How To Do a Root Canal Like an Endodontist: Q&A from Pensacola Florida

[@aksisoylenemez]

So true..Thanks for informative video and helpful insights.

[@ramyarai231]

Thank you sir for all your informative videos Thank you for sharing 🙏

[@LaminaPapyracia]

Good radiographic image is the consequence of following these endodontic principles that you have mentioned. A homogeneous opaque obturation until the apical constriction is a good indication that you have done a good job but the irrigation till the apex that went on at the backstage deserves equal recognition.

[@AANasseh]

Except that manufacturers have caught in to our need for radioopacity, so that they put so muchbradioopacifyong agents that you can simply brush one surface of the canal and it looks like you’ve done a great job on your Obturation, even though you haven’t even filled the canal!

[@vladimirsavenkov2424]

Наварра бич-самые лучшие воспоминания. Спасибо за ролик.

[@1995pearson]

UK dentist, I completely agree, so much emphasis is to do with the obturation. Which of course is very important, but the chemo-mechanical preparation is the real secret to success, and that won’t be seen on an instagram picture. I’m far from an endo specialist but just my thoughts.

[@AANasseh]

For not being an endo specialist you have certainly figured out the important parts of endo! Cheers!

[@vladimirsavenkov2424]

I remember when the philosophy of canal treatment was different. First. The treatment was free. Second. We never think about working length, apex diameter or S-shape kanals. I didn't try to search MB2, because we used method of preservation. The first 20 years I conserved the pulp another evacuated from the kanals. The third. We did not changed kanals anatomy and such complications as crack, perforations, broken file, overfill-were rarely. Fourth, last. Let's talk about fears and superstitions. I am still afraid to treat relatives , medical workers and redheads league patients.

[@AANasseh]

@@vladimirsavenkov2424 haha... I see... it was certainly easier... but was it as predictable? I think the techniques and anatomical knowledge has helped make it more successful... but the fascination with radiodontics is not helpful. Although it may help make the field more differentiated or exclusive. It's probably for the better in whole.

[@vladimirsavenkov2424]

@@AANasseh The results is predictable, a statistics speak about 8-10 years success. Did you ever see red Russian teeth? I have seen they meny times. They are so difficult to extration. This is history. It is all in the past.

[@AANasseh]

@@vladimirsavenkov2424 I've seen a lot Russian Red cases. But why would they be difficult to extract? I don't understand that. Also, how long do you expect a Russian Red case to last? I've seen them to be 15 years old. What's your experience with them Vlad?

[@celts03]

awesome talk!

[@ambienteterrazas]

I think you are right on point on all you said, younger dentist like me can be easily impressed by instagram and other social media and we overstress by how the x-ray should look while overlooking the basics. Do you think he might have meant on how the obturation looks?? maybe he uses cold lateral consensation techinque and does not obtain a uniform packed looking xray?? Thanks

[@AANasseh]

It’s mostly about taper and radioopacity which is often confused with quality of the fill. Otherwise, it should be based on the other criteria I mentioned such as getting down to apex, maintaining anatomy, and then having successful outcomes. Instagram can turn healthcare into an opportunity for selfies!!! That’s not what we should do. The most successful part of a case is the patient feedback about it. We unfortunately don’t even consider that in our field!!!

[@stevenlopez1717]

Couldn't agree more (D1, aspiring endo).

[@afiqendo]

Absolutely agree. Back to basic, biological rationale of endodontic. I hope to see u in Budapest!

[@AANasseh]

I’ll be there! 👍

[@yuxiangwang179]

thanks for sharing

[@Doctorroycom]

thanks sir 🙏

[@kirityadhikari6651]

Thanks Ali

[@ZACY1234]

Hey Dr. Nasseh! I have some more questions for you, if you could answer them in future videos that would be great! 1. Does eugenol still has a place in modern endodontics/management of emergency endodontic patient? 2. If we don’t have a special tool for ultrasonic activation of our irrigation solutions(like EDDY) is it ok to use the normal ultrasound that we use for removing calculus? (I am an associate that doesn’t decide if we are going to buy EDDY or not)

[@AANasseh]

Sure. Anything is better than nothing. Only issue is magnetorestrictive units (Cavitron) doesn’t have the proper tips. But it’s ok to use.

