Endo of Hyper-Sensitive Teeth - Dental Minute with Steven T. Cutbirth, DDS

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In this Dental Minute video, Dr. Cutbirth shows you how to perform endodontics on 3 teeth that were​ still​ hyper-sensitive after conservative treatment.
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Dr. Cutbirth is the Founding Director of the Center for Aesthetic Restorative Dentistry (CARD) (www.CenterforARD.com) and maintains a full-time restorative and cosmetic practice (www.WacoSedationDentist.com).
Caroline Hobby is host of Nashville Insider and the syndicated podcast HYPER! with Caroline Hobby. (www.carolinehobby.com)

[@brandonhammond2437]

We literally practice the exact same in all your videos! Pretty cool

[@centerforard]

Fantastic! Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@swolaceferrari6611]

This guy is like the best dentist in the world I’ve never seen any dentist use his methods

[@centerforard]

Thank you. Subscribe to DentistryMasterClasses.com if you want the really good stuff!

[@swolaceferrari6611]

Dental Minute with Steven T. Cutbirth, DDS I have a bad tooth going to the dentist tomorrow and I know he won’t just pull it and get it out of my mouth!

[@Kauailove]

Hands dow

[@Kauailove]

down!

[@AANasseh]

Very nice demo. By the way, why use the IRM at the end before bonding your access? Seems to me that the fresh Eugenol from the IRM may inhibit your composite's bonding and I don't see any benefit in the use of IRM.

[@centerforard]

I like a material like IRM between the gutta percha and the composite just in case the canal had to be reentered. This is rarely necessary, but the IRM "buffer" eliminates any chance of perforating the canal wall or floor of the chamber when trying to reenter the canal. I want a material that is white, or a different color than tooth structure, just coronal to the gutta purcha. A couple of endodontists taught me this method with the IRM years ago.

[@AANasseh]

Dental Minute with Steven T. Cutbirth, DDS Sure, but you might as well use an opacious white color core material instead of IRM. The Eugenol in IRM prevents proper bonding of your composite and can increase the chance of coronal leakage. Most Endodontists dont know this fact about eugenol which is why they continue to use ZOE based sealers! Just a thought. Cheers!

[@centerforard]

Thanks for the insight. I have never had a problem with coronal leakage using the described technique, but "perfect" is my favorite word! I am always happy to have new suggestions.

[@drmahanthashok3685]

@@AANasseh this means war

[@festimdauti7737]

​@@AANasseh what do u think about this treatment, irrigatin with 1 portion sodium hypchlorite with 3 parts of watr is effective?

[@medzoklife]

Great. In every video, some unique information is delivered which is very useful in practice. Thanks Dr. I already subscribed 👍.

[@centerforard]

Great!

[@mukeshadwani4695]

As always ... beautiful tnks sir❤

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@newmike3]

Apex locator is NSK. it’s made in Japan

[@centerforard]

Terrific. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@khalidahmed5903]

Thnx doc. I saw a patient with the same symptoms as you mentioned in the video a couple minutes ago

[@centerforard]

Great. Glad the video helped.

[@edgarricardoramosgarcia5691]

Great video !! I have seen almost all of your videos!!! Saludos desde México!!

[@centerforard]

Have you looked at DentistryMasterClasse.com? All the Dental Minute videos are organized in a library in DMC.com plus the comprehensive cases are also in DMC.com.

[@edgarricardoramosgarcia5691]

Dental Minute with Steven T. Cutbirth, DDS Thank you! I'm going to visit the website!!

[@jaganmohan8510]

super sir

[@centerforard]

Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@moneyjoyk]

Thanks eternally sir

[@centerforard]

You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@luisubtil]

My guess is the hypersensitivity in those 3 is motivated by the bruxism clearly visible in the video

[@centerforard]

I agree. Any time a patient complains of many sensitive teeth, their is no, or minimum decay and abfraction/tooth wear is present, daytime clinching/nighttime bruxism is normally the culprit. After a period of time, 3 months - 6 months - 1 year following nightguard placement, desensitizers, equilibration and possible composite bonding of class 5 abfraction areas, if the patient still cannot eat or drink moderately cold/hot things on the teeth because of extreme sensitivity, we must move forward with treatment that allows the patient to live their life, i.e., proper, conservative endodontics. These teeth have, most probably, irreversible hyperemia. Working in a real, 4 day a week dental practice, the patient does not care what the diagnosis is and they do not care if the sensitivity might go away in a few years. After a reasonable amount of time trying conservative treatment, they want someone to do something to stop the pain.

[@luisubtil]

I woudn't say no more then what you just said. At the end of the day what matters is the patient's satisfaction.

