Specialist Endo Crows Nest- Clinical hacks in Crows Nest, New South Wales, Australia | Dentist & dental surgery

Specialist Endo Crows Nest- Clinical hacks

Locality: Crows Nest, New South Wales, Australia

Phone: +61 2 9194 4610

Address: Suite 104 Level 1/22 Clarke Street 2065 Crows Nest, NSW, Australia

Website: http://www.specialistendo.com.au

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25.01.2022 We GO LIVE in under 3 hrs-get that free CPD for those in Australia-NZ

23.01.2022 Fillings canals using warm vertical condensation ? Who uses this technique?? If you would like to learn about this please join the seminar 14 sept 1900 Sydney and Melb time CPD CERTIFICATES FOR AUSTRALIA AND NZ https://facebook.com/events/s/avoiding-the-void-using-warm-v/1189488214748799/?ti=icl

22.01.2022 Techniques to remove gutta percha for root canal retreatment 1. Gates Glidden size 2 2. D retreatment rotary files 3. Using the down pack tips 4. Using Protaper universal XA and Shaper files ... 5. Use of mini steel round burs such as EndoTracer or LN burs See more

21.01.2022 What rotary files do you use for removing gutta-percha ? Ive used many - Protaper universal shapers, Mtwo 20 06, Reciproc 25, D0-D3 retreatment files. Protaper universal shapers still remain my favourite for removing gutta percha.... The online study club is less than one week away! Please feel free to invite your colleagues. 24 June at 1930 (Sydney/Melbourne time) 2130 (NZ time) 1030 (UK time). The study club will cover use of medicaments and in which cases we use them. The page to register for this event is: https://infoapac.ultradent.com/live-webinar And the FB event set up to keep up to date is : https://facebook.com/events/s/online-study-club-the-ideal-ir/320245712291824/?ti=icl

21.01.2022 Nice study by the Kings college London group - whom I worked with during my 4 years at Guys Campus Teeth with less than 30% coronal hard tissue were associated with more extractions during the 4 year observation than those with more than 30% hard tissue. RCTS which were deemed successful after 1 yr were correlated to survival for the study duration (4 yrs)... https://onlinelibrary.wiley.com/doi/full/10.1111/iej.13322

21.01.2022 Another query from a dental buddy Why do we often locate the MB2 canal and we can only reach half way down the root canal?? Answer- the second Mb canal often has an acute coronal curvature that means the coronal orifice curves mesially and then after this curves distally. This means that location of the MB2 canal is just half the battle. Once located the operator needs to follow the canal using an LN bur or EndoTracer and cut through that initial coronal curvature meaning th...at the distal curvature is the only one we need to deal with. The reason why it maybe not possible to get further than half way is that that the file is negotiating the coronal curve and ALSO trying to negotiate the distal curve. This is often too much for a K file and can lead to ledging , blocking or file fracture. We reached capacity for the seminar last week so the recording can be watched here https://www.youtube.com/watch?v=I0-Zr9DwZeI&feature=youtu.be Happy Saturday everyone See more

20.01.2022 When we fill root canals what does this do ?? -Fills the space within the canals to reduce the space for bacteria to thrive -Create some kind of coronal seal of the root canal to prevent microbes and nutrients reaching the canal -Create some kind of apical seal of the root canal, to prevent exudate in the tissues reaching the canal and bacterial toxins from exiting the root canal into the periradicular tissues ... - radiographically gives an idea of the length of preparation - radiographically gives an idea of the taper of the preparation Join the free seminar online https://facebook.com/events/s/avoiding-the-void-using-warm-v/1189488214748799/?ti=icl See more

20.01.2022 Preoperative on left 6 months review on right # X3 ProTaper next for all canals

20.01.2022 What wont be covered as part of the seminar on 24 June Hydrogen peroxide as an Endodontic irrigant- is it any use ?? It has issues - it lacks the ability to dissolve tissue and biofilms and also has the potential in rare cases to cause air emphysema due to the production of bubbles if extruded. There is not enough evidence to recommend it as an irrigant in Endodontics the seminar will discuss why sodium hypochlorite is superior to hydrogen peroxide. For you students its all in the chemistry !!Message me for details of the study club

