TEN TINY TECHNIQUES FOR RESOLVING ISSUES IN EVERYDAY ENDODONTICPRACTICE

Added: 2026-05-04

[00:00:00]or a crown it is useless in the toothpaste. For the patient the tooth has failed. Hence we have to view everything very holistically. And another thing that I personally believe is that we are lifelong learners. We are lifelong learners and the master's degree that we do is just the first stepping stone. So what I'm about to teach you today is not something which I only learned in my masters. It has been refined through practice, multiple practices, failures, learning and then correcting those failures and gaining experience which is an invaluable part of dental practice. So before we start uh is everyone comfortable in Hindi or should I just be speaking in English?

[00:00:55]Hindi ma'am.

[00:01:00]>> English ma'am.

[00:01:01]>> English both s >> both ma'am.

[00:01:10]>> Mix of both is good. That is understandable for everyone. Right. In case you feel I've said something in Hindi and somebody's not able to understand, just let me know and I'll translate. Okay.

[00:01:23]Ma'am, I think English is better.

[00:01:25]>> I'm sorry.

[00:01:27]>> Uh, English is better.

[00:01:28]>> Okay, fine. I'll continue in English.

[00:01:30]All right. So, um, this is, uh, my setup, a part of my setup, the full pictures of a relatively newer setup.

[00:01:40]I'll be uploading on Instagram. So, do follow me there. Now, one of the most important things in my lectures that I have seen is unlearning. That is the most difficult part. Learning is easy.

[00:01:55]Unlearning the old habits and then adapting to the new is the most difficult part. And that is one thing which I focus a lot on. It takes a bit of practice. It takes a lot of courage and I encourage any everyone here to unlearn what we have learned traditionally and try and embrace the new and hopefully you in the next one hour you'll be having a lot of new things to learn and old things to uncover. Okay. So these are 10 small habits for stressfree and most importantly profitable endodonics. Now uh I read this line somewhere that dental practice is too tough to not gain financially. And I personally believe that we do a lot of hard work. We work in a very very small contained space. Our necks bend, our backs bent. We need to really really be earning wealth from it to make it worth our time.

[00:03:05]And obviously it has to be stressfree for us to go about it our whole lives.

[00:03:11]Now first thing that I want to discuss before we go on to the 10 habits is why am I doing a root canal treatment. So the reason I'm doing a root canal treatment is very simple. I am removing the infection and I want to prevent reinfection and prevent fracture. Right?

[00:03:30]I want the tooth to not fracture. Now infection can be due to bacterial causes that is cavity or nonacterial causes which may include non-carious survival lesions which may include cracks which are one of the very very common reasons for teeth to go to go for root canal treatments. Now how we'll focus on the bacterial causes for today. So bacteria bacteria enter the >> ma'am is not clear actually the screen is not visible >> screen is not >> screen is not visible we can't read >> is it better now >> yeah it's okay now >> can you see >> yes >> what is on it >> a little more can you zoom little No, >> I I cannot hear you. Sorry.

[00:04:30]>> Huh?

[00:04:31]>> Yeah, it's okay.

[00:04:32]>> Yeah, that's fine. Okay.

[00:04:34]>> Yes.

[00:04:42]>> Okay. So, I believe uh that the screen is uh now visible with a little less visibility of me, but I think the screen is more important. Okay. So what do you think is the main cause that root canal treatments fail or bacteria remain inside the canal? Out of these five which is mist canal, broken instruments, incomplete da irrigation, perforation and poor posture. Out of all of these, what do you think is the most common reason for root canal treatments to fail? Anybody?

[00:05:23]Even if you're comfortable with the chart, mention it in the chat. It >> be empty and irrigation.

[00:05:30]>> Sorry.

[00:05:32]>> Option third, incomplete biomechanical preparation and irrigation.

[00:05:36]>> I cannot understand.

[00:05:41]>> Improper coronal seal.

[00:05:43]>> Okay. Improper coronal seal is actually correct. What else? Incomplete biomechanical preparation and irrigation.

[00:05:53]>> High five point.

[00:05:59]>> Anybody else?

[00:06:01]>> Five point in cat >> operative restoration is it's not a cause of failure per se that is a cause of discomfort for sure.

[00:06:16]Right now we are concentrating on the failure part that what causes the bacteria to remain or reenter right.

[00:06:28]>> Yes that is what that is absolutely correct improperinal se is correct. Now coming to what actually it is. So the ones who answered improper coronal seal and the post restorations are absolutely actually right. They are absolutely right because basically what happens is there are two reasons main two reasons for the root canal to fail or the bacteria to re-enter. One is incomplete BMT and irrigation. Either we have missed it all or BMT was not complete, pulp remained, necrotic pulp bacteria etc. Bioin remained and it again reinfected the root canal treatment failed. And the second reason is poor coronal seal. So by poor coronal seal I don't only mean the crown. It is the postendo restoration. There was a very interesting study. I'm sure some of you must have read that and most of you might have heard of it by Dr. control in I think 20045 he had actually evaluated uh what is more important a bipal seal or poly and the surprising result was that if you have a poor seal but you have a good colon your root canas will still last a long time I'm not advocating anybody to have poor a sale I'm just saying that colony is that important so you need to have a very very good colon seal and I've seen a lot of people leave behind Zomi or you know use GIC as a post and restorations none of them are good enough the acceptable post and restorations for today's endodonics modern endodonics is composite and even better is core buildup material but we'll learn about it maybe in the next lecture okay so the three most important factors which we need to focus on are you have to locate all the canals you have to do a proper BMT and irrigation and the post endo plays a huge role here. Now what do we want to see? Now one of the things no that is there is that the goal of being healthy or of keeping the symptomatic tooth like today morning I had a young girl who had babies and has root canal and what would I tell her that okay I will do a root canal treatment and the pain will go away and I will fill the gap and there will be no gap and I'll place a crown so you'll be able to chew.

[00:09:06]So the goal is healthy should be no infection and symptom free. But there is one part missing here. What part is missing? The missing part is which is a habit number one. It is the patient's responsibility of making the RCB last long. It is obviously partly your responsibility to do a good root canal but also it is the patient's responsibility on how long the root canal treatment lasts.

[00:09:35]Now, how long do you think this root canal lasted? I have not done it, by the way. But how long do you think this root canal lasted? Can anybody guess?

[00:09:47]>> 20 years.

[00:09:49]>> Okay. Not bad. What else? Who else?

[00:09:57]>> Whoever speaking your voice is very muffled.

[00:10:00]>> Some very short obser.

[00:10:03]Yeah, there are a lot of faults here.

[00:10:05]There's a short observation. There's a lesion >> and pal canal is pal and root canal would have lasted >> not more than five or 10 years.

[00:10:17]>> Not more than >> five or 10 years.

[00:10:20]>> Five or 10 years. Okay. So, uh this bangar actually lasted 32 years.

[00:10:30]And I'll tell you why. Because the patient had an impeccable oral fatigue.

[00:10:36]That is why I say that it is not only on me root canal. How long do the root canal treatment last? So when a patient asks that my answer is how long you will make it last. I will do my best. I will do 110% of what I can do. The remaining is on you. You have to brush. You have to floss. You have to basically maintain your teeth well. You have to not chew sugar again on it. You have to not break walnuts or open bottles with it. So a lot depends on the patient and the step one is the answer to the question is how long the root canal will last. It is the patient's responsibility as well and the patient that showed you he had a very high car rate and all of the crowning restorations etc last a very long time in his mouth because he has an impeccable oral size. Okay, we go to habit number two. The habit number two, the habits we're discussing right now are actually pre-enderotic which is before starting the root canal, what I need to keep in mind. So where to do a RC and where not to do a RC. Now obviously this depends on the condition of the tooth that is how much destruction of the coronal structure is there. What other conformant disease is present. So here this tooth.

[00:12:06]Yeah. So this small central incizer here.

[00:12:12]Do you think should have been done there?

[00:12:19]This fine.

[00:12:21]Do you think should have been done here also? Yes. No. Really?

[00:12:30]As you know, I have done the but you think >> we can try.

[00:12:36]>> Sorry.

[00:12:39]We can do.

[00:12:41]>> Okay.

[00:12:43]How long do you think this lasted?

[00:12:51]Any any guesses?

[00:12:58]>> Is it still lasting?

[00:13:00]>> Sorry.

