Hello dear doctor. Thanks for sharing your wisdom and knowledge. Please can you share the hole video of you doing the root canal in less then 30 min . I think it would be a great opportunity for me and my assitant to learn how to increase the efficiency of our work flow wich we really really strugguling with. Much appriciated dear doctor
Multi-visit all day!! I'm just a dental student so breaking it up into separate appointments makes my life a bit easier. I also prefer to take my time perfecting my access opening/straight-line access, and what a benefit it is to use calcium hydroxide between visits.
Thank you, Thank you so much sir for this beautiful and amazing explanation. This topic was so confused and I've probably watched dozens of videos on this topic but I was not coming to a reasonable conclusion but your explanation cleared all my doubts. Thank you.
Welcome Dr. Nasseh to Vietnam! I am dental student here and it's our pleasure to have you visited. I wonder if you would travel to other cities in the middle of Vietnam because I would love to meet you in person. I am really a fan of your enthusiasm in both dentistry and videography sir.
Thank you! It's very kind of you. I wish I could visit the rest of your beautiful country but I'm here in Ho Chi Min for just a few days and then off to Taipei. I had planned to speak at the university here but looks like it will need to happen next time. I'm definitely coming back however to visit the whole country and see the more exotic areas outside the big cities. Hopefully I'll meet you next time. :) Connect through Facebook on Insta and I will definitely announce in advance next time. Cheers!
Thank you for the video Dr. Ali it was very helpful! A follow up question to the video for you. How do you handle the case if a patient has a facial swelling? Would you finish the case in a single visit then if you could achieve all of the objectives of RCT? (assuming the patient could stay open and you could dry the canal). Would you do an I&D or prescribe antibiotics and bring the patient back once they are no longer swollen so the treatment could be done in a single visit? Curious to hear how you handle these cases. Thanks again for the great content! 👍
That's a great question.. probably should share it with others too but the only question with abscess cases is management in case of flareup afterwards. So, if no drainage, you have to assess the patient's ability to manage any potential post op flareups and your ability to I&D or manage the situation efficiently. If you have any questions, it would be prudent to not put yourself in a position where you'll have to answer to others who may question your judgement. Then just Ca(OH)2 and let the acute situation settle. I think for most people with less experience I would definitely recommend not filling in a single visit.... just to be on the safe side. Cheers!
Thank you Doc love your lectures Question is what is your opinion on intra-canal sterilization and heme control through the use of intra-canal fulguration/radio frequency use such as in the case of an electrosurgery unit.
Hi Dr Ali, If there’s a case where a traumatised tooth has gone necrotic and if you are having infective inflammatory external root resorption, would you still obturate in one visit ? Still a dental student and curious about this after traumatology lectures. Very thankful for your content!
Thta's a great question!!!! TBH.... I don't think we have clear evidence one way or another. Obviously, you'll have plenty of opinion from the "trauma experts!" But non of those opinions are substantiated by specific studies; however, considering the fact that it's an area where we don't have enough evidence, I would err on the side of safety and if inflammatory resorption has already set in, then I would try to control that first by Ca(OH)2 treatment and then proceed to obturate. Again, you'll have people with a lot of strong opinions on this topic but if you look deep enough, you'll find that most of the strong opinions are basically opinions.... but in a legally arbitrated society, opinions, especially expert opinions, whether scientific or not, count for something! So, better CYA and not take a chance! LOL!!!! But that's an excellent question!! :) 👍
Great video Dr. Nasseh. Just to clarify. If you have a case with an active fistula but you are able to clean and dry the canals, you do single visit right? :)
Yes. Provided all objectives have been achieved and the tooth is surgically accessible in case I was wrong in my assessment! (Meaning that I can do an apico if it doesn’t heal.)
Thank you Dr. basically dry root system means we can obturate. Is there any problem in with MTA (BCsealers) hardening if we have low Ph (inflamation) next to the sealer? Meaning even in asymptomatic cases its not predictable hardening so we need two visits with Caoh? I think the study was from 2010 to 2015 with MTA not sure.
