How to manage calcified chamber and canals during RCT??

A brief description of management of calcified pulp chamber and canals is given here.
References-
Mamoun JS. The maxillary molar endodontic access opening: A microscope-based approach. Eur J Dent 2016;10:439-46.

[@dr.lakshmisruthi3392]

Thank you so much for all of your videos sir. They are helping in my practice and also increasing interest in endo topics. 🙏

[@Endocrisps]

🙏🙏

[@mamounjo]

Nice video. The illustration of the three ultra-sonic tips shows a long thin tip shaped like a hummingbird's beak. This tip is useful for breaking up large pulpal stones. General method is to first locate the easier to find palatal canal as a landmark. Then, use the hummingbird tip to scale around the outer perimeter of the pulp chamber calcification. Look for areas where the pulp chamber seems to "perforate," but it is not perforating into the alveolar bone, but rather it is "perforating" into the space between the calcified pulpal tissue and the hard floor of the pulp chamber. Using microscopes, a space might be observable between the undersurface of the pulp chamber stone, and the floor of the pulp chamber. This is a very tiny difference in height, requiring microscopes and co-axial illumination for optimal detection. Hopefully, after troughing the perimeter of the pulp chamber calcification with the hummingbird beak ultrasonic tip, parts of the pulp calcification will appear to lift or peel away from the pulp chamber floor. A #2 or #4 round bur in a slow speed handpiece can be used to break up the troughed pulp chamber material, with minimal risk of gouging the pulp chamber floor. The optimal scenario of identification is if there is a clear difference between the corrugated surface of the calcified pulpal tissue and the smooth pulp chamber floor. Note that the pulp chamber floor tends to be harder than the calcified pulpal tissue or pulp stone. This is one way of distinguishing the two, in that the scaler tip will tend to more easily chip away the calcified pulpal tissue, than the more hard pulp chamber floor. Microscopes and co-axial illumination help to facilitate such differentiation between what surfaces are being damaged by the scaler tip, and which surfaces are relatively resistant to the scaler tip.

[@Endocrisps]

Excellent explanation 👌👌👌

[@sria8163]

Wonderful explanation

[@ashishchaturvedi4616]

Knowledgeable video in simple language... very nice👍👍

[@Endocrisps]

🙏🙏

[@dangtv2268]

Nice vdeo sir..as I'm having this until my second visit to.my dentist still she can not reach the stone on my root canal..can I not continue for it is their any pain after.un.succesfull operation

[@sykatdash5746]

beautiful video

[@Endocrisps]

Thankyou🙏🙏

[@mahmudshowrav6204]

Thanks a lot sir

[@Endocrisps]

🙏🙏

[@saddamsheikh3307]

Very nice informative sir

[@Endocrisps]

🙏🙏

[@drbkaroramdsmaloutdentista6186]

Very nice presentation

[@Endocrisps]

Thankyou🙏🙏

[@coolguyankit007]

Nice video sir..Keep making such videos and spread knowledge👍

[@Endocrisps]

Thankyou 🙏🙏

[@sandeepsachchade3188]

Excellent dr

[@Endocrisps]

Thankyou 🙏🙏

[@foysolzaki6496]

Thanks Sir, Love from Bangladesh ❤️❤️❤️

[@Endocrisps]

🙏🙏🙏

[@chandishrijibesh175]

Today found a palatal canal blocked!!!! The orifice is clear but beyond orifice it's blocked, view it in microscope, looks like sclerosed dentin..tried to break with gd drill but no gain..any suggestions?

[@Endocrisps]

Try with an orifice shaper (Sx). Use a little stiff file to generate torque at tip of file, D finder is good option. To increase the torque, you can cut tip of #8 file (21 mm) around 2 mm and use shortened length🙏🙏🙏

[@chandishrijibesh175]

@@Endocrisps thanks will definitely

[@Devakshi102]

Informative video. Thank you sir. How can we do hand filing in thin and narrow canals?plz suggest

[@Endocrisps]

Start with #8 k file and keep recapitulating. Maintain patency, irrigate well. Precurve files before use.

