. that's why I am still practicing the traditional way of doing my endo works for 20 years. I had my first rotary system a long time ago but am not confident using it due to problems with separated instrument, not satisfied with the support from my dealer. I tried to order online but a code is needed. So how can you help me?
Where do you practice? All systems are not available in all countries. If you practice in the US and are good at hand filing, I would say it's best to do hand filing to a size 20 and then use the XP 3D File. There's very little chance of file separation with that file. I have not broken one yet in the mouth. But the key is to do proper path using hand filing, which seems like you're already good at! :)
No. There's no difficulty if you use the RWE method of having a main cone in the middle all the way to the apex. This will make retreatment no different than other techniques. I've done an old video on the retreatment of this technique on this channel. I'll be updating it again soon. :)
If you keep in mind your estimated length, your available length should always stop short of your estimated length. Meanwhile, if you only go to available length and it's short of the actual length, you would not be pushing debris out. Keep in mind you're only pressing the file to length and are not really engaging it or doing any real hand instrumentation at this time. You're only confirming how much "safe" instrumentation length do you have in that canal for your coronal flaring and before you manage the apex. Cheers!
It's not necessary if you instrument correctly. Recapitulating will extrude debris out causing discomfort and potential apical contamination. If you instrument with constant irrigation the debris you cut will be removed througout instrumentatino and will not det stuck apically.
Just did this with my dentist. It was painful when he's determining the depth. What made it interesting, the procedures were repeated. I literally clenched on every strokes. A good dentist he is, he checked if I'm fine all the time. He said I can feel the pain because there were still nerves left in my root. Is it normal to feel the pain?
Great ... but what is the advantage of this method over the conventional technique of using a larger number of files ??? reduction of working hours ? really want to bc sealer ) ) ) ) but do not have it )
+Илья Сурайкин This is one of many ways to get the job done. This uses less files and since many people are cost conscious it saves them time and money. Also, because it uses less files it will be much faster. I will soon share another protocol that uses more files and is more predictable. But obviously will cost more per procedure since it has more files in it. Cheers!
+Ken Irari Just read this theory in Vertuchi that root canal treatment , spent the same amount of time, even if we use three tools rototornyh ostaetsya but time is the same .
apical preps at a 20 and single cone obturation, no wonder you can do a molar in 40 minutes. Do you approach your necrotic cases the same? Do you try to get your hypochlorite irrigation down to the apex? Also what is the rationale for gutta percha on the floor? Why not bond a resin or something to seal the floor and orifices? Just curious.
+Jonathan Barnes You can try to get around that 90 degree turn with a much larger file. But it will be at your patient's peril. This was a vital case and maturity and experience in actual clinical practice teaches one that successful and safe instrumentation is about understanding the limitation of each canal given its shape, not following memes like "every canal should be enlarged to a size 35!" Each canal is treated based on its specific requirements that maximizes safe instrumentation. Also, before calling it single cone you need to study the properties of bioceramics.
Hi, can I ask if biocermaic sealer is extruded accidentally into the Id canal what would happen? It seems if sealapex or ah26 is its a disaster. Also it is accepted by many that single cone can be used with ah26, what limits single cone to not being used with sealapex? I accept solubility but inside a canal that would be zero. Thanks
why do you think solubility inside the canal is zero? Have you every placed Ca(OH)2 in the canal and come back 6 months later and it's not there? That was inside the canal, right? So, soluble sealers are not good. That's why. AH26 should not be used for single cone for the same reason. The studies that show it can be used are showing seal, not solubility in the long run. If you extrude AH 26 it washes out in a couple of months. That's hardly good for a sealer. Regarding extruding bioceramic in the IAN canal, it won't be good. It doesn't belong there and will cause mechanical irritation. But at least it won't cause the same kind of chemical irritation you get with AH26, which also produces formaldehyde, a fixative agent!
This is a nice discussion. How big our apical preparation should be? 40,50,20? I think we must respect the anatomy. If someone could teach me to instrument acute apical hooks beyond 20,25 without ripping and stripping and causing chronic discomfort to our patients please show me how. This case looks fine to me
I love your videos. Thanks for taking all the extra time to put them together. When you instrument the distal canals, since they join together near the apex, do you ever modify how you instrument once you notice that on your WL radiograph? Just wondering if you ever instrument one to full length, and then check the length of the other canal with the prepared cone in to avoid stripping or over-preparing the junction of where they meet?
Thanks. Yes, that’s how you should instrument all type II canals (two orifices:one exit). Instrument the straighter canal to full length and the other up to the point of the intersection. Cheers!
silly question: do you precurve the instrument so you can get it into the mesial orifices? i find it VERY difficult to get the instrument into the M orifice especially when i can't see them.
Hi doc. Question. I like the approach in this video. The way I have been performing them is using an orifice opener like the SX... Sink it and open it well. Sometimes what I encounter though is when are use like an 8- file to capture the working length with an apex locator the tip of the file is very torturous when I pull it out. How can I combat this? I'm afraid if I don't open the canals right away with smaller files I will create a ledge or false apex. Thanks doc. You've answered some of my questions before and they have translated to clinical success!!
