Hi! You need to make a video with the limitations of endodontic therapy. There are many general dentists out there who may create fake hope for a patient. Cases that failed is a much more useful lesson than cases that went right. All the best
I'm sure that there are general dentists who don't care about treatment prognosis, but just like to take money for RCT. But I'm sure that they would not search internet to improve their skills. This is a basic university knowledge that periodontal aspects and biomechanical strength of the tooth are the main limitations beside the possibility to perform RCT. When the former are in a good condition there are so many possibilities to improve prognosis... Sealing large perforations are possibe nowadays externaly or internaly, microendodontic surgery, apical resection, premolarisation, root resection. Mostly it depends on patient's wallet. Some people can't afford expensive "attempts", other can.
For now on if I ever need a root canal I will go to an Entodontis, I also tell everyone to have an Entodontis do your root canal than a regular Dentis. Entodontis are extremely good at doing root canals. I had a so called Dentis do a root canal on my front tooth and he broke like 4 files and left them there. My Entodontis removed all of them but one, because the last one went up pass the tooth. But later he removed it by surgery. I’m really happy now my Entodontis saved my front tooth and I have no more pain.
Your story sounds traumatic, it’s more likely that a dentist specializing in endodontics would do a better job. That being said, people often look for cheapest offers, remember that cost accounts for the quality of equipment as well. Endodontic treatment is a tooth saving attempt. Many clinics use files only once per one tooth, results in higher price but lower chance of them breaking, throw in a microscope and again it goes up. Standards and price are not always proportional but in my experience it more often is than it isn’t. I work at a couple of clinics, one is a brand new private clinic with all the fixin’s, I have up to 2 assistants at all times. The other one is a state owned dump, when I’m in there I refuse any procedures that I would not be able to perform due to the available equipment (some still do and it’s their prerogative) It wouldn’t be impossible I just wouldn’t be able to put my name on it. I know many regular dentists/or people in other specialities that can do just as well, unfortunately in this world there is a high manual skill requirement, 70% of my colleagues at UNI had two wooden hands. It can be trained but there is something about having dexterous hands that have been trained ever since you can remember. My observation when it comes to basic fillings: US-from absolutely worst quality to god tier. UK-from absolutely worst quality to god tier. Sweden-(11-cases) absolutely worst quality-you guys are famous for this in Europe btw. Poland-medium-good Germany-medium-good Norway-bad-medium India-Jail-medium Japan-medium-god tier Ireland-bad-medium Remember that some of these examples have less that 5 cases to form my perception, and that I’m not even suggesting that this is how their quality of service could be marked, it’s my observation and I’m not even accounting for socio-economics etc.
Hello dr i got my rct for 4 teeth and now i have pain in all four, dr says i have broken file in all so these should be removed, is there any possible way to save these
You can't in a predictable fashion. Just use a stiff #6 file and pray. Try for about 5 mintues. Beyond that you can cause more problems and potential break another file. If the tooth was vital you may get away with it. If it was necrotic then you may have to refer out for an apicoectomy, which will have a very good prognosis in the right surgeon's hand. Good luck.
@@henmari6684 You have probably seen a lot of canals filled in 1/2 or 2/3 that are asymptomatic clinically and without radiological signs. It is because closer to the apex pulp is more vital and resistant and can remain vital. The wider the apical foramen the better chance. What's more dentin in canal is not penetrated with bacteria, so it minimizes the possibility to inflame the remaing pulp.
@@AANasseh actually I experienced broken file at the apical third of mesial root of tooth 47 last month. I irrigate thoroughly the canal and I pray hard that it will not not cause problem in the future. btw, it was a vital canal.thank you for this answer doctor.
what to do if even the bypass fail .... i have had two broken files in my rooth canal and my tooth is not healing after 3 month of treatment of the RCT
Mariam the explorer The best option is an apicoectomy if the area is anatomically accessible through surgery. You need to see an Endodontist who’s does MicroSurgical procedures. Good luck!
