Indeed apical gauging is best worked out from the plethora of knowledge guided by your own intuitive abilities.Talking of intuition I request Dr Ali to make another video of its role in the sphere of clinical practice cutting across all specializations. Loved the woods,synonyms to preserving the natural anatomy of apical third.
Hello doctor, I admire your interesting subject. An answer to the question: "How much do we need to prepare apically for proper sealing?" - I think the answer is we need to approximate. I consider that we do not yet have the necessary equipment to know for sure what the optimal diameter is. On the other hand, we must not eliminate the biological part of the problem. We know that the diameter of the apex has a different value than the apical constriction. We also know that the shape of the apex may be different from that of the circle (the shape that those who make during the preparation in the ideal case - I do not mean now in particular cases). There are studies that show electron microscopy the differences between the diameter of the needle and the apex. What we need to understand is that the endodontic system is very different from one channel to another and from one person to another. I did not find studies to show what apical constriction is like. I mean the shape, whether it is close to a circle or not - because the ones we use in the canal treatment leave this shape. The initial diagnosis matters. If it is a pulpit, we should stop at the level of constriction (0.5 mm from the apex); if it is an apical periodontitis, then we must reach 0.0. Because the endodontic system is like a cave (it narrows, it can widen, it can have isthmuses, etc.) irrigation is what helps us eliminate bacteria, pulp debris, the irrigation system that offers us advantages is with negative pressure. Let's not forget that whatever needle system we use, we only manage to reach approximately 40% of the surface of the endodontic system. In order to clean the remaining 60% as well as possible, the irrigation must be done as well as possible, and the ultrasonic activation helps us again. There is no perfect "recipe" for endodontic treatment, we adapt depending on the diagnosis and how the endodontic system is after a radiographic evaluation or CBCT. In conclusion: the diagnosis of the isolation with the dam - the shape of the canal and its instrumentation - the way we irrigate and the irrigators used - the sealing, all these matter little by little at the final result. That's about it .... I wish you success in the activity and let's hear from you soon
After achieving apical gauging, would you down pack the master cone at length or at a distance short to prevent extrusion during heated down packing. Ive seen it both ways: to length and shorter. What is your opinion/preference? Thank you. Really enjoying the videos.
I'm one of your old followers, learned (& still learning) a lot of endodontics from you, and I'm very thankful to you 🙏🏻 I just wanted to say : WOW, amazing video and I liked the cinematic editing 👌🏻 Just wow ..
Great content! Making sure I understand here, is the taper pretty much what determines the apical preparation shape? As in .04 taper is going to be more "Washington monument" in nature while a .07 taper is going to be more "conical" in shape?
Greater tapers are designed for vertical condensation yes. But here the argument is over apical diameter. The problem is if you try to have a larger apical diameter with greater taper then you end up destroying the tooth coronally. Some manufacturers make variable taper files to address this; but that's not as easy to obturate as constant taper. Essentially, having a smaller taper but larger apical diameter can theoretically clean the apex (where it matters most) better. Hope this makes sense. Cheers!
Hello Dr. Nasseh....Thank you for this great video and helpful information I'm a new GP and lately familiarized with this concept and was wondering if I can ask you a couple of questions. 1. Should the "2-3mm short from apex" protocol" be used for small canals after they're enlarged to the size of the expeditor? 2. Can protaper rotary instruments be used to gauge apex with the "2-3mm short from apex" protocol too? 3. If one is utilizing the conventional step-back technique, will apical gauging still be required? If so, how would it be? Many thanks
Good questions here. So, here we go Amir with my best estimation of answers: 1. You can certainly use them in small canals too. But most small canals end up being adequately enlarged to a size 30 or 35/04 size. But if you continue to see tissue in the file flutes it means the canal is larger. But gauging is a smaller size file (even a 02 taper NiTi hand file) may be helpful in those canals. 2. ProTaper uses progressive tapers and is not standardized. So, I'm not sure if this system really applies to ProTaper the same way. 3. You can certainly apply it to step back. but since you don't create your taper until later (after apical preparation) it's hard to know whether your files are binding at the tip or on the taper part of the file. So, it works generally better after taper has been crated. to refinish the apical size. Cheers! :)
Good question. Even if there's no biofilm, leaving devitalized tissue can act as substrate for infection of that tissue that can, in tern, cause failure. Even in the most aseptic conditions tissue can get infected, this is why removal of all tissue, or as much as practical, from the canal is important for long term success and why vital cases should also be cleaned out like non-vital cases. There, the game is total tissue volume reduction. Cheers!