20.01.2022 A question from Wednesday nights study club. Q- Bystrom and Sundqvist 1985- showed that 80% of samples were free from bacteria sampled but Retamozo 2010 showed that 5.25% sodium hypochlorite for 40 mins dissolves all the biofilm from dentine cylinders. What are the reasons for this apparent anomaly??? A-this is the difference between a clinical study Bystrom and Sundqvist 1985 is a clinical article and involved paper point sampling of the main root canal of the cases treated.... Bacterial sampling has its own challenges and many of the microbes would not get direct contact from irrigants and medicaments. The Retamozo 2010 article was a lab study looking at sodium hypochlorite DIRECT irrigation on biofilms present on dentine cylinders. This is direct contact and will reduce the time required to remove the biofilm

20.01.2022 Placement of SDR flow under composite light on the scope! A friend asked what he should use over the gutta-percha after filling the canals. I find SDR is really easy to use and place. There are many options for materials to use over the gutta-percha and as a base under the coronal restoration but in my opinion - the most important features are that the material can be placed in thick sections easily and also adapts to the shape of the orifice- the handling properties are also... very important. In the past Ive used GIC which has moisture contamination issues when you etch, necessitating more placement of bond. It also can only be packed when it is setting and this takes a bit more time. Ive used amalgam which adapts nicely but is less accepted by patients. The idea of having a bonded orifice plug and then bonded core seems logical to me - so thats what I use. See more

19.01.2022 What are the advantages of minimal invasive Endodontics??? In 2010 Clark and Khademi told us that preservation of the peri cervical dentine was important and that longevity of teeth was related to preservation of this dentine which is 4mm above the alveolar crest and 6mm below the alveolar crest. For a long time afterwards many believed that preservation of this part of the dentine improved strength of the tooth being treated. Since then there have been articles looking at wh...ether compressive strength is enhanced by the size of the access cavity Plotino 2017 , Corsentino 2018 and the answer is generally No and why is this?? When we make an access cavity we establish a fulcrum where the cusps become levers. The longer the lever the higher the increase in the bending moment (or torque) on the remaining dentine. So if we make a very small ninja access and a conservative access there is still a lever created by making the access into the root canals and therefore no significant difference in strength per se. Of course if the dentine is destroyed by making a huge access some threshold level is exceeded and the tooth then does have a significantky lower fracture resistance. This is nicely detailed in the Plotino article. So if its not overtly the actual fracture resistance that is improved by minimal invasive Endodontics why is it beneficial?? Here are some main advantages Ive thought of - keeps the fracture resistance as high as is practically possible - improves thickness of any ferrule required - retains hard tissue which is associated with improved outcome - Al-Nuaimi 2017 - retaining hard tissue makes creation of a coronal seal associated with improved outcome (Ray and Trope 1995) and restoration more predictable So minimal invasive endo has advantages but perhaps not the ones which appear to be most obvious. See more

18.01.2022 Gauge of needle tip and corresponding K file tip size 23 gauge - size 60 25 gauge - size 50 27 gauge - size 40... 30 gauge - size 30 31 gauge - size 25 See more

16.01.2022 Does Ledermix really help prevent post op pain?? This is something we will discuss at the online study club. Its a steroid antibiotic paste - but the pain of inflammation in post op situations comes from the apical tissues. Most severe post op pain is in fact from extrusion of bacteria and dentinal debris

14.01.2022 Another Q from Wednesday night ! I like this one because this person seems to have been really listening. Q- you mentioned Chlorhexidine improves dentine bonding strengths - how does this occur and are there any articles on this ??? A- Chlorhexidine has been shown to inhibit metaloproteinases these are enzymes released from dentine after etching - or use of acidic bonding agents. They appear to breakdown the collagen in the hybrid layer (the dentine bond- dentine tubule inter...face)- Chlorhexidine has been shown to inhibit these enzymes. So it could be recommended that they be used after etching. CHLORHEXIDINE 2% (Consepsis) NOT 0.2% (mouth rinse)- has been shown to improve bond strength Here is an article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040992/ See more