Yes, the better your coronal opening the better the chance of using the 8 to the apex. Just don't rush the 8 to the apex. Have adequate coronal openin and also don't push on the 8. If the tip come out crooked then you're either pushing too hard or there's curvature or a blockage. If you open up on top and not push on the file you will be able to get down the vast majority of the time. Good luck. Keep in mind comments are rarely answered on RUclips nowadays as I'm increasingly limited in time. If any questions, please post to our website at RWE and at the "Ask the Faculty Questions" area. Cheers!
it doesent hurt at all.. maby you feel alittle pinch here and there, but thats normal, i mean the guy is removing your nerve hehe.. but those sharp pains last 0.5 of a sec then pass. the only pain you will actually feel, is your neck if the chair is bad. and your jaw cause of you holding your mouth up for 1 hour XD hehe
Hi sir i have a question that i m practicing in afghanistan i ues here arsenicless paste devit s for pulp devitalization and perform endo or vital pulp removal which is better to do sir waiting for your valuable reply tnx sir
I think you use some kind of Paraformaldehyde paste for devitalising tooth pulp. It is a quick fix for acute pulpitis. The results are the same if you manage to remove most of the tissue and bacteria. Be extra careful when use this technique. This is Associated with bone loss around the tooth if this paste is put into tooth for a longer period of time.
do you think crown down is better than step back (apex to crown)? thank you! my school teaches otherwise but your technique seems more successful! thank you again!
+Jsvlad js Crown down has several advantages over step back. You just have to have a light touch and know what you're doing. You'll push less debris out the end of the root and less post operative pain. Also less chance of procedural errors if done correctly.
Hi ! I am a big fan of your work. I feel that these videos are of great help in spreading the most efficient and modern endo technique for dentists . Just one question , just before you finish the shaping you have used Kontrol Flex to shape the apical curvature . I wanna know if its mandatory to use Kontrolflex at that point or you could have acheived that with more coronal flare with 35 0.4 and then following the usual sequence till 20.? Also , can pathfiles be included for more nasty curvatures?
Using a heat treated file to open the canal in tougher canals is a little more helpful. It has a little more flexibility. So, while you can do it with a standard file, you get a little edge in safety when you open a little with a heat treated file (create a wider path) before finishing with a standard file. It helps reduce torque on the standard file. Cheers!
hi good night i enjoy your videos. I recently used endo sequence and I was told to use it opposite to crown down ( that is, from size 15 to MAF which was determined based on tactile sensation) no expeditor file was used. My question is, would this work negatively and i know you confirm length after coronal preparation but can you confirm prior to instrumentation? Im excited about using the endosequence but afraid of file breakage.
EndoSequence works better in crown down and reverse sequence. The standard step up in size is not the best way to use it. Watch some of the older videos we have on EndoSequence to show best use. If you use it correctly and with a gentle touch file separation should not be a problem, especially in the .04 taper. Any file that's over torqued will break. So, be sue not to put excessive pressure and throw file out frequently to stay ahead of cyclic fatigue. Good luck!
It was 4 years ago when I got frontal teeth filling, and now the gum having a abcess, the doctor advice to have root canal. Is it safe for someone who allergic in some of the medicine Doc? I was really afraid to undergo root canal because I also watch video that said root canal is not safe, I got a prayer of what should I do, implant is pretty expensive for me also I don't want to have a removable teeth in front. Until I search some possible positive effect of root canal and here I got your video. It makes me feel comfortable now to face my fear of undergo root canal. Thank you
I am guessing you use the ultrasonic with steril water? Since I do not have such a system, is there any point in me to use the ultrasonic without water for something? And what do you think about wave one gold system? :)
Yes, I do use distilled water for Continuous Ultrasonic Irrigation. If you have no water connections, you can place bleach in the canal and add the Ultrasonic at the end for 30 seconds. It's called Passive Ultrasonic Irrigation (PUI) and is an effective method of disinfection towards the end. Regarding WaveOne. It's not a bad file but it utilizes reciprocation; which has some limitations but some people like it. Good luck.
I had this done last month..second visit the drill broke inside my tooth..she said my canal was to tight and thin...i smile and told her get the other drill machine and dig around the broken drill part..she laugh..i told her just pull the damm tooth out i am done with drilling..
Depends. Series 1 for very difficult and curvy roots and series 2 for less curvy roots. Today, I would simply recommend ES CM files for those kinds of cases and don't use KF much any more. The CM Files are more efficient and flexible. Cheers!
RealWorld Endo thank you! I contacted a rep of the company and he recommended the same. He is bringing samples when the office reopens. Thank you for your reply. Cheers!
Wow for the amount of sealer it seemed like you applied, there didn't seem to be any excess at all out the apex. But it's odd to me that you didn't do a downpack and then a subsequent backfill? Is there any reason why you didn't in this situation? I was taught recently to downpack to -5mm of the working length, take a plugger and gently tap it and apply some pressure to compensate for the cooling of GP. Then I would coat the walls with more sealer and backfill with GP and applying hydraulic pressure to compensate for cooling and to push the GP right up against the walls and the sealer into the tubules.
