Endodontics

The Five Ages of Man are said to be the Golden Age, the Silver Age, the Brazen Age, the Heroic Age, and the Iron Age. Endodontics has passed through many ages as the discipline transitions to increasingly predictable clinical success. Within the Pantheon of gods and gurus, one stands alone as a beacon of the … Read more

The purpose of this article is to correlate the importance of irrigating with chelating agents (and their chemical reaction in eliminating the debris from between the flutes of separated nickel titanium files), with the ability to retrieve and/or bypass instruments separated within the root canal system. Several methods and techniques have been advocated over the … Read more

Picture this: A small town in the Wild West Frontier. The street is deserted, it’s high noon, and the sun is beating down on this dust bowl of a town. Two gunfighters square off for a showdown, each at one end of the main street. At one end is the lawman, wearing the white hat, … Read more

We can learn more from our clinical failures than our successes. If we will allow it, the cases that have less success can be great teachers if we are open to their lessons. Such is a case pictured in Figure 1. What went wrong? How could this have been avoided? While the radiograph is in … Read more

To answer the question that was asked (Feb/06 pg. 8) by a reader, no, hand K files are not meant to be inserted into canals that cannot support the diameter of the given file. Said differently, the hand file will have to be slightly smaller than the canal space into which they are inserted and … Read more

Recently I received e-mail from a reader asking me to comment on negotiation of canals with hand files. I had mentioned in a previous column that, all things being equal, small K files should be “precurved and placed into the given canal third” prior to the use of rotary nickel titanium files (RNT). The reader … Read more

Making endodontic access through a crown and repairing the access opening in lieu of making a new crown is problematic. In my empirical opinion and experience, the vast majority of crowns that I have accessed, either for first time treatment and/or retreatment, using the LA Axxess kit (SybronEndo, Orange, CA), have shown some measure of … Read more

Bacteria are the primary etiologic agents in pulpal and periapical infection.1-3 Therefore, the aim of successful endodontic therapy should be to thoroughly debride the canal system of organic substrate, infected pulp tissue and microorganisms and to seal the canal space to prevent reinfection of the pulp cavity.4 A missed canal is neither debrided nor thoroughly … Read more

In a word, yes! K files are indeed essential to pre-curve prior to use. First off, canal systems are never straight, no matter how the radiograph may appear. No line in nature is straight and canals contain a dimension of curvature from buccal to lingual as well as mesial to distal. Said differently, if a … Read more

Negotiation of curved canals in endodontic treatment might be thought of as a series of very small steps that collectively produce the desired endodontic result. Said differently, to obturate a curved canal with an ideal shape requires patience and the achievement of many minor objectives to arrive at the desired end point. This article will … Read more

This column will continue a discussion initiated in Part I (June ’05) and II (Aug. ’05) of this three part column, which addressed the factors that go into creating better communication and trust between doctors and patients with a simultaneous eye toward helping doctors avoid unnecessary patient management problems. Specific factors that can help identify … Read more

This column will continue a discussion initiated in Part I of this three part series, which addressed the factors that go into creating better communication and trust between doctors and patients with a simultaneous eye toward helping doctors avoid unnecessary patient management problems. Specific factors, which can help identify problematic situations, are detailed that will … Read more

To view the tables in this ariticle please click here. (14KB PDF) ABSTRACT The relationship between obturated root canal fillings and the external surface of the root was examined to determine if a correlation exists between asymmetric root canal obturations and unfilled canals. Extracted, root canal treated teeth were selected and digitally radiographed from different … Read more

Did you ever start an endodontic procedure and later wish you hadn’t? If you are like most clinicians, the answer is yes. The source of this answer is either a clinical challenge or patient management issue that arose unexpectedly after starting. The prospect of having a root canal can provoke anxiety in some patients, despite … Read more

THE MIND SET: “BETWEEN A ROCK AND A HARD PLACE” The separation of an endodontic instrument instantly transforms a case, from whatever level of difficulty it was pre-operatively, to a new level of severity. Given the variants of anatomy that Mother Nature may have placed in the canals, roots and/or jaw of that particular patient, … Read more

Numerous studies on endodontic treatment outcomes demonstrate a significant degree of predictable clinical success,1,2 however, cross-sectional, retrospective population studies have demonstrated “post-treatment disease” in 30 to 50 percent of cases.3 While recent studies have introduced significant predictors of outcome which may impact upon future treatment protocols, at present, continued sophistication of contemporary clinical treatments (debridement, … Read more

ABSTRACT Irrigation has an important role during endodontic treatment. We are proposing a sequence for the different irrigating agents in order to achieve the best chemical preparation possible. During the last several years endodontics has progressed to the point for treatment to be less traumatic for the patient and less stressful for the dentist. However, … Read more

At a recent endodontic study club meeting, we had the opportunity to discuss what endodontists often chat about. Included in the discussion were levels of busyness, new techniques and technologies being used, and the different types of procedures that we are seeing in our day-to-day practices. Before long, it became obvious that the pattern of … Read more

A discussion of the implications of obturating “short” of the anatomic apex of the root was initiated in Part I of this column last month (April, 2005). Its discussion concludes here. As mentioned, the apical foramen is, on average, located 0.26-0.99mm from the anatomic root end apex (references available). While this anatomic average might be … Read more