I am a Dentist from India. I am really greatful that I can go through your videos which contains huge amount of theoretical and practical information. I am watching your videos everymornig since past one month. The learning has significantly contributed in improvement of my skills to perform RCT. THANK YOU DR 🙏
I am an Endodontist working in Kuwait . I usually use 2.5 X , 3.5X and sometimes 5X loupes to find my MB2. Here MB2 incidence in upper 6 is close to 100℅ . As if this is not enough incidence of MB2 in upper 7 is around 60-70%. Needless to tell you about the good times I am spending opening and preparing these canals and what's more , the hard times I am having trying to explain to my patients why I am taking so much time !
Yes much of our work goes under appreciated by the patient. The key is to have enough practice on extracted teeth so you can find the MB2 safely and efficiently. Loops are good but light is a key component as the field gets darker as the magnification is increased.
@@clutchisland5323 if you're looking for good and affordable loupes check Jintan Jinyang . Similar to Microsugery while still much cheaper. Make sure to order the LED lamp + battery because you're going to need them .
Thank you sir, you saved my current pateint treatment going on. Because I started searching mb3 and mb4 too.but going that much further may lead to perforation.
I am a Dentist in Nigeria and I find your videos very helpful. I found my first MB2 canal unaided last week thanks to you. How I wish I can do residency under you.
Thank you for your kind words. I makes me very happy to know these content help people in real ways to help their patients. Best way to practice finding the MB2 is by working on a bunch of extracted teeth and sectioning it to see where it is! Good luck! :)
I have 2 questions (I think, we'll see): I've noticed you proceeded to apply the sealer after drying with the macrocanula only; you don't use paper points? This is, I believe, a 35.04 shape; the macrocanula is ISO 55 at its tip, which means it would bind 5mm short from the apex. From my experience, the macrocanula doesn't dry the apical portion of canal in such cases (if it's a 50 at the apex, than yes, it's more likely). Wouldn't excess water (if that's your final irrigant) "water down" the sealer? And perhaps that's an advantage? I ask because I sometimes struggle with hydraulic condensation: I use your method of introducing Bioceramic sealer by spinning the "masterfile" in reverse until I see the canal filled, not just coated, with the sealer and more than once, the fitted cone wouldn't go all the way the apex. This would cause some anxiety, I must admit. Last time this happend, I took a cone with a smaller taper and the cone STILL hung short! I'd imagine a slightly "watered-down" sealer, apically, would be less viscous and not do that. This happend to me with the Dentsply sirona BC sealer, which I don't use anymore because of one of your videos and with the the NeoFlo from Avalon Biomed, which is my current sealer, again, because of that same video. Second question (or is that question number 9 already), and speaking of "watering down" sealers: how would you clean the access cavity after obturation in cases where the istmus is projected into the pulp chamber, like in C shaped molar and some Mesial roots of molars? If you just wash the cavity, the sealer inside the clean istmi would be washed away in such cases. I tried to clean the sealer with cotton pellets and microbrushs, but it's a mess of a task! Thank you in Advance Dr. Ali!
Michal, I do use one or maybe two paper points after TotalVac negative pressure. I primarily do it to confirm there’s no bleeding before I fill. Even if it’s moist/ a little wet it’s ok with BC Sealer. After all, I’ve been doing it the same way for the last 15 years and have long recalls. Anyway. A paper point is a good idea. If you do t have patency and place sealer only without pushing it down there’s a chance you can create a vapor lock and that will also prevent a cone that previously seated to apex not seat fully. So, using a file is helpful in tightly fitting cases. Also, you come fit should not be super tight as it won’t leave enough room for the sealer to escape back up. Around the cone. Cheers,
@@AANasseh Thank you dr. Nasseh! So just to be sure I understand what you are prescribing: 1) use a cone that is loose at cone fitting, like an .02 tapered cone in an .04 prep (will that create enough hydraulics, though?), and 2) beware of taper lock; so when I introduce the sealer with the master file, and I slowly spin that file counter-clockwise close to working length, I'm potentially trapping air apically; if I can't "pop" that air pocket with my GP cones, you'd suggest popping it with a file, a smaller file, like a negotiation file, perhaps? I love what you said about the paper cones! This insight is really helpful. But just to insist, please: what would you do in cases where an istmus extends to the pulp chamber, like in C shape canals and some mesial canals in molars? Washing the pulp chamber after obturation in such cases might (will) wash the sealer from that space, leaving it vulnerable. Would you attempt to "seal" the space with molten GP? Take care dr. Ali!
