I'm always excited to see a new video from you Dr. Nasseh! Since the new ESX system relies on getting the 15/.02 hand file to length prior to the expeditor, it would be nice to see a tutorial on your hand filing techniques (watch winding, balanced forces etc..). Also, I've found that since switching to ESX I've begun enjoying endo so much more. My assistants love the simplicity of the system too. Thank you Dr. Nasseh for taking the time to make such high quality and informative videos! I
Thank you again to your reply. Now, I clearly got the concept of EFX file system. Have been using profile system for 18 yrs and now time to Shift to Real Endo system E FX files and BC obturation
Perfect as usual ... you make the Endodontic very easy.. this is the new concept its like the composite vs amalgam in restorative dentistry, we can give big title "Endodontic with minimal invasive technique" with sealer obturation technique ... we wait another tutorial in next time thank you very much
Thank you Teto! I have done previous tutorials in the Bonded Endodontics Series (1-6) on this channel were I talk specifically about the point you brought up. Bonded Obturation (the use of bonded bioceramic cements) is to endodontics, what bonded composites were to restorative dentistry. The concept of bonding inside the root canal allows us to get away from removing unnecessary tooth structure to accommodate pluggers/spreaders/carriers and, as a result, we can be more minimally invasive in our preparations. The success relies on our disinfection protocols. Cheers and thank you for watching!
+A Palmer The link to the full video is in the description below the video. You can see the full video on the RWE Website. A few weeks after publication, the TH-cam content becomes an excerpt of the full video.
For example, For mb root of the molar which 15 hand file can't get to working length easily, I would go from size 10/04 hand file to working length>15/04 scout file to working length then straight to expediter 15/05. As you mentioned, there is no point of using 15/02 scout file if 10/04 hand file is already at the working length. Correct?
+Jun Park First, I don't know what you mean by a 10/04 hand file. Do you mean a 10/02 hand file? In the ESX System you only have 15/.02, 15/.04, and 15/.05. You should also instrument to a size 10/02 hand file prior to using these three. The goal is to get the 15/.04 to length. If it's too curved, get the 15/.05 only to the apical 2-3mm as the taper will prevent it from getting down. Then finish with a size 20 or 25. That's only for very tough cases. Otherwise, get the canal to a size 10/.02 hand file. Then do hybridization of tapers (SSC with sizes 15/.05 followed by 15/.04, followed by 15/.02). Repeat this cycle of large to small each with a single SSC stroke until either the 15/04 or 15/.05 reach the apex. Then finish with 25. Hope it makes sense. There's obviously some variability depending on complexity of the case. THere's also an Advanced Square protocol that uses 6 files: ESX 40-20 with the Expeditor in a crown down fashion. That's for very tough cases. Good luck!
Thank you for the reply. I would like to summarize my understanding of the ESX method. I usually hand file upto size 10 and 15 to full working length. Then use orifice opener. Then go straight to expediter to finishing file. In this case, can I skip the scout files? I really don't see the necessity to scout files if I can get to working length with hand files 10/15.
+Jun Park Yes, if you get to full length with 15 hand file then you can skip the Scout files. However, you have to make a decision. If you have a very tough, curved canal, instead of using the Expeditor to length (15/05) you may want to replace the Expeditor with one of the Scouts (15/04). In tough curved roots it's safer to use the 15/.04 instead of 15/.05. Then go to 20 or 25/.04 to finish with SSC.
+Jun Park Did you mean that the other way around? Because if you ever bring 10/04 to working length there's no point in bringing 15/02 to working length as it will not engage dentin anywhere. Otherwise, yes, usually 15/02 will go down first before 15/04.
Yes, whole concept is crown down technique. Now everything make sense. Thank you for thorough explanation and hoping to discuss some cases in the future. Is it possible to discuss some of my cases with you ? If so, is there a email address of your tutorial seminar?
Dr. Nasseh, how often do you "two-step" an endo? I've been doing it for all necrotic cases with PAP...but I think it might be overkill. My local endodontist seems to never two-step the cases I send to him. I was just wondering, what is your protocol for when to two-step? Thank you!
Palmer, doing RCTs in a single visit vs. multiple visit can be simplified to the following statement: Whenever you feel that you have achieved your standards of cleaning and shaping within the allotted time, you can fill in a single visit and whoever you feel you can clean a little more and didn't have enough time to achieve adequate apical diameter, then revisit and spend more time on the tooth. The key is remembering that there's a patient connected to the tooth that's tired of being open for a considerable amount of time. This is why the more efficient you are the higher the chance that you can complete the case in a single visit. But the important thing is realizing that you're trying to achieve a certain standard and doing that achieving it within the allotted time is the goal of therapy. To make a long story short, my only contraindications for doing it in a single visit is a canal that can not be dried due to drainage, or a case where I feel I need more time to complete my cleaning and shaping but I'm not able to do so due to a lack of time or a patient that's getting tired. I hope this answers your question adequately.
Yes, that answers my question. I think I've just been burned by a few acute exacerbations of chronic periapical lesions, and I felt that if perhaps I had two-stepped the procedure it wouldn't have happened. There's nothing worse for patient confidence and goodwill than a swelling after a root canal. :(
A Palmer, doing the RCT in two visits does not reduce the incidence of fare up. Actually, one study in the '80s shows that in increased that incidence. Causes of flare up are adding inflammation to the apical area either due to debris or disinfectant extrusion that is often due to instrument motion and irrigation techniques. I'll do a tutorial on this one of these days. It's an important topic. Thanks for bringing it up. :)
Your endodontic tutorial system is excellent for many dentists out there and hope to meet you in person
At the AAE MEETING in SF. Again, Thank You!
