This subject indeed can be given another shot academically .From clinical point just to add air lock while filling up pulp chamber post endo fill or acute response to a sealer can be considered.
Doctor what are your thoughts on Intracanal medicaments, such as calcium hydroxide? can it also help to reduce flair ups and pain, by placing it a week before obturating the canal? I saw a case where immediate obturation lead to postoperative pain, where i believed if the canal was obturated on a later date it wouldn't have lead to postope pain. Thanks for the great content
Hello dr. Ali, I know this is off topic but I’m confused and would love to consult with you, I’m in for buying a microscope and I’m down to 4categories: 1- Zeiss extaro 300 : I don’t know if flourecsnce mode and true light mode are worth it 2- Leica M320: I don’t know if I will ever need 40X magnification. 3- Global A6 : made in USA 4- Labomed Magna : magnetic clutch system but I really don’t know where it is manufactured ( maybe India cz of the low price. My heart is leaning to zeiss just for the brand If you please tell me what would you recommend and why . P.S. : I’m a pedodontist but very interested in Endodontics and aesthetics. Thanks ... from Lebanon.
Hi Doc, in my practice me had a patient with severe dentinal hypersensitivity, even after nerve block ( extra oral) by endodontist patient still got hypersensitivity, we can't open that case, what all we need to consider while managing those with sever dentinal hypersensitivity
Very nice video doctor 👌 thanks for sharing. I had a front teeth root canal 5 yrs back which was giving some trouble and had periapical lesion on the radiograph. The dentist gave me a splint to wear and surprisingly from the past 3 months of wearing the splint the discomfort is less on the teeth and radiograph also show a slight reduction in the lesion. Can you explain how a splint would do such wonders and will it help heal the bone and lesion completely? Any advice would be greatly appreciated.
Unless those lesions were not causes by a necrotic pulp they will not go away by splinting. You may be merely experiencing the calm before the storm. Have an Endodontist do proper pulp vitality testing not find out the origin of the lesions (pulpal or non-pulpal). Good luck.
@@AANasseh thanks for the reply. The teeth has already had a root canal treatment done 5 yrs back but radiographically periapical lesion was still showing up but with the use of splint it seems to get better.
@@mehernoshpatel7610 That may be initial bone remodeling and may not be permanent bone coming back in. Only time will tell if the lesions redevelop. If they do, non-surgical revision or surgical apicoectomy would be the best approach.
After a flare up has occurred in may be helpful; although it take time to build up. It's not recommended to use in every case though. So, if 5% have flare ups then it's not worth giving to 100% of patients. But it's very helpful post op in surgical cases.
What about pain after treatment of vital teeth, when there is no spontaneous pain, but only mild pain and discomfort on perkussion? Also patients can normally eat using that tooth (no pain on compression). Thank You!
As an emergency treatment for pulp necrosis/SAP, after achieving the patency with 10 file, I often instrumented 1 mm short from EMR0.5 to prevent the debris extrusion. How do you think about the idea?
That's ok. But debris extrusion is a function of motion rather than location. You can push a lot of debris out even at 1mm if you have an aggressive push pull motion. So, best to focus on a healthy motion habits. I will make videos in that area this year. Cheers.
Best to stay at 0.5mm... but it depends on your apex locator technology and its standard for measurement. You should test it (take radiographs after apex locator and see where it is.) Good luck!
Shivan tata Ca(OH)2 works well to disinfect inside the canal, not really acting outside the canal and it certainly doesn’t have any anti-inflammatory effects to address the inflammatory mechanisms caused by chemo-mechanical Instrumentation and irrigation that often lead to post op pain.
Real World Endo here is a paper using cold saline as a method of cryotherapy www.ncbi.nlm.nih.gov/m/pubmed/27699913/ I wanted to know if you used this method or not. I have yet to use this method
Oh yes. The cryotherapy studies have not controlled for pre operative diagnosis and therefore are not powerful enough for their given sample size. Furthermore, cryotherapy for 5 min is not practical on a 4 canal molar that will take 20 minutes only of cryotherapy alone. So, I would not do it. The incidence is low without it as long as instrumentation and length control is managed properly. Thank you for sharing the link! :)
Mmmmm ... if it’s a single visit maybe it’s easy root canal... probably the canals are wide ... why not just use cold saline as an irrigant solution throughout the whole procedure... ?!
