Broken File Management: Concepts and Advice

Рет қаралды 6,844

AANasseh

Күн бұрын

Пікірлер: 42

@adriennegood 9 ай бұрын

Not all heroes wear capes, Dr. Nasseh! See you in LA!

@salimhaider9375 10 ай бұрын

Thanks!

@AANasseh 10 ай бұрын

Thanks! :)

@ZACY1234 10 ай бұрын

Hello! Came here after watching Ash video from all things dentistry. Ash says Hi!👋

@AANasseh 10 ай бұрын

Ash is awesome! Thanks for visiting!

@michaellupu2080 10 ай бұрын

Invaluable as always, dr. Ali! I noticed you changed the name of your channel! Happy new year and good luck with your new endeavours!

@AANasseh 10 ай бұрын

Thank you Michal. Exciting changes on the way next year. Cheers!

@gokuldentalcare8085 Ай бұрын

useful advice...thanks doc

@iyouitry 10 ай бұрын

All things dentistry made me aware of this video

@stefanczechorskidds8435 10 ай бұрын

Thank you Doctor!

@kohwenthong 6 ай бұрын

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.

@AANasseh 6 ай бұрын

File removal is not as easy as he makes it look. It's more of a magic show.

@trickjacko8482 10 ай бұрын

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.

@AANasseh 10 ай бұрын

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.)

@trickjacko8482 10 ай бұрын

@@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.

@the_bonebreaker7588 9 ай бұрын

Always a pleasure

@swimmerslice921 10 ай бұрын

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?

@AANasseh 10 ай бұрын

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. :)

@blackblood1122 10 ай бұрын

Very helpful content! Appreciated.

@BuzzJones 21 күн бұрын

I Just had an Endodontist do a Root Canal today and he said he broke off a bit or file , I forgot, in my tooth. He said that it wont be a problem and he filled everything....... I have to go back to my Dentist but am worried now I might get infected or it may even rust in time...What a terrible experience......

@RadicalModeration 21 күн бұрын

Just be sure to follow up after 3 months with your endodontist to take another xray of the tooth to make sure there's no infection and everything has healed. You should not have any symptoms in the tooth after 4 weeks from the time the root canal was done. If you do, go back to the endodontist sooner since it's not normal to have symptoms. Most likely it's not an issue and you'll be fine. If not, one extra step can often be done surgically to take care of the problem. Good luck.

@fsadjklfdhahupfdhuoi 10 ай бұрын

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!

@DrMohammadAhmadiBell 5 ай бұрын

Hello Dr Naseh there is a set of burs for slow speed with long shaft to find deep calcified canal. Do you remember what is called please?

@AANasseh 5 ай бұрын

Munce Burs.

@DrMohammadAhmadiBell 5 ай бұрын

@@AANasseh thank you very much

@walter1977ww 2 ай бұрын

1:33 ese #99.... 😂 hilaorius

@gauravchauhan285 6 ай бұрын

Hey doc,what about if file breaks in immature root apex beyond open apex

@AANasseh 6 ай бұрын

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.

@gauravchauhan285 6 ай бұрын

@@AANasseh irony is that file was brand new still this thing happened Thank you for your precious reply

@gauravchauhan285 6 ай бұрын

Hello Dr.@AANasseh,I retrieved the file in this case

@gauravchauhan285 6 ай бұрын

Thank you doctor for your quick valuable response

@dentalking7859 10 ай бұрын

Sir in sigle day how many rct u done ?? Just for query ...

@AANasseh 10 ай бұрын

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 10 ай бұрын

Hi Ali, how long do you plan for a standard 4 canal revision treatment? I usually plan 90-120 minutes. gr, @@AANasseh

@AANasseh 10 ай бұрын

@@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! 😉

@gnyaniprasad291 10 ай бұрын

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?

@AANasseh 10 ай бұрын

@@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.