[@ZACY1234]

@@AANasseh thanks for the response Dr. Nasseh! What about my first question, about the use of eugenol?

[@AANasseh]

@@ZACY1234 To be honest, there’s really no use for Eugenol in dentistry anymore, especially because it’s an oil and it inhibits composite bonding. So, unless you Are using amalgam, then there is really little need for eugenol and dentistry. Most of what eugenol does can be addressed with calcium hydroxide. Cheers!

[@ZACY1234]

@@AANasseh ok thanks! That was what I knew as well, but now I am in a new practice and everyone is using it for intracranal medicament regardless of diagnosis and stage of the endodontic therapy and I was like WTF! But I wanted to ask you too to see if I am missing something. Thanks for taking the time to answer 🙏

[@AANasseh]

@@ZACY1234 There’s a lot of old school thinking going around. People so use Screw posts, they use ribbond to fill canals, and engage in kooky views such as oil pulling and other nonsense. We have to do the best we can do with circumstances in which we practice. If anything else, I hate the smell of Eugenol that gives an office that characteristic Dental office smell and the associated fear and anxiety for some people. That might be a useful angle to convince the owners to recognize and switch from this ancient practice! 😂

[@daktariwameno]

on point!

[@yoni9stern]

Great stuff. Quick question. How do you feel about a lentulo spiral for BC sealer placement?

[@AANasseh]

As long as it's at lower speeds and doesn't push the sealer out with a massive overfill then it's fine. But I rather just use a file to push the sealer down. It's all good.

[@yoni9stern]

​@@AANasseh Thanks! Hope to see you at AAE 2023

[@meowymeow282]

Doc, is there any need to obturate at all, if one has (as thoroughly as practicable) completed chemomechanical preparation? What are your thoughts on regenerative endo in adults? Shouldn't through chemical disinfection and a good coronal seal be sufficient in all root canal cases (or is there sound eveidence regarding retrograde reinfection of a root canal system/ reinfection via small amount of residual microbiota deep with dentin tubules?

[@AANasseh]

That’s what I was eluding to. No need to Obturation if we’re could sterilize the canals. But we currently can’t despite some manufacturers claims. And the microbes in tubules are why regenerative procedures fail when they fail. But if a critical concentration is reached microbes can be killed and why Reagan cases can also work.

[@mhmmd999444]

new brand of Instagram endodontists lol love it and sad it is true

[@angelicafoster670]

Hello Dr. Nasseh , i have a question. how to tell that i removed apical inflamed tissue before commencing working length determination? usually from my experience , the last apical third is the most inflamed part and just touching it makes patient suffer severe pain under anaesthisa , the apex is reading OVER, and in x-ray we are short like 2 mm short , so i get in a loophole dilemma , how to differentiate between : if it's lateral opening that is short of apex and the patient is feeling pain cause i'm over the apex , or it's remaining inflamed tissue that is misleading the reading due to inflamed apical half! Another case , i recently broke an orifice opener in a tight mb2, following is the ray of the case : i tried to bypass it , but i'm not sure if i'm creating an extra canal or a perforation , although apex is giving me readings in it and no bleeding.

[@AANasseh]

If a patient feels anything during RCT it's usually due to anesthesia wearing off or being inadequate. Always anesthetize with extra anesthesia so these issues don't happen. We obviously get a lot of inflamed cases but by giving extra anesthesia and intrasulcular shots before access you should not have patients who feel the tissue in the apex. If your apex locator is showin 2mm short it means that you're having a circuit issue which is usually due to too much bleeding. Make sure the chamber is fully dry the whole time you're using apex locators. I'll probably make a video on best practices on apex locator measurements at some point. Cheers!

[@serenaleigh8418]

I have a lots of interest in your videos But changing locations most of the time is quite irritating cause of bad sound and light. It is very difficult to concentrate.

[@AANasseh]

Thanks for the. Feedback. These e are shot when I get a chance during travel… so, it’s hard to make them consistent. I probably should shoot more in studio. Cheers!