Inserting post into canal issues...

[yankpak786]

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I'm going to be completely honest here. I'm very unconfident when it comes to inserting a post, pre-fab into any root canal treated tooth. Today, I was working on a max. lateral incisor, and I went distal from the canal and ended up a few millimeters away from the Gutta percha filled canal. I was more than 10 mm deep, and practically would have created a new canal if I kept going. Thankfully, I did not perforate, patient was informed, we're getting it treated appropriately. But I'll be honest, I'm very concerned, wary, and just don't know how to feel more confident about it. 🙁 I can't envision seeing a canal after there's GP in it, it's so hard for me to tell if I'm going in correctly or not. RCT and crowns are okay but man, inserting a post seems like a deathly challenge to me. So please, wise folks of SDN, tell me something, teach me, because I am extremely down on my luck right now, and feel pathetic.

I want to get better, I want to do well, I feel terrible this happened and the patient was very understanding but my whole worry is now, what if this happens again? My first issue was not using gates glidden, I used my prefab post drill first, and was later informed that these can easily cut through dentin and always use gates glidden first. That's my first tip going forward into my career.
But seriously, I just want to vent, and get constructive feedback. Thank you, all.

 

[yappy]

My recommendation is to use the smallest sized gates file to length and then increase the gates file diameter until you're just under the diameter of the prefab post drill. By doing this you're creating a pilot hole that your post drill will follow down to length. You should not go off course (too much).

Assuming you're using the parapost system you will compare the diameter of your desired parapost to the closest (equal or smaller) gates drill. You will then drill in series from the smallest gates to that equal or slightly smaller gates drill. You will then use your final post drill.

Remember, you need to maintain 5mm of gutta percha for an apical seal and at MOST go down 2/3 the working length. With the bonding systems available today 2/3 is not needed. Therefore, IMO if you're getting worried about transporting or perforating I would stop at 1/2 length and place the post.

Lastly, a good clinical tip is to hold the hand piece more passively in your hand than you otherwise would for restorative dentistry to allow the tip of the GG to find the path of least resistance (gutta percha).

EDIT: I also hate endo and placing posts.

 

[Saddleshoes]

Lastly, a good clinical tip is to hold the hand piece more passively in your hand than you otherwise would for restorative dentistry to allow the tip of the GG to find the path of least resistance (gutta percha).

I have to agree with yappy on this one.
I would convey the same concept by saying an old quote among craftsmen, "Let the tool do the work."