[@b3at2]

Damn he is good...

[@celts03]

short fill, but will still probably work out just fine. I agree with Real World endo. Makes 0 sense why you use IRM since it contains Eugenol and that inhibits the bond of composite. Classic national boards question.

[@centerforard]

Not to argue the point, but the IRM is only in the orafice of the canal and is completely hardened prior to composite placement. The composite is rock hard and remains that way years following placement. I want something white between the composite and the root canal just so the canal is easier to find if the endo. had to be redone or a post placed due to a fractured tooth. I do not ever remember having to have an endodontic procedure I performed redone, but have had endo. teeth fracture and had to find the canal through composite. I was glad the white IRM was present to let me know where the canal was. Probably the pink gutta percha would be sufficient to prevent grinding around, looking for the canal. Thanks for your comments.

[@ilynpayne7491]

I had my tooth extraction 3 days ago still doing fine now slight pain remains

[@centerforard]

Terrific!

[@Carl6F]

Awesome work doc

[@centerforard]

Thank you.

[@festimdauti7737]

Doc why u irrigating with local anesthesia?

[@centerforard]

As I have stated on every endo. video I have ever made, there is nothing magic about the anesthetic. It's the 30 gauge needle that fits ideally in the pulp chamber so you can irrigate out any debris and the dilute NaOCl. The anesthetic just happens to be in the carpule. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@benjamins947]

#28 has two canals on the x-ray you missed one Dr.

[@centerforard]

No #28 doesn't have 2 canals. Look at the before and after radiographs. The single canal is exactly in the center of the tooth and there is obviously only one root. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Zim-lee3]

Sir with respect.. usually the lower premolars have pulp canals broader bucco lingually.. Will just one gp b enough?

[@centerforard]

Yes, according to Real World Endo and my personal experience. Remember, the sealer is the part that seals the canal. The GP just pushes the sealer throughout the canal.

[@ClaudiaRodriguez-hb4zl]

I love all your videos!!!

[@centerforard]

Thank you. I enjoy making them! You might enjoy attending a CARD seminar in Dallas sometime. These are live seminars on the various topics.

[@hemam8901]

Its fabulous. But why you always bending the tip of the hand file

[@centerforard]

It is normal endo protocol to place a small bend in the tip of the hand file, along with lubrication of the canal with dilute NaOCl, so the file slides along the canal and the tip of the file does not imbed in the side of the canal. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@hemam8901]

@@centerforard thank you so much ❤

[@hasansaleh6232]

First of all is that I love ur videos and I’m already a subscriber...but I have to disagree on using Irm under composite as it can prevent its polymerization , why not use gic like photac for example? And my second point isn’t the 1st bicuspid about 0.5 mm short ... again I would say my respects to u and ur great teaching videos

[@centerforard]

No, it is not short. As I am sure you are aware, you cannot tell where the exact apex of a canal is on a radiograph. Secondly, the IRM is completely set hard when the composite is placed over the IRM. I have used this technique since it was taught to me by an endodontist years ago. I have never had an issue with polymerization of the composite. It might be an issue if the IRM was not completely set prior to placing the composite. Also, I always cure the primer/adhesive in the orafice prior to placing the composite.

[@hasansaleh6232]

Dental Minute with Steven T. Cutbirth, DDS thanks for the reply

[@centerforard]

Hasan, you bring up a good point. Over the years I have seen many endodontically treated teeth obturated (filled with gutta percha or some other material) only partially down the root. Some of these teeth may be obturated only half way down the root. Amazingly, many of them have been successful for many years. I am not recommending leaving the filing and obturation short of the apex, but my experience has been if you have filed and irrigated most of the root canal, i.e., the part you can access in sclerotic canals, the endo works. Endodontists giving seminars at my teaching center in Dallas (Center for Aesthetic Restorative Dentistry) verify this observation.

[@moneyjoyk]

@@centerforard You are so practical a teacher...this is real world stuff

[@aboudaboudi8092]

So nice

[@centerforard]

Thank you.

[@ksenijastojkovski6836]

I love your videos! Do you always use the crown down technique?

[@centerforard]

Yes. I love the RealWorldEndo system. Subscribe to DentistryMasterClasses.com and watch the videos in the organized library of all the DM videos plus many complete comprehensive cases. New cases added weekly.

[@raytan5623]

love the videos doc, why do you decide to use flowable composite in this case, instead of regular composite

[@centerforard]

The orafice was small. Either flowable or highly filled resin would work in this case.

[@AP-br3io]

#28 - Did the canal split into 2 in the middle 3rd?

[@centerforard]

No, not in this case.

