I find that ESR CM system can be used for mostly anything and everything. I've been using ESR CM for almost 8-9 months now, and I perform a lot of endodontics in my office. I always open up each canal to a 10K file right up to the working length. On the extremely rare occasion where I feel the dentin is very hard I may open up to a 15k file, but I always go to my 30/.04 taper ESR CM file and take it to WL. If i feel the canal is wider I move on to 40/.04 and then 50/.04. It works incredibly well for me, and I never have any problems. The only time I have to use a different system is if the canal is extremely wide lets say an upper cental (#8 or#9), then I will go and use a size 60/70/80 endosequence file and finish with that. Perhaps the reason the system works so well for me is because I run my handpiece at 270 degrees cutting and 30 degrees non cutting. It's incredibly efficient, and cuts through dentin like butter. I swear by the ESR CM system.
Yes, the large ES files 60-80 are really helpful in those cases. You clearly are an advanced user and know what you’re doing. Keep up the great work! :)
Dr Nasseh, I see that you are using the apex stop function, where the apex locator stops the file when reaching apex. Id like to use it too, but the hypochlorite confuses the apex locator, making it think it is reaching the apex, when it is not. How do you troubleshoot this? Also what is your complete irrigarion protocol and how much time after instrumentation and before filling do you irrigate?
This is a good question and deserves its own video but the key is not to put too much NaClO in the tooth beyond the orifice of the canal. So, bleach in the canal but not beyond that! This is also why it's not a good idea to continuously instrument with the Apex function on since you really should have more irrigant in the canal than only in the canal. I'll make a video about this. Thanks!
Thank you for dispelling the single file myth. I find so many of the molars I get into require more advanced techniques which one file systems do not offer.
Yes, it's just a triumph of marketing over facts. We need to stand up to marketing hype and make sure people misinterpret marketing info for clinical advice. Minimum number is 2, maximum... the whole drawer of files in your operatory! LOL! But I think I do most of my cases in 2-5 rotary files and 1 or 2 hand files based on difficulty level. Cheers! :)
Thank you doctor for your infomative and educational videos. I do have a question. Why is it that after intrumenting to 40/04 or 30/04 the GP of the same size wont go down to the apex?
i have been using the ESR-CM system for a couple of months now, i love it. switched from wave one gold/guttacore. Sometimes, I do not have tug back with my master cones, does this happen to you? also, what brand CBCT are you using? the resolution is incredible.
Tug back is ok, and no tug back, to a certain extent, is ok too. But you have to confirm that a lack of tug back is not going to shoot the cone long! That's important! Some resistance form is needed. I use Morita's X800. It's a very good system.
My other question which I've seen you do a few times is when you use your master file to push the sealer down doesn't that introduce microbes that the file picked up when preparing the space back into the chamber? Do you think wiping the file is enough and will do the job prior to putting it back in the canal? I want to try this method, however, I've been reluctant to reuse the same file after disinfecting my canal. Hope that makes sense.
Sir I had one more question, why decay we saw in dental caries in coronal portion of tooth is not present in root canal or one can say why dental caries are not present in inside root canal?
That's a great question! The microbes that cause dental caries (S. Mutans, S. Sobrinus, and LA, are very aerobic and sucrose dependent. Therefore they can not exist too deep beyond the crown. This is the earliest form of microbial succession. This process continues even as we go deeper in the root canal as we select from facultative anaerobes to strict anaerobes. Good thinking on your part. That's an excellent question!!! : )
With more companies having flexible and heat treated files available, is there ever any indication to use standard/stiff rotary files? For instance the Endosequence vs the endosequence CM files? Are flexible rotary files almost always superior?
You can certainly do that. But most canals that are 50 in apical diameter are also greater taper than a 50/02. So, you'll need additional confirmation (accessory cones on the side). 50/04 seems to be a good size for these types of canals. Cheers!
I used a large volume of negative pressure at the end. In the early stages in this case there was little instrumentation. So, irrigaiton was limited. But we disinfected the tooth thoroughly with negative pressure of a high volume of disinfectant before obturation (was edited out). 👍
Hi doc only a question: using bc sealaer yuo have written ccw rotation: but does esr cm system work in cw rotation? Thanks a lot for sharing your cases and have a nice day.
Fabrizio, RSR CM cuts in CCW direction like ESR, WOG, and Reciproc. Therefore, in order to push sealer down, you need to use it in the reverse direction of its cutting, which would be a CW direction. I hope I didn't confuse people in the video. Thanks for the comment. :)
Thanks a lot, Doc.
