Just thought I'd get that off my chest after a frustating day at work!!
Molar Endo sucks!
- Thread starter DrRob
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I commiserate!
I had enough troubles trying to find the MB2 canal on #3 and #14... I don't look forward to doing endo on #2 or #15.. 😛
I had enough troubles trying to find the MB2 canal on #3 and #14... I don't look forward to doing endo on #2 or #15.. 😛
Yeah, it's only my first year and those upper molars seem like a real PITA already!
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Just newly implemented this year, to graduate from Nova, we have to do two molar endo on manniquin and one patient molar endo.
We just learn about the molar endos just last week in endodontics and we're just about to start our molar endo project next week. We're taught that ALWAYS assume that there are a 4th canal in maxillary molars and always use a sharp DG-16 explorer! 😀
We just learn about the molar endos just last week in endodontics and we're just about to start our molar endo project next week. We're taught that ALWAYS assume that there are a 4th canal in maxillary molars and always use a sharp DG-16 explorer! 😀
There is hope, and I can tell you that it does get easier with practice and the more and more canals you do. When you hit private practice and you've done a bunch of them, you'll start to develop something of a sixth sense by looking at the PA of the tooth, and talking to the patient about which ones will really be the PITA's (both from the tooth perspective and from the patient perspective), and for those you'll quickly, and GLADLY fill out the referral slip to your local endodontist 
On those PITA's of the personality perspective, I even have my local endodontist do the post and core build up for me, that way I get to have the PITA in my chair for even less time afterwards for the crown prep 😀
It could also be worse though. I'm guessing that most of you nowadays are be trained with rotary instruments. Back when I was in school, it was all hand files, and I vividly remember my first endo(not just molar endo, but 1st real tooth overall), #19 and 4 canals. 3 visits and about 11 HOURS later 😱 I had my first canals done. Nowadays I think about that amount of time and realize that I'd likely have about 9 to 10 molars done in that amount of time (unless ofcourse there is a high PITA factor!😡 😱 )
Keep "stepping upto the plate", it gets easier and easier the more you do. Remember they call it practicing dentistry for a reason!
On those PITA's of the personality perspective, I even have my local endodontist do the post and core build up for me, that way I get to have the PITA in my chair for even less time afterwards for the crown prep 😀 It could also be worse though. I'm guessing that most of you nowadays are be trained with rotary instruments. Back when I was in school, it was all hand files, and I vividly remember my first endo(not just molar endo, but 1st real tooth overall), #19 and 4 canals. 3 visits and about 11 HOURS later 😱 I had my first canals done. Nowadays I think about that amount of time and realize that I'd likely have about 9 to 10 molars done in that amount of time (unless ofcourse there is a high PITA factor!😡 😱 )
Keep "stepping upto the plate", it gets easier and easier the more you do. Remember they call it practicing dentistry for a reason!
Well I finished my first lower molar endo - in practice last week number 30 - 4 canals the mesial fill was short on both, but the distal were ok. Just sucks after all that effort not to get the result you want!
Rob, Jeff, et al:
I've done about 15,000 molar endos in my career. (I'm an endodontist). I still remember the first one I did in 1977. Four canals, #30. Well,... what I lacked in length on the two mesials I overfilled on the two distals, so I figured I was pretty even. I wander what ever happened to that tooth?
endotom: Penn State 75, Pitt 79, UCONN 82.
I've done about 15,000 molar endos in my career. (I'm an endodontist). I still remember the first one I did in 1977. Four canals, #30. Well,... what I lacked in length on the two mesials I overfilled on the two distals, so I figured I was pretty even. I wander what ever happened to that tooth?
endotom: Penn State 75, Pitt 79, UCONN 82.
15,000...... <gulp>
You'll likely really then apprecaite my first one then since you did your endo training at UCONN. My first one, 4 canals in #19 about 1 month into the clinical portion of my 3rd year was with Dr. Spangberg as the attending for all 3 sessions and 11 hours that it took😀 😱 I think that by the time I had the tooth obturated that I had about 50 accessory points packed into my access opening, and I know that those canals had about 12 gallons of bleach rinsed through them by the time I was done! Ahhh, the good 'ol days😀
Hey Jeff,
I remember those days very well. Matter of fact, I had dinner with Dr. Spangberg last month. He is now department chairman of Endodontology at UCONN. I was up there for a two day seminar in Endodontic Biology. Treatment's the same, new bugs including fungi and viruses down in there, so they find.
My son is applying to UCONN's dental program. How did you or anyone else find UCONN's program?
I remember those days very well. Matter of fact, I had dinner with Dr. Spangberg last month. He is now department chairman of Endodontology at UCONN. I was up there for a two day seminar in Endodontic Biology. Treatment's the same, new bugs including fungi and viruses down in there, so they find.
My son is applying to UCONN's dental program. How did you or anyone else find UCONN's program?
Endotom,
Do you routinely give palatal injections for upper molars? Today, I had a hard time anes. the palatal root of 2, 6 (#14). Even after several palatal injections he could still feel it. I had my partner try and he got him numb with the Ligajet. It pays to be working with someone who has 17 years of experience (I have only been out of school for 18 months).
Also, I know there is a high % of MB 2 in first molars. Someone one told me 95% have MB2 and 80% are negotiable.
Is this true?