Actually, no... a dry root canal doesn't mean you can fill... achieving all your objectives AND having a dry canal means you can fill.... don't forget about the rate limiting step being objectives, not a dry canal... just don't want this to be confused. Regarding your second point, some bioceramics are more susceptible to low pH. Actually, the new AHPlus BC is very susceptible to low pH considering the fact that they use PVA and PVP as their water soluble matrix for setting.... so, it's a good point to consider! There isn't much research in this area at the present time but you can make a good point, simply by logic and inference, that some of the highly inflamed and possibly low pH environment areas may not be ideal for "Some" formulations of bioceramics to work. This could be a good test for various biovermics to see which fares better in low pH environments. 👍
I practice the same. I will consider two appointments for retreatments of teeth where apical surgery might be challenging or risky due to depth from the cortical plate, proximity to antral sinus or the IA nerve. I’d rather give the tooth that extra exposure to calcium hydroxide to help address the complexities not negotiable with instrumentation. I’m peanut butter and jelly about your international speaking schedule. If you need an extra hand in filming, I’m happy to hide in your carry on luggage :)
very good! Have the end in min, consider the risk of managing complications, consider your skill to achieve all standards within the time allowed, and whenever possible, do it in one step as a service to the patient. 👍
Good question... first, about perforations, the time to repair is a critical factor... so, why wait? That's actually when you have to repair definitively as soon as possible. Resorption cases it depends if it's internal or external and whether you have enough means to touch those areas... say a 3D instrument? But again... anytime you're in doubt whether you have achieved your objectives then just place Ca(OH)2 and reappoint. :) Cheers!
Thank you doc very helpful lecture Question what is your opinion and/or are you familiar with intracanal sterilization and Heme control through the use of intracanal radiofrequency use? Such as in the case of electrosurgery cauterization?
It's a funny coincidence but I'm actually supposed to be testing that over the coming 3 months. I'll probably make a video of my results over the six months on it.
If a tooth is not known to have a vertical root fracture, what signs and symptoms will be present during the cleaning, shaping and obturation process that suggest a vertical root fracture? Thank you.
That's only clear if it's visually confirmed. Otherwise, there are many situations and infection that can mimic similar type of bone loss; but generally, deep probing to the apex, gingival sinus tracts, and narrow bone loss on CBCT have been associated with a higher "likelihood" of a fracture rather than a guarantee. There's an element of risk in all we do and we'll just have to be ablate communicate this to our patients.
@@thuvan9607 There's no accuracy there at all. No study to support that claim. I would not rely on EAL to detect VLF. Works well for Perforations but not for VLF. It can be lateral canals or other resorptive defects triggering the EAL and you wouldn't know since you can't see it. You can not distinguish by an apex locator.
Depends on the location. If near vital structures it can be a problem. Also depends on the type of cement. It’s best to manage the cement inside the canal.
Sir I m doing a multiple visit Root canal, calcium hydroxide was placed in between the visit but pt Began to feel pain after a week. Earlier it was fine. What may be wrong? Chandra Mauli from India
Could be a number of reasons. It's hard to know; but missing canals, or inadequate cleaning is one possibility. Also, everyone has different reactions. Usually if all the canals have been found and negotiated to the apex then you fill and watch. There should be no pain 4 weeks after the RCT.
Please don't forget to Like the video if you found it helpful; also, please post questions in comment section for future videos. Cheers! :)
Hello dear doctor. Thanks for sharing your wisdom and knowledge. Please can you share the hole video of you doing the root canal in less then 30 min . I think it would be a great opportunity for me and my assitant to learn how to increase the efficiency of our work flow wich we really really strugguling with. Much appriciated dear doctor
Multi-visit all day!!
I'm just a dental student so breaking it up into separate appointments makes my life a bit easier. I also prefer to take my time perfecting my access opening/straight-line access, and what a benefit it is to use calcium hydroxide between visits.
Welcome to TAIWAN, Dr.Nasseh!
Thanks Dr. NASSER
Wow, beautiful cinematic content! Thank you!
Thank you, Thank you so much sir for this beautiful and amazing explanation. This topic was so confused and I've probably watched dozens of videos on this topic but I was not coming to a reasonable conclusion but your explanation cleared all my doubts. Thank you.
