Q. Will you be holding any courses in Scotland?

A. Yes we definitely will be. We have visited both Edinburgh and Glasgow in the last few months and we will be returning to see more of Scotland later in the year (along with just about every other city and town in the UK!). Checkout the courses section of the website, we should be in a town near you soon. If not and you know that there will be a group of dentists in your area that would be interested then email Kirsty @d2dendo.co.uk and we will try to organise something for you. 

Q. Why do I have to send payment to the Royal Bank of Scotland rather than direct to d2dENDO?

A. As a new company, it was essential that our structure was as streamilned and efficient as possible. In order to keep our accounting procedures down to an absolute minimum, we used the Royal Bank of Scotland to manage our financial affairs. Now that d2dENDO has matured, we no longer need to do this. Therefore from May 2008 we will be reverting to the tried and tested method of billing our customers and providing monthly statements. We would like to thank all of our customers for their support during our first few months and we look forward to continually improve our customer service. If you have any further questions please dont hesitate to contact Kirsty (customer services manager) kirsty@d2dendo.co.uk

Q. How soon after root canal treatment should the final restoration be placed?

A. It does occasionally depend upon the specific case in question, but it is often recommended that the definitive restoration is placed as soon as is possible. This protects the tooth structurally but also provides the important bacterial seal in order to prevent re-infection of the root canal space.

Q. How long should Calcium hydroxide be left in a tooth?

A. Ideally this should left in place for around two to four weeks. It has an antibacterial action for this length of time only hence will be relatively inactive after this.

Q. What is the difference between calasept (calcium hydroxide) and Vitapex (iodoform paste)

A. Vitapex is an iodoform based paste which is used because of its antibacterial action against otherwise resistant strains especially the enterococci species. These most frequently occur in chronic cases and teeth that have been root filled unsuccessfully, hence is an important adjunct in some retreatment cases.

Q. What should I irrigate a root canal with?

A. The most important irrigant in root canal treatment is sodium hypochlorite (bleach). It is readily available at concentrations around 4% and should be used in its purest form ie. not with pine fresh scents added etc! Bleach is very antibacterial but also has the ability to dissolve organic tissue. Although incredibly important it is not the complete answer and there are other irrigants available which should also be used. E.D.T.A. in its aqueous form (eg. Smear Clear) is important as it aids the debris removal process by removing the smear layer which forms on the prepared walls of root canals and may potentially harbour bacteria. Other irrigants include 2% Chlorhexidine and Iodine potassium iodide solutions.

Q. I am considering starting to use rotary files, what would be the best system to use?

A. This is a great question and one which is difficult to give a definitive answer to! As I am sure you are aware there are many systems available to us now. It can be very confusing when starting out and what system you start with will be a matter of personal preference. It would certainly be sensible to start with as simple a system as possible, and one which is relatively forgiving in its use. Of the files around it would be worth considering ProTaper from Dentsply, this is the most common rotary system used today but others include K3 from SybronEndo and ProFile from Dentsply. All these systems have movie protocols on the website and if you wish to discuss this further e-mail or call me (see contact us). Also bear in mind we are running a nationwide series of hands-on courses which would be ideal for someone in your current situation, again see the courses section on the website.

Q. Is it important to root fill 4 or 5 canals in upper molar teeth?

A. We can probably break this question down into two parts. The first part being that it is vitally important to clean, shape and fill all root canal anatomy that exists within the tooth. The second point is how many canals one should expect to find in upper molar teeth. The most commonly missed canal in upper molars in the infamous MB2 or second mesio-buccal canal. We now know that almost all upper first molar teeth have this canal and the majority of second molars also. This is usually located in the line between the mesio-buccal canal and the palatal hence it is sometimes called the mesio-palatal canal. This anatomy exists as well as the more commonly found disto-buccal, mesio-buccal (one) and palatal canals. With the advent of magnification and ultrasonics in dentistry there are many great new products which help us locate and instrument these canals. For more details on these items and many others have browse through the products sections of our website.

