How To PROPERLY and QUICKLY Extirpate (Acute Pain) - GF016

Put down that K-file! Extirpations have just become more stealthy!
We have specialist endodontist Dr Sanj Bhanderi describing how to make our protocol for extirpations more efficient and with less future complications.
00:00 Introduction
2:38 Dr. Sanj’s journey to Endodontics
6:30 Emergency Extirpations
8:42 Diagnosis Protocol Irreversible Pulpitis
11:57 Anaesthetic for Hot Pulps
15:33 Caries and Restoration Removal Before Extirpating?
19:16 Vital Pulp therapy
21:19 Isolation Protocol for Extirpations
25:30 Sedative Dressing for Acute Pain
28:42 Temporary Restoration of choice
31:39 Post Op Medicaments
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[@adipluto9598]

Wow, so much tips i learnt today,thank you! Do you think it is acceptable to remove temporary restoration(like cavit) with an ultrasonic scaler? Or does it damage the remaining dentine?

[@protrusive]

yes absolutely, ultrasonic will not damage healthy dentine - plus you will mostly be on restorative material

[@nannag9098]

Jaz as a newly qualified dentist these videos are amazing you're helping a lot of dentists and also patients indirectly Thank you!!

[@protrusive]

really appreciate your kind words that keep team protrusive going - thank you!

[@ikeyshuster9801]

Jaz your gift is the ability to ask direct and high quality questions Love it!

[@miradehoca9930]

Omg what a great timing for this episode ! I've just been talking with a colleague about this subject !

[@crimsonrouge4016]

Brilliantly explained 👍

[@ZACY1234]

Hey Jaz! Great episode and a lot of gems! You didn’t talk about teeth that are already Endo treated and have GP in the canals and also you didn’t talk about when to prescribe ABs. Maybe a part 2?

[@JD-kp6ev]

Brilliant episode so much to take away thank you.

[@protrusive]

thank you!

[@estefaniazanetti9950]

thank you so much for shearing your knowledge

[@niujoy8904]

Thank you so much, would love to hear more about his idea of "preventodontics" and vital pulp therapy!

[@protrusive]

Good shout!

[@ahmedal-rubie411]

Brilliant episode. Sanj an absolute legend ❤️

[@khadijachikhly4193]

Great video..thankyou

[@DollyDu_mybest_barbie]

Thanks so much for the approach which no book would tell❤

[@protrusive]

appreciate your kind feedback!

[@pozer0118]

I love your video, your slang, and the knowledge you shared with us. SUBCRIBED! Keep it up dude!

[@chrysn7491]

Great content! Subscribed 👍

[@mikmikeo]

Hey Jaz, great episode. When you say you managed to elicit a necrotic response with the endofrost, what do you mean by that? Thanks!

[@protrusive]

hey Mike! I meant a negative to endofrost - however my diagnosis was still irreversible pulpitis and I suspected that it became partially necrotic- has a history of severe lingering pain on cold (and no apical pathology)

[@anisrahman5274]

Not sure if I misunderstood but if you irrigate the coronal portion of the pulp chamber with NaOCl then won't placing leddermix be ineffective because it's steroid based so needs a blood supply to be effective and the NaOCl would remove this?

[@zabjemcja]

Would dycal work (the base+catalyst mix of CaOH) if our office does not have non-setting CaOH? Could you just use the base without the catalyst to obtain the same result?

[@KHgoalkeeper21]

wouldn't dressing a hot pulp tooth with CaOH cause more post-op pain?? because of the high pH and caustic effects?

[@El_Nino_VFL]

So put CaOH on pulp layer and then sponge on top then Temp restoration material?

[@kvgolfa]

Lots of offices I've been at don't have CaOH. What's the best protocol if we don't have that?

[@protrusive]

Real shame IMHO - I'm not sure what a clinic would have that isn't CaOH - if a clinic has a K file and Sodium Hypochlorite, they should also have non setting CaOH right?

[@niall447]

You touched upon previously root canaled teeth and acute pain. Did you discuss this in the call in the end? Is it in the edits?

[@protrusive]

I don't believe we did bud! Calls for another ep - an hour just wasn't enough 😅

[@protrusive]

ah wait did you check out GF017? trying to remember if we covered it there!

[@niall447]

@@protrusive Hi Jaz, Yeah Sanj mentions it around 7:26 is mark. Just wasn't sure if he does say more about it. As he said he wouldn't talk about it yet. Such useful knowledge. No more K-files!

[@niall447]

@@protrusive I will go watch it now, it may be in that one. Cheers again Jaz.

[@anjalijain2192]

And sometimes the patient says they can feel the infection at the bottom of the tooth.. what does that mean?