@@AANassehSo if I reach full working lenght of 15 mm (for example) the cannal is super straight, I instrument it to ISO 25 and I am able to put the cannula with hypochlorite to 14mm without problem, is ISO 25 enough? Or do i need to increase the apical size in this case?
During my residency (US school), a certain company wanted my coresidents to sign an NDA prior to allowing research on their “proprietary equipment used for cleaning.” I don’t get how we will ever get good research on 🌊
@Antonio Diaz what do you think about the EdgeFiles that are “equivalent to” “better than” copy endo files of 🌊 ☝🏻 ? To me the evidence for their files also seems hyped 🤷🏻♂️
So if we have a chance to disinfect chemicaly with smaller preparations via 2 visits, why should we ever prepare more to do the case faster ( in 1 visit) ?
I don’t know about your patients but 99% of mine prefer to do the whole thing in one visit if we have the same success rate. Two visit has not shown a definitive increase in success; therefore, one visit can be successful as long as people understand what’s at stake and how it can work.
@@zDavidkAz I think you mean the opposite of what you wrote... a conservative prep conserves dentin. I think you mean a large traditional prep. In fact, we don't have any scientific evidence that shows preps of 0.02-0.06% have higher or lower clinical chance of failure. We do know that beyond a 0.06% there's weakening of dentin; but not 0,06 and below. So, at sizes we're talking about there's no significant difference in strength.
@@zDavidkAz You have to gauge canals. any standard size (35/04) is irrelevant unless you know what size your actual canal is. You can't instrument a size 70 canal to a 35/04.
the background video shots and the music could make for a cute indie movie, I'm starting to believe Dr Allen has a cinematography degree!
I love to see you complicating things, great video 👏👏
LOL! Good description!
Ha ha...good one
Another great video, thanks for sharing your knowledge!
Indeed apical gauging is best worked out from the plethora of knowledge guided by your own intuitive abilities.Talking of intuition I request Dr Ali to make another video of its role in the sphere of clinical practice cutting across all specializations.
Loved the woods,synonyms to preserving the natural anatomy of apical third.
Thank you for these video I'm new GP dentist and your video in endo very halpful and halp my skill in endo improve
Mind blowing info thanks dear master 🌹
so the master file is gonna be a larger K file with 2% taper at 1mm from the apex ?
Hello doctor, I admire your interesting subject. An answer to the question: "How much do we need to prepare apically for proper sealing?" - I think the answer is we need to approximate. I consider that we do not yet have the necessary equipment to know for sure what the optimal diameter is. On the other hand, we must not eliminate the biological part of the problem. We know that the diameter of the apex has a different value than the apical constriction. We also know that the shape of the apex may be different from that of the circle (the shape that those who make during the preparation in the ideal case - I do not mean now in particular cases). There are studies that show electron microscopy the differences between the diameter of the needle and the apex. What we need to understand is that the endodontic system is very different from one channel to another and from one person to another. I did not find studies to show what apical constriction is like. I mean the shape, whether it is close to a circle or not - because the ones we use in the canal treatment leave this shape. The initial diagnosis matters. If it is a pulpit, we should stop at the level of constriction (0.5 mm from the apex); if it is an apical periodontitis, then we must reach 0.0. Because the endodontic system is like a cave (it narrows, it can widen, it can have isthmuses, etc.) irrigation is what helps us eliminate bacteria, pulp debris, the irrigation system that offers us advantages is with negative pressure. Let's not forget that whatever needle system we use, we only manage to reach approximately 40% of the surface of the endodontic system. In order to clean the remaining 60% as well as possible, the irrigation must be done as well as possible, and the ultrasonic activation helps us again. There is no perfect "recipe" for endodontic treatment, we adapt depending on the diagnosis and how the endodontic system is after a radiographic evaluation or CBCT.
In conclusion: the diagnosis of the isolation with the dam - the shape of the canal and its instrumentation - the way we irrigate and the irrigators used - the sealing, all these matter little by little at the final result.
That's about it .... I wish you success in the activity and let's hear from you soon
After achieving apical gauging, would you down pack the master cone at length or at a distance short to prevent extrusion during heated down packing. Ive seen it both ways: to length and shorter. What is your opinion/preference? Thank you. Really enjoying the videos.
Sir I am great fan of your videos please go on to instrument fracture in canal.
So lovely
So beautiful video
I'm one of your old followers, learned (& still learning) a lot of endodontics from you, and I'm very thankful to you 🙏🏻
I just wanted to say : WOW, amazing video and I liked the cinematic editing 👌🏻
Just wow ..
Спасибо. Познавательно.
Great content! Making sure I understand here, is the taper pretty much what determines the apical preparation shape? As in .04 taper is going to be more "Washington monument" in nature while a .07 taper is going to be more "conical" in shape?