I'm always excited to see a new video from you Dr. Nasseh! Since the new ESX system relies on getting the 15/.02 hand file to length prior to the expeditor, it would be nice to see a tutorial on your hand filing techniques (watch winding, balanced forces etc..). Also, I've found that since switching to ESX I've begun enjoying endo so much more. My assistants love the simplicity of the system too. Thank you Dr. Nasseh for taking the time to make such high quality and informative videos! I
Thank you again to your reply. Now, I clearly got the concept of EFX file system. Have been using profile system for 18 yrs and now time to
Shift to Real Endo system E FX files and BC obturation
Perfect as usual ... you make the Endodontic very easy.. this is the new concept its like the composite vs amalgam in restorative dentistry, we can give big title "Endodontic with minimal invasive technique" with sealer obturation technique ... we wait another tutorial in next time thank you very much
Thank you Teto! I have done previous tutorials in the Bonded Endodontics Series (1-6) on this channel were I talk specifically about the point you brought up. Bonded Obturation (the use of bonded bioceramic cements) is to endodontics, what bonded composites were to restorative dentistry. The concept of bonding inside the root canal allows us to get away from removing unnecessary tooth structure to accommodate pluggers/spreaders/carriers and, as a result, we can be more minimally invasive in our preparations. The success relies on our disinfection protocols. Cheers and thank you for watching!
Where's the other part of this video? It stops just before the clinical portion...
+A Palmer The link to the full video is in the description below the video. You can see the full video on the RWE Website. A few weeks after publication, the TH-cam content becomes an excerpt of the full video.
For example, For mb root of the molar which 15 hand file can't get to working length easily, I would go from size 10/04 hand file to working length>15/04 scout file to working length then straight to expediter 15/05. As you mentioned, there is no point of using 15/02 scout file if 10/04 hand file is already at the working length. Correct?
+Jun Park First, I don't know what you mean by a 10/04 hand file. Do you mean a 10/02 hand file? In the ESX System you only have 15/.02, 15/.04, and 15/.05. You should also instrument to a size 10/02 hand file prior to using these three. The goal is to get the 15/.04 to length. If it's too curved, get the 15/.05 only to the apical 2-3mm as the taper will prevent it from getting down. Then finish with a size 20 or 25. That's only for very tough cases. Otherwise, get the canal to a size 10/.02 hand file. Then do hybridization of tapers (SSC with sizes 15/.05 followed by 15/.04, followed by 15/.02). Repeat this cycle of large to small each with a single SSC stroke until either the 15/04 or 15/.05 reach the apex. Then finish with 25. Hope it makes sense. There's obviously some variability depending on complexity of the case. THere's also an Advanced Square protocol that uses 6 files: ESX 40-20 with the Expeditor in a crown down fashion. That's for very tough cases. Good luck!
Thank you for the reply. I would like to summarize my understanding of the ESX method. I usually hand file upto size 10 and 15 to full working length. Then use orifice opener. Then go straight to expediter to finishing file. In this case, can I skip the scout files? I really don't see the necessity to scout files if I can get to working length with hand files 10/15.
+Jun Park Yes, if you get to full length with 15 hand file then you can skip the Scout files. However, you have to make a decision. If you have a very tough, curved canal, instead of using the Expeditor to length (15/05) you may want to replace the Expeditor with one of the Scouts (15/04). In tough curved roots it's safer to use the 15/.04 instead of 15/.05. Then go to 20 or 25/.04 to finish with SSC.
Do you usually bring 15 04 to full working length before bring the 15 02 to full working length?
+Jun Park Did you mean that the other way around? Because if you ever bring 10/04 to working length there's no point in bringing 15/02 to working length as it will not engage dentin anywhere. Otherwise, yes, usually 15/02 will go down first before 15/04.
Yes, whole concept is crown down technique. Now everything make sense. Thank you for thorough explanation and hoping to discuss some cases in the future. Is it possible to discuss some of my cases with you ? If so, is there a email address of your tutorial seminar?
Please post questions on our actual website in the forums area. More specifically in the Ask the Faculty Questions area of the forum. Cheers!
Dr. Nasseh, how often do you "two-step" an endo? I've been doing it for all necrotic cases with PAP...but I think it might be overkill. My local endodontist seems to never two-step the cases I send to him. I was just wondering, what is your protocol for when to two-step? Thank you!
Palmer, doing RCTs in a single visit vs. multiple visit can be simplified to the following statement: Whenever you feel that you have achieved your standards of cleaning and shaping within the allotted time, you can fill in a single visit and whoever you feel you can clean a little more and didn't have enough time to achieve adequate apical diameter, then revisit and spend more time on the tooth. The key is remembering that there's a patient connected to the tooth that's tired of being open for a considerable amount of time. This is why the more efficient you are the higher the chance that you can complete the case in a single visit. But the important thing is realizing that you're trying to achieve a certain standard and doing that achieving it within the allotted time is the goal of therapy. To make a long story short, my only contraindications for doing it in a single visit is a canal that can not be dried due to drainage, or a case where I feel I need more time to complete my cleaning and shaping but I'm not able to do so due to a lack of time or a patient that's getting tired. I hope this answers your question adequately.
Yes, that answers my question. I think I've just been burned by a few acute exacerbations of chronic periapical lesions, and I felt that if perhaps I had two-stepped the procedure it wouldn't have happened. There's nothing worse for patient confidence and goodwill than a swelling after a root canal. :(
A Palmer, doing the RCT in two visits does not reduce the incidence of fare up. Actually, one study in the '80s shows that in increased that incidence. Causes of flare up are adding inflammation to the apical area either due to debris or disinfectant extrusion that is often due to instrument motion and irrigation techniques. I'll do a tutorial on this one of these days. It's an important topic. Thanks for bringing it up. :)