[@qsirix]

Is this method also adequate for emergency endo on necrotic elements with apical periodontitis? Or is it purely used in cases of irreversible pulpitis?

[@protrusive]

worth asking! Will pass this on - I don't want to say for sure but I personally don't think it would work for that case

[@qsirix]

@@protrusive Thank you. Yeah, I don’t think so myself. In that case you would probably want to extirpate and clean to full length even during an emergency endo?

[@protrusive]

@@qsirix That's what I would do - however I wonder how many of these patients are given antibiotics instead.

[@tiredtrex]

In My clinic we unfortunatly not supposed to use endo irrigation at emergency departament so we just performing a trepanation, if the tooth has irreversible pulpitis we do perform protocol that has been explained at the video AND if it's necrotic, with a.periodontitit we put KAMFENOL on a cotton and close it with fletcher.

[@anjalijain2192]

This is great.. But I had a patient for whom I did just this but it took 4-5 days for her pain to go away. :(

[@protrusive]

I have done full on pulpectomies before and it had taken a week to get better. Pain is a complex beast and not even a a full length expiration is 100%

[@Nvrloptimism]

so i agree with this for SIP/normal apical tissue dx. what about SIP/symptomatic apical periodontitis? would you still not touch the apical pulp?

[@indiaturbanator]

Great video, thank you! Is the cotton pledget soaked in NaOCl left in and the dressing put on top? I thought it is just used to wipe the pulp chamber and then thrown away. Thanks. Also, at 18:54 does Dr Bhanderi say that the pulp is completely obliterate? What does obliterate mean? Calcified?

[@protrusive]

You are correct - it is used to wipe the pulp chamber and thrown away. And yes, obliterated pulp is calcified pulp

[@monaliza6234]

Hi doc,Can we place formocresol cotton pellet as dressing?

[@protrusive]

I'm not sure Doc, I believe it is banned in the UK from what I read

[@svenarbon6215]

@@protrusive Hi Jaz, great content. Do you why was it banned, It is still in use in Croatia, although patient can have it max 4 weeks, is it similar to ladermix?

[@protrusive]

@@svenarbon6215 Thanks Sven - Formecrosol was found to be carcinogenic unfortunately. I'm no expert but I think it's mechanism of action is different to ledermix - formecrosol 'fixes' the pulp making it inert

[@RoshDroz]

Does extirpation in this context = pulpectomy?

[@protrusive]

Some sources claim extirpation = pulpectomy - but extirpation is usually an emergency procedure, and can only involve the coronal pulp (therefore would be a partial pulpectomy) - ultimately the aim of extirpation is a pain free patient!

[@glenice1000]

How do u stop a haemorrhagic pulp?

[@protrusive]

I'm no specialist but I usually give an intrapulpal injection with adrenaline - also hypochlorite will be effective

[@sanjeevbhandari6000]

👍

[@naeemandalmasdentalclinics]

Just playing PTFE tape and temporary restoration should be enough, why to place dressing over pulpal floor first? CaOH is for pulpotomy and tertiary dentine formation and it can also induce pulp canal obliteration.. no sense of using it in emergency visit.. it shoudk be used as ICM if cleaning anf shaping performed

[@protrusive]

thanks for your comment and contribution!

[@payalrohra5741]

Pls stop posting about advertisements for longer duration, it is too irritating and difficult to focus

[@protrusive]

thanks for commenting on my free channel 😘

[@MaverickDMD]

I think it's dead wrong and naive to go after a hot pulp. The local anesthetic simply won't work due to the lower pH from the inflammation. Every dentist should kno. Give the patient a script for Tylenol #3's or Tramacet and

[@protrusive]

Thanks for your comment doc - valid viewpoint. I respectfully disagree Graham - I worked in am emergency department and all day I was extirpating molars. Yes there was some very tough to numb but all in all it was worth it when you call the patient the next morning to see how they are doing. I audited myself and 95% were out of pain the next day. In the times where I was unable to extirpate due to time constraints and we recommended analgesics - the majority of patients were still suffering the next day. I have suffered from irreversible pulpitis myself and needed extirpation and was very relieved I did - analgesics wouldn't touch it (lower incisors going non vital after Ortho) But you highlight valid challenges re LA difficulty

[@MaverickDMD]

.. and dexamethasone 4mg bid x3 days. Trying to extirpate a hot molar is a fool's errand. If you want to inflict pain on the already suffering patient then go for it. In private practice, not a hospital for the broke and desperate, things are done vastly differently and so they should be. Your advice for the quick extirpation is only promulgating dental phobia and is poorly thought out.

[@protrusive]

@@MaverickDMD thanks Graham - I want to learn: your protocol for irreversible pulpitis is analgesics and wait for it to go necrotic. Am I right?