[@DocCrutch]

Yes, Ajay, it does. Case can still turn out ok.

[@saadsoofi569]

Very informative. Dr Cutbirth why do you irrigate with local anesthetic before drying the canals?

[@centerforard]

The local anesthetic is not important. The 30 gauge needle is the important thing because it is small enough to enter the canals without binding or causing pressure. I could accomplish the final irrigation of the canals with plain water just as well, but I do not have a way of placing it in the canals with a small diameter needle. I am irrigating out the remaining dilute sodium hypochlorite. Be sure you do not irrigate the canals with anything under pressure. We are just "floating" any debris or, in the case of the 30 gauge needle and local anesthetic, remaining sodium hypochlorite, to the surface so the canals are clean before we dry them with paper points.

[@saadsoofi569]

Thank you for the elaboration. Can you please do a video on crown lengthening?

[@Dentist89]

i am big fan of your videos , but let ask you this single cone obturation technique ??

[@centerforard]

It is the Real World Endo Method. Remember, the sealer is the part that seals the canal. The GP cone just pushes the sealer into all parts of the canal.

[@Dentist89]

@@centerforard thank you for your answer

[@kamel7574]

Doctor what about irrigation ? We learned that we have to use fine needle with lateral open for 1 mm less than working length ?

[@centerforard]

I have never used any irrigation method but this one for 40 years. The key is to not put pressure in the canal with the fluid from the needle. Just inject irrigating fluid into the pulp chamber at the orafice of the canal. The files will take the fluid down the canal.

[@kamel7574]

@@centerforard thank you very much dr , endodontics make it more complicated 😁😁

[@centerforard]

Glad you like the videos. I try to make videos that are real and practical, as well as correct procedure. I want to keep you from having serious problems as well as producing a fantastic product. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@hosseintavassoli2894]

tnx doc, what is the base's meterial ?

[@centerforard]

gutta percha and bc paste.

[@RajeevKumar-xx8vf]

Greetings sir, Can you pls tell till what 3rd you placed the no.40 black file in the initial step of crown down. Regards

[@centerforard]

I am performing endo on a maxillary second molar right now. I start with the #10 Hedstrom hand file with lots of irrigation, then try to use the black, 40, rotary file as far into the canal as it will go with gentle pressure. I then normally move to the #25, red, rotary file, then the #30, followed by the 35 and back to the 40 if the canal will accept the 40 to the apex. If not, I use a gutta percha cone the size of the rotary file that goes to 0.5mm of the apex of the canal. It's a great system.

[@RajeevKumar-xx8vf]

@@centerforard ok Sir, Thanks

[@centerforard]

Welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@fenkicorp]

Why is no rubber dam sealer used? Surely you're increasing the risk of a hypochlorite incident.

[@centerforard]

I am using 3 parts water to 1 part hypochlorite. Also, I am not using much solution to irrigate. The solution is primarily used to lubricate the canals and "float" any debris to the coronal part of the canal. That is one reason it is important to use the "crown down" technique, opening/expanding the coronal part of the canals early in the canal filing process so it is easy for the hypochlorite solution to enter the canals. In a perfect world, yes, isolate the tooth by placing floss around the tooth over the rubber dam and tying it off as well as using rubber dam sealer. Because I am not using forceful irrigation with the hypochlorite, I am not concerned about some of the solution getting out of the tooth and into the patient's mouth. My assistant has a high speed suction operating adjacent to the tooth as I am irrigating. When I am then ready to thoroughly irrigate the debris out of the canals after filing is completed, I use the 30 gauge needle with local anesthesia placed in the coronal part of the canals with no pressure into the canals. This process gently floats any remaining debris out of the canals. Remember, the rubber dam technique I am demonstrating is not a "perfect" technique, it is a "very good" technique and is so easy dentists will use the rubber dam for more, if not most, procedures. Thank you for your question.

[@iddicted]

i was told to cut the gutta percha at the level of CEJ.. does it matter?