Спасибо. 😊 Thanks a lot.
so beautiful radiograph !!!!
Agree 100%. Thanks for your sharing!
Welcome to Vietnam! Hope I have chance to see you in Hanoi 🤗
Hope so in the future! :)
Welcome doctor to Vietnam.
A small country but with many interesting and hospitable things.
And lovely people... I've been super-impressed by how kind everyone is! :)
Welcome Dr. Nasseh to Vietnam! I am dental student here and it's our pleasure to have you visited. I wonder if you would travel to other cities in the middle of Vietnam because I would love to meet you in person. I am really a fan of your enthusiasm in both dentistry and videography sir.
Thank you! It's very kind of you. I wish I could visit the rest of your beautiful country but I'm here in Ho Chi Min for just a few days and then off to Taipei. I had planned to speak at the university here but looks like it will need to happen next time. I'm definitely coming back however to visit the whole country and see the more exotic areas outside the big cities. Hopefully I'll meet you next time. :) Connect through Facebook on Insta and I will definitely announce in advance next time. Cheers!
@@AANasseh Thank you sir. I am looking forward to your next visit
As always, the video and music are amazing👍.
It remains visit India, China and Russia then RWE will be international.
Thanks Valad. Only Russia and China are remaining. I"ve already done India 👍: czcams.com/video/3fBaIGEsHGw/video.html
Thank you for the video Dr. Ali it was very helpful! A follow up question to the video for you. How do you handle the case if a patient has a facial swelling? Would you finish the case in a single visit then if you could achieve all of the objectives of RCT? (assuming the patient could stay open and you could dry the canal). Would you do an I&D or prescribe antibiotics and bring the patient back once they are no longer swollen so the treatment could be done in a single visit? Curious to hear how you handle these cases. Thanks again for the great content! 👍
That's a great question.. probably should share it with others too but the only question with abscess cases is management in case of flareup afterwards. So, if no drainage, you have to assess the patient's ability to manage any potential post op flareups and your ability to I&D or manage the situation efficiently. If you have any questions, it would be prudent to not put yourself in a position where you'll have to answer to others who may question your judgement. Then just Ca(OH)2 and let the acute situation settle. I think for most people with less experience I would definitely recommend not filling in a single visit.... just to be on the safe side. Cheers!
Thank you Doc love your lectures
Question is what is your opinion on intra-canal sterilization and heme control through the use of intra-canal fulguration/radio frequency use such as in the case of an electrosurgery unit.
Hi Dr Ali, If there’s a case where a traumatised tooth has gone necrotic and if you are having infective inflammatory external root resorption, would you still obturate in one visit ? Still a dental student and curious about this after traumatology lectures. Very thankful for your content!
Thta's a great question!!!! TBH.... I don't think we have clear evidence one way or another. Obviously, you'll have plenty of opinion from the "trauma experts!" But non of those opinions are substantiated by specific studies; however, considering the fact that it's an area where we don't have enough evidence, I would err on the side of safety and if inflammatory resorption has already set in, then I would try to control that first by Ca(OH)2 treatment and then proceed to obturate. Again, you'll have people with a lot of strong opinions on this topic but if you look deep enough, you'll find that most of the strong opinions are basically opinions.... but in a legally arbitrated society, opinions, especially expert opinions, whether scientific or not, count for something! So, better CYA and not take a chance! LOL!!!! But that's an excellent question!! :) 👍
In generally sir how long you put Ca(OH) inside the canals?
Great video Dr. Nasseh.
Just to clarify. If you have a case with an active fistula but you are able to clean and dry the canals, you do single visit right? :)
Yes. Provided all objectives have been achieved and the tooth is surgically accessible in case I was wrong in my assessment! (Meaning that I can do an apico if it doesn’t heal.)
Thank you Dr. basically dry root system means we can obturate. Is there any problem in with MTA (BCsealers) hardening if we have low Ph (inflamation) next to the sealer? Meaning even in asymptomatic cases its not predictable hardening so we need two visits with Caoh? I think the study was from 2010 to 2015 with MTA not sure.