Do you routinely give palatal injections for upper molars? Today, I had a hard time anes. the palatal root of 2, 6 (#14). Even after several palatal injections he could still feel it. I had my partner try and he got him numb with the Ligajet. It pays to be working with someone who has 17 years of experience (I have only been out of school for 18 months).
Also, I know there is a high % of MB 2 in first molars. Someone one told me 95% have MB2 and 80% are negotiable.
Is this true?
Rob,
I can't remember giving a palatal injection since I was in my endodontic residency. I did it there because I thought I needed the practice. If you are having trouble getting this upper first molar numb, it's probably due to the fact that the mesiobuccal root is getting some innervation from the anterior superior and middle superior alveolar nerve. Maybe somewhere in the superior plexus. What happens is that in your infiltration just buccal to this root, the root sometimes is sitting in the middle of the maxillary sinus. If you could look in there, you would see a root tip sitting in air with a covering of mucosa over it. You can't get the infiltration to hit it at all. Consider using the PSA, then infiltrating over the root tips as well as high over the premolars. If you want, you could do an infraorbital injection, but I hate doing those. This should get your tooth numb. The palatal injection doesn't allow for enough solution to do much and it's probably not that root giving you the trouble. I might add, the Stabident System with the X-tip works pretty good for times like these. It's an interosseous injection technique you might look into. Now, if it really is the palatal root you can't get numb when you are trying to instrument, give a quick intercanal injection and get the pulp out fast.
As for the stats on the ML, MB-2, or what ever you want to call it canal in the MB root, you should figure on it always beeing there in some form or other. This root never has a nice round single canal. This one little quirk is why God invented endodontists. There are lot's of ways of cleaning it, shaping it, and filling it, but you gots to do a whole lot of them before you feel comfortable with it. The idea if you miss it," well, I got a good seal at the little tip down there anyway" doesn't work.
I'm not speaking as an endodontist, but as a lowly GP here😀 , but I'll always either give a palatal injections or infiltrate through the papilla to get some palatal coverage. This way I know that the patient will be comfortable even if the rubber dam retainer catches some palatal gingiva😱 With a couple of carpules of Articaine on board(absolutely love that stuff for endos and exos and can't imagine practicing without it!), I'm able to get all but the hottest of teeth numb.
As for the MB2, I find that I'm seeing them/attempting to negotiate them in about 2/3rds of my under the age of 40, and decreasing percentages with increasing age (I'm guessing the "natural obturation process" i.e. calcification is taking care of those). I'll also admit that my success rate with the MB2 has gone up once my partner and I got an ultrasonic tip (that and alot more #8 files). I will admit that I find it truely satisfying when I'm looking at a final fill and see those 2 canals in the MB root, especially if they've both got little sealer "poofs" out the apex!
As for the MB2, I find that I'm seeing them/attempting to negotiate them in about 2/3rds of my under the age of 40, and decreasing percentages with increasing age (I'm guessing the "natural obturation process" i.e. calcification is taking care of those). I'll also admit that my success rate with the MB2 has gone up once my partner and I got an ultrasonic tip (that and alot more #8 files). I will admit that I find it truely satisfying when I'm looking at a final fill and see those 2 canals in the MB root, especially if they've both got little sealer "poofs" out the apex!
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Ho Endotom... I just started my dental program at UCONN. The program can be summed up by one word: INTENSE. It not just the fact that one has to concurrently do all the Medical school courses and dental school courses the first two years, but also that the school takes its ranking pretty seriously and goes all out in terms of sqeezing as much material as they can... at the same time, the faculty is just unbelivably accessible and helpful and there is a small school feeling on the whole. And you also can't beat the relatively cheap tution in this era of 50k annual costs at some schools. Do I regret coming here? Too early to tell as I am just trying to stay sane! Best of luck to yr son and I would be happy to answer any specific questions he might have.
Cheers, Crimson
Cheers, Crimson
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Got molar endo practical tomorrow morning at 8 AM, one mandibular and one maxillary (two molars). We get one hour to do each molar, two hours total. Thank god that we only have to do coronal and radicular accesses and no obturation.
For the final course practical next week, we need to do a two-rooted maxillary premolar endo from start to finish (access, clean/shape and obturate) in two hours. 😱
All practicals are done in manniquin (with rubber faces) with rubber dams.
For the final course practical next week, we need to do a two-rooted maxillary premolar endo from start to finish (access, clean/shape and obturate) in two hours. 😱
All practicals are done in manniquin (with rubber faces) with rubber dams.
How do you deal with those accessory (lateral) canals ? Do they teach you how to look for it in dental school ? I just studied about them from my dental embryology class few days ago.
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Hey Larryt,
The nice thing about sodium hypochlorite is that dentin and pulpal tissue are somewhat dissolved by it, so in the course of irrigating the root canal with NaOCl it might actually dissolve out whatever is in the accessory canals.
Our endo instructors are fond of showing post-op x-rays of endo cases they did where you can actually see the radiopaque sealer extruded through the accessory canals (which effectively seals them up).
Neat!
The nice thing about sodium hypochlorite is that dentin and pulpal tissue are somewhat dissolved by it, so in the course of irrigating the root canal with NaOCl it might actually dissolve out whatever is in the accessory canals.
Our endo instructors are fond of showing post-op x-rays of endo cases they did where you can actually see the radiopaque sealer extruded through the accessory canals (which effectively seals them up).
Neat!
