Thank you for sharing this. I had just attended Dr Terauchi class regarding broken files retrieval. It might be slightly invasive if didn't follow the protocol correctly.
Thank you for sharing your take on this topic Dr. Nasseh If a rotary separates in a necrotic canal with a periapical lesion, before any meaningful cleaning has taken place in the apical region, is it a foregone conclusion that the periapical tissues will not heal? Or is it possible cleaning the canal coronal to the separated file is enough to lower the overall bacterial load in the canal such that periapical healing can still occur?
Great question. Clearly it’s worse prognosis than otherwise, but it’s not a forgone conclusion. I should make a separate video for your great question. But the short answer is it depends! How much space around the file and can you get enough disinfectant down there as well as some additional factors I’ll try to respond to it. :)
Dr. Nasseh, do you by any chance have a link to the FDA article or release where they recommend endo rotary files being used only once? I tried to google it but couldn't find anything... Thank you!
I have adopted the single use microscope protocol JK! great content and great video edition. It is so true, the fact that the reason for the separation determines in a great way the difficulty in retrieving the broken file. For me, when this happens the goal is to bypass and most of the time the broken file comes out by its own during the rest of the treatment.
Lol! Yeah.. removing coronal their broken instruments is easy… as it goes to the middle and apical third and around the curve you reach the point of diminishing returns. It’s important to pick the right choice for the right situation. What percentage of apically fractured files would you say you bypass? Are these files broken by yourself or others? My assumption is that if you break a file it’s invariably because of torque and not cyclic fatigue (tough canal and not file overuse) … but others break it it’s likely cyclic fatigue rather than torque (non endodontists overuse files too much whereas most endodontists use them single or max twice.)
@@AANasseh The likelihood of me successfully bypassing apically fractured files is probably under 50%, with the majority of these cases being referrals from other dentists for retreatment. In situations where the canal is not excessively curved, bypassing these isntruments tends to be relatively straightforward. I prefer using TFA files (Kerr) due to their triangular cross-section, which is easy to bypass. My decision-making process is influenced by an algorithm developed by Dr. Michael Solomonov, available on the AAE website, and a memorable piece of advice from one of your earlier videos that has stayed with me: "if you can't see the broken instrument, don't attempt to remove it." Moreover, I've noticed a relatively high occurrence of inadvertently removing the file during ultrasonic activation, but this primarily happens in cases where I was the one who broke the file, likely because it wasn't firmly lodged in the dentin.
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.
Now that I'm older I'm working more relaxed and have slowed down. I now work only about 6 hours a day and do about 5 to 6 fills/day and 8-10 consults and follow ups.. But when I was younger it was sometimes twice as much. Cheers.
@@molaartje 95% of my cases are done within 60minutes. I time every case. We potentially schedule 90minutes but it's because I'm doing consults and follow ups on the side. The procedures is always times form the first shot to the end and that's on the average 45min for a molar. I used to be faster but in my old age I'm slowing down to smell the roses! 😉
Hi doc, Thank you so much for covering an anxious topic for more no of dentists. What magnification of loupes do you suggest for file retrieval of apical 3rd particularly? Can you through some light upon usage of silicon oil suggested by Dr Teruchi for file retrievals,Is it safe to use?
@@gnyaniprasad291 Don’t waste your time trying to remove Apically separated files. It’s awfully unpredictable at best and actually destructive to the tooth and the patient at worst, especially if you’re thinking of just using loops instead of a microscope. I don’t know how you can even begin to removing apically positioned broken instruments using loops alone. I think a minimum of 10-20X magnification is needed deep in the canal with specially strong lights. Loops won’t cut it in a predictable manner. Cheers.
Hello! Came here after watching Ash video from all things dentistry. Ash says Hi!👋
Ash is awesome! Thanks for visiting!
Not all heroes wear capes, Dr. Nasseh! See you in LA!
Thank you Doctor!
Very helpful content! Appreciated.
All things dentistry made me aware of this video
Always a pleasure
Thank you for sharing this. I had just attended Dr Terauchi class regarding broken files retrieval. It might be slightly invasive if didn't follow the protocol correctly.
File removal is not as easy as he makes it look. It's more of a magic show.
Invaluable as always, dr. Ali!