@@michaellupu2080 yes but don’t use a 02 cone in an 04 taper canal or you’ll have too much space. I would use. Matching cone or if the matching cone is way too tight then one size smaller as long as it’s not going long (eg 30/04 come in 35/04 shape as long as the 35/04 cone is 05mm short or something like that. Otherwise same size cone.) Use a clean file that’s also either a size smaller than the master file or the master file itself (as long as clean) and push the sealer down to length or 1mm short of it (the rest will get pushed to length as the cone goes down). You’re not trying to pop the air bubble… you’re just trying to make sure you coat the canal walls all the way to the apex and not have air prevent full seating if the cone or get mixed into the sealer too much. Cheers.
Thanks for answering me doc regarding the previous question. I do have an additional one. I recall watching a video where you stated you primarily seem to treat younger folks so you don't deal with many calcifications. I thought of a question. When accessing younger patients, does it seem like finding MB2 is easier? Whenever get into a pulp chamber, I can almost immediately locate all the canals after clearing the viewing area. That is, I can see the pin point "exposure" of the MB2 canal if its a type 2 or type 3. Do you feel that as the patient gets older, this becomes harder and thus a search for MB2 is imperative ? thank you
Yes. The MB2 is easier to find in younger patients. But they also can get calcifications if they have a long term mesial decay or old large inter proximal filling. Those cause reparative dentin over the MB2 and make it very hard to find it.
Great presentation. would it be possible to make one for how to use microscope with respect to patients positioning especially treating lower molars as am quite new to microscope use and am finding it hard how to adjust patient/microscope and mirror.... would appreciate your input.
In this video with MB2/MB3 sharing a common foramen, did you cut-back the master point in MB2 (and not shown)? With converging canals I'll make incremental cutbacks until I feel the 2nd point binding in the canal and obturate from there.
Thanks for the reminder. Yes. It wasn't mentioned in the video but it's a good idea to trim the GP before cementation when two canals join. You find the point of junction and cut at the point. Otherwise, you have too much sealer around the cone. Of course, it doesn't matter much if you're using bioceramics but it will create a denser "looking" fill the way.
I am a patient and had a missed mb2. The tooth started giving me periodic pain after a couple years. Pain with chewing crunchy or hard foods or when I’d tap the tooth. But the pain would always subside and go away for months or a year on end. Finally had the tooth totally retreated and haven’t had any issues since
In a tooth that I am doing a prophy endo on (i.e. not infected), that is, decay is encroaching the nerve and a composite/ crown build up will surely cause post op sensitivity and pain... If a MB2 is missed in a type 2 canal orientation, how can it cause any issue if there was no bacteria to begin with?
Good question. If you have a perfectly sterile technique there will not be any problems. The problem is that no one has a perfectly sterile technique and that's why contamination causes problems. I've made this argument for every with the residents at Harvard. We've tried to test my hypothesis but it's not been easy to set a model for testing. Cheers!
Hai sir irequest the root canal problem docter can use gutta purcha this stics effect of my health you suggest him sir, this stics effects on heart problem
Since the tooth is isolated and the patient is already there, why didn't you place a permanent restoration? it will only take 5 minutes or so and saves a lot of the patient and other dentist time.
Geographically, every place has its own set of politics and turfs. Here in Boston, General dentists want to place the final restoration themselves. When they refer a patient for a root canal, they expect to place the core thereafter. In other places, Endodontists place the post and core too. So, it's very dependent on the location, and also the referring dentist you're working with. I would prefer to place the restoration; but that's not always what. We have to cater to our referral sources and their individual needs.
So while we're searching for MB2 we can't go deeper than two milimeters because there's a increased risk of acidents envolving furca floor? When I'm treating maxilary molars, I ALWAYS look for MB2. But only after finish the root canal preparation of another canals. Thanks for the video, doctor.
