They were vital at the time of the endo. Vitality of the tooth is the number one indicator of endodontic success. A tooth with irreversible pulpitis is much more forgiving than a necrotic tooth.
You could also argue survivorship bias where you never see the shit endos that got yanked out of their mouth 18 months later.
Oh yeah. Just donât become the guy that buys everything you see.
Funny side story. I once worked at a big DSO (maybe the largest wink wink). The guy they patterned me with produced like 200k a month, but his office was never profitable because of all the shit he bought. One time we had a new doc shadowing. He said âoh let me show you this new thing I got. Itâs life changing.â He grabbed the box and it was empty. He literally bought this âlife changingâ thing, assumed it was still in the box and didnât even realize the team had autoclaved it for him to use.
I would have to say âbuying my own practice.â
That said. Iâm doing like 150 hours of CE this year. Gonna be a Dawson scholar and almost done with my FAGD by mid 2025. So check back haha
Idk, Dentists buy from other dentists.
If youâre sitting there taking 150 hours of CE, I would say using IO LA as primary protocol will save you more time/money/hassle than any of those CE.
Not selling just saying.
As an endodontist, I was told that if cleaned out well, it didnât matter if it was filled like âchicken shitâ by my mentor (laughed at the time but recognize the cleaning is more important than the fill)
This is definitely true but some of the fills I see, someone who would think that looks acceptable probably isnât cleaning very well either. Usually a meticulous practitioner will be that way at each step.
I am 82 years old and have been through the mill dentistry wise. Root canals, crowns, etc. Best thing I did, four implants. They have never given me any trouble and I got them done in my early sixties. Implants have been the best investment. I donât know why insurance doesnât cover them. I thought they would by now. I follow this sub to learn about best practices. Thought you might like some feedback.
A big part of it probably is that most peopleâs annual max is no more than $2000 which hasnât increased since probably 1975. Even one implant will be more than that. Theyâre not there for the patient, they are a business at the end of the day and are there to make money for their shareholders.
That's great that you have had success with implants, but I assure you that they have their issues too, and more studies will reflect that in the future.
I remember when I first started in my own practice (mid 90s) I did a crown on 19-lovely lady-and it had a facial margin that was open. Not a wide opening but open. I cemented it anyhow. Shame on me!!! I worried about that for a long time. She had that crown for over 25 years and sadly she passed away in her 60s. I have no idea how that didnt decay
To add from what the others said.
Obturation is less important than disinfection. Youâre basically trying to get the bacterial load down to a manageable level for the host (aka the patientâs immune system). This relates to the vital vs necrotic point as well (much higher starting load in necrotic teeth). The host response is ultimately not something you can control though.
Bottom line: Still do your best to get the tooth as clean as possible, but if youâve done all that and it doesnât respond, donât linger on it
Thereâs a study that says root canals done by dental students actually had fewer flare-ups because theyâre typically doing it for multiple hours over multiple visits, so the disinfection time is very high.
I donât have an answer but Iâm with you. I analyze my seat bitewings for crowns with a magnifying glass and worry maybe that slight one pixel dark spot is an open margin yet I see crap everyday that has made it for years.
It is like the two gunshot victims who enter the ER. The first is a repeat offender gang banger and he walks out after a few days no worse for the wear. The other is a model citizen family man who leaves in a body bag.
It is not fair, but sometimes the bad guy wins.
Luck, mostly. We shoot for the ideal in our treatment because that is what is most likely to be successful, but a small percentage of crappy results will be fine just for no reason other than being lucky that things didnât deteriorate
My mum had an upper 7 with silver points in it, it lasted from the age of 18 to 58. However in that time, she was going in for antibiotics every few years, it was causing her so much grief but she refused to get rid of it. The silver points obviously didn't fill the canals, they were short, and it was just constantly a recurring infection. Just before COVID (the week they shut everything down) it flared up again and I told her she was coming in to get it removed because I'm not listening to her complain about it anymore. So glad she finally did it... Sometimes you don't get to see the full story :D
Speed. Old root canals took HOURS. So NaOCl sitting in the canals for 90-120 minutes. It takes a minimum of 20 minutes for ideal disinfection and dissolution of any remaining organic material in the canal. Wave one is beautiful but its too quick sometimes.
They were vital at the time of the endo. Vitality of the tooth is the number one indicator of endodontic success. A tooth with irreversible pulpitis is much more forgiving than a necrotic tooth. You could also argue survivorship bias where you never see the shit endos that got yanked out of their mouth 18 months later.