12.01.2022 Why does my tooth hurt when it has been root canal treated??? There are many reasons for this including unlocated canals and a root fracture. Lets assume all the canals have been located and the root canal treatment has been successful. Anything that causes inflammation of the periodontal tissues around the tooth can cause discomfort. The tooth might be dead but the patient is very much alive

11.01.2022 Time heals all wounds patient attended at the time of the restrictions as an emergency. Preparation of all 4 canals was done. Calcium hydroxide was used as the intracanal medicament, because after I removed the pulp tissue there was no pulp and therefore no need to use a steroid antibiotic paste. Calcium hydroxide changes the environment to an alkaline one and this retards proteins synthesis and DNA replication. It also helps denature remaining pulp tissue making it easier ...to dissolve using sodium hypochlorite. Activation of the irrigants was done with Eddy and the finishing files were TruNatomy prime for all 4 canals. Ortho band placed The patient returned to complete treatment after 4 months and I filled the canals using warm vertical condensation of GP and sealer. SDR base and composite core was placed. Post op radiograph shows some healing and Ive advised that a crown is required See more

11.01.2022 What irrigants wont be covered in the online study club. Iodine as an irrigant was introduced in 1979- it offers a broad anti microbial spectrum- viruses bacterial and fungi but many patients are allergic to it and it cannot dissolve pulp tissue or biofilms 5 days till we go live ...

11.01.2022 A question from Wednesday evenings study club Q - if I prepare a canal to a finishing size of F1 ProTaper gold (20 07 variable taper) then use a 35 k file to prepare an apical stop. If I trim the F1 GP cone to make the tip 35 the cone no longer reaches the working length. What can I do??? A- This is called TAPER LOCK- the cone has been trimmed back about 2mm but the taper of the cone is wider coronally than the F1 File. So essentially the gutta percha cone is locking in the... coronal part of the canal preventing it reaching the apex. The best way to overcome this is to use a narrower cone and cut the tip to make it a size 35 that is close to the taper you have prepared the canal. A cone such as 20 06 could be an option - if this still doesnt reach the apex then if you are using warm vertical condensation a wide 4% tapered cone such as 35 04 could be warmed and then adapted to the apical region. The remaining part of the canal is back filled with warm gutta percha and easily adapts to the remaining space. See more

11.01.2022 2 hours till I talk on this YouTube podcast https://youtu.be/7UAtMtHdpjk

10.01.2022 Over the last few days Ive seen some very happy posts from newly graduated dentists in the Northern hemisphere. Congratulations to all the new dentists on completing your dental courses. You are just a few weeks away from entering a great profession. The finale of the dental degree signals the conclusion of 5 or more years of tertiary education, the end of compulsory exams and the end of tutors looking over your shoulder in clinics. Its such an exciting time and what often...Continue reading

09.01.2022 Healing of radiographic apical periodontitis- what is actually happening when we achieve this ?? Reduction of microorganisms inside the canals reduces the inflammatory process that is in the periradicular tissues. This allows the body to replace the bone lost as part of the inflammatory process and the lesion heals. Basically healing of an apical radioluncency, shows that the body no longer perceives a threat from the microorganisms within the root canal system. Join the fre...e online seminar Monday at https://facebook.com/events/s/avoiding-the-void-using-warm-v/1189488214748799/?ti=icl

09.01.2022 Thanks to those that were part of the study club on Wednesday night! Im answering some of the Qs for the study club that came up on Instagram @SpecialistEndo and some other ones here on the SECN clinical hacks Fb page. So here is another Qs- which brand of calcium hydroxide do you use ? Does this make a difference?? Well like most things in dentistry some calcium hydroxide pastes are good sometimes and other at other times For example I commonly use Ultracal it has an aqu...eous vehicle and this means it can be injected through a Navi tip but also means it dissociates into ions quickly - Fava and Saunders This is desirable for most of the cases If a case has sustained release of exudate into the canal to prevent dilution a viscous or oily base is desirable. Different situations can mean using different types of calcium hydroxide See more