Greater tapers are designed for vertical condensation yes. But here the argument is over apical diameter. The problem is if you try to have a larger apical diameter with greater taper then you end up destroying the tooth coronally. Some manufacturers make variable taper files to address this; but that's not as easy to obturate as constant taper. Essentially, having a smaller taper but larger apical diameter can theoretically clean the apex (where it matters most) better. Hope this makes sense. Cheers!
@@AANasseh That makes perfect sense! Thank you so much!
Ur incredible
hi doctor my question is why did you recommend the use of CAOH in case of schildre school and how we apply it pls i need some guidlines
Hello Dr. Nasseh....Thank you for this great video and helpful information
I'm a new GP and lately familiarized with this concept and was wondering if I can ask you a couple of questions.
1. Should the "2-3mm short from apex" protocol" be used for small canals after they're enlarged to the size of the expeditor?
2. Can protaper rotary instruments be used to gauge apex with the "2-3mm short from apex" protocol too?
3. If one is utilizing the conventional step-back technique, will apical gauging still be required? If so, how would it be?
Many thanks
Good questions here. So, here we go Amir with my best estimation of answers:
1. You can certainly use them in small canals too. But most small canals end up being adequately enlarged to a size 30 or 35/04 size. But if you continue to see tissue in the file flutes it means the canal is larger. But gauging is a smaller size file (even a 02 taper NiTi hand file) may be helpful in those canals.
2. ProTaper uses progressive tapers and is not standardized. So, I'm not sure if this system really applies to ProTaper the same way.
3. You can certainly apply it to step back. but since you don't create your taper until later (after apical preparation) it's hard to know whether your files are binding at the tip or on the taper part of the file. So, it works generally better after taper has been crated. to refinish the apical size.
Cheers! :)
@@AANasseh Thanks again Dr. Nasseh for taking the time and answering my questions.
Best
Just been watching your video with your son 7 years ago before they installed the CBCT and now this....HAHA..God has kept you for this generation...
For eg..if we prepare the anterior tooth's canal upto 25 k file with taper 0.2%..what will be the consequence of preparing the canal in this manner?
Sir..to what size apical preparation needed to be done in anterior tooth?
👍👍👍
What if there is no biofilm? Fo example pulpitis or tooth devitalisation for prosthetic? Does apical size matter?
Good question. Even if there's no biofilm, leaving devitalized tissue can act as substrate for infection of that tissue that can, in tern, cause failure. Even in the most aseptic conditions tissue can get infected, this is why removal of all tissue, or as much as practical, from the canal is important for long term success and why vital cases should also be cleaned out like non-vital cases. There, the game is total tissue volume reduction. Cheers!
@@AANassehSo if I reach full working lenght of 15 mm (for example) the cannal is super straight, I instrument it to ISO 25 and I am able to put the cannula with hypochlorite to 14mm without problem, is ISO 25 enough? Or do i need to increase the apical size in this case?
During my residency (US school), a certain company wanted my coresidents to sign an NDA prior to allowing research on their “proprietary equipment used for cleaning.” I don’t get how we will ever get good research on 🌊
I agree. It’s egregious that the scientific process is corrupted by corporate interest at an institution of higher learning.
@Antonio Diaz was this a company that makes 🌊 ☝🏻?
@Antonio Diaz what do you think about the EdgeFiles that are “equivalent to” “better than” copy endo files of 🌊 ☝🏻 ? To me the evidence for their files also seems hyped 🤷🏻♂️
So if we have a chance to disinfect chemicaly with smaller preparations via 2 visits, why should we ever prepare more to do the case faster ( in 1 visit) ?
I don’t know about your patients but 99% of mine prefer to do the whole thing in one visit if we have the same success rate. Two visit has not shown a definitive increase in success; therefore, one visit can be successful as long as people understand what’s at stake and how it can work.
@@AANasseh thank you, for the answer, but wouldn't conservative preps make teeth more prone to VRF in long term?
@@zDavidkAz I think you mean the opposite of what you wrote... a conservative prep conserves dentin. I think you mean a large traditional prep. In fact, we don't have any scientific evidence that shows preps of 0.02-0.06% have higher or lower clinical chance of failure. We do know that beyond a 0.06% there's weakening of dentin; but not 0,06 and below. So, at sizes we're talking about there's no significant difference in strength.
@@AANasseh mostly i mean why should we prepare any canal larger than 35/04 , when we can use CaOh and scraping instruments ?
@@zDavidkAz You have to gauge canals. any standard size (35/04) is irrelevant unless you know what size your actual canal is. You can't instrument a size 70 canal to a 35/04.