[00:13:02]>> Still lasting. Oh, you are a very nice person. I wish that was correct. Uh, this lasted two years and it fell out of the patient's palm. That is where the importance of conformant disease comes.

[00:13:15]Peru never underestimate perio. This tool should not I should not have seen it. This was done when I was fresh out of PG. I was under the impression that I can play probably save everything for which is not true. Hence now how do you decide what uh tooth in which tool would you do a par or not? Like I said, patient wants a tooth back. They don't want good endo, right? Obviously, they want good endo, but nobody comes and says, "Give me a good opturation, right?

[00:13:48]They want the tooth back. They want the tooth restored. They want to chew on it." So, do you think that these teeth, this preolar here and that mer there, do you think we I should have done the I should have done root canal in there.

[00:14:08]Yes. No. This one. This one. And this one.

[00:14:18]Pro. How many yeses do I have?

[00:14:25]>> Yes. No.

[00:14:29]Anyone?

[00:14:30]>> I'm definitely Yes.

[00:14:32]>> Okay.

[00:14:34]Uh what about the molar?

[00:14:37]>> Yes.

[00:14:39]>> Okay. So here what I would like to say is that we have to first see if the tooth is restorable and it has to be restorable margin wise. What do I mean by that? You remember crash and rank loss the floor of p chamber lies at the level of CJ. Right? The floor of p chamber lies at the level of cj.

[00:15:02]CEJ in this tooth is here and the Kies is going below CJ. If the carries is going below CJ, it is obviously of the root. So whenever you see Kies going below floor of pulp chamber. Okay.

[00:15:18]Whenever you see Kies going below the floor of pulp chamber like the floor of P chamber is here. This carries is partly slightly below the floor of P chamber that is root carries and here the restoration obviously becomes questionable.

[00:15:35]Okay, the restoration obviously becomes questionable. You can say it not a problem.

[00:15:42]Okay. Huh. So, the restoration obviously is questionable because I cannot see on the roof surface, right? Okay. Let's see the next one.

[00:15:57]This is an easy one, right? We can save this because it's fairly easy. This thing is a very ideal cavity. We are good to go.

[00:16:10]Next one is interesting.

[00:16:13]Okay, this uh upper in the corner.

[00:16:18]This one.

[00:16:23]Do you think I can do an RC here margin wise? Because like I said, a patient wants a tooth. I should be able to see the margin. If the margin is on the root, I cannot seal it predictively. The margin is on dentine. I can seal it.

[00:16:37]So in this one, do you think we can in the seven? Do you think we can do the rook?

[00:16:44]No wrong answers here.

[00:16:51]Anybody send me there? Has everyone left? I don't know. I cannot see the screen.

[00:16:56]>> Mer is restorable I think.

[00:16:58]>> Yes.

[00:17:00]This is a badly X-ray. You can see the floor of P chamber is here and the is well above that. So this is fairly restored. Okay. And very good prognosis to be honest.

[00:17:17]What about this central incizer? That is a favorite. Do you think I can do a post and say this? This is right at this entire muscle.

[00:17:28]Can I Yes, it can be done.

[00:17:37]>> Difficult to save.

[00:17:40]>> What do I need to do for that? To save this is for sure. But what else do I need to do?

[00:17:49]>> Post and CP.

[00:17:51]>> Okay.

[00:17:53]>> Yeah, >> ma'am. We can go for lengthening.

[00:17:56]>> Yes, that's absolutely correct. So in these cases uh it is only stable if I do a crown lengthening to gain 2 mm of healthy root structure. Okay? Otherwise this thing will break and it did break because I did not do crown lengthening.

[00:18:13]So I need to lengthen the crown gain 2 mm of tooth structure so that when my final crown comes it will be something circling the entire tooth. So this would be somewhat my final preparation. The orange this part being a healthy crown structure.

[00:18:34]This part being the healthy crown structure post here over here. And my crown will be enveloping the healthy tooth structure. 360° F is needed for me. Unhealthy tooth structure is needed for me to save this. Okay. So you cannot just save it with the post code. I have done that. It has failed after that also and I don't can I save this the broken?

[00:19:08]>> No I cannot save this. It's >> okay another thing >> I have to do root canal or not.

[00:19:17]>> Sorry >> in root K's cases will you suggest do root canal or not?

[00:19:24]I butt carries >> root carries cases in root carries.

[00:19:30]>> Yeah.

[00:19:32]>> So we can do can we do root canal or not?

[00:19:36]>> No root carries case extract. I cannot seal the margin predictively. If the patient is like okay I'm paying you a lot of money and it's okay if it fails in one month then go ahead but usually extract root cases. There's no point in even attempting the loop can because you cannot seal the margin.

[00:19:55]Hence no point doubt. Uh can we expose the uh like the margin which is not accessible and then uh treat to it and once it's done then we restore it.

[00:20:09]>> How do you make it accessible?

[00:20:11]I mean by removing the >> removing the tissue.

[00:20:21]>> Can you please stop? Ma'am like uh if there's a case of root carries can we like expose some part of the uh area where root carries is inaccessible and then >> case of root carries and >> uh expose it and then treat to it once it's restored properly then we have a intact margin which can be tended uh and then we can treat the tooth as normal tooth with without root carries. No, but the thing is that it's not about the margin being exposed. Okay? It's not about the margin being exposed or not.

[00:20:57]It's about not being able to bond to the root dendine and cementum.

[00:21:02]>> Okay?

[00:21:03]>> Right? There will be leakage there. See, if you can expose the margin and all that there is a whole other issue of biological weight etc. Okay. I we can always change the biological width. We can do a crown lengthening with bone removal and everything. That all is fine. But the fact is that you still cannot bond to root dentine predictably and these cases basically fail at a faster rate than you would born to coronal dentine. That is the reason we don't do uh RCTs and root carries.

[00:21:34]>> Okay.

[00:21:35]>> We cannot bond there. If I can access it like suppose you have a gingal recession patient.

[00:21:41]>> Yes.

[00:21:41]>> Right. So even then I would tell the patient that I don't have much hopes for this because even though it is exposed this it is going to uh you know again leak after a while >> could we not use a material like bioactive material like biodentin mta uh placed there because we use it within a deeper length of the tooth. So what if we can use it on such places and then uh use another material which can bind better to uh the MT or biodentin rather than binding directly to the root portion of the dentin.

[00:22:16]>> I did not understand your question. MTA biodentine like you're planning to uh basically bond and make your margin with MTA.

[00:22:27]uh ma'am a little layer of MTA because you said that which is true that there's a issue with bonding to the root portion of the dentin but what if we apply one layer of MTA and then restore it with other restorative materials I mean can it work is it a possibility >> I've never tried that if it works let me know also >> yes ma'am >> I have never tried it but uh I I have my doubts because >> uh I don't know how how much it will be able to take the load of uh occlusal load you know eventually uh there on the post endo then the cervical margin you will have occlusal loads >> so how much of occlusal load will that MTA be able to take how much would be required that all needs to be investigated >> yes >> so maybe maybe it might might work I still have my doubts so in clinical practice if the patient is not hellbent on uh basically uh saving the tooth. I would go like extract and get a bridge or an implant make it easier on easy on the patient.

[00:23:34]So you won't even recommend hemisctions also >> hemisex um see in my practice uh if you're talking academically hemisction is a good procedure right but in my practice if you look at the surgical aspect of it and the financial aspect of it patient somehow are way more comfortable that you know take it out and place an implant >> so that section and by customization can be tried I guess like instead of completely going for extraction >> we can because most of the times patient won't be like you know ready to get the teeth extracted just because it is like you know uh almost in Indian scenario we get almost one maybe two to three cases will be having root carries for all the cases we cannot recommend extraction I guess we have to be little conservative what do you say >> so uh see if if your practice patients Pats are ready to understand the hemiseps that works well for you. Go ahead with it. It's a legit procedure.

[00:24:38]It is not something which is not to be recommended. In my practice, I feel that patients who are against instruction, they don't want any part of their tooth removed or sectioned or anything. So, you know, there they ask me, you know, this is also surgery in a way. You know, this is like extraction only. Might as well get it removed and place an implant. So you know there uh plus I personally feel this is completely a personal choice. I personally feel the more longlasting and final uh restoration or a final uh result I can give the patient the better my reputation and the patient retention is hence and I don't like giving something which I myself I'm not sure how long it will last. So that is one of my reasons.

[00:25:27]But yes, if patients are willing to understand hemisection, it's a good procedure to recommend for saving teeth.

