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Questions and answers
Browse published questions by topic or search with keywords.
Questions and answers
Questions by topic
Browse published questions by topic or search with keywords.
73 · available answers
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Diagnosis and Treatment Planning10
Infection, Drainage and Antibiotics6
- Can CaOH2 be placed in a patient with ongoing active abscess drainage?
- Can NaOCl be used while active drainage continues?
- Doctor, I have lost faith in root canal treatment for teeth with a sinus tract. What do you recommend?
- Doctor, yesterday I started root canal treatment on tooth 23 in a patient with an abscess beginning in the canine fossa. I irrigated thoroughly, enlarged the canal and tried to establish drainage. There was no drainage. I dried the canal, placed calcium hydroxide and closed it. I did not prescribe antibiotics because I thought I had eliminated the cause. However, the patient returned today with increased swelling, and the eyelids were also affected by peripheral edema. Whenever I try to avoid prescribing antibiotics unnecessarily, I end up regretting not prescribing them. Why might this have happened?
- In a patient with an abscess on the face, should the tooth be opened for root canal treatment, or should antibiotics be given first and treatment started after it has improved?
- What are the active ingredients of the drugs in the antibiotic combination commonly prescribed in endodontics?
Clinical Assessment and Imaging2
- Hello, Doctor. I treated the root canals of tooth 14 in a patient, but the patient says, ‘I feel pain when I touch the cheek side.’ I took repeated periapical radiographs, but the filling looked quite good. Then I carried out retreatment, and the patient returned with the same complaint. What approach do you think I should take? No apical radiolucency is visible.
- Hello, Doctor. The other day you mentioned taking RVG from the distal side for lower molars. It has helped a lot; thanks to you, I can see the final X-rays more easily. Thank you very much. 🙏 I find it very difficult to take RVG of upper 6 and 7. I want to take a check RVG for every patient, but unfortunately I cannot do so in the upper posterior region. Do you have any advice for this?
Root Fracture Assessment1
Treatment Planning During Pregnancy1
Root Canal Preparation16
Access Cavity and Isolation3
- Doctor, can we do it without removing the endocrown, or do we need to remove it?
- Doctor, do you have any advice for a clear view and file access to 17? That area is awkward for me.
- Doctor, in a patient with an extraoral fistula, is anything needed beyond the standard procedure? I am going to start treatment on tooth 43 in one of my patients. The patient's crowns are joined, and the patient does not want them removed. I will drill through the top. What do you think?
Working Length and Endodontic Motors3
- Do you support endomotor modes that slow down as they approach the apex and stop at the apex?
- Doctor, good day. When working with an endodontic motor with an integrated apex locator, should we set the apical stop to the 0 point? We are told to work 0.5 short of the 0 point, but is it possible to tell which line on the endodontic motor represents 0.5 short? Or would it make more sense to work according to the exact 0 point?
- You said that the ideal apex locator measurement is the one taken before obturation. So which length should we use for shaping?
File Selection and Use5
- Doctor, do you deliberately avoid using hand files? If so, what is the reason?
- Doctor, do you think treatment would be incomplete if we always used a 0.4 system? That is, 20 0.4, 25 0.4 and finishing at 30 0.4. I really liked it when I used it. Now I use an F-series system; the canals are difficult to open because of the taper.
- Doctor, isn't the angle, the taper, of the F system very high? How does the 0.4 system contact the wall more?
- Is it more appropriate to start rotary files before entering the canal, or to enter the canal orifice and then start them?
- Some people say that 0.4 files are inadequate and do not shape sufficiently. Yet I used to open all the canals very comfortably. Now I have doubts.
Instrument Reuse and Fracture Risk2
- Doctor, I hope your work is going well. While advancing with perfect in calcified teeth, I sometimes break glider and glider pro files in the apical third despite sufficient coronal enlargement and using crowndown. I also keep the torque and rpm values low as I proceed. How can I prevent this complication? In 1 year, altogether, it has happened in 3–5 teeth, but it is an annoying issue. Do you think it makes sense to treat these files as single-use in calcified teeth?
- Hello, Doctor. I bought super system retreat one and the advance kit. Yesterday I treated a completely calcified tooth 37; the advance kit 10 0.7 file was truly excellent. Any other file would definitely have fractured. What I really want to ask is how many times I can use these files. Because I do not have a microscope, I generally discard them after 5 uses.
Canal Location and Negotiation2
- Doctor, these mb2 canals are quite blocked. Could we not assume that bacteria cannot get in where we cannot? I cannot find time to treat mb2 at adsm, but I also feel uneasy about it.
- I struggle to reach the apex in the mesial canals of lower molars; sometimes I hit something and cannot progress. What could cause this?
Irrigation and Disinfection10
Irrigation Activation3
- Doctor, hello. For irrigant activation, would you recommend an activator device with a plastic tip or a metal tip?
- Doctor, regarding your ultrasonic activation video, I have an eighteeth ultra-x. I use it for activation, but the hypochlorite does not foam at all like yours. In the device’s promotional videos, there is also hypochlorite in a glass; when the ultrasonic tip enters it, the hypochlorite foams incredibly, but this never happens for me, even though I use a high setting. Why is that?
- Hello Doctor, is there a method you could recommend for activation if a sonic instrument is not available?
Irrigants and Application Sequence3
- Doctor, I remember you saying something in your earlier posts along the lines that the gas released during irrigation with hydrogen peroxide creates pressure at the apex and causes pain. Am I remembering incorrectly? I am unsure.
