Root Canal Bleed {ANXIETY During Endodontics}
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- Опубліковано 16 вер 2024
- What a case! This patient is such a nice guy and I'm grateful for his patience.
There are many reasons a root canal won't stop bleeding. Those may include:
Perforation, inflamed pulp, PDL irritation, strip perforation to mention a few. I hope this video gives you an idea of one option to solve this problem.
If you're looking for a confidence building endodontic course that is affordable, look no further. allthingsendo.ca may be what you're looking for! It takes my 2 decades of endo experience and training - and we package it into a course that is intended to take your endo skills to the next level. It's not the big things that matter, it's those little tips that will save you time and increase your efficiency.
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Just had root canal done on my front left tooth (Tooth broke off and could not be salvaged, no crown, just tooth rebuild). As a patient, we can't see what's going on so i found your video to see how the procedure was done. After watching this, thank God i didn't have access to watch during my 2 hours and 15mins today in the chair today lol. I kept my eyes closed as soon as i saw the instruments to reduce anxiety. For those that will be going through the process, it's not as bad as you think. As long as you get numb from the needle, you're all set. There was some pain near the end during cleanup, i imagine the numbing was wearing off by then, but so far, so good.
Thank you to my wonderful dentist and assistant for being gentle 🙂
Your videos are pure gold. I've been in this exact same situation and i have tried asking so many endodontists about it but never got a clear explaination and then i stumble upon your video showing the exact same case. Cannot appreciatr your efforts enough sir.. Thank you.. ❤
There are so many things I have implemented into my practice watching your videos. And my favorite is the two file technique in working length estimation using apex locator.
I had a similar case 2 weeks ago tooth 36 just won't stop bleeding from the distal canal. I could not find any pulp remanants and there was no perforation. I decided to go ahead with the rotary file to radiographic length, and that's when small pulp fragments started to show up and hemorrhage stopped slowly. These videos really help. Keep up the good work. And please make a video on the best sealant to use. There's MTA based, CaOH based, Resin, Bioceramic, and ZOE. I'm confused as to which one to use and how good they really are.
An extreme case, good job Doc. Never happened to me that a bleeding would persist through weeks, but I’ll keep an eye out for large canals from now on
Thank you for your comment.
I agree that it’s not frequent that canals don’t stop bleeding, however, I figured someone could benefit from seeing how much pulp tissue can remain in those large canals.
As well, I had a hard time anesthetizing this tooth, and I wanted to show that in Endo, you can always just stop, place in intracanal medication, and either referral or come back and finish the case.
@@AllThingsDentistry Is aneasthesia easier when the intercanal medication has been inside the canal for a aperiod of time ? Is that what you mean ?
@@diaotse It just means you can always take it easy in endo and give yourself time in between cases, expecially hard ones like this one stressing too much on a case, making the appointment unnecessarily long and stressful on the patient and on yourself. Sometimes you need a break to let the case evolve, watch a response and eventually figure out a reasonable solution.
Definitely one of the biggest bleeders I've seen for an RCT. If that were my case, I'd be panicking because I thought I perforated haha.
Thanks for the education on this one!
You’re welcome. They certainly don’t happen often and yep - perfe bleed like crazy as well. Thank you so much for the comment
Started my RCT today and stumped sooo many endodontists because my tooth was hemorrhaging for almost 2 hours straight (my mouth was filling with blood repeatedly) and nothing they were doing was working. heard many many curse words and worried gasps and it freaked me out 😂. Was told they’d never seen anything like it. Was a scary experience for everyone involved I think, but they eventually got it under control thankfully. I go back for them to finish it in a few weeks, hoping it goes smoother 😅
Thank you so much to everyone for being here. I’m grateful for your time, your questions and your comments.
What i did in dentalschool was basicly the same, but i drew a random figure, and then tried to follow the line in a mirror, about the same as you did. It helped me out quite a bit.
God bless you,as a Dds (GD) my low confidence( lower…) you make something as these tips fun and it’s just miracle, thank you dr ,i watch many but those pro proffesionals is not like you🔱♠️
Your videos are great!! And the Fotos and clips in between, they are just perfect!! Do you have a video on occlusal trauma periapical lesion / necrosis treatment? Having a hard time figuring out how much to remove from lower central insisor with problem like that from the contact with upper insisor. Thank you in advance !