[00:25:32]That's not a bad option.

[00:25:33]>> That's a totally legit option.

[00:25:35]>> Yes.

[00:25:39]>> Okay. So, we go ahead.

[00:25:43]>> What specific color?

[00:25:46]Okay. So, now we move on to the second thing. So do you think this yellow arrow tools I can save?

[00:25:58]>> Yes ma'am.

[00:26:00]>> Okay. What procedures do I need to save the roof?

[00:26:06]>> Root canal followed by post and code and then full crown.

[00:26:11]>> Canal and post and core followed by full crown.

[00:26:16]>> Followed by full crown. Do you think a post and code only is enough?

[00:26:21]Sorry ma'am.

[00:26:23]>> You think only four is enough or maybe reinforcing it with ribbon.

[00:26:34]>> Round lengthening.

[00:26:45]>> Maybe what is enough?

[00:26:49]I did not catch that. Can you please repeat?

[00:26:55]>> Round lengthening.

[00:26:57]>> Yes. So again here the root structure is fairly robust. But after I remove all the carries I will just barely have a very teeny tiny >> I will have a very teeny tiny portion of this part left. Right. And after crown removal hardly anything will be left. So I'll have to again do a crown lengthening procedure. Okay, if I really want to save it and like I said in my practice my patients generally want a simpler solution. So since they want a simpler solution this patient opted for extraction and implant. I'm not saying that you cannot do ground lengthening and postcore. I had actually offered that to the patient but he was not going for such a long crown procedure. He wanted something simple.

[00:27:48]So always assess what it would be like after removal of Kies and after crown preparation then only go for a so patient who was uh RCD lasted uh 32 years. So he came to me because his crown broke. The crown also lasted 32 years. Now what do you think? Should I do a here or just change the crown? He has no signs and symptoms.

[00:28:18]>> No, no root can >> only change.

[00:28:28]Ma'am as it is like >> why?

[00:28:40]>> I did not understand why >> ma'am slight resolency seen in the uh disturbal root.

[00:28:50]So there is a symptom.

[00:28:53]No. Uh I'm asking should I do a rears here or should I just change the crown?

[00:28:59]He has no symptoms.

[00:29:00]>> Mommy, you should just change the crown according to me because it's been such a long case. So that it would be a proper zone of uh uh without bacteria. So uh and it has a proper seal. So rather than changing and risking again infection, we should just change the crown according to >> okay. So what I uh so here is where I differ. If I can see >> maybe we could go with RCT selective RCT only for one route wherein the oxidation is short. We can only go for selective DRCT only for that route and then we can go with the crown without exposing the gutapkas of the other two canals.

[00:29:43]>> Okay. So again this is where I differ.

[00:29:47]So uh first is that I would do a full RC >> explain the patient about what treatment and ask them to select a treatment procedure.

[00:29:57]>> You can but as a doctor what would you recommend? So that is my question. So here as a doctor I recommended him full riarsity uh along with crown because see the way I see it is we are dealing with bacteria. If the bacteria has infected the GP in the misobuckle, it has probably infected the GP in the deep distbuckle and pars the buckle canal operation is also short now.

[00:30:24]>> The distbuckle canal, right?

[00:30:26]>> Yeah. Because I went for >> buckle and distbuckle canal obsuration short.

[00:30:34]>> Yeah. So I went for a fullity year which is this. I went for a full RCT and uh I then changed the crown because a I am never comfortable wherever I see a lesion even if the patient has no symptoms I am not comfortable leaving the tooth without a RC. uh obviously if the patient doesn't want then we can perhaps give a crown but in those cases I am still a very selective I would rather let the patient go but uh on to that later but uh wherever you can see a lesion do an RC do a rear not even a >> which you prefer in palatal 356 or 36 >> what do I prefer in >> pal canal how do you how much you optate in 36% or 356% I don't do 6% at all. I do only 4%. Uh so for the pal my preparations usually range from 44% to 454%.

[00:31:36]Uh 35 to 454% uh is the range. I don't do any 6% because I don't feel they are necessary and I feel that we are being more conservative with 4% and as long as I can irrigate properly with 4% I don't think I need 6% at all.

[00:31:55]Okay ma'am.

[00:31:56]>> And uh >> if you're using 6% more portion of the tooth is cutting.

[00:32:02]>> Yes. If I use a 6% then I'm cutting more portion of the tooth. That is why I would basically use a 4% I use 4% everywhere. There's hardly a case where I use 6%.

[00:32:15]Okay. So yeah tell me anything. Okay. So I it's definitely a case uh again case is same patient basically lost the ground. The RCT or the lack of RCD whatever you can call it was done 10 years ago by the senior practitioner actually. Uh but the doctor the patient went to this time told him that he needs to do an RC because RC was not done. Now there extreme calcification all the canals are calcified. We took a CBC. We found no lesion on the CBC. Patient also has no symptoms. Do you think I should do a RCT here?

[00:33:07]No signs of lesion. No signs of infection. No symptoms. Just a local ma'am.

[00:33:16]>> It is an asytomatic pulpit. We should go for RCD now as a indicator for RCD.

[00:33:23]>> I'm uh indicated for RCD. Why?

[00:33:27]It is like asytomatic but it is pulpitis like it might be necrotic but I don't think it is required.

[00:33:55]Okay. So here what I feel is I ask but really I would feel that if this lasted 10 years without any signs without symptoms the also indicates there is no lesion whatsoever I would leave this I would leave this if the CBC confirms no widening no lesion >> no symptoms.

[00:34:28]>> No symptoms.

[00:34:31]There are no symptoms.

[00:34:33]>> The voice mute the >> Somebody's speaking. I'm not able to understand you if you are >> mute or >> or maybe by mistake you put yourself on unmute. Okay. So here I would say that if it's extremely calcified, there is no pain, no sign, no symptom, you can also let the patient be after informing the patient. If like in the previous case, we had signs, it's a rear. That is clear. Okay, we move on to habit number three.

[00:35:07]Doing RCT just because the tooth is GOP positive or is sensitive is a big and I'll tell you why. So what does TP positive or what does actually sensitivity mean? Now TP positive basically means damage to the paradoxia damage to the aal paradoxia. Right? Now the a paradonium can be damaged by it can be damaged by crack. It can be damaged by abusal overload. It can be affected by recent or treatment at roughism perodics. a lot of things. It can also you can have only positive in cases where you have the patient chewing on that single known tooth and patient will only have obviously because the paron is overloaded right. So just because the paradon is overloaded I will do a RCD that is not correct I have to find out why the paradon is overloaded and the same actually goes for sensitivity. What does sensitivity mean?

[00:36:17]Now the thing is that for the patient know whenever the patient has parodontal damage they will tell you when I bite I feel sensitivity because they cannot differentiate between parodontal pain and sensitivity. To them this appears sensitivity and this is the reason when sometimes after placing the crown patient comes back everything is perfect. Your RC is perfect everything is perfect. The patient places the crown come crowns back and says crown after the crown I'm having sensitivity they are not having sensitivity after the ground they are having high points maybe lateral movement issues that we need to adjust the parodontia is getting overloaded and that is what they are feeling as sensitivity so after ground if the patient comes back with sensitivity don't just start removing GP and things evaluate the ground first it is mostly that okay so another thing is like I said look for the cause of the sensitivity and I'll show a case why so uh this is a young woman uh she came to me around 5 years ago she had discolored centrals and uh that is because she had gotten RCD done in those centrals like five years prior to that and May I asked her why didn't you get you know done you don't seem to have cavities or anything she said no uh my teeth central suddenly started feeling sensitive so 5 years ago she came to me for just an aesthetic purpose she said I just want to take a or something to cover the discoloration because she was getting married then the reason she had gotten the RC >> just sensity in the centers. Now can you tell me what was the actual reason of her sensility and I can tell you it is >> trauma from occlusion >> trauma from occlusion.

[00:38:30]>> Yes, you're absolutely correct because she returned three months later with this. She fractured one of her essentials and the sensitivity had returned she said a few days back and after that suddenly the tooth started feeling loose and it fractured. So now she has agreed to order treatment which I had advised her five years ago and is undergoing invisal line now. So that is why she should not have been treated by endodontic treatment like 10 years ago that she should have been treated orthodontically that would have threated the sensitivity. That is why I am telling you to not treat every case that is sensitive with RCD because sometimes it is just not that.

