Irrigation discussion with Dr. Stephen Buchanan

During a visit to Boston and NE area, Dr. Nasseh organized a session for Dr. Buchannan with HSDM Endo residents and sat down with him before the talk to discuss the topic of irrigation.

[@abbie2151]

What a great watch! Thank you both for this content and your contribution to endodontics!

[@shot336]

Thank you Dr. Nasseh for keeping it simple and honest for all those years and for not promoting these hype products. Can you please clarify the ideal method or ratio that you recommend alternating sodium hypochlorite and EDTA at the various stages of the procedure. Thank you :)

[@AANasseh]

If you're not using a combined procedures, you can do one of two things, 1. Alternative between a EDTA and NaCLO syringes in irrigation throughout the procedure or 2. Use EDTA in the early phase of treatment and then switch to NaClO after determining working length and remove smear layer at the end. There are obviously many other combinations of things. I'ts laso important to add energy using ultrasonics whenever possible. Cheers!

[@shot336]

@@AANasseh Thank you :)

[@michaellupu2080]

Wow Dr. Ali that was excellent! I was not aware Dr. Steve gave up using GW, being one of its greatest promoters just a short while ago; that's something I always appreciated about him; he seems to always explore new ways of performing his treatments, seemingly always switching his protocol up, perfecting it. I can't say the same about other Santa Barbara endo Juggernauts.. Happy to see your excellent videos, as always! Gives me lots to think about 😊

[@dtba]

Thank you! Great video 🙏

[@medabdo23]

Amazing discussion, thank you guys 🙏

[@michaelwang4222]

Great talk!

[@sria8163]

This entire conversation brings us back to square one... Someone has to next answer "what's square one? "

[@AANasseh]

LOL! True. Square one is lack of consensus and leading to my point that given all discussions lead to square one, try simple and efficient means rather than costly and complicated ones. 👍

[@avinawprakash9390]

Nice insight thanks I have encountered upper front tooth retreat, resorption necrosis cases with a open apex or broad apex so much that F3 of ptg or 6% 20 whwre not engaging apex enough there was no point in shaping themm more instead i call them 3 days in contin and just irrigate iirgate and irrigate after necessary shaping no caoh and amazing i had great results . So i even before scouting for canals always use ultrasonic, hypo preirrgation as far the double vent needle goes then proceed. With edta n saline

[@ashutoshshirsath3582]

Enlightened😊

[@vladimirsavenkov2424]

Thanks a lot. Very useful. I like such discussion. When speak well educated man better keep silent because there are interesting idea s.

[@johannc2451]

beautiful exposed the irrigation question, so interesnting and deep science understanding in this matter, congratulations both doctors thanks for sharing. my post is about to share a book I like it . the different angles to this topic is : Endodontic Irrigation Chemical disinfection of the root canal system Editors: Bettina Basrani Springer Verlag, thanks a lot blessings

[@AANasseh]

Dr. Basrani is great in this area and I agree with many of her findings and descriptions. Best wishes. :)

[@fabrizioruffa7705]

Hi Doc!! Great video, as always!! In your opinion, should hypochlorite be heated? I don't heat it because I believe it decreases the percentage of free chlorine which is the active part of sodium hypochlorite. Greetings and thanks again 👋🍀

[@AANasseh]

It's a pain in the neck to deal with heated irrigant but there's no question heating it will increase its efficacy and efficiency. No worries about the percentage of free chlorine. First, it's the hypochlorous acid that disinfects and second, it it's a high enough concentration it's still going to be more effective than cold solution. But it's an inconvenience.... so, I tend to skip it until we can have an easier way to do it. cheers!

[@fabrizioruffa7705]

thank you for the answer!! have a nice day@@AANasseh

[@dentalparkSHC]

❤

[@someoone1419]

Thank you sir for this awsome discussion but may I ask, is sodium hypoclorite activation with hydrogen peroxide as effective as ultrasonic activiation or less and do you recomend it?

[@AANasseh]

When you mix NaClO with H2O2 you only get a chemical reaction causing effervescence and agitation and not any fluid activation, cavitation, and acoustic streaming that you get with a piezo electric ultrasonic. So, it's not bad but certainly not as good. However, there are some people who have concerns with nascent Oxygen generation when you mix H2O2 with NaClO. I'm not that sure how big a deal that is; as usual, there are many people with many opinions and not enough facts and science to back such claims. Cheers!