You need to follow us on our website to see. Our obturation technique Hydraulic Condensation is sealing based on Bioceramic based bonding obturation. It's more like bonding a post all the way to the apex than any of the thermoplastic techniques. You need to read up on the philosophy. Watch the video titles restorative endodontics on our website to understand the philosophy. Cheers!
+Mohammed Khattari Great question! The KontrolFlex is too flexible and will not conform to the 20/04 shape of the GP. It will otherwise under prep the canal. The ESX is what the cone is matched to. You can get away but using one size smaller cone but I didn't want to fill with a size 15/.04 GP.
I use the EndoSync A.I. Any of the latest generation apex locators are good. It's more important to learn how to use the apex locator and apply the principles of predictable use.
@@AANasseh thanks for the answer . I mean the name of the ultrasound head you use. I have a similar one called p3d - for woodpecker ultrasound. Don’t tell me how to buy one like yours, what’s it called (nozzle)
пам пам пам There are lots of different brands with different names, there’s some differences in quality and how long it lasts but as long as the same shape and function you’re fine. I was using a E14D and E15D for the top and E12/12 with size 20 U File inserts for inside the root canal. Cheer!
The patient is fully anesthetized and it should always feel like a filling if you have a competent dentist. Otherwise, if you watch any medical procedure it seems like torture if the patient is not numb.
I had this done last month..second visit the drill broke inside my tooth..she said my canal was to tight and thin...i smile and told her get the other drill machine and dig around the broken drill part..she laugh..i told her just pull the damm tooth out i am done with drilling..
God bless the inventor of anaesthetics!
YEAH!
hell yeah
William T. G. Morton
I just got a Root canal this morning and let me tell you, I asked them to numb the hell outta me. When my Dr. got to 3:30 he wanted to make sure that i was 100% numb so he said he was touching the root of my tooth with one of his tools before he proceeds and asked me if i could feel anything. I said no and he said "Yay, Lets proceed". I asked prior to him working on me if he could tell me which steps he was on during my "operation" so I knew and could "follow" along in my mind, he didn't have a problem with that and was happy to keep me in the loop:-) After everything was good I asked him "was my roots infected or just inflamed?" and he told me that my roots were "pretty badly inflamed" and that's why i had soo much trouble with my tooth(hurting so bad). I was soo glad I got that procedure done, now all I have to do is cap my tooth and i'll be golden:-)
@@millerdownlite Keep flossing, buddy ;) Glad you feel better, now :)
I always enjoy my canals digging tutorials at 5 am.... afterall is my passion and career, being myself an unemployed waiter
Just because we’re unemployed doesn’t mean we can’t work on being more intelligent 😷 your next career could be a dental assistant 🤷🏼♀️
@@njk9989 lol... How often do you get out of your bedroom my friend? 😂
Marco I was a root canal virgin at 60 yrs old. I had two emergency root canals in March at the beginning of the pandemic because of complications - I am very unique in that I had three roots = 3 nerves = the 3rd wasn’t found on the 1st treatment resulting in recurring pain. Videos help to know what to expect as a suffer from Agoraphobia and leaving my home is one traumatic event on top of another and another!
I have yet to return for the final permanent filling, build up for a crown and the crown placement!
Marco I have no TV, Couch, recliner, etc. I only have a table, some chairs, a desk and a bed. I’m living as they did in the Homesteading days when people didn’t have the luxury of a sitting room or a living room!
@@njk9989 what I meant was: you don't become a dental assistant by randomly watching canal diggings videos on RUclips. You might, if you're studying for it, and watching these kind of video on purpose. But not if you randomly do it in the middle of the night, while being an unemployed waiter which means you're life has nothing to see with dental practicing. As I said. So if you believe so, maybe you believe nice unrealistic stories which don't really happen. That's why I said you must not go outside a lot. And apparently I was right, as you've just confirmed to me
Had a root canal Thursday. I was watching the tools they used. It was painless. I feel asleep while in the chair.
How long did it take?
Everytime I have toothache and decide to go to dentist, I'm watching kind this video first. Wish my dentist good as dentist in this video. Always had bad experience with dentist.
Dini Harum Sari I advise you search for a Dental School. They do the best work, make sure you have no pain so you will return and not so expensive!
The most difficult part usually is achieving WL and patency with hand files especially the last few mm. Step no 3 in this video. Please make a detailed video on this step as well. Thanks
i'm not a medical student( physics major)
but you demonstrated very clearly
These video are great! Im not a dental student yet but I have a huge interest in endo
Glad you enjoy them. Good luck!
@@AANasseh Its 2 years later, im in dental school now, and im getting ready to apply to endo programs in the near future. Time flies. Thank you for the great videos!
غرابه
@@stancj7 *patience 100*
@@stancj7 It has been 3 years now, still considering endo?
I found this tutorial very, very, very helpful. Thank you doctor.
Hello from Brazil, thanks for the didactic and detailed tutorial. Always objective and smart. Congratulations on the noble mission.
It nice and very helpful for me thank you
Dr Allen you are the best.
When you use 30, 25, 20 cycles, do you not recapitulate using handfiles? I thought it's important to recapitulate each time you switch a rotary instrument.
