Xtreme Endodontics

08/01/2024

17/06/2022

Apical delta (or apical ramifications)
The region at or near the root apex where the main canal divides into multiple accessory canals (more than two)..

15/05/2022

Scouting is exploring & reaching the untouched (hidden) areas of root canal..

1- Mechanically by file( k file (SS) no.8.10.12,C pilot)
2- Chemically by Sodium hypochlorite (ICH) with ultrasonic and sonic activation devices for proper cleaning the dentinal mud and debris so that we can achieve 3D obturation...

15/05/2022

EXTRACANAL HEATING vs INTRACANAL HEATING OF NaoCl :

EXTRACANAL HEATING :
It means warming outside the canal by a syringe of hypo with various means such as coffee warmer, immersing it in hot water.

The temperature of hypo is supposed to reach around 55-60 degree Celsius.
However heating a syringe of NaoCl is less effective , as by the time you reach the canal, the temperature of the irrigant becomes close to normal temperature .so unable to give excellent results..

INTRACANAL HEATING : Means heat the NaoCl Solution within canal system.

Research article-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161513/
Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls
September 2018
Journal of Conservative Dentistry21(5):569
DOI: 10.4103/JCD.JCD_245_18

Alfredo Iandolo, Massimo Amato, Alberto Dagna ,Giuseppe Pantaleo.

1-We can use a heat carrier (System-B sybron endo). The temperature of the heat carrier is set to 150°-180°.
2- We can use Downpack device as a heat carrier for heating the solution. (By Dr.Alfredo Iandolo et al)
This will improve the efficacy of Naocl for better pe*******on, tissue dissolution , debris and bacteria removal .

-Don't heat too much or for long , PDL injury can happen..
-Don't agitate forcefully ,hypo extrusion can occur .

1-The root canal is filled with sodium hypochlorite through the 30-G needle.
2-The heat carrier is used for heating & activation
3- Agitation by activation device (Sonic or Ultrasonic )

Each cycle of activation of the heat-carrier lasts 5-10 s with a further 5-10s intervals.

Sodium hypochlorite - Chloroxid Cerkamed used.
I have made a vedio about it..👇

30/04/2022

Mandibular first Premolar type V is always challenging because of deep mid split anatomy and tortuous narrow canals..
Poor accessibility, poor visibility , angulation , tortuous narrow canal path...one of the toughest negotiation i hd.

1- Cone shift IOPAR
2- Depth measuring of the split
3- Flaring and straightening of canal
4- Can use Canal detector for finding orifices
5- Use smaller no. files to negotiate with edta
6- Glide path with Pathfiles
7- Rotary preparation in steps with continuous irrigation and lubrication
upto 4% size.

High chances of ledge or file separation in lingual canal due to narrow passage..so prepare cautiously...

First practice ,then do it in patients....

30/01/2022

A challenging case of C shaped canal of 37.
some key points while treating C shaped canals-
1- Examine Pre Op IOPAR carefully.
2- Prepare Smooth and clearly visible access and removal of overhanging dentinal shelf...
3- Use broach if canal is wide , otherwise H- File carefully to remove some amount of pulp.
4- Generally canals are wide so , Do circumferential shaping along the walls nicely.
5- 3 D cleaning is must and it Needs copious irrigation so ,Use fresh Full strength Sod Hypochlorite 5.25% , Intracanal heating will give you additional benefit to remove pulp ..
6-Activate sodium hypochlorite with sonics and ultrasonics.
7- Obturate 3 Dimensionally..
8- Always take cone shift IOPAR after completion...

Shape ,clean and fill nicely....
Enjoy Endo ..👍🇮🇳

29/01/2022

..
Why we fail..?
Iatrogenic errors, correction, & retreatment..

History according to patient.
-RCT was first attempted in a college 3 months ago, after some days patient felt severe pain took some medication for relief but there was no relief ,
again went to other dentist , he cleaned the canal and placed calcium hydroxide ,situation went from bad to worse with severe swelling and extreme pain with mild paraesthesia in the lip area and advised for extraction ,
again went to third dentist ,he understood the situation & removed all calcium hydroxide and gave medication and referred to my clinic. Patient came to my clinic and said “can you save my tooth or will extract ?. I said “ let me see what I can do …

Points to remember-
-First take past treatment history with present symptoms , listen carefully what patient is saying .
-Take a nice clear IOPAR with atleast 3-4 mm periapical area
- Analyze the IOPAR & the understand the past treatment errors.
-In this case ,apical curvature was not negotiated and overprepared canal with apical perforation due to stiff files used forcefully.
-Tell the whole condition of tooth to the patient .
If he agree for retreatment make a proper working plan.
-Anaesthesia, isolation
-Manual handfile negotiation in curvature is must with prebending the files 6,8,10….
-Rotary preparation is very difficult in this case ,because of perforation in apical 3rd region near curvature ,whenever you place rotary files it will always go into perforated area. I did with precurved controlled memory file and used manually ..
-Clean the canal cautiously with side vented needle and endo aspirator..
- obturate nicely.
-Be careful about mental foramen any chemical can harm if goes beyond ..
Apical perforation cases always challenging ,do cautiously ....if unable to do kindly refer to nearest specialist....
Its better to refer the case rather than doing a complication....
Thanks... ❤️👍