I find that ESR CM system can be used for mostly anything and everything. I've been using ESR CM for almost 8-9 months now, and I perform a lot of endodontics in my office. I always open up each canal to a 10K file right up to the working length. On the extremely rare occasion where I feel the dentin is very hard I may open up to a 15k file, but I always go to my 30/.04 taper ESR CM file and take it to WL. If i feel the canal is wider I move on to 40/.04 and then 50/.04. It works incredibly well for me, and I never have any problems. The only time I have to use a different system is if the canal is extremely wide lets say an upper cental (#8 or#9), then I will go and use a size 60/70/80 endosequence file and finish with that. Perhaps the reason the system works so well for me is because I run my handpiece at 270 degrees cutting and 30 degrees non cutting. It's incredibly efficient, and cuts through dentin like butter. I swear by the ESR CM system.
Yes, the large ES files 60-80 are really helpful in those cases. You clearly are an advanced user and know what you’re doing. Keep up the great work! :)
Fantastisch. Very nice and helpful video for dental professional ,
Thanks a lot for such informative video!
Thank you sir excellent presentation sharing with us
Dr Nasseh, I see that you are using the apex stop function, where the apex locator stops the file when reaching apex. Id like to use it too, but the hypochlorite confuses the apex locator, making it think it is reaching the apex, when it is not. How do you troubleshoot this? Also what is your complete irrigarion protocol and how much time after instrumentation and before filling do you irrigate?
This is a good question and deserves its own video but the key is not to put too much NaClO in the tooth beyond the orifice of the canal. So, bleach in the canal but not beyond that! This is also why it's not a good idea to continuously instrument with the Apex function on since you really should have more irrigant in the canal than only in the canal. I'll make a video about this. Thanks!
Thank you for dispelling the single file myth. I find so many of the molars I get into require more advanced techniques which one file systems do not offer.
Yes, it's just a triumph of marketing over facts. We need to stand up to marketing hype and make sure people misinterpret marketing info for clinical advice. Minimum number is 2, maximum... the whole drawer of files in your operatory! LOL! But I think I do most of my cases in 2-5 rotary files and 1 or 2 hand files based on difficulty level. Cheers! :)
Thank you doctor for your infomative and educational videos. I do have a question. Why is it that after intrumenting to 40/04 or 30/04 the GP of the same size wont go down to the apex?
Sir,what brand is the Cone beam CT used ? Great image quality!!
i have been using the ESR-CM system for a couple of months now, i love it. switched from wave one gold/guttacore. Sometimes, I do not have tug back with my master cones, does this happen to you? also, what brand CBCT are you using? the resolution is incredible.
Tug back is ok, and no tug back, to a certain extent, is ok too. But you have to confirm that a lack of tug back is not going to shoot the cone long! That's important! Some resistance form is needed. I use Morita's X800. It's a very good system.
My other question which I've seen you do a few times is when you use your master file to push the sealer down doesn't that introduce microbes that the file picked up when preparing the space back into the chamber? Do you think wiping the file is enough and will do the job prior to putting it back in the canal? I want to try this method, however, I've been reluctant to reuse the same file after disinfecting my canal. Hope that makes sense.
I made a video about that a long time ago. I just put it in NaClO the same way I disinfect the GP cones.
Sir I had one more question, why decay we saw in dental caries in coronal portion of tooth is not present in root canal or one can say why dental caries are not present in inside root canal?
That's a great question! The microbes that cause dental caries (S. Mutans, S. Sobrinus, and LA, are very aerobic and sucrose dependent. Therefore they can not exist too deep beyond the crown. This is the earliest form of microbial succession. This process continues even as we go deeper in the root canal as we select from facultative anaerobes to strict anaerobes.
Good thinking on your part. That's an excellent question!!! : )
@@AANasseh Thanks Sir
With more companies having flexible and heat treated files available, is there ever any indication to use standard/stiff rotary files? For instance the Endosequence vs the endosequence CM files? Are flexible rotary files almost always superior?
Sir...,
Would it be more wiser to use 50.02 taper after 40.04 since the tooth material loss would be lesser when compared to 50.04 ?
You can certainly do that. But most canals that are 50 in apical diameter are also greater taper than a 50/02. So, you'll need additional confirmation (accessory cones on the side). 50/04 seems to be a good size for these types of canals. Cheers!
Sir very video... Sir I noticed in your videos u use very less amount of irrigant, can u elaborate it. Thanks
I used a large volume of negative pressure at the end. In the early stages in this case there was little instrumentation. So, irrigaiton was limited. But we disinfected the tooth thoroughly with negative pressure of a high volume of disinfectant before obturation (was edited out). 👍
Hi doc only a question: using bc sealaer yuo have written ccw rotation: but does esr cm system work in cw rotation? Thanks a lot for sharing your cases and have a nice day.
Fabrizio, RSR CM cuts in CCW direction like ESR, WOG, and Reciproc. Therefore, in order to push sealer down, you need to use it in the reverse direction of its cutting, which would be a CW direction. I hope I didn't confuse people in the video. Thanks for the comment. :)
Can we use endoactivator?
@@yogeshadling1126 I sometimes use it at the lowest power
@@yogeshadling1126 Yes.
@@AANasseh Boss! To push sealer apically: we use the CCW…right?