tips and tricks

 When I was taught at uni by the clinical instructors in endodontics I was given a mix of advice on how to negotiate canals with hand files. One instructor said she never precurved hand files, another said to do it when there is a curve in the canal and push apically with the curve in different directions until you can bypass the curved area. Some provided no instruction at all. In hindsight, my endodontic instruction at university was misguided, limited and in some instances completely counter to sound endodontic principles.   The best way to solve a ledge is prevention and the best way to cause a ledge is to enter a canal with files that are too stiff to early and to put them in without precurving then. Below is a photo I got off the internet that shows a precurved file. You want a gentle curve as a sharp curve will concentrate stress and have more risk of breakage. You don't want too much of a curve as it will straighten itself out when you put it into the canal. A sli...

I have recently been getting back into endos after spending the past year referring them to the principal dentist who was an endo aficionado. I find endos quite difficult, therefore time consuming and draining. Logically I know that the less I like something, the more I should do of it to become proficient but I thought that I had reached a point in my career where I could focus on my special interests. However, due to changes in my work circumstances, I have to take on these procedures again.  I have recently gone through the All things endo online course from Ashley Mark in the US (https://all-things-dentistry.teachable.com/courses). It was a very cost effective course that gave a good refresher for endo knowledge. The main benefit I got from it was the repetition of recordings of endo accesses. This is the most important part of the endo procedure and improves the outcome of each step follow this. Seeing this being done over and over with some tips to give confidence to know tha...

Just a friendly reminder to take good care when using a heat out tip to remove gutta percha. At my hospital position, the access to an electronic heatout tip is sporadic so we often have to pull out the bunsen burner and heat out instruments. The instruments are quite clunky and very long and under magnification, the other day I didn't realise that the shank of the instrument was hitting the patient's lip and burning them through the rubber dam.  It is very possible to burn a patient through the dam so take extra care when using a heated instrument, you can put your mirror further from the tooth holding it under the shank of the instrument so it is not possible to contact the dam or soft tissues. Alternatively, if you are getting close to touching something else, the assistant can place a mirror or hold gauze to block the hot tip.

I have had multiple instances of rubber dam clamps getting stuck on the tooth as it is difficult to insert the tips of the forcep back into the  holes when it is time to remove the dam. The problem usually arises when the holes of the rubber dam clamp are angled towards each other which hinders penetration by the rubber dam forcep tips as the angled hole is not the same size as the forcep tip. I commonly see this on when the clamp is overstretched with the bending of the clamp bow changing the angle between the flat sides of the clamp. It is also more common in clamp designs that have the points of the clamp pointing downwards as the flat sides have a preexisting slope to them (Figure 1). Occasionally, teeth that have bulbous crowns and recession will have a clamp that sits more apically on the tooth, the clamp will be closed further and the contour of the tooth crown can hinder access of the forcep tips to the hole. One modification I have seen suggested is to grind back the later...