Basic Perforation Repair (Friday Questions)

[@shahendamahmoud9651]

Thank you Dr Ali for this helpful video , please explain for us how to treat other endodontic mishaps such as ledge, apical perforations and zipping .

[@amirmo6615]

Thanks a lot for sharing these invaluable information with such a detailed explanation. A question occurs to me though and that is how you can deal with an apical or mid root perforation? It doesn’t seem possible applying BC putty in such deep area using this method or using hemostatic agent in there. Many thanks in advance

[@waterdilusion]

Hi Dr Nasseh, does the person have to repair and re-do the root canal treatment even when the patient shows no symptom of pain or inflammation?

[@benlloyd3155]

Do you think that the bio ceramic sealers have helped us better manage strip perforations? Do you think that the high bio compatibility of this sealer will reduce the frequency of minor strip perforations deep in canals from becoming symptomatic at a later time?

[@AANasseh]

That's a great question deserving its own little short video. But to make a long story short I do. Although the mechanisms of failure are always microbes, not necessarily lack of biocompatibility. I'll make a video on this. Thank you Ben! 👍

[@kareemqwasmi9583]

Could u please explain what is the factor affecting on prognosis, recently the time is nt considered important factor as location and probing depth, what do u think 🤔

[@rolandfrancis7066]

@Real World Endo .Can't you just retrieve the GP, control the bleeding and reobturate the canal using Bioceramic Material canal sealer like Total Fill ?

[@nauxsi]

My general dentist attempted RCT, overdone it and now has said its not worth saving it. Put temporary filling in meantime.

[@mulham4268]

Good job and nicely explained

[@Canal13hifi]

Hi Dr Nasseh ! Thank you for your video ! Aren't you affraid of extruding Hypochlorite while disinfectig the camber and the perforation ?

[@stephenp2980]

I suppose that's why he uses a soaked cotton pellet and not irrigating with a syringe which could cause a build up of pressure

[@jasongoldthorpe6532]

Hi Dr. Great video. Can I ask what you use to disinfect the area and what you use as your hemostatic agent? Thank you.

[@AANasseh]

It's best to use Sodium Hypochlorite in a 1-2% solution. Use a cotton pellet with the NaClO solution and place pressure and hold for a full minute. You will get adequate hemostasis. If not, repeat and hold longer. Don't use hemostatic agents as they cause inflammation. You can use Epinephrine too if 1% NaClO alone is not enough. Cheers! :)

[@san5a89]

hello Dr Nasseh. thanks for you interesting video. I would like to ask you what you think about posts advantages with modern materials (for example glass fiber composites like GC ever X flow) and if you agree that, in case of good endodontics but filtration of the crown or restoration, the only possible therapy should be an apicectomy and NOT a post removal with an orthograd retreatment. thanks

[@AANasseh]

It’s true but other risk factors such as surgical accessibility, vital structures, medical history, and other factors change the balance of surgery vs revision. But surgery is without a doubt underutilized in endo,

[@san5a89]

@@AANasseh I'm sorry maybe I did not explain myself well. What i mean to say is, do you think that this reasoning is correct? if the endo treatment is properly done and we put a fiber post on top of it and after some time we have an infection, the only problem can be a difficult apical anatomy, so, we shouldn't waste time on removing the post and perform an apicectomy

[@AANasseh]

@@san5a89 Well, if the infection is limited to the root where the post was placed it may often be a break in the seal caused at the time of post placement, especially if the post was placed without a rubber dam, causing contamination of the space before post cementation. But if it's a recently cemented post then it's usually better to do surgery instead of disassembly as removal of a recently well cemented post can cause too much trauma to the root itself. So, it's a balancing act. cheers.

[@mohamedelshikh9090]

Thank you

[@talschneider9667]

Can you repair perforation using equia?

[@harebalaram898]

Can I use GIC?