- I have just remembered, while reviewing my day, that after irrigating the canals with hypochlorite, WITHOUT doing a final rinse with physiological saline, I first aspirated the excess fluid (hypochlorite) from the canal with a syringe, dried the remainder with paper points and then obturated. I am certain of this. My working length was at the apex, which I confirmed with the obturation radiograph. Do you think I will have a serious problem? Have you ever encountered anything like this?
- My assistant gave chlorhexidine instead of hypochlorite, then gave hypochlorite, and para-chloroaniline formed. How should I remove it?
Intracanal Medicaments4
- Dear Doctor, would leaving “kalsin” in the canals for 5 weeks not cause a problem?
- Hello, Doctor. A paediatric dentist friend mentioned a so-called 3-antibiotic paste. They crush the usual antibiotic tablets and make a paste with physiological saline. I had not heard of this before. What do you think about it?
- How can we best remove the ca(oh)2 placed at the first visit at the 2nd visit, and what problems could caoh2 that we cannot remove cause later? ( My method in the clinic: at the first visit, I prepare with 20/04 and place kalsin; at the next visit, I prepare with 25/04 and use copious irrigation and an activator. I watched your stories but could not find anything on this if you have posted about it.
- Is there any information suggesting that calcium hydroxide mixed with physiological saline may increase bacterial growth?
Root Canal Obturation7
Master Cone Fit and Tug-Back6
- Doctor, how will I obtain tug-back with 0.2 taper in a canal I have prepared with 06 taper?
- Doctor, is it necessary to obtain tug-back when using a bioceramic root canal sealer?
- Doctor, sometimes I cannot perform lateral condensation even though I want to. If I finish with 25/06, a 30/06 master cone generally binds at length. When I then want to place an accessory cone, I cannot even insert a 20 spreader into the canal. Sometimes, when I apply a lot of force, the spreader penetrates the master cone and pulls the gutta-percha back out. Is there any objection to using a single cone in these situations? Because our gutta-percha cones do not match, 25/06 usually extends beyond the apex.
- Doctor, why does the gutta-percha not reach all the way to the apex after we instrument with f1?
- I have started using the Supersystem advanced kit. I work with a motor with an integrated apex locator and do not measure the length separately. After shaping is complete, when selecting the master cone, do you insert sizes 25, 30 and 35 one by one and take a periapical radiograph?
- If we use a 0.6 file and gutta-percha with a 0.4 taper, can we say that the binding will occur apically?
Root Canal Filling Techniques1
Endodontic Retreatment1
Anesthesia During Retreatment1
Complications14
Material Extrusion5
- Doctor, some long-serving dentists reportedly deliberately extrude calcium hydroxide beyond the apex. Is there a logical explanation for this?
- I completed the root canal treatment of tooth 26 with MTA, but the palatal canal was related to the sinus. When delivering the MTA, it extruded, and a little too much extruded. What should I do?
- I had retreated a lower number 6 tooth and filled it in a single visit with MTA using a single cone. Some MTA had extruded at the apex. The patient had severe pain. I have a radiograph, but I cannot send it to you right now; I think permission is needed. Can MTA extrusion cause pain?
- In a webinar, a lecturer made a statement about bioceramic material along the lines of: there is no problem with extrusion, it does not cause flare-ups and it causes minimal trouble. Then the lecturer explained in detail what should be done to avoid extrusion, such as dispensing it coronally and keeping it 1–2 millimeters short of the canal length. In some cases abroad, I see Dr.Rico Short deliberately extruding it. What do you think about this, Doctor? Large lesions regress even with extrusion, but is there a possibility of complications such as paresthesia?
- When overfilling occurs, can the patient have pain on percussion and when chewing?
Irrigation Complications2
Postoperative Pain and Flare-Ups5
- After a flare-up, how long do you leave the newly placed “kalsin” in place?
- After treating the root canals of a tooth that is tender to percussion, when should the percussion tenderness resolve?
- Doctor, does every tooth you treat with root canal treatment become tender to percussion afterwards?
- What approach do you take when a patient presents with pain during a flare-up?
- Why might a tooth that had no symptoms and was filled over two visits hurt the very next day?
Separated Instruments in the Canal1
Vital Pulp and Regenerative Therapies4
Open Apex and Apical Barrier2
Restorative Procedures10
Fiber Posts2
Coronal Seal and Temporary Restorations3
- Doctor, what can be used instead of cotton to temporarily cover the canal orifices?
- We learned that the maximum interval between visits should be 10-14 days and that bacterial accumulation can begin after 14 days. Is that correct?
- What are your thoughts on whether placing zinc oxide eugenol at the canal orifices after root canal treatment has been completed has any effect on reducing postoperative pain?
Bleaching and Discoloration2
- Doctor, in one of your cases, you sealed the cavity opening with composite after MTA. But I remember being told at dental school not to use resin-containing materials because bleaching agents damage them, so I use conventional glass ionomer cement (GIC) when I do this. Am I mixing things up? 🤔 Thank you for your work; it is another very nice case 😌
- Doctor, why does this yellow discolouration occur after root canal treatment? Is it from sealer remnants, or is there another reason?
Direct Restorations and Cavity Preparation3
- How do you remove the rubber dam between the matrix band and the tooth? I had the same problem today and found the solution in tearing the rubber dam in the interproximal area.
- Sometimes there is hard, brown decay at the cavity margin, and it does not come off with the micromotor. Should we leave this decay there? If we leave it, will it adversely affect the bond?
- When restoring two adjacent teeth, which cavity should be prepared and its restoration completed first? Can both be prepared and restored at the same time?
Other Professional Topics1
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