Thank you so much for the amazing comment! I do want to help you, but I’m having a difficult time understanding the situation. Can you elaborate a little more on your case you are talking about? Thank you in advance.
@@AllThingsDentistry Thank you so much for your so quick responce. The situation is like that : a patient has had periodic pain in the lower right central insisor since 10 years. A week ago, she came with pulpating pain, sharp and pain when touching the chin and under the lower jaw. In the radiograph there is a periapical radioluscent lesion, around the apex of 41. I suggested endo and a little preparation with a diamond on 41 to free it from the occlusion. I suggested preparing the upper insisor palatinal, so that the lower doesnt get short. Sorry for my english, i am from Greece. Hope I could explain it better now. Thank you in advance !
I had a case like this last week, I really thought I perforated and referred the patient for cbct. She didn’t want to do it, I referred to oral surgeon. They also got fed up for coming 3 times, I
You’re not alone. Thank you for your comment. I’m grateful you’re part of this community.
I read the other day that a paper point with endo ice will cause vasoconstriction and stop it!
God bless the inventor of anaesthetics!
(And you toothdrillers, too!!)
Very helpful! Thanks for the explanation ❤
my main problem is that when i get to work with hyperemic pulps, i can't seem to get to tooth numb in order to work comfortably both for me and the patient. this leads to an underworked canal and most of the time i can't even take down all the pulp tissue before sending calcium hydroxide.
Hot tooth has to be managed using Articaine (local infiltration only. Never use articaine for nerve blocks coz it can cause paresthesia).
thanks sir ,can we insert caoh2 when the canal is full of blood??
Haven't seen the video but this happened to me last year.
Great explanation thanks
I'm in the wait 2 weeks and we'll see if it calms down stage. He said it was angry and inflamed, hurt no matter the 4 different times he pumped numbing in me.
Hii Doc i witnessed the same when doing on grossly decayed 36 there was profuse bleeding and pain
Thanks for this!
What is your take on introducing some aluminium chloride (eg. in hemostatic fluids used for retraction cords) on a paper point and then taking it to working length? I've had some success with reducing or even eliminating blood flow in cases like these. All the best from Poland.
thanks for sharing ,i had a case like that tonight ,this is why i am here watching your vedio,i was perfoming rct on upper fiirst molar ,i shaped the buccals first ,then come back to palatal ,just by inserting the irrigation needle there was prfound bleeding , i think i have done pulp removal completely in palatal canal ,anyway ,i have shaped until f4 but still profuse bleeding ,took x ray to know whether it is perfoation or not ,every thing was good ,so i sopped bleeding in the pulp chamber but not intracanal ,put some cottons and tf,two days later the patient came back, after removal of tf ,and inserting a file in to the palatal canal it started bleeding again ,but the bleeding was not usual ,it was like perforation , i irrigated with naocl and saline ,but no stop ,i started using paper points ,after using 20 or more ,i controlled bleeding fortunately ,so i have placed caoh2 and scheduled the patient to next week .
Thank you for your comment. I feel your frustration and potential anxiety about perforation.
You’re not alone.
It’s hard for me to say if it is a perforation or not - however, the first thing that comes to my mind is that- time is required for the pulp to reduce in inflammation in that canal. 2 days is typically not enough to get a pulp to calm down.
In this video’s case - whether it was the CaOH that actually dissolved the tissue - or just natural necrosis - it’s hard to say. If you don’t suspect a perforation, waiting is the only thing you can do normally.
However, as I have been taught - the best to time solve a perforation is immediately.
It sounds like you’re experiencing canal heme though. Let us know how it goes.
@@AllThingsDentistry thanks we are waiting
i am back every one ,the canal was not perforation fortunately.
amazing!
I had a root canal when i was 8 now im 9 but it the scale of pain is probably a 8/10 no crying but pain
OMG, yes! This was me 2 days ago! Can apical resorption with lesions behave the same way?
Thank you
This makes me so glad I just had all of my teeth replaced with dental implants. Never again will I have to suffer through this 😂
Thank you for the comment.
Do you have a fixed or removable denture?