Dr. Nasseh , i just broke a #10 k manual file in the apical third past a curvature ,measured around 7mm ,i already had achieved patency in that canal prior to separation. i was able to bypass the broken file and even file till 35 taper 4 with rotary files to almost full wl ( lost half a mm), the obturation GP goes along the broken file , but it's almost 2mm short of the end of the file. any tips for proper obturation after bypassing, i wish i could share x-ray but youtube doesn't allow links, on x-ray it looks as if i broke a 2mm file and then slapped a gp on top of it.
Not a lot you can do in these cases and simply filling a couple mm short is not as bad as not instrumenting to length. Probably best to focus on causes of file separation. Otherwise you can overfill by pushing too much without knowing exactly how to manage. Better luck next time.
@@AANasseh the cause i think was the severe curvature and limited mouth, i could tell there was a risk, so i used a new manual file, but yeah got unlucky. should i have used a lesser taper for obturation like taper 2 instead of 4?
Hello Dr. Nasseh , Just a question. I had a root canal done on one of my molars by an endodontist. He said my tooth was one of the hardest he treated yet. When we looked at the X-Rays after, 2 files got seperated, each in a different root. The fragments are minuscule, probably less than a millimeter, and located at the very end of the roots. The endodontist admitted it could have went better, but that the prognostic is "good", and that the cleaning was done "to perfection" regardless. He said I shouldnt be worried, but check once a year or so to be sure. My tooth had a big cavity, but according to him it was in overall very good condition, a healthy strong tooth, hence his prognostic. Not going to lie, I am extremely worried. I've been scrolling trying to find advices from other endodontists and to get some peace of mind. At face value, would you say that his opinion is correct, or was he trying to save face? Thank you. I know its never clear to answer without inspecting the images yourself but I appreciate your opinion.
Especially if your tooth was vital to begin with your prognosis is still good if the instruments separated later during instrumentation after some cleaning and shaping was already done. But I agree. It’s best to leave it alone if it’s at the end of the root. If you’re in the 10% or so of these cases where the problem arises down the line, a surgical apicoectomy can easily be done and the fragments removed surgically (going from the side.) So, the important thing is follow up. If one month after the root canal you have no pain be sure to go back and take a CBCT 6months after the procedure to confirm things are ok. Then take another CBCT in two years and if no problems then you’re in good shape and can follow up every five years and just see how it goes. But in these situations it’s best to take it out of your mind and do t focus on it as problems magnify when you focus on it. There’s no problem with these files being in there is the canal was already clean before it broke in there. The instruments can act as the filling material and are if no harm in themselves. The only issue is if everything around it is clean and that can be confirmed with follow up. No problem. If you already saw a specialist then you’ll have proper follow up and directions. Good luck... and don’t focus on it is no symptoms at one month! 👍
@@AANasseh Thanks for the quick response, it echoes more of less what he said and it is comforting to have extra comfirmation. I will follow what you said and check back in a month. The procedure happened literally 2 days ago. I do get little flares up of pain but I assume those are related to the healing more so than my paranoia about the files. Now I will go ahead and schedule a crown. I was hesitating at first because of the files but that seems to be foolish. Better safe than sorry. Thanks again for the response. Root canals sure are an interesting procedure.
@@polyfission2776 hello sir/madam same situation happened with me in my one of teeth files got broken 2 days ago,now I am worried can you please tell how is your teeth now
@@shubhamphadtare9019 Hello sir, I have not had any problems since. But to be honest, I have not had any x-lately, so I am not 100% aware if something bad is happening. But I can tell you that I feel no pain, no infection, everything is normal. Dont stress about it, everything will be fine.
Have not used it and have no idea how good it is. But the idea is the same as all the other techniques. Create a platform around the broken instrument and use an ultrasonic to dislodge, only in cases you can see directly with straight line access.