That's not necessarily a bad strategy. Once you have the other orifices well marked, this can help you better identify the MB2. Just make sure you reinstrument MB1 along with MB2 so the debris from MB2 is not pushed into MB1, especially when they join. Cheers.
Following the dentinal map. There's dentinal shading when searching in a ribbon shaped root where the MB2 is hidden. You can see the pattern of secondary vs. reparative dentin in these cases. CBCTs are now commonly recommended in cases when an MB2 is not found in a first molar but one is suspected. They help triage the patient without removal of excessive dentin.
Great vid. My mb2 was located, filed, and filled, but it looks like the root was perforated. I got jolt of severe pain at the side of my head during the procedure, then an episode of severe pain a day or 2 later, and I still have chronic pain 7 years later. A small glob of Endosequence bioceramic sealer was extruded. From a CBCT, the 3D image and a series of axial planes through the root suggest that the gutta percha point perhaps poked out through the perforation maybe 1 mm. I am not sure if the CBCT has enough resolution to tell for sure. There is no significant amount of pain in the tooth itself. The pain is at the side of my head. My left pinna is simultaneously painful and partially numb. It turns bright red. Neurologist and otolaryngologist did not find anything. I've finaly accumualted enough money for further treatment. Would like to save the tooth.
Sorry to hear that. It may be a case of neuritis following apical perforation. If MB2 was already located, further treatment may be limited to an apicoectomy by a properly trained microsurgeon endodontist (don't see an OMFS!) But if the case is neuritis or neuropathic pain, then there's a chance some of the pain may persist following surgery too. Just a possibility. Good luck!
@@AANasseh Thank you for your response. I really appreciate it. As a result of reading about my situation for these last 7 or 8 years, I have gradually come to think exactly the same thing. I have lived in a small city of about 90,000 people, over the last 9 years. It has over 200 dentists, but apparently only about 5 individual endodontists, at 3 endodontia practices. I am acquainted with a number of capable general dentists here, but there is one who I especially like, and trust. It is from this dentist that I learned about one local endodontist who may be our best choice. The endodontist's web site refers to using an "operating microscope" and "fiber-optic illumination," and how this tool "has paved the way for more predictable and more successful endodontic results." Does this make her a "microsurgery endodontist"? I am planning to make an appointment soon. About 3 years ago I consulted an endodontist, who is part of the faculty practice in endodontia at a dental school, but who is 5 hours away by car from where I live. It would be easier for me, and less expensive, if I could have a capable endodontist who is closer to where I live. I know there must be some good endodontists in the NYC metro area. If I use one of those endodontists I could stay at my son’s house and avoid the trouble and expense of staying at hotels. I have a grandson who is a student at northeastern University in Boston and I might be able to stay with him for a few days. My understanding is that you are in Boston. Are you taking any new patients?
@@soilmanted BTW, if cost is a factor you can see one of my endo residents at Harvard School of Dental Medicine (where I teach, specifically this surgery!) and I would supervise your case. You'll save enough for your plane ticket and hotel stay in Boston! LOL! Surgery with our residents is less than $500. It's three times that much with me. So, you can have big savings and the quality will also be good. But obviously it will take much longer since the residents are learning.
@@AANasseh LOL - How much longer does the resident take? Seriously though, I doubt it is a problem. I live in Asheville NC by the way. Western NC. Not too far from Charlotte NC, eastern TN, southern VA, northern GA and northern SC.
Putting MB2 aside... I dont like the sentence "Assume there is ___X____ unless proven otherwise." where X = MB2... You can't prove otherwise. You can keep looking until infinity.
+Jsvlad js Since this is not mathematics, some common sense is required. When something is present 60-90% of the time, you would be wise to assume it's there until proven otherwise. Each person will have to make a clinical judgement. Ultimately, if your capture rate is far below 50%, then you're not looking hard enough. Of course, if you have a CBCT, it helps reduce some of the unknown aspects of this equation.
