Endo with Dr.Nael

Endo with Dr.Nael From real cases to common mistakes and smart tips.everything you need to master root canal treatment.

The truth about endodontics
08/02/2026

The truth about endodontics

With prof Essam Zatar
04/02/2026

With prof Essam Zatar

20/01/2026

🔴حقائق لازم تعود نفسك عليها وانت شغال RCT. 🔴

1-Try to train yourself to finish RCT in single visit whenever possible ( always keep this as your goal)

2-Re treatment cases always couldbe finished in single visit ( special cases)

3-At obturation step.. ( lateral condensation)
*The spreader size larger than the auxiliary cone.,
**Sealer only apply on master cone .
***When you cut the Gp, always leave it at the or***ce level or at least 2 mm below it, so you can place flowable composite to achieve agood coronal seal.

4-Try to complete the coronal restoration in the same visit as obturation ,to ensure aproper coronal seal together with the apical seal as coronal seal affect on success rate of rct.

18/01/2026

🟥 To avoid instrumentation mishapes!!

-Before rotary shaping canal:
1-canal scouting (file 10 k)
2-Negotiation to patency.
3-Coronal flaring ( or***ce opener)
4-Determination of W L
5-Glide path preparation (till file 20 )

15/01/2026

🔴 SHOULD THE CROWN COVERAGE BE REMOVED OR KEPT DURING RE RCT??

دايماا بننصح removing the existing crown عن اني اعمل access through it

ليه!!
ده بيخليني اتجنب risk of iatrogenic errors
PERFORATION
الافضل نشيل الكراون as single unit
وبستخدمه كمؤقت بين الزيارات ..

احتماليه اني اشيل الكراون بتزيد لو not clinically perfect
Such as, in cases of defective restorations as open margins
وبالتالي
1-caries beneath the crown.
2-periodontal inflammation ( periodontal pocket mimicking endo pain.

**Rationale for crown removal in re rct;

1-Elimination of potential sources of infection , including micro leakage beneath defective crowns.
2-Improved visualization and straight line access to the pulp chamber and root canals .
3-Reduced risk of perforation and missed canals.
4-Better assessment of the remaining tooth structure and ferrule effect for restorability.

12/01/2026

Removal of over extended G P
(Same visit of obturation)

08/01/2026

Where there’s awell,there’s away!

07/01/2026

🔴اشيل ال Gutta PERCHA ازاي ؟

🔴In cases of coventional Retreatment ..

التعامل مع G.P في الاغلب بيكون الاسهل من Post removal
لو موجود ولكن بنواجهه صعوبه لو؛

-G.P well sealed.
-Old obturation (10 years or more)
-Mishapes during removal: ledge specially with use Gattes ,broken file with use H file with force.

-Step by step G.P removal;

1-coronal 2/3

ممكن ابدء باستخدام Ultra sonic وديه بتكون امنه جداا ومش حتعمل ledge
او استخدم Manual files لو poor obturation افضل استخدم C file مقاس 10,15 في الاول حعمل path جنب G P watch winding motion. وبعدين استخدم H file
ربع لفه واطلع outward

لو عندي System B حستخدمه ك heat generation

لو obturation well sealed حستخدم rotary retreat files
ب سرعه عاليه 900 -1000 rpm واقل torque
وده طبعا لو straight canal .
السرعه العاليه اللي بيلف بها Rotary حتعمل heat generation

استخدام Rotary بيكون بس في coronal 2/3

2-Apical 1/3
Only use manual files .. بنفس الطريقه اللي قلناها ☝️

طيب استخدام Solvent ؟؟
مش مفضل استخدام solvent عشان بتصعب ازاله ال G P ولو نزلت لل periodontium بتكون irritant جداا
طيب استخدمها ازاي؟؟

Drop صغيره علي rotary file
Drop علي cotton pellet on canal or***ce

يبقي خلينا نلخص كل اللي قلناه :
GP ممكن اشيلها
1-Mechanical ; manual files ( C -H files)
Ultra sonic
Rotary files

2-Thermal : heat generation by system B
3-Chemical :chloroform only solve GP not remove it.

{عشان منعملش ledge بلاش Gattes Glidden
{Rotary file في Straight canal

04/01/2026

🔴 WHEN DO I NEED A RETREATMENT ( RE RCT)??

قرار اني اعمل اعاده علاج جذور ده قرار مش سهل ابداا لان اعاده علاج العصب اصعب بكتير من علاج العصب ..
ونجاح اعاده العلاج بيعتمد علي قدره الطبيب علي فهم وتحليل ومتابعه اسباب failure
عشان كده دايما بنأكد علي CBCT في حالات Retreat.

من جهه تانيه ..
ايه ال factors اللي بتكون مهمه جداا في clinical examination
& Radiographic examination
وده اللي بتكلم عليه في البوست

٤ حاجات ..
1-Adequate or inadequate old Rct?
2-If any clinical symptoms?
3-With or without lesion?
4-Quality of coronal seal?

(Adequate RCT )
1-With out cl. Symptoms +without lesion+Adequate coronal seal ………… No need to Retreat.
2-Without cl. Symptoms +without lesion+in adequate coronal seal…………. Retreat…
3-Without cl. Symptoms +with lesion ….. Retreat.
4-With cl.symptoms…………..Retreat.
5-Without cl. Symptoms +with lesion+good coronal seal …………..No Retreat. As local adaptation syndrome in chronic cases.

( In adequate Rct)
1-With cl. Symptoms…………Retreat.
2-Without cl. Symptoms +with lesion ……..Retreat.
3-Without cl. Symptoms +without lesion+inadequate coronal seal……………..Retreat.
4-Without cl.symptoms +without lesion +Adequate coronal seal………….No Retreat.

31/12/2025

Always remember;
The aim from rct isnot to obturate the canal,but is to disinfect the canal!

30/12/2025

The only thing more dangerous than ignorance is arrogance
-Albert Einstein

02/12/2025

Broken file ازاي بيحصل؟؟
(Operative causes of failure)

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