@@AANasseh just tried it. Didn't work. The screw got jammed with dentin, and as a whole, it's just an overpriced pack of gates and endo z drills. Sometimes I think it would be easier to try a brute force approach, and remove the files with a very long high velocity diamond drill, on a counter clockwise movement, just the way we remove metallic posts
@@koni00004 I asked my professor he said that we cant put iron while manufacturing the files and the broken file is screwed in the canal (because of the flutes) so we basically cant just pull it
Doc #15 k file was separated at apical third covering more than half the root length if I don’t have the option of retrieval and have obturated. What is the prognosis of such a teeth . Patient complained of pain on the day of obturation on pressing the teeth . Thank you sir.
I am having broken file beyond tooth in bone what should I have to do. After 8 months pain reduced. But can it cause cancer as it may cause repeated wound
I am having broken file beyond tooth root in bone what should I have to do. After 8 months pain reduced. But can it cause cancer as it may cause repeated wound
If you are a patient please see a specialist for a consultation as you may require surgical removal of the instrument if infection or pain is present. If no infection or other symptoms following clinical and radiographic evaluation then the broken segment can be monitored with occasional radiographs to see if any infection develops. No worries about cancer at all. At least, not because of the instrument! Good luck!
@@AANasseh will you please give me mail id or other means to show you radiograph (x ray) it shows broken segment protruding out of canal root in bone. If I chew with that tooth I got little pain. Doctor suggest to remove tooth or surgery to remove segment of tooth previously (when the pain are more now pain are diminished), but I want to retain the tooth. Please help.
@@dekhanesandip683 then surgery to remove the segment and a proper apicoectomy and retrograde filling by an endodontist is indicated. please see a surgically trained endodontist.
Hi I have a file broken in my root canal 13 years ago doctor said it’s ok nothing to be worry about ! What do you think ? In the same time I don’t have any pain in that tooth, I am always worried if that file move from that spot and goes somewhere else inside my mouth
As long as you have no symptoms you should be fine. But if worried, just take a CBCT by an Endodontist to make sure there's no chronic infection. If no issues, then don't worry about it.
+theexperiment asd The annotation explains that this is an excerpt and you can see the full video on the RealWorldEndo website (link in the description). BTW, basic membership on the website is free.
My mother is 55 years old ,she have no tooth left in mouth , please suggest me best treatment So that She chew again ....she have high BP and Sugar also ....I am waiting for your reply Doctor .. thanks
@@sourab11 Just need recall. Every case is unique and it depends on your specific case and how much infection was present beyond the break when it broke. just follow up with xrays for a couple of years to make sure it heals..
Thanks, Ali, good discussion and techniques.
Great video, thank you
Hi! You need to make a video with the limitations of endodontic therapy. There are many general dentists out there who may create fake hope for a patient. Cases that failed is a much more useful lesson than cases that went right.
All the best
You need to not make a rude and demanding comment. All the best
@@alexva210 Definitely not rude. I am not a rude person. Read the comment again and imagine me saying this with a smile. I find this channel great.
I agree, It's just a constructive comment
I'm sure that there are general dentists who don't care about treatment prognosis, but just like to take money for RCT. But I'm sure that they would not search internet to improve their skills. This is a basic university knowledge that periodontal aspects and biomechanical strength of the tooth are the main limitations beside the possibility to perform RCT. When the former are in a good condition there are so many possibilities to improve prognosis... Sealing large perforations are possibe nowadays externaly or internaly, microendodontic surgery, apical resection, premolarisation, root resection. Mostly it depends on patient's wallet. Some people can't afford expensive "attempts", other can.
For now on if I ever need a root canal I will go to an Entodontis, I also tell everyone to have an Entodontis do your root canal than a regular Dentis. Entodontis are extremely good at doing root canals. I had a so called Dentis do a root canal on my front tooth and he broke like 4 files and left them there. My Entodontis removed all of them but one, because the last one went up pass the tooth. But later he removed it by surgery. I’m really happy now my Entodontis saved my front tooth and I have no more pain.
Your story sounds traumatic, it’s more likely that a dentist specializing in endodontics would do a better job.