Q. What would you recommend for the immediate treatment of irreversible pulpitits?

A. Once you are happy with your diagnosis and you have established the cause and the specific tooth, one should ideally aim to carry out as much of the treatment as is possible. We all know that time constraints and other factors may prevent us from doing this hence the minimum that should be achieved would be the location of pulp chamber and its associated root canal orifices. At the very least we should be aiming to place a sedative dressing eg. Ledermix in this area and arranging to see the patient for their definitive treatment as soon as possible.

Q. What do you do if a patient is complaining of pain during treatment i.e. the hyperaemic tooth which is really sensitive?

A. Everybody has experienced these hot pulps and this can be a real challenge to carry out any invasive treatment. There are now aids to assist us now such as the intra-osseous local anaesthetic device Intraflow, from ProDex. This phenomenally easy to use device has revolutionised anaesthesia in the States and provides a nice adjunct to our clinical treatment of these cases. Take a look at the product movie on the website. Even more simple steps exist such as the advent of articaine (trade name Septanest) local anaesthetic which provides a more potent form of local, or the not particularly popular intrapulpal injection which although very sore, is only tender for a couple of seconds and provides immediate relief, allowing us to carry out more of the remedial treatment. If none of these appear to work simply place some ledermix wherever you are in the pulp chamber seal up the tooth and review again as soon as possible. A nice addition to this is to get the patient to take 400mg Ibuprofen (if they have no-contraindications) around 45 minutes prior to the procedure. Studies have shown this to be an effective adjunct to achieving a comfortable level of anaesthesia.

Q. Do you always give local anaesthesia for root canal treatment even if you know the tooth is non-vital?

A. The quick answer to this is a most definite yes! One of the first reasons for giving local is to anaesthetise the gingivae for rubber dam clamp placement.  Next there are cases where even though the tooth is obviously non-vital there may be areas of inflamed tissue inside the root canal system which will be tender if not anaesthetised. As part of our thorough cleansing process we will occasionally be placing our smallest hand file 1mm through the root canal terminus into the surrounding periapical tissues (this process is called patency and help us prevent apical blockage). Again if the area is not anaesthetised this will be uncomfortable for the patient.

Q. I sometimes find that following preparation of the root canals when I come to fill, my gutta percha cone fails to go to the full length.

A. This has to be one of the most commonly asked questions, but has many possible solutions. It may well be that your preparation may not be quite tapered enough to accept the gutta percha cone which you are using. There are many sytems available these days which have matching gp cones to the particular finishing file which was taken to full length. Even in these situations however we can still sometimes find our master cone coming up short. A common reason for this can be the loss of patency throughout the cleaning and shaping process. Keeping the canal patent involves taking our smallest hand file 1mm long through the end of the root canal. This prevents the build of debris in this area which if continues throughout the process can result in the root filling coming short of the full working length. Since there are so many product around now it is important to realise that there are different shapes of gutta percha and the answer may simply be to use a different shape or taper of gp. If want to discuss this with more specifics ie. the type of rotary you are using or the type of gp, drop me a line and we can discuss it further (see the contact us section).

Q. What obturation system would be a good starting system to use?

A. There are many systems around now and much of the decision comes down to personal preference and the shaping systems you are using prior to filling. The common methods employed now tend to be warm obturation techniques. These include the popular Thermafil technique which now has matching obturators to the finishing rotary file. Also popular is the continuous wave of obturation technique using the Elements obturation unit from SybronEndo (see website products and movies). Again these employ the placement of a master gp cone of which we have matching versions for the popular brands of rotary file. A heat probe is then used to compact this cone to form a 5mm apical plug then warm gp is injected into the space above this to create a uniform mass of gutta percha.

Q. Is rubber dam always required?

A. The short answer to this is Yes. Rubber dam is important for a number of reasons. Medico-legally a situation of carrying out any root canal procedure and an instrument becoming swallowed or inhaled without the operator using rubber dam is indefensible. Also we know the success of our root canal treatment depends on removing bacteria from the entire root canal system. If we dont isolate the tooth well enough saliva will re-infect the tooth making our intervention irrelevant. The rubber dam also prevents our irrigants, usually bleach, from entering the patients mouth, allowing us to work in a much more relaxed manner. Therefore we can see the vital importance of being slick at rubber dam placement, something with a bit of practice is really straight forward.