I can see the root cause in my opinion that you didn't extirpate the entire pulp tissue in the first visit entirely, it could be done with the aid of H files easily with copious Saline only irrigation
Why do you shape the canal dry?
That is a great question.
Normally, I do not shape, canals dry. In this situation, 90% of the canal would not be touching the file, and I wanted to see if there was going to be debris on my apical flutes. The debris helps me decide what my final apical size will be. In my experience, when the canal is full of liquid in this type of situation, the debris falls off, and my proxy indicator of debris is not effective.
Now, there is a risk to doing this without a doubt.
Certainly, what I could have done was to shape with liquid in the canal, engage with a hand file, the final size of the portal of exit.
@@AllThingsDentistry got it, thank you for the answer!
Had a case yesterday where i supposedly found the mb2 on a upper first molar. it seemed pretty calcificated so i chased the orifice until I encountered a profound bleeding. When using the electronic Apex-Locator to measure the length it showed critical length as soon as i went into the canal. This is often a sign of perforation, isn't it? When i took a radiograph with an instrument in the canal i couldn't 100% figure out if it was perforated indeed because the instrument was still somewhat in the curvature of the mesial roots.... Hard to tell right there. As I was in doubt I decided to seal this canal with MTA. What would you have done? Thanks!
I applaud you for having the courage to write this here. Perforations are stressful everytime. I would have done the exact same thing - so great job.
You did the right thing. Stopped, re-evaluated and took action.
In my experience, you’re right, perforations cause the apex locator to ring like the entire building is on fire 🔥.
We teach the same thing. Place a bioceramic if in doubt and refer.
@@AllThingsDentistry Great to hear that, thanks for the response!🙏🏻
Great content but please turn the background music off or lower, Its hard to understand your voice
Thank you for your comment. I’m on the fence of using music or not using music. What are your thoughts?
@@AllThingsDentistry I love your content. i already bought your All Things Endo course + MB2 Hunter and its a Godsend. I just don't have the best hearing from dentistry and it can be tough to pick up the nuances of your voice through the music. But I don't want to tell you how to run your channel, just wanted to share my one opinion.
@@AllThingsDentistry i like it. perhaps clicking closed captioning on the bottom of the video will help @muskydusty
What does it mean, that root canal failed?
I had a pulp removed from my molar 2 months later i got a infection was put on antibiotics but still months later i was still in extreme pain. To find out i had 4 roots but only 3 were showing up on the xrays and only 3 were done. I ended up just getting the molar pulled out.
How did you find out that you had 4 roots?
will the hemorrhage stop if i will use vitapex (calcium hydroxide with iodoform) for infected canals? thank you
I had a root canal done yesterday. It seemed to me like my dentist was having a difficult time. I was bleeding alot, and there was a time she kept trying to do something where she put a angle something she called it but it kept bending.
I'm not in terrible pain but significant pain when biting down,is this normal?
excelent😁
Thank you for sharing doc, but why not continue the canal preparation at approximate radiological Working length with rotary instruments?
That should have shredded the remaining nerve and mitigated the bleeding problem.
If pain was the issue: why not insert a needle in the canal and directly anesthetise the tissue?
Thx for the amazing vids.
Such a great question! I should have mentioned that I did give him several “practice building” (LOL) intrapulpal injections and it just didn’t stop. Perhaps this is a good indicator of the problem with reciprocating instruments. They don’t pull the pulp out.
@@AllThingsDentistry thx, makes more sense now. I was just thinking why would you go through the hustle of another appointment, rubber dam, etc... otherwise.
Hey Capt. can you share the PDF link? "In Vitro solubility of human pulp tissue in calcium hydroxide" Andersen 1992? That would be most helpful as right now I can only view the abstract :(
pubmed.ncbi.nlm.nih.gov/1289067/
Does not give access to the full article unfortunately:(
i have this study as a pdf , u're still interested? i can send it to u
Absolutely. I’m currently trying to get ongoing access to my alma maters library/pubmed account. Currently they only offer access to alumni when they’re on campus only.
Absolutely. I’m currently trying to get ongoing access to my alma maters library/pubmed account. Currently they only offer access to alumni when they’re on campus only.
Amazing!