Thank you for the great info. Kindly tell what is the sealing material used alongside the rubber dam clamp in this video.
I will try this technique on my next endo case in sha Allahh
What is your feedback?
Tips Of Dentist allahu akbar
Thanks!
Thanks again! :)
Assalam wa alaikum,Thank you very much sir this video helped me a lot . jazakallah
Full thanks prof , do you have vedios about 1- orifices findings ...2- ledges passing ??
The available length 👍🏻👍🏻 but using 30 file before the apex could that lead to ledge ?
Beautiful, beautiful work!
All hand files should have slight bends on them to help negotiate even on radiographically straight canals. The reason is a straight file tip will always catch on something while a curved tip may catch but on watch winding will bypass the catch. It is also unfair not comparing old single cone with Zoe sealer . Zoe is an incredibly well tested sealer standing the test of time of perhaps more than 50 years. The one study on bioceramic sealer I read showed a poorer seal than Zoe. I think it is un fair that books like pathways of the pulp critisised single cone. It works if you can get enough sealer in.
I'm afraid you're wrong on this issue. ZOE is soluble whereas BioCeramics are not. That's why you don't use ZOE for a retrofill but do use a BioCeramic for a retrofill. Pooling is an issue in one and not in the other. I hope it makes sense. Also, the issue of single cone with ZOE is a done deal. It was settled back in the 1960's that it doesn't work. So, you should not compare Hydraulic Condensation with ZOE single cone. It's apples and oranges. Watch this, it may explain a little better: ruclips.net/video/2s2gSh9xXs8/видео.html
Regarding pre-bending files, yes, I agree it's better for the novice to prebend. Once you reach Jedi Master Level you know when to prebend and when it's not necessary!! ;) (Just kidding!!) :)
Amazing Work.
I always achieve proper working length until the final fill
what medicine should i take for moderate pain
Great video, very helpful and informative
Great video and extremely informative
It is a nice video but using a mirror while working is useful for a better view. Thanks
I've had 5 root canals so far and 1 extraction. It's so freaky seeing this at this angle
Did it hurt?
@@itszaldy9416 in my case yes as my adrenaline was counteracting the numbing effect of the local anesthetic. They had to give me 5 injections, the last one directly into my nerve in the tooth to fully numb the pain. After that no pain but it was a 3 hour ordeal.
@@cactusjack5423 fuck
@@cactusjack5423 thanks
Wondering why you would want to line the floor with gutta percha instead of searing them off at the orifices. Thank you
I have the same question. Wouldnt lining the whole floor with gutta percha decrease the available dentin for bonding?
@@Mcknockout777 I think he said it's so he doesn't have sealer mixed in there, but yeah, I just clean out the sealer with some cotton and bond to dentin.
Your two distal canal one reach upto the apex other a little short. Short ones wl is same as long one???
Amazing work😍.
where can i buy your suction tip please let me know
glad I found your videos. I almost started to believe those idiots saying all root canals are evil and so I should just take my tooth out.
Just see a qualified and experienced person. These procedures are skill based. Good luck!
what?? i was debating wheather I want to save my own tooth by doing a root canal or just have it pulled. I went with root canal. so far I am doing fine but further xray will confirm how things are.
Thank you dr. Ali for amazing info. But I use to use wave one gold system, can you explain how to manage so curved canals by this system. Regards
Wave One is a different concept of instrumentation. Instead of crown down it's basic step back. So, after coronal flaring instrument the canal by hand to a size 15 (ideally 20) hand file, and then use your primary and final file to finish instrumentation. If you don't like hand instrumentation you have picked the wrong instrumentation system. But the Proglider helps a little. Good luck!
What a lovely approach! Thank you for sharing!
Just to clarify, after you use the expiditor at 19mm, you don't use it at 22mm once length is confirmed with hand files?
If not, what do you think of using the expiditor after the first cycle of 30 to 20 04. files? Wouldn't it be of value?
As always, I thank you for the amazing quality content!
Michael, in the ESX technique, you should always get the Expeditor to the Apex after working length before using the finishing file.
@@AANasseh fantastic, thank you dr. Ali!
I just asked because it was not shown on the video and I'm not well versed with this file system.
Take care!
Is this the same steps if using Endo sequence expeditor? You take that to WL?
why not use more than one rubber stops , so that you can stop at the desired length. ? Initially when I started using rotary ,I used to go deep step by stap removing a stop at a time.
fantastic sir
how live and lively and lovely
Excellent video. Is it better to place a layer of molten gp at the floor of the chamber rather than push it down the canals then put gic on top to in the canals ?
Never want to put GP on the chamber floor as GP is probably the worst filling material around. Would be better off putting a resin ionomer, an glass ionomer, or pretty much anything else on the floor of the chamber rather than gutta percha that has zero bonding ability and is porous!
Cheers!
@@AANasseh thanks for reply on 13:41 when floor of chamber lined is that later cut back at some point prior to filling or is there set criteria when it's done ?
@@bestporridge Frankly, this is an older video. If given the option, I would not line the floor with GP any more. The GIC or Liner would do a much better job of sealing the floor than Gutta Percha. I should have made that point. Thanks you for bringing it up! :)
@@AANasseh thanks for clarifying and an excellent video
Do you use this method exclusively for curved canals or all endo?
