Molar access opening

[Big_Poppa DDS]

Ok, so I didn't get the greatest experience with endo at Marquette, only 1 molar, 1 canine and 1 premolar so what is a good way to tell if you have removed all the roof of the pulp chamber when accessing a molar. I seem to be ok with finding the canals but can't tell depth wise how far I've gone especially if there is a lot of bleeding.

Any suggestions?

---

Members don't see this ad.

 

[UBTom]

OY..

Here at Buffalo we did 14 extracted tooth projects in the preclinic lab for our endo course... And I feel I didn't have enough practice.!

On judging the depth... My instructors say to stop and take an X-ray if you are not sure how further to go, and use the endo explorer frequently to judge how deep one has gone.

Bleeding management... The one dentist I shadowed before I got into dental school had this technique for managing bleeding when opening the chamber: He would give an intrapulpal injection with a bit of 2% lido with 1/100,000 epi. The epi would decrease the bleeding and help keep the field clear. Not sure if my endo instructor would agree with that procedure though (I'll have to ask).

 

[DrJeff]

Exactly, if you're not sure where you are, take a film, please, please, please. As someone who once or twice has lost my orientation while trying to locate the canals and perforated a tooth , it's perfectly okay to take an x-ray (consider it stopping to ask directions when you're lost.

Also, don't try and be ultra conservative when making your access prep. Open that occlussal surface wide open, especially around the mesial buccal cusps on molars. After all, almost all teeth that you're doing endo on will be receiving a crown afterwards, and you'll be filling up the access prep with build up material anyway, so why not make it easier on you by opening up the tooth enough so that you can see as much as possible.

Intra-coronal hemostasis can be difficult until all the tissue has been removed. Here's what works for me. #1, when you've unroofed the pulp chamber, irrigate copiously with local anesthetic(anything with epi as the vasoconstictor will do), and if your assistant tries to place the suction tip by the tooth, knock it out of the way, after all you want the epi to sit there for a minute or two. Then, what I like to do is put a #6 or #8 round bur in the low speed and really, really work it around the pulp chamber to basically liquify the pulp tissue in the chamber, I'll then irrigate copiusly again with local anesthestic (I'll let my assistant use the suction a little bit now). Finally at this point I'll determine what my working lengths will be and set my files (basically I'm stalling for a minute now to let that epi work). This generally works pretty well at controlling intra pulpal bleeding, although occasionally you won't have a bloodless field until all the tissue has been removed from the canals. Lately though since I've gotten the Nd: YAG laser in my office, if I've got a tooth that is really bleeding, I'll just take the laser and set it into coagulate mode and give it a few seconds inside of the canals (the fiber that transmits the laser energy is roughly the diameter of a #30 file), I've then not only achieved hemostasis, but also asepsis in the canal. Technology is great!!