[00:39:19]Okay. Now habit number four is again a pre-endic habit. This is where it is most important.

[00:39:26]Ma'am, what can be the treatment done for that case?

[00:39:31]>> If you don't do an RCT, what can be done?

[00:39:34]>> Or trauma from promotion, right? She has a >> treatment or she's being treated. She's being aligned.

[00:39:44]Or is the treatment like it should it should have been done 10 years ago. It would have saved her incizer.

[00:39:53]>> Sorry.

[00:39:53]>> Sorry to interrupt you, ma'am. uh but for that initial case usually patients are reluctant in getting auto treatment thinking that it will be it will take a longer duration of time for their auto treatment to get completed. So if the patient asks for uh immediate treatment what do you think should be the immediate treatment plan?

[00:40:14]So immediate treatment plan you can just give her over the counter desensitizers and tell her the sequence that will happen. That is what I see I I told her five years ago also when she had come for 10 years that you will fracture your central incizer and the only reason she came back to me was because what I said turned out to be true. She fractured her tooth. So you know you have to tell the patient that you can take sensitizers you can take whatever mouth you have.

[00:40:39]You can have ACP gels applied anything but you need to get the pipes corrected.

[00:40:46]If you don't get the pipe corrected your teeth are going to get fractured.

[00:40:51]And usually I have seen once you say this patients genuinely convert for ortho maybe not immediately maybe six months later for her she really didn't believe me and it happened five months later.

[00:41:04]>> Do you think relieving PFO then and there by like selective grinding like not like just one or two strokes of B is can be done at at that moment.

[00:41:18]It's extremely deep like how much would you reduce right how much would you reduce it's not unless I choke the center inside to the third it's not going to be okay right see the amount of deep bite the entire >> even this case is difficult in also since it is severe deep bite >> it is >> difficult in normal also because it's severe deep bite.

[00:41:49]>> No, no, normal as in no sensitivity is normal. Normally having sensitivity, severe deep bite requires immed if she had not fractured her central incizer. What other thing could have happened? She would have grown up her teeth eventually at the age of 55, she would be getting an FMR.

[00:42:14]That's what happens to these kids. she will start grinding down either her lower sensials or the parallel of her uppers mostly both then have aesthetic issues then have fractures on the posterior teeth and eventually all the teeth because will one by one start going for arcities causing pain and she will have asthma so you I don't think you can ever leave a similar deep bite like that you have to treat that deep bite orthodontically otherwise they are going to face problems there are some people who are okay fine I will face problems when I'm 55 that's okay okay that is their call but for a young girl who's not even 35 girl it's not even 35 right now who lose her central in size or is this and these things happens very frequently okay so in this case very lower seven exposed because of an impacted eight what would you treat first patient has come with severe Okay.

[00:43:15]>> Eight extraction first.

[00:43:16]>> Extraction of eight.

[00:43:19]>> Okay. Why?

[00:43:24]>> To stop the reabsorption of the other tooth. Adjacent tooth.

[00:43:28]>> Okay. But where do you think the pain is coming from?

[00:43:34]>> It is it might it is because of seven.

[00:43:36]But then treatment of seven cannot be carried out until unless eight is extracted.

[00:43:42]No, that's not true. So here basically the pain whenever in these cases when you tell me the pain is from impact the pain is mostly from the external cell and you can always do an access here.

[00:43:55]No, you cannot complete the treatment. I agree because of the a but you can do an access opening and DMP. Once the access opening DMP is done, patient pain is gone. In the same visit itself, take out the and after like two three weeks of healing of the ear, you can complete the RC and to the reason I will >> but it's surgical exposure. How can we do a RC treatment and surgical exposure in the same case like at the same time?

[00:44:25]Five seven doesn't need to be surgically exposed. Seven is standing on its own. 8 needs to be surgically exposed. So for seven I would do an access open BMT and once the access open BMD is over then I will open surgically. If the patient is not feeling then we'll do it in the second visit. But I have done >> Can we do the surgical extraction of eight after doing after placing crown on seven?

[00:44:55]>> You can place a crown at the seven when it is already being pushed.

[00:45:00]>> Yeah. So that's the first visit of RCD for seven to relieve the pain. Take the eight out then complete seven RC and ground. That is how the ideal thing works. What will happen if I extract the eight first? The patient will be in for the next three weeks will not be able to open their mouth. I will not be able to do the acetone and patient will say yeah >> ma'am I will explain the patient ma'am that the carriage has been due to food impaction because of impacted where you can't able to maintain or gyms. So we will open the access and we will not do BMP in the first visit and and then we can go for extraction then we can go for uh complete uh RCD after extraction.

[00:45:43]5% of the BMP.

[00:45:46]>> Ma'am uh BMP like uh ma'am I think uh uh we can as a dist caris it requires so much of tooth removal. So it requires definitely an full coverage after doing completing the RCT.

[00:46:03]>> No I not do the PND in the same as access opening.

[00:46:09]Yes like single visit if you prefer for single visit we can do in the same if you have preference.

[00:46:16]>> Yeah see the first thing is that pain relief comes not from access opening pain relief comes from removing the >> and pain relief will come only when you do the and do the means full for me a full is up till 25% minimum.

[00:46:33]>> Yes ma'am. Yes ma'am.

[00:46:34]>> Yes ma'am.

[00:46:36]>> But if you can do the access you can do the in the same visit. do the access through the BMT then extract patient will be fine. If I extract and not start the root canal, patient will be in pain for next 3 weeks because healing and mouth opening will take that long or at least 2 weeks or whatever and patient will come back and say after extraction of eight so much pain I'm never getting any uh tooth extraction from you that is how it happens. So actually the surgical extraction of eight doesn't cause that much pain. It's the seven which is actually causing pain. So treat the cause of the pain from seven. The eight will heal in one week. Like patient will be completely fine after surgical extraction patients take one week or 10 days of issues very nicely.

[00:47:25]Okay.

[00:47:27]Now how do you decide in any case suppose that sensitivity case right and uh the other top positive cases where you cannot see KPS or you cannot find a crack how do you decide whether you have to do a canal or not the answer is a cold test. Whenever you are confused whether you should do a root canal or not you do a cold test. A cold test is the most easiest test to do and I'm not asking you to fill syringes and put it in the fridge. Just take endo ice by 14.

[00:48:04]Spray it on a freezer. First the process to do it is this. Spray it on a bottle freezer. Apply it on a normal tooth.

[00:48:14]See the patient's reaction. They used to read in no 5 seconds up 5 seconds down that doesn't hold anymore. You see the patient's normal reaction. I have had patients who basically yell as soon as I touch the tooth and I've had patients who I have been holding there for 10 seconds and they're like, "Oh yeah, I can maybe heal something." You have to assess the patient's normal and then touch the cotton pellet to the affected tooth. Take the cotton pellet to the affected tooth and then gauge their reaction. Compare it to the patient's normal. Whenever you are confused, compare the pull test reaction to the patient's node.

[00:48:56]Pull test is here because it's one of the best tools that we can have for diagnosis whether you need to do a root canal or not.

[00:49:06]Yes, you can go ahead.

[00:49:09]Okay. Now, I get this a lot. There is a very lesion. You started the root canal.

[00:49:15]You did the PFP and now you are wondering when to do the opturation.

[00:49:21]So you optate as soon as the canal is dry. You cannot wait for the lesion to heal.

[00:49:29]Legion healing will take 6 months to an year and maybe more. So this is a patient who lived in US. He comes to his hometown here in Kolkata for like a month in a year. He had these two RCS and you can see this is the master pole ext you don't have to wait for the lesion to heal and the third X-ray is after one year the lesion has healed completely so lesion healing will take its own time you don't have to wait for the lesion to heal and can do then you'll be waiting for one >> yeah tell me >> in this case can we use bioam >> yeah in all cases I use in all cases why would you use in all cases they're very easy to use this is after one year so healing also takes its own time this was the pre like imager and this is afterwards Okay.

[00:50:40]Uh now one of the important things that I have learned for basically myself because whenever a patient with a lesion you know comes on followup and we still see a lesion we like okay what did I do wrong is the case failing that is not always true. You remember we used to have this whole chapter on medical history. The reason we had that was this periodical lesion healing is slower in certain cases. In which patients? In patients who are on SSRIs, you know, for depression, anxiety, SNRIs, testine, all of these medicines, peroxid all of these medicines will slow down per diabetes. Even control diabetics will have slightly slower healing liver disease. This is one of the most common liver disease. Even thyroid patients who have high DSS have very slow healing.