Depends how hard it is to get down. But pretty much in most molars. Easy cases I would go straight to the .05 or .04. The key is the SSC motion. Cheers!
Hi Dr Ali, thank you for an informative video! I’m a dental student in Australia and we’re taught to work from smaller files up to our target maf in the apical zone. What’s the advantage of repeated cycles of larger to smaller files with the initial few cycles unable to reach full length, as opposed to a technique where we prep to length with 15 then 20 then 25 then 30? Thank you doctor!
I have another video on Crown Down vs. Step Back that explains this reasoning; but to make a long story short doing crown down (large to small) will extrude less debris and provide a more accurate working length. IMO, it also reduces the odds of procedural errors. You just have to learn how to use crown Down so you can improve the odds of your success.
How can U do a root canal on an upper back molar with a giant hard post that can not B drilled?
If the post is blocking the root canal the end needs to get to to do the of the root (THE distal) I believe it is called?
This would B the 2nd root canal surgery on the same tooth.
It had a root canal over 10 years ago.
Any ideas how to do the the troth canal so I don't have to ave no tooth pulled??
There must B an end doc who can get passed the giant post to get to the distal root.
Know any end doctor doctor what can do the tough surgery
I refesure to pull the tooth.
It's often possible to do that but you need to see a proper specialist in your area. If not, go to a dental school and see a senior post doctoral fellow or even a faculty. But 90% of the time it's possible. Just need to see someone with experience who can get it out. But a specialist will assess the risk of how much tooth structure is remaining after it's removed. Because it could potentially weaken the root too much in which while you've removed it your tooth may be weaker or break in function soon thereafter. Someone has to assess that risk for you. Good luck!
OMG I just came from the dentist. Did he do that to my POOR tooth??? =/ =I
Yes. Bet you're happy to live in the modern world where they can do that without much pain.
aww your poor tooth
Always thought dental was an interesting career, I looking to get into George Brown in Toronto after the lock down is over, any advice for a fresh mind going into this program? How difficult is this line of work for an average IQ type? Thanks in advance, cheers.
I'm an average IQ type with a A+ work ethic. Third year dental student now and It's a lot of never ending hard work, exams, and self doubt. but worth it at the end as a secure job in any economy and there is so much you can do in the field. Let me know if you need any more advice.
What do you do when you can't get the expeditor or any size handfile to WL
What would you have done if the case was necrotic? I'd be afraid to leave the apex at such a small apical size but also afraid to go up in size in a tooth with freaky anatomy, exhibiting severe curvatures and apical impediments.
It's one of those Endo conundrums...
That’s why we try to gauge the canal and not necessarily increase to a cookie cutter size solution in all cases. For that small of a canal the smaller size is enough. But that same size would not be enough for larger cases. Gauging the apex hells with the decision that’s case based and customized to each root.
@@AANasseh thank you dr. Al, I definitely am not talking about cookie cutter shaping, and I always gauging the apical diameter with 02. niti files, but I was commenting on the effective apical size that would allow NaOcl to do its thing. As you taught us, scraping the walls is only one part of the chemo-mechanical equation, and there are many opinions regarding what apical prep size (and what taper) allows for complete desinfection.
@@michaellupu2080 Based on studies by Christine Sedgely and others a size 30 is all that's needed to get the irrigation going to the end. But not all cases can be worked out to a size 30 (curvature, etc.) So, a size 25/04 can sometimes be substituted as long as enough irrigation is done. Keep in mind that every time you take a file to the apex you're taking NaClO down with you. Also, you can prepare to a size 25/04 and take a size 30/02 file to finish the apex to a larger size. Then you fill with a 25 cone with a larger sealer ring at the apex. As long as the sealer is a stable sealer like BC, then it wouldn't be a problem. That's one solutions too.
@@AANasseh You're phenomenal! Thank you for taking the time! I remember that 30 02. approach; I might use it for an upcoming case that is at least as complex as the one you showcased, but it is purulent (draining upon access) and exhibits a sinus tract.
Apart from the FKG race/endosequence 02, do you have any other 02. file recommendation? The market is not providing a lot of options..
Great explanation. How long does this procedure going? One time visit procedure or couple or more times? once again, thank you dr. Nasseh.
I love your videos and you've taught me a lot. I'm really thankful! BUT did 25/04 get separated in ML and got eddited out or is it just me?
LOL! Thanks. Regarding the tooth. No, not a file. It's sealer streak. That's why it looks thin. The cone doesn't go all the way to the end and the apical hook is filled with radiopaque sealer. Cheers.
Thank you for this kind video but there's no way in hell I will get another root canal I kind of forgot how much it suck the last time so I will be kindly removing that m***********out for good but I must say your job is a work of art
It's a very helpful and informative topic. Very systematic and It almost answered my questions. The only thing I like to know is to where we could purchase the equipment. It's been years I really like to know which system I could use in my daily practice without questions behind my mind and worries of breakages. that's why I am still practicing the traditional way of doing my endo works for 20 years. I had my first rotary system a long time ago but am not confident using it due to problems with separated instrument, not satisfied with the support from my dealer. I tried to order online but a code is needed. So how can you help me?