I am a Dentist from India. I am really greatful that I can go through your videos which contains huge amount of theoretical and practical information. I am watching your videos everymornig since past one month. The learning has significantly contributed in improvement of my skills to perform RCT. THANK YOU DR 🙏
I am an Endodontist working in Kuwait . I usually use 2.5 X , 3.5X and sometimes 5X loupes to find my MB2. Here MB2 incidence in upper 6 is close to 100℅ . As if this is not enough incidence of MB2 in upper 7 is around 60-70%. Needless to tell you about the good times I am spending opening and preparing these canals and what's more , the hard times I am having trying to explain to my patients why I am taking so much time !
Yes much of our work goes under appreciated by the patient. The key is to have enough practice on extracted teeth so you can find the MB2 safely and efficiently. Loops are good but light is a key component as the field gets darker as the magnification is increased.
as an endodontist you should really consider buying a microscope...real game changer.
@@cosmiqueorg I already did ...but 5X loupes with LED lamp can also be v useful while staying more affordable than microscope..
@@rolandfrancis7066
I’m upgrading from a 3.5
Could you suggest me any good 5x at reasonable price
@@clutchisland5323 if you're looking for good and affordable loupes check Jintan Jinyang . Similar to Microsugery while still much cheaper. Make sure to order the LED lamp + battery because you're going to need them .
Thank you sir, you saved my current pateint treatment going on. Because I started searching mb3 and mb4 too.but going that much further may lead to perforation.
I am a Dentist in Nigeria and I find your videos very helpful. I found my first MB2 canal unaided last week thanks to you. How I wish I can do residency under you.
Thank you for your kind words. I makes me very happy to know these content help people in real ways to help their patients. Best way to practice finding the MB2 is by working on a bunch of extracted teeth and sectioning it to see where it is! Good luck! :)
Doc Nasseh, your videos are highly resourceful to practice. Thanks for taking efforts to post pertinent videos on a regular basis.
Thank you for the feedback. Means a lot to hear this! :)
I have done selective rerct of 16 which has missed mb2 canal done at dental school .. And I found mb2 in almost every case
Am a general dentist from India. Recently I did RCT in Upper second molar. And I found mb2 without any magnification. I was really happy that I found.
Thank you!!! Impressive how you were able to know exactly where to make the access!
Thank you Dr, very helpful. I've been struggling with Mb2 for so long.
The case you showed was simply brilliant Dr! Amazing work and knowledge
Great work doctor, what did you use to cut the excess gutta percha?
Superb work....your videos are really inspirational and educative..thankyou
I have 2 questions (I think, we'll see): I've noticed you proceeded to apply the sealer after drying with the macrocanula only; you don't use paper points?
This is, I believe, a 35.04 shape; the macrocanula is ISO 55 at its tip, which means it would bind 5mm short from the apex.
From my experience, the macrocanula doesn't dry the apical portion of canal in such cases (if it's a 50 at the apex, than yes, it's more likely).
Wouldn't excess water (if that's your final irrigant) "water down" the sealer?
And perhaps that's an advantage? I ask because I sometimes struggle with hydraulic condensation: I use your method of introducing Bioceramic sealer by spinning the "masterfile" in reverse until I see the canal filled, not just coated, with the sealer and more than once, the fitted cone wouldn't go all the way the apex. This would cause some anxiety, I must admit. Last time this happend, I took a cone with a smaller taper and the cone STILL hung short! I'd imagine a slightly "watered-down" sealer, apically, would be less viscous and not do that.
This happend to me with the Dentsply sirona BC sealer, which I don't use anymore because of one of your videos and with the the NeoFlo from Avalon Biomed, which is my current sealer, again, because of that same video.
Second question (or is that question number 9 already), and speaking of "watering down" sealers: how would you clean the access cavity after obturation in cases where the istmus is projected into the pulp chamber, like in C shaped molar and some Mesial roots of molars? If you just wash the cavity, the sealer inside the clean istmi would be washed away in such cases.
I tried to clean the sealer with cotton pellets and microbrushs, but it's a mess of a task!
Thank you in Advance Dr. Ali!
Michal, I do use one or maybe two paper points after TotalVac negative pressure.
I primarily do it to confirm there’s no bleeding before I fill. Even if it’s moist/ a little wet it’s ok with BC Sealer. After all, I’ve been doing it the same way for the last 15 years and have long recalls.