[00:51:36]Stress is obviously a factor. You have drugsism that is there pero issues. And also patients where you have extruded calcium oxide they will have slower heal. So whenever you see a bio lesion which is healing slower assess whether the patient is taking SNRI SSRI has liver issues a diabetic multiple other things before questioning to the root canal what is SNR and SSR >> uh those are anti-depressants anti-depressants antiotics anti-anxiety medications >> okay so So if a patient is taking something like keroxitin which is common then you have acetalopram which is very common these days you find despan laxin these are very common these days. So what I do in my practice is I get them to fill a medical history and preferably write down the medicines. If they cannot write down the medic I mostly ask them you know go home and just take a picture and show me what medicines you take. So there I'm kind of aware that if I'm extra if I'm doing any raction or if I'm even doing aroon canal is uh you know going to take time to heal and I learned this the hard way in a lower eight compacted patient. Uh he she actually did not have very severe infection or something. The tooth was out in like what like half an hour to 40 minutes and it was fairly easy but she did not heal for a long time and continuous pain continuous pain I'm giving I thought it was a dry socket I'm giving all those alo gels red o nothing is working then I asked her to get blood tests done I had asked her to get blood tests done before also but she had some local lab which was giving her a huge discount And on that everything looked perfect. Then I asked her to go to the standard lab.

[00:53:30]There's a good lab in the city and for whom whose results you know we can trust. Turns out her DS was sky high.

[00:53:37]The minute she went to the endocrinologist got that under control the lower eight socket healed beautifully. So you really have to be careful in these scenarios.

[00:53:50]Okay. Habit six.

[00:53:53]You need to have good back position.

[00:53:56]This is not industry and that is not at all industry. Please do not do your root canal scanning. Whenever even if you're doing with naked eye under the microscope under the 12:00 or maximum 11 now this comes as a shock to most people there is nothing called as direct vision even your lower sixes. If you see in direct vision your back will break in 2 years. Please do not do that. I don't I have paid therapists and support so please do not do that use mirrors take the 11:00 or 12:00 position now uh what my root canal treatment set contains so my root canal treatment set said restoration set whatever other endwork procedures or so procedures I'm doing have the same things one is a good front surface mirror which I use either relax or uh whichever good mirrors I find uh now the two things which I really really advise to invest on is a good PG16.

[00:54:56]Either take two or they are expensive yes maybe 1500 per instrument now but they will last you a very very very long time. I have two dens 16 which have lasted me 8 years and more. Similar same goes for spoon excavators. Spoon excavators are actually a set of six.

[00:55:15]Spoon excavators come in a set of six and the most the ones that are mostly used as 13 14 and 11 12 I'm not wrong take them to dod dens manufacturing them they are worth it once you like in especially in restoration cases you know where you are unsure how much kies is remaining etc I won't prefer using k detecting dough you can use that but these excavators are excellent if there's anything left they will take it So invest in a good DG16 a good front surface mirror and good spoon excavators the rest of plastic use whatever and GDC is not good for DG16 I have had many of them they are too thick they will not help you locate the canals for upper now I use a scope so my position is always 12:00 but the same thing holds for anybody using loops or even with the naked eye you go on 12:00 or the 11:00.

[00:56:14]Now this mistake I see very frequently.

[00:56:17]People position their light chair light people position here.

[00:56:25]You know that should not be your position. The upper 7 will not be illuminated directly with your chair light. Your illumination has to be perpendicular to the mirror and the mirror will be sitting in the preolar area on the opposing arch.

[00:56:43]And the light reflected from a mirror will illuminate the upper 7 and you'll be able to see much better. And preferably use a rubber damp or even those ultra damps, you know, single use damps that come. They are also decent because you get cheek shadows there.

[00:56:59]Once the shadows are out of the way, it'll be much easier.

[00:57:07]Okay. Now, habit seven is a personal favorite. I advise everyone who use magnification. It's a true game changer.

[00:57:16]If you are have used loops or are using loops, good for you. And if not, please start. You can start with those loops that come from Endoing. You know the simpler ending hooks at 3K. They are also decent. The best thing is to get something custom made for you. But uh yeah, if not, then at least use those.

[00:57:40]So this is my setup where I basically so I show my students the procedures of the scope on a big screen so that it's much more easily uh visible to all and obviously visibility increases dramatically when you use loops or a microscope what So I have um yes.

[00:58:20]Yeah. So dental roots are basically like investing in your career longevity.

[00:58:28]The more you can have your back straight and your neck straight, the longer you can practice without paying the physical therapist.

[00:58:37]Now a good magnification to start with is 3.5x.

[00:58:42]Uh you can have them in any company you want. Whichever is good service in your area, they are good enough. But please don't sit like this. You will have lot of neck and back issues. And once they set in, they never go away. Now loops are of two kinds. This is a very very basic info on the loops because we have less time. One is a flip. So these flip up style are the general ones. So suppose if you are in your clinic and you and your spouse are both dentists and you want to invest only in one loop then you take flip up because you can actually change the interupary distance according to your eyes. interupary distances where the lens will be placed like you have for specs similarly you have for loops uh and if you want to invest a little more then go for the lens or even better loops are coming so is even better a good loop I think is by IDS if I'm not wrong it's fairly budget friendly even though I can't comment on the quality so is like this right for loops you have to bend your head a little but for is you can just keep your neck straight and it's like a tiny microscope on your eyes. So er loops are excellent and I would highly recommend them. They're custom made for your eyes.

[00:59:59]So obviously apart from you nobody will be able to use them but they are an excellent option and uh like for magnification the higher you go the field of view how much you can see decreases. So in the microscope I see something like that right? So for elo it is excellent for restorative procedures and hindo combined you can go for something like 3.5 to 4x and you can do everything in there and before you select the loops do a test drive take the loops do a test drive of the loops and uh you know use them for 10 days or so they'll give it to you and then only decide because it also matters what your power high power is. So if you have a very high I power then you cannot have TTL loops you have to have a different kind of loops.

[01:00:54]So always do a test drive and check whether you have any headaches or not before you commit to using any loops.

[01:01:00]Now we come to habit care which is within the RCT at the beginning painless anes.

[01:01:07]Now what is the advantage of painless anesthesia? So the advantage is mainly for me. I never like it when the patient goes ah a in the middle of a procedure.

[01:01:17]The patient falls asleep. I can work.

[01:01:20]They don't talk once they have the rubber damp on. I'm good to go with that. Okay. And I can work faster. I can work better. So a good local anesthesia is always always important. Now problem is that as dentists we are also afraid of global anesthesia and what I want to do through this PPT is this I want to make anesthesia great again so for that you have to understand one of the most fundamental things first visit second visit so my first visit is access open BMP my second visit is irrigation option give anesthesia in both the visits it's not fun for the patient patient to feel that 10 number five going beyond even in the second visit. So give anesthesia patients will be thankful for it and you don't ask the patient before giving anesthesia. You just portray it as a part of the process. Now a tip for inferior alvular nerve block and one of the most important blocks that we give every single day. Traditionally we have been taught that the inferior alvular nerve block feel that you know a coroid notch and then you give the uh an area and I'm sure you have seen a lot of your blocks failing and getting repeated that is because we are targeting the mandibular nerve the lingula where the mandibular nerve is coming out of that may not always be at this position right so a better technique that was actually given by Dr. Angelo and surgeent walls to give give the angel sururgent block which means as high up as possible. It is distilled to the terrago mandibular raf just below the last cusp of the last tooth. It is as high as possible and if you do this your blocks will never fail.

[01:03:19]In the annular surgery, you go from the opposite direction.

[01:03:25]You target as high up as possible just below the cusp of the last tooth or even below that. There is no need to hit the bone. Just a 1.5 in 27 gauge needle.

[01:03:39]Insert 2/3 of it inside and inject. You do not need to feel the bone, hit the bone, nothing. Ma'am the cusp of third mer >> I'm sorry >> below the cusp of third mer >> yes below the cusp of the third mer or the second mer whichever is okay and as high up as possible if I can go above the cusp I do that also because if if here you get aspiration positive that means you are at the right spot where the mandibular nerve along with the artery is coming so you go higher up Okay. So you go higher up and you inject here. You don't hit the bone. You just go from the opposite direction. There is nothing extra to be done for the lingual nerve. No need to take it straight or anything from the lingual nerve. Just inject the patient will be anesthetized.