[@Devakshi102]

@@Endocrisps okk thanks

[@jaspreetchotalla]

very helpful

[@Endocrisps]

Yes this is effective method to locate the canal😄😄

[@dr.sanavvarhusain8847]

Nice explain sir👌

[@Endocrisps]

Thankyou 🙏🙏

[@sayantankarmakar3150]

Greetings sir. Even after canal location & BMP if pulp stones persist should we attempt to remove it? Or should we go ahead and obturate if the tooth is asymptomatic?

[@Endocrisps]

It is always better to remove pulp stone as there can be some pulp tissue below it which can lead to hot sensitivity later on

[@sayantankarmakar3150]

@@Endocrisps understood sir. Thank you so much

[@haialent04]

What if calcification is in middle third of the canal???

[@Endocrisps]

Use C++ files

[@jdkjcjf4114]

Sir which ultrasonic tips can be used?

[@Endocrisps]

Many long shank tips are available

[@noone-zl2di]

I have calcified canal after a dental filling? Is tooth extraction the only option?

[@Endocrisps]

No RCT can be a possibility

[@noone-zl2di]

@@Endocrisps sir do you practice in india?

[@Endocrisps]

@@noone-zl2di yes in Delhi

[@dentalking123]

How are you sir? What is you opinion on dental practise post lockdown Plz make a video What will be the protocols What will going to change forever from now i

[@Endocrisps]

Hi.. I am good. There are a lot of senior dentists giving opinions about post lockdown practice. I am still in dilemma because there is no solution to aerosols produced during treatment. So dental procedures without aerosols (simple extractions, hand scaling, ortho treatment etc.) you can perform normally without much difficulty as in those procedures; you have to save yourself only. But in aerosol generating procedures, there are risk of cross infection to other patients as they will not be wearing N 95 mask during treatment. So, you can keep only 1 aerosol generating patient a day after all other consultations or without aerosol procedures and another method is go for covid test before treatment. Regards

[@Zara-ZAF]

@@Endocrisps what is aerosol generating procedures

[@peaa666]

Sir, in a recent case I couldn't negotiate the DB canal of upper 6. I tried all methods. But nothing helped. Should I just leave it this way?

[@Endocrisps]

Is it visible on radiograph?

[@peaa666]

Not visible Sir. It looks opaque- I mean like the root structure. The file is only going just few mm from the orifice.

[@Endocrisps]

Then it may be calcified. You can leave it if there is no pain and there is no periapical lesion

[@peaa666]

@@Endocrisps thank you Sir

[@abhinavadvani3996]

How to achive apical patency in calcified canal

[@Endocrisps]

Use C+ files

[@ayanpratihar1881]

hello sir hope you are in good health. sir I am a fresh dentist from westbengal currently doing houstafship I have encountered a RCT pt with calcified pulp chamber I have removed it as much as i can but when i put the files it doesn't going all the way in and apex locator is showing only upto white lines and can't force the files any further. plz give me your valuable suggestions.. or if you can provide your IG handle or other platforms in which i can contact you. thanks in advance

[@Endocrisps]

Share xrays through mail

[@legobant2751]

hello doc if you cant go into the canal is it okay not to force it?

[@Endocrisps]

Forcing instrument in canal can lead to fracture

[@legobant2751]

@@Endocrisps hello doc is optradam better or the coventional rubber dams are still of higher quality?

[@Endocrisps]

@@legobant2751 purpose is same. Use any

[@bodisandeepnaidu7049]

How to do BMP SIR..FOR BEGINNERS OR ANYONE

[@Endocrisps]

Already made a video... Search in the rotary playlist👍

[@drabdulnandi5573]

Nice

[@Endocrisps]

Thankyou 🙏🙏

[@unstoppable2242]

Hello dear doctor we are waiting from you videos please if possible 🙏 also what we can do if apex locator is not showing correct apex (ex: at 2/3 of canal showing as apex) thank you a lot

[@Endocrisps]

Sure👍

[@unstoppable2242]

@@Endocrisps 💖💖

[@indianyoutuberremme2310]

Sir where do you practice ?

[@Endocrisps]

New Delhi🙏

[@reybon9081]

Lop😊