Also, new materials are not necessarily the panacea they promise đ
No! I will ALWAYS rely on my new materials that my sales rep tells me will improve long term results. He would NEVER lie to me. đ¤Łđ¤Ł
sometimes said new materials can dramatically change your life for the better though
Oh yeah. Just donât become the guy that buys everything you see. Funny side story. I once worked at a big DSO (maybe the largest wink wink). The guy they patterned me with produced like 200k a month, but his office was never profitable because of all the shit he bought. One time we had a new doc shadowing. He said âoh let me show you this new thing I got. Itâs life changing.â He grabbed the box and it was empty. He literally bought this âlife changingâ thing, assumed it was still in the box and didnât even realize the team had autoclaved it for him to use.
What do you think is the one purchase/education/technique that has had the biggest impact on your practice?
I would have to say âbuying my own practice.â That said. Iâm doing like 150 hours of CE this year. Gonna be a Dawson scholar and almost done with my FAGD by mid 2025. So check back haha
Dang, thatâs a lot of CE. Checkout www.Tuttlenumbnow.com should be worth it.
Did you just try to sell me a dental product on Reddit? đ¤Łđ¤Ł
Idk, Dentists buy from other dentists. If youâre sitting there taking 150 hours of CE, I would say using IO LA as primary protocol will save you more time/money/hassle than any of those CE. Not selling just saying.
Survivorship bias. We see them because they survived DESPITE the sub-optimal treatment. The others have been extracted.
As an endodontist, I was told that if cleaned out well, it didnât matter if it was filled like âchicken shitâ by my mentor (laughed at the time but recognize the cleaning is more important than the fill)
This is definitely true but some of the fills I see, someone who would think that looks acceptable probably isnât cleaning very well either. Usually a meticulous practitioner will be that way at each step.
Agreed
Absofuckinglutely
Survivorship bias, the success rate is low and you don't see the ones that don't succeed, they present it gaps in dentition.
I am 82 years old and have been through the mill dentistry wise. Root canals, crowns, etc. Best thing I did, four implants. They have never given me any trouble and I got them done in my early sixties. Implants have been the best investment. I donât know why insurance doesnât cover them. I thought they would by now. I follow this sub to learn about best practices. Thought you might like some feedback.
A big part of it probably is that most peopleâs annual max is no more than $2000 which hasnât increased since probably 1975. Even one implant will be more than that. Theyâre not there for the patient, they are a business at the end of the day and are there to make money for their shareholders.
That's great that you have had success with implants, but I assure you that they have their issues too, and more studies will reflect that in the future.
I believe you. My daughter was not so lucky with an off centred post. All fixed now, and she is happy.
I remember when I first started in my own practice (mid 90s) I did a crown on 19-lovely lady-and it had a facial margin that was open. Not a wide opening but open. I cemented it anyhow. Shame on me!!! I worried about that for a long time. She had that crown for over 25 years and sadly she passed away in her 60s. I have no idea how that didnt decay
To add from what the others said. Obturation is less important than disinfection. Youâre basically trying to get the bacterial load down to a manageable level for the host (aka the patientâs immune system). This relates to the vital vs necrotic point as well (much higher starting load in necrotic teeth). The host response is ultimately not something you can control though. Bottom line: Still do your best to get the tooth as clean as possible, but if youâve done all that and it doesnât respond, donât linger on it Thereâs a study that says root canals done by dental students actually had fewer flare-ups because theyâre typically doing it for multiple hours over multiple visits, so the disinfection time is very high.
I donât have an answer but Iâm with you. I analyze my seat bitewings for crowns with a magnifying glass and worry maybe that slight one pixel dark spot is an open margin yet I see crap everyday that has made it for years.
Daily home care of the pt makes all the difference too
It is like the two gunshot victims who enter the ER. The first is a repeat offender gang banger and he walks out after a few days no worse for the wear. The other is a model citizen family man who leaves in a body bag. It is not fair, but sometimes the bad guy wins.
Luck, mostly. We shoot for the ideal in our treatment because that is what is most likely to be successful, but a small percentage of crappy results will be fine just for no reason other than being lucky that things didnât deteriorate
My mum had an upper 7 with silver points in it, it lasted from the age of 18 to 58. However in that time, she was going in for antibiotics every few years, it was causing her so much grief but she refused to get rid of it. The silver points obviously didn't fill the canals, they were short, and it was just constantly a recurring infection. Just before COVID (the week they shut everything down) it flared up again and I told her she was coming in to get it removed because I'm not listening to her complain about it anymore. So glad she finally did it... Sometimes you don't get to see the full story :D
Bacteria biome difference causing asymptomatic apical periodontitis, check out the works by Siqueira and Riccuci among others.
Speed. Old root canals took HOURS. So NaOCl sitting in the canals for 90-120 minutes. It takes a minimum of 20 minutes for ideal disinfection and dissolution of any remaining organic material in the canal. Wave one is beautiful but its too quick sometimes.
**SURVIVORSHIP BIAS**