[@centerforard]

No, just cut the GP with a heating device at the orafice of the canal, then pack it into the canal with a plugger, with medium pressure, while the cut part of the GP is still warm. The idea is for the GP to force the sealer into as much of the avenues of the canal as possible. If you follow the steps I am teaching you, endo. will be almost 100% predictable. By predictable I mean the tooth is comfortable, healthy and long lived. Do remember many endodontically treated teeth are a bit uncomfortable when tapped on the side or moved horizontally. This does not mean anything is wrong with the tooth or the endo. , it just is a part of endo. The sensation is not real pain, just "I wish you would stop tapping that tooth on the side" discomfort. Another thing that can cause discomfort in an endodontically treated tooth is hyper occlusion as well as eccentric occlusal force. Be sure the endodontically treated tooth is slightly out of occlusion following the endo. procedure and always eliminate working and balancing side contacts on those teeth. It is harder to eliminate eccentric contacts on anterior teeth because of anterior guidance ideally being on anterior teeth. Just remember, if the patient is experiencing discomfort following endo. performed with the method (Real World Endo.) I am teaching you, the cause of the discomfort is probably hyper occulsion or eccentric contacts. Dentists debate the small points of endo., such as should you use a microscope and all the different ways of filing and filling canals. As practicing dentists, we just want a technique that works! This technique works and it has been almost 100% effective for many years. One more note, patients often complain that the actual endo. procedure itself was uncomfortable. Be absolutely certain to give an intraligamental injection in the sulcus gently with a 30 gauge needle and Citanest 4% plain local anesthesia prior to the procedure. Watch my videos on painless and profound local anesthesia. Most patients are terrified of the word "root canal." They will love you if the procedure is painless and works!

[@zoyamulla7102]

@@centerforard Amazing Dr Cutbirth!

[@dr.abulbasher565]

Does this concentration (naocl) burn gum?

[@centerforard]

The NaOCl solution should not get on the gums. It probably does not burn the gums, it would just taste bad. You would not want the patient to swallow it. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@dr.abulbasher565]

Thank you very much ❤️

[@MrHuney]

Nice1

[@centerforard]

Thank you.

[@Channel_976]

❤️❤️❤️🌸

[@ghazal2527]

‌like

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@foodforthought1916]

Everything is great except annoying lady suddenly starts shouting, gives me mini heart attack.

[@centerforard]

Sorry. She is my favorite part of the videos. Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@andybrito3]

i highly doubt all three of those teeth needed root canals, and either way you should of had better isolation

[@centerforard]

What a strange thing to say without examining the patient personally. I wonder how long you have been in practice. One of the things I have learned is to never judge the decisions or work of another dentist until I have examined the patient myself. If you are in practice long enough, you will occasionally see patients who are severe teeth clinchers/bruxers who sometimes have multiple teeth that are so sensitive they cannot enjoy a normal life. Room air puts them through the roof with pain and even moderately cool liquids and foods are intolerable. I have gone through the process many young dentists go through, sometimes for over a year, trying to remedy the situation with night guards, dentin blockers, even light acid etching followed by primer/ adhesive. In my 36 years of practice I cannot remember one of these patients who did not end up with endodontic therapy on those hyper, hyper sensitive teeth simply because they were sick of messing with the pain, to the point of wanting the teeth extracted. Better isolation to do what? I am trying to teach techniques that the dentist in practice can use. Nothing is perfect. This is a very good rubber dam technique for endodontics if the dentist is reasonably careful. For instance, I have never been comfortable using 100% sodium hypochlorite for irrigation. If one performs many endodontic procedures, one day some of the irrigating solution is going to pass through the apex of the canal. It is simply going to happen. Many endodontists have reported this occurrence to me. One of the worst things that can occur in dentistry is for 100% sodium hypochlorite to get into the inferior alveolar nerve canal or into the sinus. Read about it. For that reason I am recommending you use 3 parts water to 1 part sodium chlorite. I was taught that technique by several long time endodontists years ago and have employed that method successfully for 36 years. With the "crown down" method of Real World Endo, the canal is widened or flared from the coronal aspect so plenty of irrigation liquid gets into the canal. With the canal constantly flooded with the dilute sodium hypochlorite, the canal is well cleaned with the rotary files combined with the #10 Hedstrom and K-type hand files. If one of my patients has had problems with endo I have performed in all those years they failed to report it to me. I have been taught to clean and irrigate well, and it works beautifully with the technique described. Bottom line, I hope we are all trying to do the best we can for our patients while subjecting them to the least potential harm. When I teach a technique, I am not just talking to hear myself speak. I am also trying to pass along things I have learned from 36 years of practice and teaching complex dentistry so that you have wonderful practices, produce world class dentistry and do not have avoidable problems. We bring experts into my teaching center in Dallas (CARD), including world class endodontists, to update us on current techniques.

[@RenuYadav-ul8kb]

Sir u r doing a great job, thanku so much for putting such efforts. Sir sometime I end up making ledge while crown down technique...any suggestions!!!

[@bilaliq1449]

Excellent reply Dr.Cutbirth to @andybrito3's arrogant and unnecessary comment. Keep the video coming!

[@nikishah4736]

What a troll Andy britto

[@ClaudiaRodriguez-hb4zl]

I totally agree!!!!!