[@shahsdentalclinickarad3032]

Sir what are your thoughts on triple antibiotic paste instead of calcium hydroxide.

[@AANasseh]

It ceratinly works and is effective; but if the third antibiotics is minocyclin it can stain teeth. More importantly, it can increase the incidence of resistant bacteria as well as antibiotic sensitivity and allergies. Lastly, it's expensive as it has to be made by compound pharmacy. Therefore, Ca(OH)2 is ai simpler alternative and is a worthwhile tradeoff.

[@moneyjoyk]

When Dr Ali is talking with anyone who he brings on board..the best i can do i shut up and learn

[@thuvan9607]

Dr. Stephen Buchanan said: A Single-File Case is when a 15-.05 miniKUT EZP rotary negotiation file cuts to length, rotary negotiation as first file to length

[@AANasseh]

Unfortunately, because there’s little longitudinal long term research clinicians must agree to disagree on such concepts. I generally do t agree with that but I accept that Dr. Buchanan certainly believes that. For me, instruments do clean as well; but because they don’t clean completely we must irrigate too. But irrigating alone is generally not enough to remove the greater mass of biofilm and that’s why we’ve historically referred to it as chemomechanical cleaning and shaping. I probably should make a video about this topic alone. Cheers!

[@michaellupu2080]

​​@@AANassehthe one thing I didn't buy about what Dr. Buchana said in this video was that it takes 1-2 minutes to shape a canal: I've seen plenty of his hands-on cases, generously uploaded on KZbin, and all his cases last 2-3 hours, excluding pre-treatment procedures, like anesthesia, which means chair time is even longer, And that's when he used Gentlewave. I can only imagine that his pulp-sucker (which is a cool take on negative pressure irrigation, in which the direction of flow is from the apex going coronally, unlike in endovac) would make cases longer, as it seems quite cumbersome to setup, at least on a molar. It was totally disheartening seeing one of his calcified molar cases, because even after 3 hours, having gentlewave and 3D dynamic guidance x-nav technology on board (and his vast clinical experience) the case was still unfinished. It made me say to myself: "if he can't do it under these ideal conditions, what chance do I have?"

[@user-dx4xm2rv5e]

Sir why u use edta at beginning? What is the benefit of that ?

[@AANasseh]

Need to soften dentin to get down on narrow canals easier.

[@michaellupu2080]

​@@AANassehI asked Prof. Markus Hapasalo about using EDTA as the irrigating solution during shaping, as Dr. Buc prescribes. He was intrigued by the idea of EDTA dissolving the smear layer/dentinal debris before they get a chance to clug lateral anatomy, but said that no studies are available regarding this strategy. Of course, he's "biased" as he's the prominent researcher regarding dentine erosion caused by NaOcl following EDTA. Your Triton, of course, has no such limitations. At least I hope so!

[@AANasseh]

@@michaellupu2080 We're lacking research in so many of these recommendations... but it's possible that we're grasping at straws and the statistical significance and clinical significance are factors we constantly confuse. At the end of the day, there are many ways to get good results IMHO. Cheers!

[@michaellupu2080]

@@AANasseh thank you dr. Nasseh for taking the time. What is "disheartening" is the lack of concensus on things that seem clear-cut. I participated in a lecture by prof hapasalo and he showcased his studies regarding NaOcl concentration, demonstrating that the higher the concentration, the better and faster the cleaning, but then you hear Dr. Ricucci saying that he's only using 1% NaOcl because "biological school", and he collaborates closely with Dr. Siqueira and Rocas, some of the best endo microbiologists living today, so it's not like he's uninformed. There's also diametrically-opposed opinions between dr. Hapasalo and Ricucci regarding Calcium Hydroxide. I guess that can be seen as a good thing, as that means that there's more than 1 way of gaining success, but it adds to the overall sense of confusion. Dr. Ricucci is coming to my city this weekend for a presentation, maybe I'll get to ask him to clarify his position. Hope it'll go well 😀