Anyway. A paper point is a good idea. If you do t have patency and place sealer only without pushing it down there’s a chance you can create a vapor lock and that will also prevent a cone that previously seated to apex not seat fully. So, using a file is helpful in tightly fitting cases.
Also, you come fit should not be super tight as it won’t leave enough room for the sealer to escape back up. Around the cone.
Cheers,
@@AANasseh Thank you dr. Nasseh! So just to be sure I understand what you are prescribing: 1) use a cone that is loose at cone fitting, like an .02 tapered cone in an .04 prep (will that create enough hydraulics, though?), and
2) beware of taper lock; so when I introduce the sealer with the master file, and I slowly spin that file counter-clockwise close to working length, I'm potentially trapping air apically; if I can't "pop" that air pocket with my GP cones, you'd suggest popping it with a file, a smaller file, like a negotiation file, perhaps?
I love what you said about the paper cones! This insight is really helpful.
But just to insist, please: what would you do in cases where an istmus extends to the pulp chamber, like in C shape canals and some mesial canals in molars? Washing the pulp chamber after obturation in such cases might (will) wash the sealer from that space, leaving it vulnerable.
Would you attempt to "seal" the space with molten GP?
Take care dr. Ali!
@@michaellupu2080 yes but don’t use a 02 cone in an 04 taper canal or you’ll have too much space. I would use. Matching cone or if the matching cone is way too tight then one size smaller as long as it’s not going long (eg 30/04 come in 35/04 shape as long as the 35/04 cone is 05mm short or something like that. Otherwise same size cone.)
Use a clean file that’s also either a size smaller than the master file or the master file itself (as long as clean) and push the sealer down to length or 1mm short of it (the rest will get pushed to length as the cone goes down). You’re not trying to pop the air bubble… you’re just trying to make sure you coat the canal walls all the way to the apex and not have air prevent full seating if the cone or get mixed into the sealer too much. Cheers.
I am an endodontist working in Udaipur.The canal can be modified to rhomboidal or trapezoidal shape to get greater access to canals
Did u watch the video or not ?
Thanks for answering me doc regarding the previous question. I do have an additional one. I recall watching a video where you stated you primarily seem to treat younger folks so you don't deal with many calcifications. I thought of a question. When accessing younger patients, does it seem like finding MB2 is easier? Whenever get into a pulp chamber, I can almost immediately locate all the canals after clearing the viewing area. That is, I can see the pin point "exposure" of the MB2 canal if its a type 2 or type 3. Do you feel that as the patient gets older, this becomes harder and thus a search for MB2 is imperative ? thank you
Yes. The MB2 is easier to find in younger patients. But they also can get calcifications if they have a long term mesial decay or old large inter proximal filling. Those cause reparative dentin over the MB2 and make it very hard to find it.
Great presentation. would it be possible to make one for how to use microscope with respect to patients positioning especially treating lower molars as am quite new to microscope use and am finding it hard how to adjust patient/microscope and mirror.... would appreciate your input.
Dr. Could you throw light on what dental microscope are you using?
In this video with MB2/MB3 sharing a common foramen, did you cut-back the master point in MB2 (and not shown)? With converging canals I'll make incremental cutbacks until I feel the 2nd point binding in the canal and obturate from there.
Thanks for the reminder. Yes. It wasn't mentioned in the video but it's a good idea to trim the GP before cementation when two canals join. You find the point of junction and cut at the point. Otherwise, you have too much sealer around the cone. Of course, it doesn't matter much if you're using bioceramics but it will create a denser "looking" fill the way.
dear Dr do you have a paper or a vedio about how to retrieve over apex gutta percha. ?
Could anyone explain what is the protocol and sequence after the crown preparation for its closure?
what kind of problems patient will face in tooth in which i missed the MB2
The same as not having a root canal. Bacteria in the canal will cause a chronic infection that becomes acute at some point down the line.
I am a patient and had a missed mb2. The tooth started giving me periodic pain after a couple years. Pain with chewing crunchy or hard foods or when I’d tap the tooth. But the pain would always subside and go away for months or a year on end. Finally had the tooth totally retreated and haven’t had any issues since
Great video once again, thank you Doctor.
wonderful explanation indd. Thanks
Superb work sir...I really love you're videos.