[@ahmadyusef5891]

thanks for the video i have one question how effective is RRM bio ceramic as retrograd Filling or is MTA a better chose

[@AANasseh]

Based on both histological and CBCT research done at U. Penn on Dogs it's equally as effective as MTA for retrofilling. The only difference is that it's much easier to apply, especially if you use the Surgical Lid Technique that I've described for it. You can see the video I made on it. kzbin.info/www/bejne/pKmwmIWmfbugmdk, and kzbin.info/www/bejne/hoSzln2FmdaVbcU

[@ahmadyusef5891]

@@AANasseh thanks

[@freeduckie]

Why the heck did the dentist put a post in distal root of #18?? Plenty of coronal tooth structure

[@AbsoluteXero]

One day, you will make decisions and perform a procedure in which another dentist will question it as well. The important thing is although we judge each other's work, you should not voice your judgment, especially to the same patient, you don't want someone to do that to you.

[@stevegin3194]

I dont know. Doesnt look like it wad needed.

[@ypherrist2792]

@@AbsoluteXero Needed this reminder. thank you

[@reemismail7768]

this technique is for furcation perforation only ??

[@AANasseh]

Any area where you can see or access the perforation is where you can use this technique.

[@amrabdelftah4136]

Thank you very much for your helpful videos, I 'd like to ask you a question, in case we have a pinpoint furcal perforation how can we place MTA in such a small perforation?

[@AANasseh]

Just dry the area and control bleeding, then place the MTA. You'll likely have to place a wet Teflon tape over it to let it set hard before you can bond to it in a subsequent appointment. BC liner should work with MTA as well.

[@burakozbalta]

⁠@@AANasseh can we use glass ionomer liner after placing MTA?

[@AANasseh]

@@burakozbaltayes you can. That has been shown to work too.

[@lenarey2539]

So if during an rct that I had done today, if my dentist couldn’t stop the bleeding at all and had to wait to finish another day... does that mean it was perforated?

[@pedroandrade7426]

The canal needs to be dry in order to do the obturation. Sometimes there's some bleeding that comes from the inside of the canal that simply won't stop and after a while it's just better to send the patient home that day and finish another day.

[@dufourally]

I have been using the same material & technique for direct and indirect pulp caps. There doesn't seem to be much literature for utilizing BC putty for pulp caps, mostly perforations. Would you do anything different (as far as technique) for a pulp cap?

[@AANasseh]

+Andrea DuFour Same exact for a pulp cap. The concept is the same. During a pulp cap you can use the Putty or you can also use the RRM and place Fuji IX on top of it. See here: realworldendo.com/videos/cbl-13-indirect-pulp-capping-and-some-diagnostic-factors

[@amrabdelftah4136]

Great video, I 'd like to ask you a question, if i use MTA for perforation repair can i use glass ionomer line at the same visit and proceed with the final restoration?

[@AANasseh]

to be honest I didn't know since back when I was using MTA I used to do these types of cases in two visits, allowing the MTA to set first after the first visit before applying a material to it.

[@ahmedtaha6738]

can i use amalgam to seal a perforation ?

[@AANasseh]

You can but is not as ideal as calcium silicate cements. Amalgam doesn't bond, seal as well, and can stain the tooth. It's also not as biocompatible.

[@drrrreddy1147]

I got a perforation in upper left 6 what is sucess this tooth

[@AANasseh]

Time, location, and status of the tooth/perforation at the time of perforation makes all the difference. There's no generic answer.

[@bestporridge]

You must have face palmed seeing a post perforation after your rct

[@swagat1dentist]

hey, you dint add a clinical video.. I just love to see your work.. don't keep us midway with curiosity..

[@AANasseh]

+Swaggy Dev LOL! Thank you. This one was a quick one on concepts. There will be others with actual video. Although, I do confess that we don't see a lot of perforations at my office. Our sources know when to refer the patient out, before they perforate! :)

[@sria8163]

@@AANasseh ha.. ha.. good one

[@swagat1dentist]

:-) ;)