Where do you practice? All systems are not available in all countries. If you practice in the US and are good at hand filing, I would say it's best to do hand filing to a size 20 and then use the XP 3D File. There's very little chance of file separation with that file. I have not broken one yet in the mouth. But the key is to do proper path using hand filing, which seems like you're already good at! :)
@@AANasseh oh, i just noticed you replied. This is Daisy of ESP Philippines :)
Thank you very much for your information.
Can i use DAKINS/Bleach instead of alcohol for my endo swipe?
Great video! Do you find it harder to retreat canals filled with this method?
No. There's no difficulty if you use the RWE method of having a main cone in the middle all the way to the apex. This will make retreatment no different than other techniques. I've done an old video on the retreatment of this technique on this channel. I'll be updating it again soon. :)
10.55, what is that black material going up the suction? Is that related to infection?
do you pre-bend hand files when finding final wl?
Depends on the curvature of the canal. It's recommended, however, and is a good idea to prebend even though I don't always do it that way.
Thank you so much for the video
Dr. Nasseh, I like the concept, however what about forcing tissue . debris out of the apex when you perform available length determination?
If you keep in mind your estimated length, your available length should always stop short of your estimated length. Meanwhile, if you only go to available length and it's short of the actual length, you would not be pushing debris out. Keep in mind you're only pressing the file to length and are not really engaging it or doing any real hand instrumentation at this time. You're only confirming how much "safe" instrumentation length do you have in that canal for your coronal flaring and before you manage the apex. Cheers!
@@AANasseh thank you! stay safe
Hello Dr. What is the rationale to not recapitulate between the instrumentation with the rotary files?
It's not necessary if you instrument correctly. Recapitulating will extrude debris out causing discomfort and potential apical contamination. If you instrument with constant irrigation the debris you cut will be removed througout instrumentatino and will not det stuck apically.
wow!!! excellent technique
Great job sir
Just did this with my dentist. It was painful when he's determining the depth. What made it interesting, the procedures were repeated. I literally clenched on every strokes. A good dentist he is, he checked if I'm fine all the time.
He said I can feel the pain because there were still nerves left in my root. Is it normal to feel the pain?
its normal
@@frostedlambs thanks. I'll do my third procedure this weekend.
@@NicholasVLee your third? He didn't finish? I have to go back too. Im hoping after the numbness wares off its not too painful
i love real world endo.plz make it available in india.cant find a dealer here
Thank you for this video !!!
Great ... but what is the advantage of this method over the conventional technique of using a larger number of files ??? reduction of working hours ? really want to bc sealer ) ) ) ) but do not have it )
+Илья Сурайкин Same question I had.
+Илья Сурайкин This is one of many ways to get the job done. This uses less files and since many people are cost conscious it saves them time and money. Also, because it uses less files it will be much faster. I will soon share another protocol that uses more files and is more predictable. But obviously will cost more per procedure since it has more files in it. Cheers!
+Ken Irari Just read this theory in Vertuchi that root canal treatment , spent the same amount of time, even if we use three tools rototornyh ostaetsya but time is the same .
apical preps at a 20 and single cone obturation, no wonder you can do a molar in 40 minutes. Do you approach your necrotic cases the same? Do you try to get your hypochlorite irrigation down to the apex? Also what is the rationale for gutta percha on the floor? Why not bond a resin or something to seal the floor and orifices? Just curious.
+Jonathan Barnes You can try to get around that 90 degree turn with a much larger file. But it will be at your patient's peril. This was a vital case and maturity and experience in actual clinical practice teaches one that successful and safe instrumentation is about understanding the limitation of each canal given its shape, not following memes like "every canal should be enlarged to a size 35!" Each canal is treated based on its specific requirements that maximizes safe instrumentation. Also, before calling it single cone you need to study the properties of bioceramics.
Hi, can I ask if biocermaic sealer is extruded accidentally into the Id canal what would happen? It seems if sealapex or ah26 is its a disaster.
Also it is accepted by many that single cone can be used with ah26, what limits single cone to not being used with sealapex?
I accept solubility but inside a canal that would be zero. Thanks
why do you think solubility inside the canal is zero? Have you every placed Ca(OH)2 in the canal and come back 6 months later and it's not there? That was inside the canal, right? So, soluble sealers are not good. That's why. AH26 should not be used for single cone for the same reason. The studies that show it can be used are showing seal, not solubility in the long run. If you extrude AH 26 it washes out in a couple of months. That's hardly good for a sealer. Regarding extruding bioceramic in the IAN canal, it won't be good. It doesn't belong there and will cause mechanical irritation. But at least it won't cause the same kind of chemical irritation you get with AH26, which also produces formaldehyde, a fixative agent!
This is a nice discussion. How big our apical preparation should be? 40,50,20? I think we must respect the anatomy. If someone could teach me to instrument acute apical hooks beyond 20,25 without ripping and stripping and causing chronic discomfort to our patients please show me how. This case looks fine to me
why not a n10 k file ?
This video is helpful. I subbed.
