need help on molar root canals

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razor1911

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I'm wondering if there's a good tutorial site ( online ) that instructs you on how to radiographically get canal length measurements and doing instrumentation and condensation within molar teeth, using handfiles and gutta percha only. I would appreciate some links if anyone knows of any. If not, then hopefully maybe someone can type up and post some very good and clear instructions.

It's not that I don't know how to do root canals. I'm used to relying on apex locators, rotary, and thermaplastic materials for endo. I don't know to perform manual endo at all using hand files. And my endo textbook isn't straightforward with this topic.

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I'm wondering if there's a good tutorial site ( online ) that instructs you on how to radiographically get canal length measurements and doing instrumentation and condensation within molar teeth, using handfiles and gutta percha only. I would appreciate some links if anyone knows of any. If not, then hopefully maybe someone can type up and post some very good and clear instructions.

It's not that I don't know how to do root canals. I'm used to relying on apex locators, rotary, and thermaplastic materials for endo. I don't know to perform manual endo at all using hand files. And my endo textbook isn't straightforward with this topic.

In all seriousness, if you're used to apex locators, rotaries and thermoplastic fills, why would you want to step back to a much less predictable, multi-hand file, watch wind, step back, master cone, multi accessory cone lateral condensation technique????

It would be like going from an air turbine handpiece to a belt driven handpiece
 
In all seriousness, if you're used to apex locators, rotaries and thermoplastic fills, why would you want to step back to a much less predictable, multi-hand file, watch wind, step back, master cone, multi accessory cone lateral condensation technique????

It would be like going from an air turbine handpiece to a belt driven handpiece

I wouldn't want to revert either. But I just took up employment at an office that doesn't carry automated endo equipment.
 
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It's worth it just to buy the rotary system yourself even if the office don't have it. You can find some good but inexpensive endo system on ebay. You can get a new Parkell apex finder on ebay for $200, which works just as good as the $1500 ones.
 
I wouldn't want to revert either. But I just took up employment at an office that doesn't carry automated endo equipment.

It's worth it just to buy the rotary system yourself even if the office don't have it. You can find some good but inexpensive endo system on ebay. You can get a new Parkell apex finder on ebay for $200, which works just as good as the $1500 ones.

Agree with Daurang! If you have to, buy a rotary system and an apex locator yourself! It will be a tax write off for you, and with what most offices charge for endo's these days, you'll pay for them very, very quickly in time saved!

Otherwise, heres the "old school" technique as was taught to me now close to 15 years ago.

Access as you would for a "modern" rotary endo - STRAIGHTLINE ACCESS is key no matter what style your using, since if you can't easily see/access the canals, chances are you won't be doing your best endo work - Also, throughout the description, irrigation in between files accessing the canal(s) goes without saying.

Working length determination - use the largest file you can that will EASILY access your radiographically pre estimated working length. Take a film to verify radiographically the working length and make any adjustments as needed. This file that EASILY reaches working length will be your MASTER APICAL FILE (MAF)

From the MAF, using a "watch wind" motion with your fingers, you'll re-instrument the canal(s) to working length with the next 4 larger sized files. (i.e. if your MAF is a size 25, you'll then instrument the canal to length with a 30,35,40 and a 45 - thus enlarging the canal a total of 5 file sizes) Each time you're working a file in the canal, copious irrigation and lubrication of the canal/file is needed. This is called the "Step Back Preparation" and is basically opposite of modern canal "crown down" preparation in that you start small to full length and then make it larger vs. modern theory of starting short and wide and then moving to full length with smaller files.

After you've done you're Step Back preparation, grab a master cone of appropriate size, if I remember correctly the gutta percha master cones are sizes as fine/fine, fine/medium, medium/medium, medium/large and large/large or some maunfacturers will have them sized according to file size. Fit the largest master cone that will goto length and give a slight resistance when you pull it out of the canal (this is called "tug back") and then take a film to verify that you're to length.

Grab some sealer and load up the canal, then first place your master cone into the canal. Then using a room temperature finger spreader, which you'll insert into the canal as far as possible to basically compress the gutta percha cones LATERALLY against the canal walls AND create space to add the accessory cones. Add as many accessory cones as you can make room for - technique is insert accessory, then re-insert finger spreader then add another accessory cone - spreader - cone - spreader, etc, etc, etc. You'll generally be able to add between 5 to 10 accessory cones.

When you can no longer add any more accessory cones, fire up the torch/alcohol lamp/bunsen burner, and heat a plugger. Then sear off the ends of the cones that protrude above the canal orifice and then VERTICALLY compress the cones in the canal with the warm/hot plugger for a few seconds.

Temporize your access hole, and then bill the patient - and then when you've realized how much less predictable and efficient this technique is, order your rotary system!
 
Temporize your access hole, and then bill the patient

Thank you for the instructions. I have three questions though.

What is a reasonable amount time I should be spending on a molar RCT ( let's assume the worst possible case: max molar? ) when working in an Medicaid office AND using hand instruments?

What difficulty should I expect when instrumenting and obturating ( by hand ) molar endos as opposed to anterior endos?

What can you do to avoid bent gutta percha cones when doing molar endos?
 
and then when you've realized how much less predictable and efficient this technique is, order your rotary system!

What do you recommend? And what is its commonly listed price? Generally how much are the rotary files and other accessories going for?
 
What do you recommend? And what is its commonly listed price? Generally how much are the rotary files and other accessories going for?

What were you trained on in school? I dont think I would just start using a system you are not trained to without some CE first to become acquainted. Rotary files can be very expensive/patient if you are not re-using them multiple times (which is not recommended unless you want a separation headache). If you are in a medicaid office, it might be in you best interest to see what the overhead to collection is for that particular procedure. The file expense adds up especially if you are doing a case or more a day.

To answer your question, I like Pro-Taper and K3 files. I think they work out to like $15/rotary file. You could probably get a handpiece for 1k 1.5k.
 
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