That being said, people often look for cheapest offers, remember that cost accounts for the quality of equipment as well.
Endodontic treatment is a tooth saving attempt.
Many clinics use files only once per one tooth, results in higher price but lower chance of them breaking, throw in a microscope and again it goes up.
Standards and price are not always proportional but in my experience it more often is than it isn’t.
I work at a couple of clinics, one is a brand new private clinic with all the fixin’s, I have up to 2 assistants at all times.
The other one is a state owned dump, when I’m in there I refuse any procedures that I would not be able to perform due to the available equipment (some still do and it’s their prerogative)
It wouldn’t be impossible I just wouldn’t be able to put my name on it.
I know many regular dentists/or people in other specialities that can do just as well, unfortunately in this world there is a high manual skill requirement, 70% of my colleagues at UNI had two wooden hands.
It can be trained but there is something about having dexterous hands that have been trained ever since you can remember.
My observation when it comes to basic fillings:
US-from absolutely worst quality to god tier.
UK-from absolutely worst quality to god tier.
Sweden-(11-cases) absolutely worst quality-you guys are famous for this in Europe btw.
Poland-medium-good
Germany-medium-good
Norway-bad-medium
India-Jail-medium
Japan-medium-god tier
Ireland-bad-medium
Remember that some of these examples have less that 5 cases to form my perception, and that I’m not even suggesting that this is how their quality of service could be marked, it’s my observation and I’m not even accounting for socio-economics etc.
Very good video and helpful thank you do much but where is part but where is part 2
Thanks for these tips are very helpful ... regard Dr.Mohammad Khalil, M.Sc.
Hello dr i got my rct for 4 teeth and now i have pain in all four, dr says i have broken file in all so these should be removed, is there any possible way to save these
Can I use a c plus file to bypass
Hi Dr,
Please can you do a video on pulp diagnosis.
thank you
Sir today I did a root canal...but my 8 no. File at least 1.5mm broken in canal... what should b the best treatment onwards...tooth no. Is 37
Dr How can we bypass a broken file in the apical third especially if the root was curved ?
You can't in a predictable fashion. Just use a stiff #6 file and pray. Try for about 5 mintues. Beyond that you can cause more problems and potential break another file. If the tooth was vital you may get away with it. If it was necrotic then you may have to refer out for an apicoectomy, which will have a very good prognosis in the right surgeon's hand. Good luck.
Thanks Dr, it really helped :)
@@AANasseh what do you mean you may get away with it dr?
@@henmari6684 You have probably seen a lot of canals filled in 1/2 or 2/3 that are asymptomatic clinically and without radiological signs. It is because closer to the apex pulp is more vital and resistant and can remain vital. The wider the apical foramen the better chance. What's more dentin in canal is not penetrated with bacteria, so it minimizes the possibility to inflame the remaing pulp.
@@AANasseh actually I experienced broken file at the apical third of mesial root of tooth 47 last month. I irrigate thoroughly the canal and I pray hard that it will not not cause problem in the future. btw, it was a vital canal.thank you for this answer doctor.
what to do if even the bypass fail .... i have had two broken files in my rooth canal and my tooth is not healing after 3 month of treatment of the RCT
Mariam the explorer The best option is an apicoectomy if the area is anatomically accessible through surgery. You need to see an Endodontist who’s does MicroSurgical procedures. Good luck!
Dr. Nasseh , i just broke a #10 k manual file in the apical third past a curvature ,measured around 7mm ,i already had achieved patency in that canal prior to separation.
i was able to bypass the broken file and even file till 35 taper 4 with rotary files to almost full wl ( lost half a mm), the obturation GP goes along the broken file , but it's almost 2mm short of the end of the file.
any tips for proper obturation after bypassing, i wish i could share x-ray but youtube doesn't allow links, on x-ray it looks as if i broke a 2mm file and then slapped a gp on top of it.
Not a lot you can do in these cases and simply filling a couple mm short is not as bad as not instrumenting to length. Probably best to focus on causes of file separation. Otherwise you can overfill by pushing too much without knowing exactly how to manage. Better luck next time.