I love your videos. Thanks for taking all the extra time to put them together. When you instrument the distal canals, since they join together near the apex, do you ever modify how you instrument once you notice that on your WL radiograph? Just wondering if you ever instrument one to full length, and then check the length of the other canal with the prepared cone in to avoid stripping or over-preparing the junction of where they meet?
Thanks. Yes, that’s how you should instrument all type II canals (two orifices:one exit). Instrument the straighter canal to full length and the other up to the point of the intersection.
Cheers!
@@AANasseh Thanks so much!
What is the rationale of using ultrasonics while root canal ?
Ultrasonic energy is the most efficient way to disrupt the biofilm and remove debris/tissues packed in the nooks and crannies of the canal.
Excelente tutoría.
silly question: do you precurve the instrument so you can get it into the mesial orifices?
i find it VERY difficult to get the instrument into the M orifice especially when i can't see them.
Yes you can
seems that distal root has a bifurcated canal... see the radiograph at 14.29.....
I couldn't locate the orifice of the palatal root... Please help should I leave it?
No. Refer to a specialist with a microscope who can hopefully find it. You cover yourself medicolegally that way.
Whats buy this endodontic file cleaner and endoaspirator?
Hi doc. Question. I like the approach in this video. The way I have been performing them is using an orifice opener like the SX... Sink it and open it well. Sometimes what I encounter though is when are use like an 8- file to capture the working length with an apex locator the tip of the file is very torturous when I pull it out. How can I combat this? I'm afraid if I don't open the canals right away with smaller files I will create a ledge or false apex. Thanks doc. You've answered some of my questions before and they have translated to clinical success!!
Yes, the better your coronal opening the better the chance of using the 8 to the apex. Just don't rush the 8 to the apex. Have adequate coronal openin and also don't push on the 8. If the tip come out crooked then you're either pushing too hard or there's curvature or a blockage. If you open up on top and not push on the file you will be able to get down the vast majority of the time. Good luck. Keep in mind comments are rarely answered on RUclips nowadays as I'm increasingly limited in time. If any questions, please post to our website at RWE and at the "Ask the Faculty Questions" area. Cheers!
You are very kind to answer queries. God bless Dr Nasseh.
Can you be asleep during this treatment?
it doesent hurt at all.. maby you feel alittle pinch here and there, but thats normal, i mean the guy is removing your nerve hehe.. but those sharp pains last 0.5 of a sec then pass. the only pain you will actually feel, is your neck if the chair is bad. and your jaw cause of you holding your mouth up for 1 hour XD hehe
The doctor or the patient?
Up with pain now watching the 2nd stage of my procedure, why (?) 😂
Hi sir i have a question that i m practicing in afghanistan i ues here arsenicless paste devit s for pulp devitalization and perform endo or vital pulp removal which is better to do sir waiting for your valuable reply tnx sir
I'm sorry. I'm unable to comment as I'm not familiar with the technique you mentioned.
I think you use some kind of Paraformaldehyde paste for
devitalising tooth pulp. It is a quick fix for acute pulpitis. The results are the same if you manage to remove most of the tissue and bacteria. Be extra careful when use this technique. This is Associated with bone loss around the tooth if this paste is put into tooth for a longer period of time.
Still learning k files there so many 🙁
Very good case
do you think crown down is better than step back (apex to crown)? thank you!
my school teaches otherwise but your technique seems more successful! thank you again!
+Jsvlad js Crown down has several advantages over step back. You just have to have a light touch and know what you're doing. You'll push less debris out the end of the root and less post operative pain. Also less chance of procedural errors if done correctly.
Hi ! I am a big fan of your work. I feel that these videos are of great help in spreading the most efficient and modern endo technique for dentists . Just one question , just before you finish the shaping you have used Kontrol Flex to shape the apical curvature . I wanna know if its mandatory to use Kontrolflex at that point or you could have acheived that with more coronal flare with 35 0.4 and then following the usual sequence till 20.? Also , can pathfiles be included for more nasty curvatures?
Using a heat treated file to open the canal in tougher canals is a little more helpful. It has a little more flexibility. So, while you can do it with a standard file, you get a little edge in safety when you open a little with a heat treated file (create a wider path) before finishing with a standard file. It helps reduce torque on the standard file. Cheers!
hi good night i enjoy your videos. I recently used endo sequence and I was told to use it opposite to crown down ( that is, from size 15 to MAF which was determined based on tactile sensation) no expeditor file was used. My question is, would this work negatively and i know you confirm length after coronal preparation but can you confirm prior to instrumentation?
Im excited about using the endosequence but afraid of file breakage.
EndoSequence works better in crown down and reverse sequence. The standard step up in size is not the best way to use it. Watch some of the older videos we have on EndoSequence to show best use. If you use it correctly and with a gentle touch file separation should not be a problem, especially in the .04 taper. Any file that's over torqued will break. So, be sue not to put excessive pressure and throw file out frequently to stay ahead of cyclic fatigue. Good luck!
Real World Endo thank you for replying. Valuable info, will check out the older videos.