That risk is not quantified anywhere. But since the source of disease is bacteria anything we do to keep things clean will go a long way. You can autoclave your paper points. Just take them out of their plastic container so it doesn't melt! :)
@@AANasseh wow I really couldn't imagine paper points could be autoclaved. I'll try to divide them in small packets and then autoclave. thanks so much for your help
I've worked with it. It's a different way of doing the same thing, shaping. If your question is whether there's more or less post op extrusion with it I would think there's not a lot of extrusion. The only issue with SAF is the fact that it's fairly inefficient method of instrumentation. Otherwise it's good.
Therapeutic cements in endo have not been studied as extensively. Plus the role of allergies and their solubility, shrinkage, and washout has been questionable in the long run. Sticking to the conventional materials with sound cleaning and shaping protocols is likely the better way to go.
Those are good points. I should make another video to get into that topic. Steroid are not indicated routinely. NSAIDS are a lot safer overall. Occlusal reduction I wish I had mentioned. It's been shown to be helpful; although some authors believe that it doesn't make a difference. I believe in the former.
Thank you very much for your informative videos , But please,i 'd like to know if i want to prescribe an antiinflammatory for a breastfeeding patient to reduce post.op pain and acetaminophen alone does not work properly, what should i prescribe ? and is that necessary to prescribe tha antiinflammatory ? Is not pain and inflammation could be reduced by time without the intervention of any medication ? Thank you
It's less of a problem for a nursing mother than it is for a pregnant patient. But some OBGYNs still prefer not to have Ibuprofen for the nursing mother. One solution for temporary pain control in such patients is to administer Marcaine anesthetic. Have them come to the office and administer at the beginning part of the day and then at the end of the day before you go. This way, they can have some relief for several hours and until the post op flare up is under control. You'll have better luck in the mandible than in the maxilla however. Good luck!
Dr thank you for video,, But can you explaine why after 1st visit ؛ of Rct whether vital tooth or necrotic, swelling Happen !! Especially on child when make pulpectomy knowing that cleaning and shaping up to WL are done!!? So why swelling Happen?
Many factors; but often it's a combination of the type of bacteria present, the children's compromised immune system compared to adults, and motions and techniques that would potentially push debris and irrigant past the apex. It's better to be a millimeter short than a millimeter long in those cases. Also up and down push pull motion creates too much debris. It's multifactorial otherwise.
@@AANasseh Thanks Dr for your answer,,So i'm always give AB after 1st visit like (amoxycillin & clavulanic acid) and metronidizole to avoide this situation (when P. T sooo apprehensive So he come after 1st day of ttt to see what happen having swelling some times can be large swelling on face)
@@user-sp1uc6em4c Definitely not needed to give such broad spectrum antibiotics. We're now understanding the devastating effect of antiobiotics on people and their healthy gut bacteria (Biome). It's important to limit antibiotic usage to a minimum; which is only where there's already systemic signs of infection, an immune compromised patient, or presence of rapid cellulitis. Please consider the endodontic therapy as adequate in addressing the infection. Over prescription of antibiotics "just in case" has a much greater negative effect on the patient in the long run. Only 2-5% of endodontic patients really require antibiotics afterwards.
@@AANasseh Dr. I respect your opinion,, But as you said( immune compromised) In my country life style and eating habits of people are So wrong, So People who usually come to their or me, Immunity are weak،، So I have tried a lot to minimize the use of AB,, But most of time i don't give AB after 1st visit of RCT Especially on teeth with abscess or periapical lesion, They come with Face swelling, So I can't always Face P. T after 1st visit on seconde day with face swelling, Note that i made on 1st visit efficiently cleaning & shaping up to WL, So may P. T understanding me wrong or leave me to go to another Dr.
