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@@AhmadNouroloyouni I would wait 4-6 weeks… also you have to rule out healing by scarring as it may heal leaving a bumpy scar that can be confused for a persistent sinus tract. If you see a scar Confirm it has no opening and nothing is expressing out. 👍

@@AANasseh Thank you so much for your answer! I have a follow-up question: In one of your videos, I saw a resident performing microsurgery through the sinus tract. I'm wondering, do you recommend curettage through the sinus tract for persistent cases?

@@AhmadNouroloyouni Persistemt cases are different than what the resident was doing in that video, in which he was washing out and removing large overfill of sealer past the apex and into the lesion and through the sinus tract before the material had set (washing out through the sinus tract.) In persistent lesions/cases apico would be the better option than washing through the sinus tract. Otherwise, I generally don’t manipulate the sinus tract and let natural healing take place after conventional treatment/retreatment and then triage based on follow up. Cheers.

@@AANasseh Thank you so much for the comprehensive answer🙏🏻

My pleasure! Let me know if other specific topics can be helpful. :)

Also, yes I agree that achievements, awards, honors, and degrees aren't going to fill the hole in your soul if you have one. Neither will a partner, a house, or anything else.. that's an entirely different problem than one of financial success and status. That's something that requires perspective change, like you said, and also a ton of personal exploration-- finding one's place in the world again and feeling fulfilled day to day. Whether that's taking up a hobby that was ignored in favor of career advancement, joining a community simply for social connection etc etc. It differs from person to person. I think outside of that, though, solely looking at endodontics vs general dentistry and what either one can offer you.. Endodontists in the US can charge higher fees for treatments due to their specialty license, and they focus on RCTs, RC retreatments, and apical surgery, like you said-- doing the same thing over and over again. This might be intellectually "boring", but business wise it can prove extremely streamlined with lower overhead costs, less patients seen to produce the same amount as a general dentist doing the same procedures. And the narrower scope of practice may be a better fit for certain personalities who have a hard time juggling a plethora of patients all with different needs, treatment plans, etc. Of course, this is all from an outside perspective as a D3 who hasn't even practiced general dentistry yet. Just throwing my thoughts out there.

@@Alex-mt7vg True, like anything else, your best decision becomes clear only with introspection, after you’ve known yourself, your values and priorities, and what you want to do with the time that’s given to you on this earth! ;)

It's different lifestyles, partially based on practice base and the other is location you live. If you live in the US, endodontists and oral surgeons make similar income. LIfesyle of endodontists tends to be a little better and the practice is cleaner. Patients are, in general, more upscale than oral surgeons (Prefer to save their teeth rather than extract them!) I think you won't go wrong with either decision, it's a matter of what you prefer to do. I started dental school with the goal of becoming an oral surgeon like my Dad; but after my rotation I realized I didn't want to do another 6 years of school and was ready to get on with my life after a shorter residency. In retrospect I"m happy but you have to see what your main goals are in life and also speak to as many people as you can who share the same vision in their lives. There's no right or wrong, just different tastes or visions when it comes to this decision. Good luck! :)

That's a good question and has to do with where you finish. I just did an article review with Drs. Blitcher and Pryles that will be coming up in the next couple of weeks. It does address this exact issue based on the article about the role of patency, etc.

I have tried it already. I have to see some long term results before I'm comfortable sharing any feedback on it. Cheers.

Why would such thing happen? The immature tooth means there’s little to no contact with the walls (no torque on the file) and beyond the apex means there’s no proper working length. So, all these issues are preventable unless an old rusted file is used that breaks… which is also preventable. If it happens then just inform the patient and refer to a specialist to manage it. Will likely need close observation or surgery depending on the details of the case.

@@AANasseh irony is that file was brand new still this thing happened Thank you for your precious reply

Hello Dr.@AANasseh,I retrieved the file in this case

Thank you doctor for your quick valuable response

You should have asked him where did he/she get their endo certificate from? LOL! Of course, not all bioceramics are created equal and there's a lot of poor materials; but there are good ones that work and are time proven. Cheers!

I prefer occlusal plane perpendicular to the floor and use a scope. You can also use it almost parallel to the floor and try to use direct vision assisted by the mirror.

Thank you so much for your reply sir​@@AANasseh

File removal is not as easy as he makes it look. It's more of a magic show.