[01:04:34]Okay. Another thing is that you need to give at least 3.6 ml of the you need to give at least 3.6 6 ml of window for it to be effective. 1.8 ml hardly does anything.

[01:04:53]Another trick is that if you want to avoid that needle sensation, everybody sprays, but this is actually wrong. What you need to do instead is if you want to use the cotton freezer and spray, just spray, hold there for 1.5 minutes. If you want to use like a gel, this is available onies for like 30 bucks. Take a dioine 5% gel on a Q-tip. Hold in the exact same position where you will puncture the needle. Hold for 5 minutes.

[01:05:25]Gel 5 minutes. Spray cotton twer not spray in the mouth directly. Spray on cotton tweezer. Hold for 1.5 minutes.

[01:05:33]And there's another trick that works that is buffer anesthesia. Now what is buffer anesthesia? Buffer anesthesia basically is buff where it pains. One is needle brick pain right one is the pain of the needle brick.

[01:05:52]What is happening?

[01:06:02]Sorry. Just give me a second.

[01:06:11]And that above arrow you have to click.

[01:06:19]>> Yes ma'am. That left hand side corner.

[01:06:22]Thank you. Thank you.

[01:06:35]Hold on.

[01:06:45]Okay. Yeah. Buffered anesthesia. So what is buffered anesthesia? Adding sodium bicarbonate. So you get sodium bicarbonate in these files at like 7.8 or 4%. You add 5 to 5 ml of anesthesia and you have to make it there and then cannot store it anywhere. So it is.5 ml through 5 ml of anesthesia which is 110 and you inject the patient. Why buffered anesthesia? We all used to write how to make local anesthesia painless as now why buffered anesthesia because the first pain can be needed break which we have eliminated with the topical. The second pain is the pH difference when we inject the anesthesia. We inject it slowly. That is one way to avoid it. The second way is give buffer. If the anesthesia is neutralized, the pH is neutralized, the patient doesn't even realize that they are being checked. So your anesthesia truly becomes painless. And uh painless dental treatment is what makes or breaks a dental practice.

[01:07:51]That is why so much emphasis on painless anesthesia. Now for hot tooth, how do you anesthetize? You use all the blocks you have, which is your inferior. For hot tooth which is mostly your mandibular 67. You anesthetize with inferior alvular nerve block. Give RDK local infiltration buckle and lingual.

[01:08:11]You give a my hyroid nerve block. You give a long buckle nerve block. You give intragmentaryary nerve block. After this you might still have pain when you place a drop with the rumbar. When you have that you have to give intraalpel and that is truly what works best for what intraal is the thing that works. The trick with intraal is to give it with a lot of pressure. You have to wedge the needle and give it with a lot of pressure.

[01:08:41]Now we come to habit number nine which is if you want to avoid lees what do you do? So the first thing that you do is you recurve each and every file you use.

[01:08:58]Pre-curving is very simple. You get these endo benders but I feel they're a waste of money. Just use the non-dominant hand. And the movement that you do is this. This is the movement.

[01:09:11]Like you can see in the video. This is literally the movement against the nail.

[01:09:16]This is the movement that you do. prec files and the first movement that you will have is the wash pointing movement with a pressure. Now once you have reached the ale form and the apex locator is telling you that is your working length. The second thing that you do prevents ledges which is this uh no.

[01:09:48]Yeah. This is the way. Yeah. So you are going to read and file at the working length which means this stopper this stopper has to be in the same position.

[01:10:04]If the stopper is here, it always has to come back here when you're filing. When you are having the outstroke, now sometimes what happens, we have the outstrokes, we go back in and we basically have the outstroke again before actually reaching the working length and that is what actually leads to ledges, lot loss of working length or a blockages. You need to be very very mindful of your stopper. Again, I want to play this video because you have to be really very mindful of the stopper. You have to ream and file. This is the filing motion. And I'm again going back to my stop.

[01:10:52]Every time the stopper has to touch the stop. Every time you file, if you file above your working line, you are going to create a less. and a 15 number five can create a ledge and a verified ledge of that.

[01:11:05]Okay. Now the habit number 10 this is one trick that will help you negotiate all canals. What is the first trick? Second trick was fine with a pressure. Third trick is raining and filing at the working length. Keeping the stopper at the reference point at the reference point from which you have taken the working length. Keep the reference point consistent throughout rotary BMT hand BMP everything. Now third the OG trick here is which is a little anticlimactic is never use any file without lubricant.

[01:11:50]Now what lubricant am I talking about here?

[01:11:55]What lubricant am I talking about here?

[01:11:58]I'm talking about sodium hypocchlorite.

[01:12:00]No not gel. I have not ever gel in the last so many years. So not gel. Please, if you don't remember anything out of this, throw these gels out. They are leading to blockages and perforations.

[01:12:17]Sodium hypocchloride is the only lubricant you need. Just add one or two drops of sodium hypocchloride into the chamber every time you're using a hand instrument and it is good enough. So why not ED? I'll tell you why not. What EDA does is EDA is a chilating agent. When you put EDA on that file and introduce it, the pulp chilates with the ETA and forms a complex. Now that complex follows up by the blockages. You will you would have seen it that one time we were reaching the working length. The second time I'm not reaching the working length with rotary. There is no file broken anything. But still I'm not reaching the working length with rotary or my next file. Why? because and pulp formed a complex a very hard complex which is very hard to remove also very difficult to remove and has blockure fiber.

[01:13:12]So EDTA is not indicated as per lubricant. Second EVTA with rotary is actually contraindicated also EDTA causes something like this which is your perforations. So if you want to avoid perforations don't use EDTA. Sodium hypocchloride is best. Now EDTA is because it affects the structure of ni and makes it more prone to degradation and breakages. We always wrap a lot of around our protein files thinking we are lubricating. We are not lubricating. We are just making them more prone to breakage. So do not do not use EDTA with rotary files. So why was EDT invented if you're not supposed to use it? So the only case where it is recommended is where you have very vital highly bleeding cases like you have in 13 14 year olds or poly where you can't see anything there also. How are you supposed to give it? Take the ED gel syringe and directly through the syringe, insert it into the chamber, not having it on your file and then take a 10 member file and through that EDA just do a bit of filing and then rinse with saline. Most of the pulp will be chilated with EDA. It will stay in the corn and you can remove it very easily.

[01:14:40]Then again you rinse with saline and give hypo as a lubricant and cartilage.

[01:14:46]This was the sole reason EDA gel was invented not to be used as lubricant error. Please throw them away tomorrow when you go back. Now another uh this was a 10 habit but I could not resist adding this habit number 11 because it's going to save your patient some money.

[01:15:06]The trick to truly painless. So when before a root canal do you give painkillers or do you give after >> ma'am?

[01:15:18]Ma'am >> hello.

[01:15:21]>> Yeah.

[01:15:21]>> Uh if we can't use EDTA gel then how can we remove the smear layer ma'am like eda gel is main purpose is to remove smear layer.

[01:15:31]That the main purpose that is the main purpose of liquid 17% to use it as an irrigant in your irrigation portfol used in a single canal >> as much as you can use as long as you can as much as you can. It is the best thing you can do. Hypo dissolves the hypo removes the bofilms. Hypo dissolves the organic component. It inactivates the endotoxins.

[01:16:01]There is nothing hypo cannot do. So bear with >> how to prevent hyperactivity.

[01:16:08]>> How to prevent hypo hypervented needle. No speed, no pressure. Inject >> inject the basically in the canal. Use a silicon double side vented irrigation needle. Double side vented irrigation middle 3 mm short of working length. No wedging, no pressure, no speed. Very slow speed.

[01:16:38]That is >> into the canal before every file.

[01:16:46]If hyper is occur already then prevention or treatment plan if hypo accident is occurred and it has almost everybody the first thing you do is you take another 30 gauge double sideed needle not the one you did the extrusion with other one take 5 ml syringe with la and push very hardly alternate with saline and uh this LA till the time you have less of bleeding.

[01:17:20]Let me see. I think I have this in my I'll show you.

[01:17:25]>> Ma'am, does EDA gel or solution is mandatory ma'am to remove the smear layer or any works?

[01:17:33]>> For removing the smear layer in components you need but use liquid and not gel.

[01:17:40]>> Is it mandated to use ma'am?

[01:17:44]>> Yes.

[01:17:46]1 ml per >> so in every case we should use solution ma'am.