In general you're right. If someone has post op pain all the time then it would indicate that; but otherwise, each individual patient can have post op pain due to other specific factors, including the kind of bacteria in the canal and their immune response to it.
That’s a blanket statement that isn’t necessary true. Generalizations could make a perfectly executed procedure appear as if the doctor did a bad job. Everyone is different. Some people are woosies, some are brutes. I’m not a doctor, just was neuroscience student, but credentials
best endodontist ever thanks for helping
Dr ali u can't thank you enough for providing rich original endo content on CZcams for free to raise Endo awareness woldwide
May god bless u ;)
Excellent teacher. Thank you doc!
Great explanation 👍🏻 thank you dr Nasseh 😊
You did it again! Good job
Thank you Doc !
Excellent. Explanation. Dr. Thank you kindly
Excellent lecture by endomaster...
Thanks doc. For your awesome video 💜
Great tips,doc
Thank you :)
Cool. Thank you.
Excellent lecture doc.. Cheers
such an informative video..
waiting for video regarding acute and chronic periapical abcess and manangement
Thank you
Thanku soo very much u help us alot to understand endodontics bettr☺. Big fan😀
So helpful. Thank you
Thak sir for providing such a informative vedio
Thank you .....it was helpful
Thanks a lot dr
very good !
This subject indeed can be given another shot academically .From clinical point just to add air lock while filling up pulp chamber post endo fill or acute response to a sealer can be considered.
Doctor what are your thoughts on Intracanal medicaments, such as calcium hydroxide? can it also help to reduce flair ups and pain, by placing it a week before obturating the canal? I saw a case where immediate obturation lead to postoperative pain, where i believed if the canal was obturated on a later date it wouldn't have lead to postope pain. Thanks for the great content
Thanks very much ❤️❤️
Can you make a video about management of acute & chronic periapical abscess please
Hello dr. Ali,
I know this is off topic but I’m confused and would love to consult with you,
I’m in for buying a microscope and I’m down to 4categories:
1- Zeiss extaro 300 : I don’t know if flourecsnce mode and true light mode are worth it
2- Leica M320: I don’t know if I will ever need 40X magnification.
3- Global A6 : made in USA
4- Labomed Magna : magnetic clutch system but I really don’t know where it is manufactured ( maybe India cz of the low price.
My heart is leaning to zeiss just for the brand
If you please tell me what would you recommend and why .
P.S. : I’m a pedodontist but very interested in Endodontics and aesthetics.
Thanks ... from Lebanon.
What is your refrances ? I want to read more about this amazing lecture from textbook please
Should I wait until the post operative pain reduces or can continue with the post endondontic restoration ?
I want ask what the bast chair position in the Endo
Hi Doc, in my practice me had a patient with severe dentinal hypersensitivity, even after nerve block ( extra oral) by endodontist patient still got hypersensitivity, we can't open that case, what all we need to consider while managing those with sever dentinal hypersensitivity
Extra-oral nerve block?!!! What is that?
Are you trying to say a conventional mandibular block?
Hi doc. Just a random question. What software do you use for creating these videos
I use a couple of different softwares, Premiere Pro and Final Cut Pro. Hope it helps. :)
Very nice video doctor 👌 thanks for sharing.
I had a front teeth root canal 5 yrs back which was giving some trouble and had periapical lesion on the radiograph.
The dentist gave me a splint to wear and surprisingly from the past 3 months of wearing the splint the discomfort is less on the teeth and radiograph also show a slight reduction in the lesion.
Can you explain how a splint would do such wonders and will it help heal the bone and lesion completely?
Any advice would be greatly appreciated.
Unless those lesions were not causes by a necrotic pulp they will not go away by splinting. You may be merely experiencing the calm before the storm. Have an Endodontist do proper pulp vitality testing not find out the origin of the lesions (pulpal or non-pulpal). Good luck.
@@AANasseh thanks for the reply. The teeth has already had a root canal treatment done 5 yrs back but radiographically periapical lesion was still showing up but with the use of splint it seems to get better.