@@AANasseh the cause i think was the severe curvature and limited mouth, i could tell there was a risk, so i used a new manual file, but yeah got unlucky.
should i have used a lesser taper for obturation like taper 2 instead of 4?
Hello Dr. Nasseh ,
Just a question. I had a root canal done on one of my molars by an endodontist. He said my tooth was one of the hardest he treated yet. When we looked at the X-Rays after, 2 files got seperated, each in a different root. The fragments are minuscule, probably less than a millimeter, and located at the very end of the roots. The endodontist admitted it could have went better, but that the prognostic is "good", and that the cleaning was done "to perfection" regardless. He said I shouldnt be worried, but check once a year or so to be sure. My tooth had a big cavity, but according to him it was in overall very good condition, a healthy strong tooth, hence his prognostic.
Not going to lie, I am extremely worried. I've been scrolling trying to find advices from other endodontists and to get some peace of mind. At face value, would you say that his opinion is correct, or was he trying to save face?
Thank you. I know its never clear to answer without inspecting the images yourself but I appreciate your opinion.
Especially if your tooth was vital to begin with your prognosis is still good if the instruments separated later during instrumentation after some cleaning and shaping was already done.
But I agree. It’s best to leave it alone if it’s at the end of the root. If you’re in the 10% or so of these cases where the problem arises down the line, a surgical apicoectomy can easily be done and the fragments removed surgically (going from the side.) So, the important thing is follow up. If one month after the root canal you have no pain be sure to go back and take a CBCT 6months after the procedure to confirm things are ok. Then take another CBCT in two years and if no problems then you’re in good shape and can follow up every five years and just see how it goes.
But in these situations it’s best to take it out of your mind and do t focus on it as problems magnify when you focus on it. There’s no problem with these files being in there is the canal was already clean before it broke in there. The instruments can act as the filling material and are if no harm in themselves. The only issue is if everything around it is clean and that can be confirmed with follow up. No problem. If you already saw a specialist then you’ll have proper follow up and directions.
Good luck... and don’t focus on it is no symptoms at one month! 👍
@@AANasseh Thanks for the quick response, it echoes more of less what he said and it is comforting to have extra comfirmation.
I will follow what you said and check back in a month. The procedure happened literally 2 days ago. I do get little flares up of pain but I assume those are related to the healing more so than my paranoia about the files.
Now I will go ahead and schedule a crown. I was hesitating at first because of the files but that seems to be foolish. Better safe than sorry.
Thanks again for the response. Root canals sure are an interesting procedure.
@@polyfission2776 hello sir/madam same situation happened with me in my one of teeth files got broken 2 days ago,now I am worried can you please tell how is your teeth now
@@shubhamphadtare9019 Hello sir, I have not had any problems since. But to be honest, I have not had any x-lately, so I am not 100% aware if something bad is happening. But I can tell you that I feel no pain, no infection, everything is normal. Dont stress about it, everything will be fine.
@@polyfission2776 Thank you so much dear😊
What do you think about the komet endo rescue retrieval kit? Have you used any other kit?
Have not used it and have no idea how good it is. But the idea is the same as all the other techniques. Create a platform around the broken instrument and use an ultrasonic to dislodge, only in cases you can see directly with straight line access.
@@AANasseh just tried it. Didn't work. The screw got jammed with dentin, and as a whole, it's just an overpriced pack of gates and endo z drills.
Sometimes I think it would be easier to try a brute force approach, and remove the files with a very long high velocity diamond drill, on a counter clockwise movement, just the way we remove metallic posts
I have a question, can't we invent something like magnet to iron by which can just make the broken file attach to it without widening the canal?
Lol. I was thinking the same thing
@@koni00004 I asked my professor he said that we cant put iron while manufacturing the files and the broken file is screwed in the canal (because of the flutes) so we basically cant just pull it
Try to invent it. I think its a good idea
Sir, most of yout tutorial videos are incomplete. Kindly share the full videos if possible.
