another week gone by. exams draw close, and frankly it looks pretty worrying. i have no momentum to study, and the extra lessons that pop up after five totally drain me so that i just end up slumped in some chair in the library in fitful slumber. must... have... energy...
after polling class i have come to the conclusion that endodontics is the most hated subject on a class-wide basis. seems as if no-one who is still working on it has any kind of flare for it, and many of our class dont even understand half of what is going on anyway... and that kinda goes for me too. reading the textbook and seeing the studies quoted, it seems as if we really are working with primitive tools in an inexact science. its like... who the hell has perfectly round roots anyway? if there are little blebs of dead meat on the walls, interconnections between canals in a wide roots, they'll never get debrided. and the most we can do is try and file away blindly with the Step-Back Method (Clems 1959) and hope that we get it all. anything with a bigger-than-30-degree curve and we get all spazzy. we need better tools, mon!
anyway... for my rare fans out there here are some little important details that might save your kah chng. esp since the class is running out of molars to do up...
1) when they say work wet, they mean so wet that the pulp chamber is in fact holding a reservoir of water inside.
2) straight line access does not mean just being able to see every single canal without tilting your mirror. it means that dentine shelves and enamel triangles have been removed so that your #08 file goes down the canal without deflection until it hits the terminal bend at the apical third. this eliminates the chances of a stripping perforation high in the canal as you have less bends to work around.
2a) hence the Gates Glidden Drill set is your best friend. followed by Hedstroms. for the timid-of-heart, keep these up in the coronal third. which is where dentine shelves hang out anyway.
3) dont dry-file the canal when trying to get tug-back. re-cap instead. and be very gentle about it. related to 1) and 5)
4) some posterior teeth have very low floors. way lower than the CEJ. please remember your floor height. and stop your cone stuffing acordingly. go too high and you will frustrate yourself by cone-stuffing the chamber instead of the canal. learn to check orifice height from radiographs by spotting for 'fast-break'. this is the point where the root canal suddenly turns lighter as it splits into 2, and hence casts a smaller air/tissue shadow.
5) learn the Tao Of The Apex. an apical stop is an iatrogenic ledge created exactly at working length. it is so damn retentive that even if u use a file size 1 smaller than MAF it will not do further down the canal. an apical seat is a funneling toward the minor foramen. not as retentive as the stop but still amenable to lateral condensation. an open apex means you have just screwed up the tooth by filing right into the PA lesion. this may be achieved by
5a) not checking working length. so yeah, the stop on the file is loose. change stop with that #15 file you just banged up. or check after every few pulls. if not, you may well get carried away and find that you have gone about 2mm further than where you wanted to.
5b) excessive enlargement at working length may result in weakening of the tip of the root where your seat ledges overhang. and if you push too hard this might just end up with you snapping them off and pushing them right into the PA lesion. a sudden increase in the length you can go to with that file is a very very bad sign.
5c) a zipping perforation is created by making many many many small ledges that hook into the foramen of a curved root tip and pull it in-line with the higher part of the canal. this is very bad news. usually due to improper pre-curve and canal flare technique. what you in essence end up with is an inverse funnel narrowing towards the crown.
6) change dead files. files with kinks, bends and thread strips are not only not worth saving, they are dangerous to the patient. they are too blunt to work with and may break in the canal. as soon as you see a file too banged-up to use, salvage the stop and bend the file 90 degrees so that you will never be tempted to use it again.
7) when condensing with a spreader do not pull out the spreader until you have the GP cone measured and crimped and coated with sealer ready to stuff in the space. so you dont know the distance between your stop and cusp tip? estimate lah! make up your first 3 cones to working length. then estimate the shortening in length accordingly. once you hit mid-root, you may re-measure the length before you re-insert the spreader.
8) excessive vertical force may split a tooth weakened by a long soak in bleach. force should actually be directed laterally. use the length of the spreader and force it against the GP to compact it. and wipe your spreader after every withdrawal.
9) burn-off may be conducted a lot earlier than you think. speader depth of 3mm away from desired height is way enough. the GP will flow into the canal anyway and you can compact this with the cold pluggers to a very nice density.
10) 1 drop of eugenol is in fact adequate to do a whole damn molar even if thickly mixed, which is in fact the way. thick, but not lumpy. learn to mix neatly so as not to waste the eugenol. and collect the Roth on the spatula, then wipe off the whole glass slab before putting the eugenol back on. this makes it way easier to work with.
Clan BDS is in formation! the DotA brotherhood are considering changing nicks so as to reflect our profession. still considering what to call myself...
Blame It On My Youth - Jamie Cullum
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