Thank you Dr. Nasseh!
Dr. You are awesome im a big fan of yours!
In a tooth that I am doing a prophy endo on (i.e. not infected), that is, decay is encroaching the nerve and a composite/ crown build up will surely cause post op sensitivity and pain... If a MB2 is missed in a type 2 canal orientation, how can it cause any issue if there was no bacteria to begin with?
Good question. If you have a perfectly sterile technique there will not be any problems. The problem is that no one has a perfectly sterile technique and that's why contamination causes problems. I've made this argument for every with the residents at Harvard. We've tried to test my hypothesis but it's not been easy to set a model for testing. Cheers!
Bacteria is slick indeed ;)
Are any of these offices in NYC?
Hi Dr. Nasseh, do you have some kind of contract or deal with Brasseler or Endosequence? You seem to promote them a lot. Just being curious
+Diced2TheSox Dr. Nasseh developed the ESX system!
I have to get a retreatment because my former endo missed my mb2. My new endo saw it immediately with her advance imaging.
yeah theres no incentive at all for the second guy to say that.
Thank you Dr Ali , that is a very important video.
shahenda mahmoud
Passport
Hai sir irequest the root canal problem docter can use gutta purcha this stics effect of my health you suggest him sir, this stics effects on heart problem
I had to get a root canal redone because my dentist missed this root.
Very informative.
Excellent video! Thank you
what made you suspect an mb3?
Just visually saw it. Didn’t suspect it before I got there since this was before CBCTs. :)
Thanks for you reply
Very good Dr. Nassih BTW Nassih mean the helpful and the truthful لنَّصِيحُ : النَّاصِحُ ، ذُو النُّصْحِ ، الْمُخْلِصُ في نُصْحِهِ وَوُدِّهِ
In arabic i forget to say!
nice video and i cant say nice work because it is like i am a storm trooper telling darth vader * nice work with the light saber *
beautiful work
Which file system is used here
Thanks for these great videos
Where can I get that 'stiff #6 file'...?
+Suhasini Sukumar Only available in USA.
RealWorld Endo Which company is it available with?
Suhasini Sukumar BrasselerUSA. Stiff Files sizes 6-10.
In what case we can search for MB 3
Extracted tooth !
thanks for a very informative illustration
Thanks doctor
Since the tooth is isolated and the patient is already there, why didn't you place a permanent restoration? it will only take 5 minutes or so and saves a lot of the patient and other dentist time.
Geographically, every place has its own set of politics and turfs. Here in Boston, General dentists want to place the final restoration themselves. When they refer a patient for a root canal, they expect to place the core thereafter. In other places, Endodontists place the post and core too. So, it's very dependent on the location, and also the referring dentist you're working with. I would prefer to place the restoration; but that's not always what. We have to cater to our referral sources and their individual needs.
Awesome Work!!!
well said. I'm always nervous if I don't find it.
great video
برنس اقسم بالله برنس ...u r prince of Endo
Good information .. ty☺
Because of MB2, I refer any case I get to an endodontist
Thanks. Very clear.
So while we're searching for MB2 we can't go deeper than two milimeters because there's a increased risk of acidents envolving furca floor? When I'm treating maxilary molars, I ALWAYS look for MB2. But only after finish the root canal preparation of another canals. Thanks for the video, doctor.
good job without magnification lot of wasting time and not always sure best result
That's not necessarily a bad strategy. Once you have the other orifices well marked, this can help you better identify the MB2. Just make sure you reinstrument MB1 along with MB2 so the debris from MB2 is not pushed into MB1, especially when they join. Cheers.
Beautiful 👌
A really great video
But if you keep any extracted teeth, who gets the money from the Tooth Fairy?
why don't u be 0.5mm away from radiographic apex?
Root canals do not fail even if you skip mb2 because mb2 do not have separate apex.
In 20% of the cases they do. In the rest, it take several years for the microbes in the untreated canal to reach the apex. So, they do fail in time.
wow this is mastery
how can you prove that the MB2 is NOT there? seems kind of weird?... you basically say "i cant find it."