The incomplete videos are on our website in their complete form.
@@AANasseh what is your website doctor?
@@Teeth_builder1991 the link is in the description. RealWorldEndo followed by .com.
What about the file broken beyond apex
I'm still a student but can you chop off an instrument ?(the GG) is that a thing?
Yes you actually can do it very easily with an aerotor bur.
Doc #15 k file was separated at apical third covering more than half the root length if I don’t have the option of retrieval and have obturated. What is the prognosis of such a teeth . Patient complained of pain on the day of obturation on pressing the teeth . Thank you sir.
I am having broken file beyond tooth in bone what should I have to do.
After 8 months pain reduced.
But can it cause cancer as it may cause repeated wound
@@dekhanesandip683 Stay with the smaller files in a linear filing motion for a longer time before going to larger files.
tnxxxxxxxxxxx
I am having broken file beyond tooth root in bone what should I have to do.
After 8 months pain reduced.
But can it cause cancer as it may cause repeated wound
If you are a patient please see a specialist for a consultation as you may require surgical removal of the instrument if infection or pain is present. If no infection or other symptoms following clinical and radiographic evaluation then the broken segment can be monitored with occasional radiographs to see if any infection develops. No worries about cancer at all. At least, not because of the instrument! Good luck!
@@AANasseh will you please give me mail id or other means to show you radiograph (x ray) it shows broken segment protruding out of canal root in bone. If I chew with that tooth I got little pain.
Doctor suggest to remove tooth or surgery to remove segment of tooth previously (when the pain are more now pain are diminished), but I want to retain the tooth. Please help.
@@dekhanesandip683 then surgery to remove the segment and a proper apicoectomy and retrograde filling by an endodontist is indicated. please see a surgically trained endodontist.
Hi I have a file broken in my root canal 13 years ago doctor said it’s ok nothing to be worry about ! What do you think ? In the same time I don’t have any pain in that tooth, I am always worried if that file move from that spot and goes somewhere else inside my mouth
As long as you have no symptoms you should be fine. But if worried, just take a CBCT by an Endodontist to make sure there's no chronic infection. If no issues, then don't worry about it.
Thank you so much
this video is broken near the end of the canal . thank u anyway
+theexperiment asd The annotation explains that this is an excerpt and you can see the full video on the RealWorldEndo website (link in the description). BTW, basic membership on the website is free.
+RealWorld Endo i cant signup because there is a problem with the captcha code button . how can i fix this ?
+theexperiment asd
Hi - what browser and OS (mac or PC) are you using - we will look into the issue for you.
+Marko Basten i changed wifi connection and the captcha button appeared . thank u for ur concern
+theexperiment asd
Wonderful! Thanks for the note.
necesitamos de la magnificacion!! microscopio!!
My mother is 55 years old ,she have no tooth left in mouth , please suggest me best treatment So that She chew again ....she have high BP and Sugar also ....I am waiting for your reply Doctor .. thanks
If she has no teeth left her options are limited to a removable denture or an implant supported fixed or removable denture. Good luck .
@@AANasseh Can I get your Gmail ID so that I will show you CBCT Report to You ..
Can file be left inside
If it can’t be taken out yes. But it should be monitored closely to see if it causes problems.
@@AANasseh my dentist will try to by pass and if she is sucessful will it have any impact on the rct if its left inside
@@sourab11 Just need recall. Every case is unique and it depends on your specific case and how much infection was present beyond the break when it broke. just follow up with xrays for a couple of years to make sure it heals..
@@AANasseh thanks for your reply
I just left the dental an they left it in there but didn’t feel it I’m so 😠
Had an apicoectomy done, it's barbaric.
Ike Does Stuff sorry... you went to the wrong guy! It’s not a barbaric surgery at all if done right.
Useless video
You talked a lot generally ! when you arrived to the main subject you passed quickly
To be fair, this is a TH-cam video and not a Masters Program in Endodontics! Cheers!