@@mehernoshpatel7610 That may be initial bone remodeling and may not be permanent bone coming back in. Only time will tell if the lesions redevelop. If they do, non-surgical revision or surgical apicoectomy would be the best approach.
how do you see the use of corticosteroids in treating a flare up ? systemic or as intracanal medicament .
thank you !
After a flare up has occurred in may be helpful; although it take time to build up. It's not recommended to use in every case though. So, if 5% have flare ups then it's not worth giving to 100% of patients. But it's very helpful post op in surgical cases.
thanks for the video . my question is do you think that using bioceramic sealer may reduce post op pain compared with AH PLUS?
Sir can we please have a video on Importance and types of post endodontic restoration???
What about pain after treatment of vital teeth, when there is no spontaneous pain, but only mild pain and discomfort on perkussion? Also patients can normally eat using that tooth (no pain on compression). Thank You!
depends on the case. x-ray is needed to decide what could be the problem.
As an emergency treatment for pulp necrosis/SAP, after achieving the patency with 10 file, I often instrumented 1 mm short from EMR0.5 to prevent the debris extrusion. How do you think about the idea?
That's ok. But debris extrusion is a function of motion rather than location. You can push a lot of debris out even at 1mm if you have an aggressive push pull motion. So, best to focus on a healthy motion habits. I will make videos in that area this year. Cheers.
Thank you, sir.
Dr Do u prepare the canals with rotary files to the 00 point on apex locator or u stay a bit shorter to that ?
Best to stay at 0.5mm... but it depends on your apex locator technology and its standard for measurement. You should test it (take radiographs after apex locator and see where it is.) Good luck!
@@AANasseh thanks alot for the reply I appreciate it 🙏🏻
Would re-irrigation and placement of non-setting CaOh not work instead of prescribing pain meds ?
Shivan tata Ca(OH)2 works well to disinfect inside the canal, not really acting outside the canal and it certainly doesn’t have any anti-inflammatory effects to address the inflammatory mechanisms caused by chemo-mechanical Instrumentation and irrigation that often lead to post op pain.
Thanks for that. Keep up the good work, doing a fine job!
Thank you for the video. What about the use of cold saline at the end of the treatment before obturation? Thank you
Can you elaborate why cold saline could be helpful at the end?
Real World Endo here is a paper using cold saline as a method of cryotherapy
www.ncbi.nlm.nih.gov/m/pubmed/27699913/
I wanted to know if you used this method or not. I have yet to use this method
Oh yes. The cryotherapy studies have not controlled for pre operative diagnosis and therefore are not powerful enough for their given sample size. Furthermore, cryotherapy for 5 min is not practical on a 4 canal molar that will take 20 minutes only of cryotherapy alone. So, I would not do it. The incidence is low without it as long as instrumentation and length control is managed properly. Thank you for sharing the link! :)
Real World Endo keep up the videos
Mmmmm ... if it’s a single visit maybe it’s easy root canal... probably the canals are wide ... why not just use cold saline as an irrigant solution throughout the whole procedure... ?!
what a bout the sealer does it cause a pain??
You are correct. The sealer is also a part of chemical injury/inflammation. Dr. Nasseh forgot to mention that. He did mention it on our website.
Sir , in some patients dead asymptomatic pulp shows pus discharge after 1st visit ( initial BMP) and intra oral sinus , what should be the cause ...
An asymptomatic apical abscess.
Doc how can we avoid ledge formation in advanced canals
Correct access and instrument motion.
Sir... in vital tooth after bmp patient experiences severe pain for a day ..how can i avoid it?
BMP?! What is that?
@@AANasseh Bio mechanical preparation or Cleaning and shaping...
is it a big risk to use non sterile paper cones?
That risk is not quantified anywhere. But since the source of disease is bacteria anything we do to keep things clean will go a long way. You can autoclave your paper points. Just take them out of their plastic container so it doesn't melt! :)
@@AANasseh wow I really couldn't imagine paper points could be autoclaved. I'll try to divide them in small packets and then autoclave. thanks so much for your help
Sir, what do you think about self adjusting file system in new era of endodontic.. ?? Please review this ..