Following the dentinal map. There's dentinal shading when searching in a ribbon shaped root where the MB2 is hidden. You can see the pattern of secondary vs. reparative dentin in these cases. CBCTs are now commonly recommended in cases when an MB2 is not found in a first molar but one is suspected. They help triage the patient without removal of excessive dentin.
great job
Great vid. My mb2 was located, filed, and filled, but it looks like the root was perforated. I got jolt of severe pain at the side of my head during the procedure, then an episode of severe pain a day or 2 later, and I still have chronic pain 7 years later. A small glob of Endosequence bioceramic sealer was extruded. From a CBCT, the 3D image and a series of axial planes through the root suggest that the gutta percha point perhaps poked out through the perforation maybe 1 mm. I am not sure if the CBCT has enough resolution to tell for sure. There is no significant amount of pain in the tooth itself. The pain is at the side of my head. My left pinna is simultaneously painful and partially numb. It turns bright red. Neurologist and otolaryngologist did not find anything. I've finaly accumualted enough money for further treatment. Would like to save the tooth.
Sorry to hear that. It may be a case of neuritis following apical perforation. If MB2 was already located, further treatment may be limited to an apicoectomy by a properly trained microsurgeon endodontist (don't see an OMFS!) But if the case is neuritis or neuropathic pain, then there's a chance some of the pain may persist following surgery too. Just a possibility. Good luck!
@@AANasseh Thank you for your response. I really appreciate it. As a result of reading about my situation for these last 7 or 8 years, I have gradually come to think exactly the same thing.
I have lived in a small city of about 90,000 people, over the last 9 years. It has over 200 dentists, but apparently only about 5 individual endodontists, at 3 endodontia practices. I am acquainted with a number of capable general dentists here, but there is one who I especially like, and trust. It is from this dentist that I learned about one local endodontist who may be our best choice. The endodontist's web site refers to using an "operating microscope" and "fiber-optic illumination," and how this tool "has paved the way for more predictable and more successful endodontic results." Does this make her a "microsurgery endodontist"? I am planning to make an appointment soon.
About 3 years ago I consulted an endodontist, who is part of the faculty practice in endodontia at a dental school, but who is 5 hours away by car from where I live. It would be easier for me, and less expensive, if I could have a capable endodontist who is closer to where I live.
I know there must be some good endodontists in the NYC metro area. If I use one of those endodontists I could stay at my son’s house and avoid the trouble and expense of staying at hotels. I have a grandson who is a student at northeastern University in Boston and I might be able to stay with him for a few days. My understanding is that you are in Boston. Are you taking any new patients?
@@soilmanted Yes we do, but if you end up in NYC you can see Dr. Synguk Kim, who's an excellent endodontist surgeon too. Good luck!
@@soilmanted BTW, if cost is a factor you can see one of my endo residents at Harvard School of Dental Medicine (where I teach, specifically this surgery!) and I would supervise your case. You'll save enough for your plane ticket and hotel stay in Boston! LOL! Surgery with our residents is less than $500. It's three times that much with me. So, you can have big savings and the quality will also be good. But obviously it will take much longer since the residents are learning.
@@AANasseh LOL - How much longer does the resident take? Seriously though, I doubt it is a problem. I live in Asheville NC by the way. Western NC. Not too far from Charlotte NC, eastern TN, southern VA, northern GA and northern SC.
In few years u'll be sounding exactly like CHRISTOPHER WALKINS
LOL! I think I already do! ;) th-cam.com/video/GxX8WDsBTf8/w-d-xo.html
just wow!
This, THIS is mastery
I find them more often than not. The commenter isn't using enough magnification
Putting MB2 aside...
I dont like the sentence "Assume there is ___X____ unless proven otherwise." where X = MB2... You can't prove otherwise. You can keep looking until infinity.
+Jsvlad js Since this is not mathematics, some common sense is required. When something is present 60-90% of the time, you would be wise to assume it's there until proven otherwise. Each person will have to make a clinical judgement. Ultimately, if your capture rate is far below 50%, then you're not looking hard enough. Of course, if you have a CBCT, it helps reduce some of the unknown aspects of this equation.
🙏🙏
I have mb2 in 100% of my practice. Even second upper molars have it everytime i do reendo or primary treatment
I’m a patient. Rare patient
S today I objurate two mb2 cases
Rockstar