I noticed you changed the name of your channel! Happy new year and good luck with your new endeavours!
Thank you Michal. Exciting changes on the way next year. Cheers!
Thanks!
Thanks! :)
Thank you for sharing your take on this topic Dr. Nasseh
If a rotary separates in a necrotic canal with a periapical lesion, before any meaningful cleaning has taken place in the apical region, is it a foregone conclusion that the periapical tissues will not heal? Or is it possible cleaning the canal coronal to the separated file is enough to lower the overall bacterial load in the canal such that periapical healing can still occur?
Great question. Clearly it’s worse prognosis than otherwise, but it’s not a forgone conclusion. I should make a separate video for your great question. But the short answer is it depends! How much space around the file and can you get enough disinfectant down there as well as some additional factors I’ll try to respond to it. :)
Dr. Nasseh, do you by any chance have a link to the FDA article or release where they recommend endo rotary files being used only once? I tried to google it but couldn't find anything... Thank you!
I have adopted the single use microscope protocol JK! great content and great video edition. It is so true, the fact that the reason for the separation determines in a great way the difficulty in retrieving the broken file. For me, when this happens the goal is to bypass and most of the time the broken file comes out by its own during the rest of the treatment.
Lol! Yeah.. removing coronal their broken instruments is easy… as it goes to the middle and apical third and around the curve you reach the point of diminishing returns. It’s important to pick the right choice for the right situation. What percentage of apically fractured files would you say you bypass? Are these files broken by yourself or others? My assumption is that if you break a file it’s invariably because of torque and not cyclic fatigue (tough canal and not file overuse) … but others break it it’s likely cyclic fatigue rather than torque (non endodontists overuse files too much whereas most endodontists use them single or max twice.)
@@AANasseh The likelihood of me successfully bypassing apically fractured files is probably under 50%, with the majority of these cases being referrals from other dentists for retreatment. In situations where the canal is not excessively curved, bypassing these isntruments tends to be relatively straightforward. I prefer using TFA files (Kerr) due to their triangular cross-section, which is easy to bypass. My decision-making process is influenced by an algorithm developed by Dr. Michael Solomonov, available on the AAE website, and a memorable piece of advice from one of your earlier videos that has stayed with me: "if you can't see the broken instrument, don't attempt to remove it." Moreover, I've noticed a relatively high occurrence of inadvertently removing the file during ultrasonic activation, but this primarily happens in cases where I was the one who broke the file, likely because it wasn't firmly lodged in the dentin.
Как всегда актуально, спасибо.
Hey doc,what about if file breaks in immature root apex beyond open apex
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
Sir in sigle day how many rct u done ?? Just for query ...
Now that I'm older I'm working more relaxed and have slowed down. I now work only about 6 hours a day and do about 5 to 6 fills/day and 8-10 consults and follow ups.. But when I was younger it was sometimes twice as much. Cheers.
Hi Ali, how long do you plan for a standard 4 canal revision treatment? I usually plan 90-120 minutes. gr, @@AANasseh
@@molaartje 95% of my cases are done within 60minutes. I time every case. We potentially schedule 90minutes but it's because I'm doing consults and follow ups on the side. The procedures is always times form the first shot to the end and that's on the average 45min for a molar. I used to be faster but in my old age I'm slowing down to smell the roses! 😉
Hi doc,
Thank you so much for covering an anxious topic for more no of dentists.
What magnification of loupes do you suggest for file retrieval of apical 3rd particularly?
Can you through some light upon usage of silicon oil suggested by Dr Teruchi for file retrievals,Is it safe to use?
@@gnyaniprasad291 Don’t waste your time trying to remove Apically separated files. It’s awfully unpredictable at best and actually destructive to the tooth and the patient at worst, especially if you’re thinking of just using loops instead of a microscope. I don’t know how you can even begin to removing apically positioned broken instruments using loops alone. I think a minimum of 10-20X magnification is needed deep in the canal with specially strong lights. Loops won’t cut it in a predictable manner. Cheers.
It looks like a AI generated video
😂 I can assure you I’m real!! 😂
You are certainly not old, what is age anyway? , just a number. I know endo specialists working in their 70's
Absolutely. Dentists of all types are like diesel engines, just getting broken in at 200,000 miles! You still have 35 clinical years left!!