Actually, no... a dry root canal doesn't mean you can fill... achieving all your objectives AND having a dry canal means you can fill.... don't forget about the rate limiting step being objectives, not a dry canal... just don't want this to be confused. Regarding your second point, some bioceramics are more susceptible to low pH. Actually, the new AHPlus BC is very susceptible to low pH considering the fact that they use PVA and PVP as their water soluble matrix for setting.... so, it's a good point to consider! There isn't much research in this area at the present time but you can make a good point, simply by logic and inference, that some of the highly inflamed and possibly low pH environment areas may not be ideal for "Some" formulations of bioceramics to work. This could be a good test for various biovermics to see which fares better in low pH environments. 👍
Thank you Dr.@@AANasseh
Thanks Dr Ali, very informative.
What are your thoughts on letting the tooth open for drainage?
If you have to do it you can but no more than 24hrs as you will colonize new, and potentially more difficult microorganisms in there.
I practice the same. I will consider two appointments for retreatments of teeth where apical surgery might be challenging or risky due to depth from the cortical plate, proximity to antral sinus or the IA nerve. I’d rather give the tooth that extra exposure to calcium hydroxide to help address the complexities not negotiable with instrumentation. I’m peanut butter and jelly about your international speaking schedule. If you need an extra hand in filming, I’m happy to hide in your carry on luggage :)
very good! Have the end in min, consider the risk of managing complications, consider your skill to achieve all standards within the time allowed, and whenever possible, do it in one step as a service to the patient. 👍
In that case, can I also obturate some canals ahead of the rest in multirooted tooth if I think I’ve cleaned and shaped the easy canals?
Of course. You can treated a four canal molar as four central incisors.
Dr. What about cases of resorption , old existing perforations?
Good question... first, about perforations, the time to repair is a critical factor... so, why wait? That's actually when you have to repair definitively as soon as possible. Resorption cases it depends if it's internal or external and whether you have enough means to touch those areas... say a 3D instrument? But again... anytime you're in doubt whether you have achieved your objectives then just place Ca(OH)2 and reappoint. :) Cheers!
Thank you doc very helpful lecture
Question what is your opinion and/or are you familiar with intracanal sterilization and Heme control through the use of intracanal radiofrequency use? Such as in the case of electrosurgery cauterization?
It's a funny coincidence but I'm actually supposed to be testing that over the coming 3 months. I'll probably make a video of my results over the six months on it.
let me know if you need help I’ve done it for an long time
@@diegoospina4086 Ok. Please DM me on one of the social media so I can share emails and get your feedback on your experiences with RF. Cheers!
If a tooth is not known to have a vertical root fracture, what signs and symptoms will be present during the cleaning, shaping and obturation process that suggest a vertical root fracture? Thank you.
That's only clear if it's visually confirmed. Otherwise, there are many situations and infection that can mimic similar type of bone loss; but generally, deep probing to the apex, gingival sinus tracts, and narrow bone loss on CBCT have been associated with a higher "likelihood" of a fracture rather than a guarantee. There's an element of risk in all we do and we'll just have to be ablate communicate this to our patients.
@@AANasseh Accuracy of electronic apex locators in detecting horizontal and vertical root fractures? Thank you so much.
@@thuvan9607 There's no accuracy there at all. No study to support that claim. I would not rely on EAL to detect VLF. Works well for Perforations but not for VLF. It can be lateral canals or other resorptive defects triggering the EAL and you wouldn't know since you can't see it. You can not distinguish by an apex locator.
CaoH dressing not give in resorption case…
Hi sir,
What happened if you accidentally flush ca(oh) beyond apex! Is that something that I should worry about?
Depends on the location. If near vital structures it can be a problem. Also depends on the type of cement. It’s best to manage the cement inside the canal.
thanks@@AANasseh
Sir I m doing a multiple visit Root canal, calcium hydroxide was placed in between the visit but pt Began to feel pain after a week. Earlier it was fine. What may be wrong?
Chandra Mauli from India
Could be a number of reasons. It's hard to know; but missing canals, or inadequate cleaning is one possibility. Also, everyone has different reactions. Usually if all the canals have been found and negotiated to the apex then you fill and watch. There should be no pain 4 weeks after the RCT.
@@AANasseh Sir thank you so much for the reply.