[01:17:54]>> Yes.

[01:18:00]>> Okay. So this is hypoextrusion. So if you have hypoextrusion what do you need to do? First of all learn to recognize it. Hypo exclusion is immigrant. patient will tell you immediately even under anesthesia that I'm having pain. Okay, swelling may or may not occur but if it occurs it's instant. So if the patient calls you up after 2 hours and says I have swelling and pain that's a flare up that's not because of hypo. Hypo is immigrant.

[01:18:29]Second you will have copious leaving from the root canal or fist from bridge to excluded. You may have discoloration if you have exuded too much of it. Okay.

[01:18:39]And in cases of papers you may also have chlorine taste in mouth in the throat.

[01:18:44]Now first thing to do is stay calm. It is reversible. This was done in my practice by one of my associates. The patient mouth with the patient's face got swollen. The discoloration is hers not done by us. At 2 weeks and four weeks she's absolutely fine. Now what do you need to do? Rinse the canal with copious amounts of tea and salary. Like I said 30 gauge double-sided bended needle a new one push perially till the time bleeding slows bleeding will not stop bleeding will not stop because bleeding is the body's mechanism to take that toxin out then prescribe antibiotics analesics 24 hours of cold compress for the swelling and then boline rinses if the patient is not diabetic you can give steroids otherwise let it be and patient will be fine in 1 to 8 weeks. 8 weeks is only for discoloration. Usually in two weeks they are perfect.

[01:19:44]And how does hypo exclusion look? After you have done so many of them, you start to record them like I did. And this is how it looks. Okay. There is copious bleeding. It's like a fountain of blood coming out this orifice. Iating with saline and again it's coming out. Right.

[01:19:59]This is how obvious leading from the root can actually looks like but it's reversible. There's a fair amount.

[01:20:13]>> What sorry >> ma'am when we do perforation there is also no bleeding from the >> bleeding is not this perforation bleeding is very different. perforation first of all unless you're done like a huge ass perforation it gets very early okay and it is very easily controllable with a heach so if it's perforation the you you can see it on the X-ray you can just insert a file there set it on the X-ray second if in hypo extrusion you would have actually been irrigating with hypo to actually extrude hypo that is like way after the BNB is done everything is done so there you have hypo exclusion because you have been irrigated with perforation will occur usually during access opening and if perforation is there just control that he start gel after that place MDA plug MTA there then the patient go the MDS okay we come back to the last sage now before uh I was asking painkillers before or Afterwards this already answered you before. Now what painiller do you give? What is the best painiller for root canal, for extraction, for anything else?

[01:21:42]>> 25 mg.

[01:21:45]>> Okay.

[01:21:46]H what is the best pain?

[01:21:48]>> Zerodol.

[01:21:51]>> Zerodol. Ibuprofen and ibuprofen and paracetam combination.

[01:21:57]>> Yes, that is absolutely correct. The cheapest option has no real role in it. You may not give every days and the patio will still be fine.

[01:22:11]>> Okay. So why that? Now pain relief is maximum with paracetamol and ibuprofen.

[01:22:19]It's a very cheap and I'll just say paracettool. Basically what it does is it raises the pain threshold and ibuprofen has a very very rapid onset.

[01:22:31]Whatever those keto DT people are telling ibuprofen is more effective.

[01:22:40]Now there was a study done uh this was evaluating pain after third surgery.

[01:22:46]It's a very old article and acetak and ibuprofen. And guess what? One ibuprofen. Ibuprofen 600 mg plus 1,00 mg is a very important combination. It reduces pain in even the worst of places. So you can easily give it TDS like three times a day. ibuprofen 400 or 600. And I always give it before starting the root canal because ibuprofen has a rapid onset and it actually prevents the prostand from being released. So if you give it before before your before >> I'm sorry [clears throat] you okay >> okay >> mute background I again I'm not able to understand. Uh is anyone asking something?

[01:24:01]>> Okay. So uh with this we come to the end of the uh QT. Thank you so much for being a very engaged and a very interactive audience. I really enjoyed the session with everyone and I hope you did too. uh I have my next endo workshop on 9th and 10th of May where we go further into depth into all of this and there's a very very very practical aspect to these workshops and I hope to make enderodonics more stressfree and eventually earn more money from endo from there apart from my endo workshops we do run an academy with various kinds of courses and if you want to contact me. These are my IDs. Please do follow me on Instagram especially because we'll be uploading a video of the new setup and I hope all of you will see it and give your views on it.

[01:25:02]>> And also let me know and I'm adding to the group also. If you want to text me, you can text me anytime.

[01:25:08]>> Ma'am, one last question I have.

[01:25:11]>> Yeah. Yeah. Tell me.

[01:25:16]Can what about the um about the tapers in each in every tooth like maxer anteriors lower anteriors palatal and distribal canal or distal canal of mandibular motor sh how much you how much till we have to prepare >> so I prefer both I prepared in 44% about 45% auxilary anterior teeth >> sorry ailary Max for pal or dist 4% 44% mers and maxillary anterior I am very partial to hand filing there and I prepare till for one canines still at least 60 and for laterals still at least 40 35 to 40.

[01:26:09]I hope that answered your doubts and I will see the chat if there are any questions.

[01:26:14]>> Ma'am ma'am uh what will be the taper uh used in misobar and misolingal in mers and upper and >> 4% 4% >> 225 25 or 30 >> depending on the canal 25 or 30 whatever one is whichever one it is it will be 4%.

[01:26:37]How how to decide master file which one up to how much do we do?

[01:26:45]I think I have it on that for master.

[01:26:48]Okay, I now understood what you're asking. Okay. So you are asking how to decide whether it will be 25 or 30 like yes what is the criteria to decide up to which 30 or four or 25 or 24 like in MB2 like most of the cases MB2 is conricted >> okay so the first thing to remember is that 25% is the bare minimum preparation that we have to do okay 25% is the bare minimum preparation that we'll have to do all days. After 25 4% we can decide how much to go. Okay. Now how do you decide that? So 25 4% is bare minimum for 25% is bare minimum. Okay it's not here.

[01:27:40]Okay I explained. So 254% is the bare minimum you go for MB MLB. After that you take a K file 25 K file take it to the working length and then tap okay tap on it tap on it and see whether it is going beyond or not that is this process is called as a gauging now for 25 4% for 25 K5 which is 2% for 25 6%. Your tip diameter is always 25 right. So if I am introducing a 25 K5 in a canal that has been prepared. So if I am Yeah. So if this is my canal and this is my preparation with 4%. Right now if I am introducing a 25k file it should stop here right because a is 25 2% file is a thinner file it is just that it's a thinner pile right but the diameter is it should stop here if when I tap on it like literally just my I mean what what I'm doing is I'm just pushing from the literally tapping. Okay. When I tap on it, if it goes beyond that means that naturally the a size is greater than 25.

[01:29:13]Okay. Then I will move on to 34%.

[01:29:19]After preparing 34% to working length, I will again try with a 30 30k file.

[01:29:26]Okay. If the 30k file is snug and it does not go beyond working length on tapping that is your master file.

[01:29:36]Is that clearer or it's still confusing?

[01:29:39]>> Yes ma'am.

[01:29:40]>> Will you please repeat again?

[01:29:42]>> Ma'am repeat again.

[01:29:44]>> Yeah I'll show you a video I have of >> ma'am your voice is not clearly audible.

[01:29:52]Yes, ma'am. Voice and pictures. That's why I have that's why I say pictures.

[01:30:00]>> Okay. Okay. Give me a second. Huh? I just have I want to see where >> I have the Yes.

[01:30:19]Can you see the video?

[01:30:25]is here. No.

[01:30:28]>> Yeah.

[01:30:30]See, I am inserting 25. I'm tapping like this.

[01:30:35]I am inserting 25 tapping like this. If it goes beyond that means I have to prepare further with 34%.

[01:30:44]If it does not go beyond the working levels, then it is fine.

[01:30:51]Right? See this right? I'm tapping on it and it is not going beyond that means it is 25 is enough. If it goes beyond like it did in one of the distance I'm preparing further. I'm preparing with 30 or 40. I'm not sure which one is this.

[01:31:09]And then again I will try with the K file. AIT gauging basically means that I'm trying to guess the size of the athleon for the natural size of the aon for okay so I'm trying with 30 now 30 is stuck to the working length it is not going beyond okay if that is not going beyond that means 30 is my master file so this step you have to do always after 25%.