09.01.2022 How many of you use this simple but very helpful clinical tip?? Arnaldo Castelluci published an article on this technique. Also posted on @specialistEndo The other day I decided to document this technique. There are so many techniques where we can check that canals join. Juggling the Gp cones to see if we can get one of them to length and putting files in the canals to feel if they touch when we place them, using irrigants in one canal and seeing if they pass into the other ...canal. Yet this is the only clinical technique that shows- firstly that they join and secondly and very importantly WHERE THEY JOIN. This is an upper first molar where Ive prepared MB1 and MB2. To see if they join Firstly place a Gp cone to the WL in one of the canals- in this case I chose MB2 because the curvature allowed me to obtain a very reproducible seat. Secondly - take a K file and place it in the partner canal (in this case MB1) the file will easily go to the apex if the canals DO NOT join - but in this case the file didnt reach the apex - indicating they join somewhere. Push the k file to make an indentation on the Gp cone. Remove the K file FIRST always remove the K file first ! Then the Gp cone and examine the cone for where they join. In this image you can see the canals join in the apical 1/3 close to the Tip of the Gp cone. To fill the canals put the cones in with the easiest one to reach the apex first and then the other one after to hold its space. Downpack the one which goes to length the easiest for me this was the MB2. Then down pack the other canal in this case MB1. Then backfill the one you downpacked first. Keep safe everyone! Have a great weekend See more

09.01.2022 How long should I irrigate with sodium hypochlorite for ? A study by Retamozo et al 2010 showed that direct irrigation of 40 mins with 5.25% sodium hypochlorite eliminated all E faecalis biofilms. This is the minimum irrigation time we should use and shows that a higher percentage and activation of sodium hypochlorite is necessary if we are performing single visit Endodontics and dont have the luxury of the protein denaturing properties of the calcium hydroxide dressing.

08.01.2022 One of my favourite articles to quote patients regarding crowns on molar root filled teeth Nagasiri et al 2005 Survival without crowns 1 yr- 96% 2 yrs 88% ... 5 yrs 36% Root filled molars with maximum hard tissue had a better survival rate 5 yr= 78% Direct composite restorations gave better survival than amalgam and zinc oxide restorations https://endoexperience.com//Long-termsurvivalofendodontica

07.01.2022 Why is sodium hypochlorite the gold standard irrigant for root canal treatment?? Is Chlorhexidine effective ?? When should we use Ledermix? When should we use calcium hydroxide? Is it good to mix these medicaments??? If you would like to know some explanations of these Qs please join the online study club 24 June

05.01.2022 Another Q from the study club 24 June How would you anaesthetise a hot pulp?? Assuming the tooth is a lower molar - a hot pulp is a pulp that has irreversible pulpitis.... For these teeth an intraosseous injection is a good option, if you have the kit. If not then articaine used as a inferior dental block is very helpful for these cases in my hands and is safe to use (i only use it for a block in hot pulp cases). A buccal infiltration and lingual infiltration using articaine is also a good option, to anaesthetise any accessory nerves. Always wait for lip numbness and then 10 mins by the clock!! Then test the tooth with cold or EPT and see if you get a response. If you need to give more anaesthetic I use lignocaine as an intraligamentary injection. Then after this if necessary intrapulpal

05.01.2022 Rubber dam set up for treating calcified canals in upper anterior teeth. The ASH EW is a good one to use or in this case Ive used a W2A clamp on the canine. I choose the canine to clamp if the cingulum is bulbous and if not then I clamp the first premolar! Then floss the dam between the teeth and then cut the corner off using scissors and use this as a wedget. This is an old Otago uni trick !! It allows you to take radiographs using a REGULAR HOLDER and see the angulation of... your access- without the clamp blocking the view. With calcified upper anterior teeth access just palatal to the incisal edge and keep the angulation palatal. Most perforations occur through the buccal aspect. There will be an online study club on 24 June at 1930 (Sydney/Melbourne time) 2130 (NZ time) 1030 (UK time). The study club will cover use of medicaments and in which cases we use them. The page to register for this event is: https://infoapac.ultradent.com/live-webinar And the FB event set up to keep up to date is : https://facebook.com/events/s/online-study-club-the-ideal-ir/320245712291824/?ti=icl