Not a silly question at all. You measure using a perio probe or something else to the orifice of the canals (or in the case of the post space to the point where you will insert the post) before you make the cut. So, just have to use the probe or even one of your files to measure up to the orifice of the canal. Maybe I'll make a video to show that. Thanks! :)

That’s a good point. Unless the dentist plans on staying a few years and will manage the situation if a problem arises then yes; it’s like a multi visit root canal. But if they are not planning for the long term, then it won’t be ethical to create a future liability for the owner without their consultation. Thank you for bringing up this topic. It’s a great point I did not address in the video!

@@AANasseh Im in my own private practice. And i never understand why someone would work in other way. Mybe the only point i have is that you have multiple specialist on one place and that is convenient for the patient. Maybe you can make video on that topic in future. Thank you.

If there is no probing and if the smile line is high, studies show less recession associated with Submarginal incision rather than a intrasulcular or Papilla incision. Also it’s easier to raise and then suture so it’s quicker.

Thank you Sir for the quick response. I have a question: I had a cyst removal some years ago, would it be possible that i can send you the images and you could give me feedback if the result is okay? I would pay for your feedback, of course.

@@Razoras123 But why do you need feedback on a cyst removal? It’s hard to evaluate from X-rays and images anyway. Don’t you think?

It would be nice to see the result reviewed by an expert, the suregon who did the work moved to another town unfortunately. It would help me tremendously.

Thanks! The ball burnisher is a great way to conpact the margins and the edges of the retrofilling. If it's too loose it can wash out and burnishing the edges can make the margins denser. Cheers! :)

Currently no plans for Brasseler itself to do that wih files. Sorry.

Thank you! 👍

@@AANasseh thank you sir . I got very much supports from your videos. Thank you for your kind and helpful video sir

Depends on the dentist and it also depends on the actual diagnosis. If it's technically possible then it's possible to do it. But have to understand the unknown outcome.

Personally, I don't value waivers like those. For example (in the US especially), patients have signed "X-ray refusal" forms to deny radiographs during routine checkups, then successfully sued the dentist later for dental issues that radiographs would have found. In court, the judge didn't care about the signed waiver, because "the dentist knew it was malpractice to skip the x-rays regardless of what the patient wanted." I can understand the hesitancy with adult pulpotomies right now; I've seen a handful of failed long-term adult pulpotomies, and zero successes. Hopefully more research shows predictable success like Dr Nasseh says here, which will help them become the standard of care.

These machine nag give YOU less radiation ( negligible ammount) but you now get MORE RADIATION from other sources you didn’t use to airports etc… IT ALL ADDS UP

Yes Dr. McSpadenn really helped explain this phenomenon the best. The current way people recommend the use of reciprocation is incorrect and it creates large amount of debris that's counterproductive to the cause of RCT. I've been working on ways to help address this issue. Stay tuned and I'm hoping to discuss at some point the way I think Reciprocation should be used to reduce its debris issue. Cheers and thanks for great point you brought up! : )

@@AANasseh Thank you so much for you answer ! I'm very big fan of all your videos and I learn a lot from them.

That's a great question and point.... only problem is what is the alternative if we abandon endodontic treatment? Wholesale extractions? Implants have a similar fate as root canals with periimplantitis.. so that's not a good option... Or maybe, for the time being, we shouldn't let perfect be the enemy of good enough? IDK... what do you think?

@@AANasseh not sure doctor, but occassionally having to extract teeth with good RCT is taxing my mind.

@@narad8165 I'm sure you are also extracting teeth with fillings and periodontal disease.... non of that is an indication for extraction instead of filling or periodontal treatment. All dentistry is postponing the inevitable and eventual tooth loss the same way all healthcare is postponing death! All we do as healthcare practitioners is allow more time.. Ultimately, all efforts are temporary attempts at slowing down the wheel of time. If we follow high standards and also do a good job at treatment planning and case selection, the majority of people can benefit from keeping their teeth longer and not go toothless too early in their lives. Meanwhile, it's important to educate our colleagues as to what makes up quality root canal therapy and best practices for successful outcomes. Keep at doing your best my friend. Cheers!

Difficult to say on the internet. It depends on what's the problem and who's the person trying to fix it. They can be saved in majority of cases but in some cases they still have to be removed if the infection is too much. It all depends on the skills and capability of the operator as well as your physical anatomical limitations and the kind of bacteria you've got going in that tooth. If you're super motivated to save the tooth try it and follow up to find out; if you're not, then remove it.

Yes it is! :)