[01:31:44]>> 25% is bare minimum for uh basically hypo to reach the yeah 25.

[01:32:05]Yes, absolutely ma'am. What is the correct technique for placing calcium hydroxide up to the aex in case of any pathological >> cases change?

[01:32:18]We don't place calcium hydroxide. We don't use metapex at all and we don't place calcium hydroxide till we first of all calcium hydroxide is an irritative. If it goes beyond it's quite annoying for the patient. Second, we place calcium hydroxide till around the middle third.

[01:32:42]That is because the parodonal ligament is filled with inflammatory fluid. After you have done your BMT, that inflammatory fluid actually needs you know area to relieve where will it relieve itself? The if you give it till the arrival and have no space left over, patient will keep saying pain pain.

[01:33:04]Okay. So what you do nowadays is calcium hydroxide in the middle third let the inflammatory fluid enter the canal patient will have pain relief vision. So that is what I follow and that disinfection because calcium hydroxide acts by dissociation of calcium and hydroxy ions and placing it till the middle third achieves the desired antibacterial effect and also gets the patient. So that is how I do it. And second, if you want to ask me the actual technique, then I inject calcium hydroxide. You have these silicon tips available on the entry part with many dealers also. You I buy those.

[01:33:44]I inject calcium hydroxide. Then I take a K5 number K and agitate the calcium hydroxide till the working so that it goes into the dentinal tubes for disinfection. Then I inject little bit of calcium hydroxide again and then after that test on temporary let the patient go no below the temporary test.

[01:34:08]>> Ma'am one more question. Hello. Yeah ma'am.

[01:34:24]So anesthesia Second.

[01:34:44]Okay. Okay.

[01:34:58]without anesthesia.

[01:35:00]>> Okay.

[01:35:01]>> Uh ma'am uh how do we know that we have uh removed all the pulp or we have cleaned enough of the canal?

[01:35:10]>> You have we have to do remove all the pulp and >> yes how do we like uh how do we know like we sure that the pulp is removed completely from the canal or the canal is completely clean.

[01:35:25]So basically doing your BNB clear out 4% using a leaging concept is number one.

[01:35:32]Number two is go to use a good amount of hypo use hypo as lubricant. The longer you use hypo at least irrigate with sodium hypotar for like 20 minutes. Okay that does the job. Main job is hypo hypo needs to be activated. So activate the health that is the best way we can ensure that partic >> ma'am I have one question uh I go to my friend's I go to my friend's clinic and uh what he's practicing is like after opturation every time he is giving patient predisolone like why I don't understand like why to uh to settle down the inflammation like he says uh whenever he opturates he's giving the prednisolone 20 migs Uh so basically this was a concept that was followed like long ago. Basically was that to control the inflammation and the swelling if any. But nowadays we have bioceramic seers. They will not cause any pain. So as long as you're not going over or anything there won't be pain you know with after observation. So why are necessarily different? This was a very old concept when like we didn't have that those nice the sealers used to hurt. Techniques were also pretty rough. So that time it was done now require I did painkillers.

[01:37:01]See after every root canal result even after obseration I tell the patient take I give before and then I tell the patient take 1 hour afterwards and take six hours after. The reason being that pain can occur postulation pain is normal. They might have reacted to a bit of sealer. Even though bioamics people don't have pain at all but even then I still prefer just giving pain just giving them a pain not just typical 400 or 600 >> ma'am. What is the reason for not using 6% rotary files?

[01:37:40]What is those >> reason for not using 6% rotary files?

[01:37:46]What is the reason for not using 6% rotary file?

[01:37:51]>> My see my why am I doing BMP? I'm doing BMP so that my irrigation needle can reach 3 mm short of the A 4 mm 3 mm short of the working length. So if I'm able to achieve that with less of cutting with 4% rotary files then why would I use 6% 6% cut too much if I cut too much I'ming to uh ma'am what about ma'am what about yes >> ma'am one question is this key actually most of the patients second patient.

[01:38:38]There was no pain and no then second in any case.

[01:38:53]>> I find it better. I always give anesthesia because uh I have seen that anesthesia along with the painiller.

[01:39:07]So and plus I apply I want the patient to be relaxed.

[01:39:17]It's easier for me to give anesthesia and work faster. So that is why second anesthesia and pain combined patient That's good.

[01:39:31]>> Ma'am, what about files? They are 8% paper. Uh I heard that they are 8%.

[01:39:49]I uh >> ma'am uh which bioceramic sealer do you prefer or do you suggest which is good uh efficacy?

[01:40:00]>> Which what are you asking?

[01:40:03]>> Uh which brand of bioeramic sealer will you suggest which is best result.

[01:40:11]I am using currently I had used but I find better but then I is good. There is anti bio which is actually quite nice. So these two brands I found that are really nice the cheaper ones also I don't like them uh and uh the more expensive ones though are quite unaffordable to be honest. So I have used Sarah seed. Sarah seed is also good but personally I like the flow of Angelus more. So prefer >> uh ma'am how do you prevent the wastage of this bioamic sealer because once we place it in the tip and then insert in the canal the one in the tip is like after some time or this it will set. So we have to throw and then take a new tip. So how do we prevent that?

[01:41:07]basically it does not completely. So what you do is to prevent it from setting you need to have no moisture and damage. So the minute I am done with the bioeramic sealer the tip is sealed with a 10 number K file or whichever K file which is getting so that prevents the sealer itself.

[01:41:28]So I insert like a 10 number K file into the table and that does the job.

[01:41:35]>> Ma'am, what is the protocol for flare of cases after obsuration?

[01:41:40]>> What is the protocol for what?

[01:41:42]>> Flareups after obsuration.

[01:41:47]Flare of cases.

[01:41:52]uh sorry I'm just not able to understand after we do patient says there's a pain there's discomfort and many times also there nothing exusion just the patient what is the irrigation protocol final irrigation protocol ma'am. What is the final irrigation protocol before oculation?

[01:42:36]>> My irrigation protocol is 3 ml of 5.3 times uh heat accurate. Uh I heated with the downpack device. each then I uh give hypo again and do a circumferential filing with H5 and then if need be if I still feel that I am seeing that bubbling and everything and pulp is remaining or it's a very necrotic case then I would go for two or three times of hypo and my final result since it liquid 17% 1 ml per kl and activation every time I'm using hypo I'm activated >> also can we use ed as our final irrigation >> I'm sorry can you use >> use eda liquid as our final irrigation >> yeah option >> ma'am uh when you shifted 2% to 4% file why need to ditch again uh to bar ma'am what should be the ideal torque for 4% file in messial and distal canal or in buckle or parallel canals >> manufacturer recommendation >> okay >> uh excuse me ma'am ma'am is it possible to share the artic ical versus that you compare between ibuprofen and acloen.

[01:44:22]>> Yeah, I'll share I have it. I'll share.

[01:44:25]>> Sure. Thank you, ma'am.

[01:44:30]>> Yeah, you're welcome. So, I think it's >> Yeah, >> ma'am. You are showing that 2% to 4% while sifting again.

[01:44:42]Again rotor is ditching like man. So why ma'am? Again ditching >> not I did not understand air is doing what here >> ma'am you are showing now when is it's not uh fing inside it's 2% 4% it's 25 to 34%.

[01:45:12]Huh? 25 to 34% is the preparation I'm doing. DMP. Yeah.

[01:45:19]>> Uh so need to p again. Uh if not uh going inside >> you need to do what again?

[01:45:37]I think the best thing is there is some network issue that I think even I am having and it's 12:30 and I actually do have patients waiting. So what we do is I uh request uh Dr. Sharon to just open the chat WhatsApp chat for uh some time so people can post their questions and I can reply so that way every I can also understand because I think my network I hope that's okay with everyone.

[01:46:06]>> Yes ma'am.

[01:46:08]>> Yeah Dr. Sharon, please open the WhatsApp group so that uh people can ask the questions they want to ask and I can reply uh to the questions they have.

[01:46:22]>> Yeah, I'll let you know doctor.

[01:46:25]>> Okay. Okay. Okay.

[01:46:28]All right. So, uh thank you so much for being here on a Sunday morning. It was a very nice session, very engaging, very interactive and I will answer all your questions in the chat and um do connect with me on Instagram, YouTube, you have your you have my number also you can message me there. Thank you so much everyone and I'll take my leave now.

[01:46:50]Thank you.

[01:46:51]>> Thank you so much ma'am.