05.01.2022 I had a request from a dental buddy who finds the patient leaflets on this page helpful. They requested that I do a post about external inflammatory and internal inflammatory resorption. Internal inflammatory resorption is easier to explain so here goes....... Internal inflammatory resorption occurs as a side effect of bacteria and their toxins gaining access to the root canals of a tooth. Most commonly the bacteria overwhelm the pulp necrosis ensues and the inflammation then... continues at the end of the root canal (periapical tissues) in response to the bacterial toxins leaving the canal. This inflammation at the end of the canal causes a periapical radiolucency. In some cases however full necrosis of the pulp doesnt occur and there are some vessels that allow osteoclasts (in their new role as dentinoclasts) inside the canal and rather than removing bone at the apex they remove dentine from the walls- causing internal resorption. Removal of the bacteria and severing of the vessels inside the canal will stop the resorption. External inflammatory resorption occurs when bacteria gain access to the root canal and the ensuing inflammation at the apex causes so much inflammation that it begins to resorb not only the bone at the apex but also the root cementum and dentine. Most teeth with periapical lesions have some kind of external inflammatory root resorption. Removal of the bacteria and pulp tissue from within the canals will stop the resorption. It can also occur as a result of orthodontic tooth movement or trauma and this is related to inflammation due to these, rather than inflammation due to infection. Because trauma is transient then resorption will stop after the trauma and if its related to orthodontic tooth movement then this will also cease once the forces are removed. External cervical resorption occurs when cementum is damaged at the neck of the tooth (cervical region) most often as the result of trauma. Damage to cementum permits an inflammatory reaction. There is new evidence that these lesions are very idiopathic and that although certain conditions such as internal whitening , trauma etc are risk factors many of these cases occur without any risk factors. Treatment involves removal of the inflammatory tissue or monitoring its progress if it is stable or advanced and treatment would reduce longevity. Extraction is often an option for advanced or symptomatic lesions. If you would like to join in the free online study club this Wednesday please send me a message

04.01.2022 Some patients request really good music to be played during the appointment and sing their way through each appointment, even with the dam on. Well this patient did ! Endo causing perio PAL swelling 7mm perio pocket on PAL- healthy patient with no other risk factors for perio disease and 16 no response to cold. This is Primary endo and secondary perio but there is always the chance of a crack when the tooth is crowned. Canals were medicated with calcium hydroxide for 4 weeks ...after cleaning all 4 canals (sizes MB1 MB2 DB Trunatomy Prime 26 04v -Palatal canal X2 25 06v PTN) before the final appt the healing of the PAL pocket was assessed and this reduced to 3mm. Then the Canals filled using micronised GP and sealer. SDR base and comp in access 16. See you at the charity podcast with @dentistsofinsta Sunday 2nd August 830am UK time 530pm Syd/Melb time See more

03.01.2022 Tooth 27 symptomatic apical periodontitis associated with a necrotic pulp. Leakage noted under previous MO composite restoration. Long and curved canals for the MB1 MB2 and DB. To me these canals are perfect for 26/v04 Prime TruNatomy- because the shape of the file fits the shape of these canals. However the Palatal canal is much wider and has an associated periapical radiolucency. For this canal the X3 ProTaper next file was a good one. After filling if the canals SDR base was placed and then composite in access cavity. Happy patient to be out of pain!

03.01.2022 Braiding technique using H files to remove a Lentulo spiral filler - use one file down one side of the spiral filler that seats at the apex and the other file should be the the widest one you can find that fits over half way down the canal. Twist the handles of the files together and pull !

03.01.2022 Tooth 36- cleaning of the canals 4 months before filling the canals due to the restrictions. Good healing so far . Trunatomy prime for all canals

01.01.2022 Calcium hydroxide works by breaking down and releasing hydroxyl ions (OH-) When in direct contact the ion binds to the lipid transport channel on the cell membrane and creates a lipid free radical destabilising the membrane and causing lysis. The rest of its antibacterial properties are due to its high PH which changes the environment and makes it more alkaline. The high PH Denatures the enzymes of the bacterial cell shutting down DNA replication and also protein synthesis.... To join the irrigation and medication online study club 24 June at 1930 (Sydney/Melbourne) 2130 (NZ) 1030 (UK) please register here: The page to register for this event is: https://infoapac.ultradent.com/live-webinar And the FB event set up to keep up to date is : https://facebook.com/events/s/online-study-club-the-ideal-ir/320245712291824/?ti=icl