It was 4 years ago when I got frontal teeth filling, and now the gum having a abcess, the doctor advice to have root canal. Is it safe for someone who allergic in some of the medicine Doc? I was really afraid to undergo root canal because I also watch video that said root canal is not safe, I got a prayer of what should I do, implant is pretty expensive for me also I don't want to have a removable teeth in front. Until I search some possible positive effect of root canal and here I got your video. It makes me feel comfortable now to face my fear of undergo root canal. Thank you
Don't think about extraction, do the endodontic treatment and speak with your dentist
I am guessing you use the ultrasonic with steril water? Since I do not have such a system, is there any point in me to use the ultrasonic without water for something? And what do you think about wave one gold system? :)
Yes, I do use distilled water for Continuous Ultrasonic Irrigation. If you have no water connections, you can place bleach in the canal and add the Ultrasonic at the end for 30 seconds. It's called Passive Ultrasonic Irrigation (PUI) and is an effective method of disinfection towards the end. Regarding WaveOne. It's not a bad file but it utilizes reciprocation; which has some limitations but some people like it. Good luck.
First patient with a white teeth in root canal case!!! I watched many today and they were yellow and brownish color which was a bit nasty to watch...
It is a zirconia crown. Yellow/brown teeth are not nasty
Can we obturate with small gp without accessory cones impacted in canals?
you can if you're using bioceramic sealer
I had this done last month..second visit the drill broke inside my tooth..she said my canal was to tight and thin...i smile and told her get the other drill machine and dig around the broken drill part..she laugh..i told her just pull the damm tooth out i am done with drilling..
Great video. Do you prefer KontrolFlex series 1 or series2? Thank you
Depends. Series 1 for very difficult and curvy roots and series 2 for less curvy roots. Today, I would simply recommend ES CM files for those kinds of cases and don't use KF much any more. The CM Files are more efficient and flexible. Cheers!
RealWorld Endo thank you! I contacted a rep of the company and he recommended the same. He is bringing samples when the office reopens. Thank you for your reply. Cheers!
Great video. what's the name of that instrument (sponge) to clean the files everytime you use them through the canals?
gberto That’s a product invented by Dr. Nasseh called EndoSwipe. It’s sold by BrasselerUSA.
RealWorld Endo thanks a lot !
Can I repost your video to my APP, I will indicate the author
sure.
@@AANasseh Thank you！！
why am I grinding my teeth while I'm watching this video..
Wow for the amount of sealer it seemed like you applied, there didn't seem to be any excess at all out the apex. But it's odd to me that you didn't do a downpack and then a subsequent backfill? Is there any reason why you didn't in this situation? I was taught recently to downpack to -5mm of the working length, take a plugger and gently tap it and apply some pressure to compensate for the cooling of GP. Then I would coat the walls with more sealer and backfill with GP and applying hydraulic pressure to compensate for cooling and to push the GP right up against the walls and the sealer into the tubules.
You need to follow us on our website to see. Our obturation technique Hydraulic Condensation is sealing based on Bioceramic based bonding obturation. It's more like bonding a post all the way to the apex than any of the thermoplastic techniques. You need to read up on the philosophy. Watch the video titles restorative endodontics on our website to understand the philosophy. Cheers!
sir how you trimmed the distal GP?can't we enlarge to one size more if the GP is extruding after BMP
dollar attri Yes you can. That's an alternative option.
Real World Endo, so in case i want to trim how should i do that..simply cutting the 1mm by scissors?
yes you can. Although a scalpel is better since it doesn't crimp the tip of the gutta percha.
Why did you instrument with the ESX 20 0.04 after the Kontrolflex 20 0.04 when both files have the same tip size and taper? Thanks
+Mohammed Khattari Great question! The KontrolFlex is too flexible and will not conform to the 20/04 shape of the GP. It will otherwise under prep the canal. The ESX is what the cone is matched to. You can get away but using one size smaller cone but I didn't want to fill with a size 15/.04 GP.
+RealWorld Endo great thank you!
What apex locator do you recommend/use?
I use the EndoSync A.I. Any of the latest generation apex locators are good. It's more important to learn how to use the apex locator and apply the principles of predictable use.
What does ssc stand for?
"Single stroke and clean"
it is really helpful . thank you!
No dental floss on the tooth clip?
Fine 💙
this is p3d ultrasonuc in 4.30?
No that unit is the Forza V3 by Brasseler.
@@AANasseh thanks for the answer .
I mean the name of the ultrasound head you use.
I have a similar one called p3d - for woodpecker ultrasound. Don’t tell me how to buy one like yours, what’s it called (nozzle)
пам пам пам There are lots of different brands with different names, there’s some differences in quality and how long it lasts but as long as the same shape and function you’re fine. I was using a E14D and E15D for the top and E12/12 with size 20 U File inserts for inside the root canal. Cheer!
what are the RPM and torque settings for each instrument
Looks like it cuts alot of tooth structure aint it?
This is legitimate torture
The patient is fully anesthetized and it should always feel like a filling if you have a competent dentist. Otherwise, if you watch any medical procedure it seems like torture if the patient is not numb.
I had this done last month..second visit the drill broke inside my tooth..she said my canal was to tight and thin...i smile and told her get the other drill machine and dig around the broken drill part..she laugh..i told her just pull the damm tooth out i am done with drilling..