I've worked with it. It's a different way of doing the same thing, shaping. If your question is whether there's more or less post op extrusion with it I would think there's not a lot of extrusion. The only issue with SAF is the fact that it's fairly inefficient method of instrumentation. Otherwise it's good.
Is it. Wrong to use endomethasone as r c sealer...?
Therapeutic cements in endo have not been studied as extensively. Plus the role of allergies and their solubility, shrinkage, and washout has been questionable in the long run. Sticking to the conventional materials with sound cleaning and shaping protocols is likely the better way to go.
What about the use of oral steroid or intracanal steroids..or should be totally contraindicated. Do u recommend occlusal reduction before RCT started.
Those are good points. I should make another video to get into that topic. Steroid are not indicated routinely. NSAIDS are a lot safer overall. Occlusal reduction I wish I had mentioned. It's been shown to be helpful; although some authors believe that it doesn't make a difference. I believe in the former.
Thank you very much for your informative videos ,
But please,i 'd like to know if i want to prescribe an antiinflammatory for a breastfeeding patient to reduce post.op pain and acetaminophen alone does not work properly, what should i prescribe ?
and is that necessary to prescribe tha antiinflammatory ? Is not pain and inflammation could be reduced by time without the intervention of any medication ?
Thank you
It's less of a problem for a nursing mother than it is for a pregnant patient. But some OBGYNs still prefer not to have Ibuprofen for the nursing mother. One solution for temporary pain control in such patients is to administer Marcaine anesthetic. Have them come to the office and administer at the beginning part of the day and then at the end of the day before you go. This way, they can have some relief for several hours and until the post op flare up is under control. You'll have better luck in the mandible than in the maxilla however. Good luck!
Thank you very much ,Doctor🌷🌷
Dr thank you for video,, But can you explaine why after 1st visit ؛ of Rct whether vital tooth or necrotic, swelling Happen !! Especially on child when make pulpectomy knowing that cleaning and shaping up to WL are done!!? So why swelling Happen?
Many factors; but often it's a combination of the type of bacteria present, the children's compromised immune system compared to adults, and motions and techniques that would potentially push debris and irrigant past the apex. It's better to be a millimeter short than a millimeter long in those cases. Also up and down push pull motion creates too much debris. It's multifactorial otherwise.
@@AANasseh Thanks Dr for your answer,,So i'm always give AB after 1st visit like (amoxycillin & clavulanic acid) and metronidizole to avoide this situation (when P. T sooo apprehensive So he come after 1st day of ttt to see what happen having swelling some times can be large swelling on face)
@@user-sp1uc6em4c Definitely not needed to give such broad spectrum antibiotics. We're now understanding the devastating effect of antiobiotics on people and their healthy gut bacteria (Biome). It's important to limit antibiotic usage to a minimum; which is only where there's already systemic signs of infection, an immune compromised patient, or presence of rapid cellulitis. Please consider the endodontic therapy as adequate in addressing the infection. Over prescription of antibiotics "just in case" has a much greater negative effect on the patient in the long run. Only 2-5% of endodontic patients really require antibiotics afterwards.
@@AANasseh
Dr. I respect your opinion,, But as you said( immune compromised) In my country life style and eating habits of people are So wrong, So People who usually come to their or me, Immunity are weak،، So
I have tried a lot to minimize the use of AB,, But most of time i don't give AB after 1st visit of RCT Especially on teeth with abscess or periapical lesion, They come with Face swelling, So I can't always Face P. T after 1st visit on seconde day with face swelling, Note that i made on 1st visit efficiently cleaning & shaping up to WL, So may P. T understanding me wrong or leave me to go to
another Dr.
Plz reply sir
Thanks doc.love from Bangladesh
Post op pain indicates a faulty technique
In general you're right. If someone has post op pain all the time then it would indicate that; but otherwise, each individual patient can have post op pain due to other specific factors, including the kind of bacteria in the canal and their immune response to it.
That’s a blanket statement that isn’t necessary true. Generalizations could make a perfectly executed procedure appear as if the doctor did a bad job. Everyone is different. Some people are woosies, some are brutes. I’m not a doctor, just was neuroscience student, but credentials