Tooth Story #11: The Urban Myth That Root Canals Don’t Work
September 7, 2018
Two Easy Radiograph Solutions
October 26, 2018
I bet you never thought of this one before. I sure hadn’t… until, one day, one of my attendings in residency brought this up. (We’ll call him Dr .G). It made my lightbulb go off!
If you are ever doing two root canals together side by side, did you know that your diagnosis of each tooth could have an impact on each other?
A Case for Two Root Canals at One Time
I thought the best way to answer this question was to give you an example, so here’s a case we can look at. Tooth #8 was diagnosed with Asymptomatic Irreversible Pulpitis and Normal Periapex, and Tooth #9 was diagnosed with Necrotic Pulp and Asymptomatic Apical Periodontitis.
This patient was scheduled to have both teeth #8 and 9 root canalled together. I love these cases because they are a slam dunk for me. But, even though they are clinically straight forward, there is still a strategy I use to instrument these cases.
Tooth #9 has a periapical radiolucency and is necrotic, while tooth #8 is about to have a pulp exposure, and the tooth is still vital. Because tooth #8 is still vital, the bacterial load is much greater in tooth #9 than in #8. For the sake of time and efficiency, I will be treating these teeth together, but I will sequence my instrumentation a certain way.
Instrumentation When Doing Two Root Canals at One Time
I want to make sure that my files are used in tooth #8 first before tooth #9 because I don’t want to carry the bacteria from #9 into tooth #8. That said, you could either instrument #8 to completion, or you could use each file first in tooth #8. (You’d want to use it before you ever use it on tooth #9 so that you don’t contaminate tooth #8 with bacteria that it never had in the first place.)
This is such a simple concept that Dr. G taught me, something I had never thought of on my own. So simple, so sweet!
Here’s the Big Tip
When you have more than one root canal that you are doing together, make sure you always keep in mind the diagnosis for those teeth. Make sure you clean your cleaner teeth first!!!
-Sonia
28 Comments
Very useful and interesting to know . Basic tip to increase chances of survival of the tooth.
A Big tip for me…. i have never thought about it…
Hello dr Sonia
Thank you for your tips.
Thank you Siri! Please help me spread the word and share the blog with your dentist friends!
-Sonia
I know! It’s the little things that lead to a big increase in success rates!
-Sonia
Thank you for reading!
-Sonia
Sonia!
Long time no see, looks like you are doing great, so wonderful to see you! Thanks for the tips and tricks.
Thank you for following Justin!
-Sonia
Sure, and for those people who dread the needle, best to have both together. I drive my dentist crazy by the fear of the needles before root canal.
I’m your little brother from dental school in case you don’t recognize the name. BCDS 2004.
Yes Justin, I totally remember you and am so happy you’ve found my blog! Follow me on Instagram so I can DM you and catch up!
@soniachopradds
-Sonia
You’re right – another great reason to minimize appointments for a patient!
-Sonia
I used to treat such cases with different set of files and even irrigation needles!
Very useful tip mam
So glad you found it!
-Sonia
Thanks for sharing that. I never thought it like that but totally make sense. I saw your other articlen you had sent about taking x-rays for endo and SLOB rule explanation. I showed it to my staff thyey loved it and we been using that technique.
Thanks again
Rupinder
I love reading your blogs.
Everything , every bit of it is so beautifully put in words.
Thank you
Thank you Rupinder — I’m so glad you shared them with your staff! That’s why I do this!
-Sonia
I love that you are sharing this with your team. That’s where it all starts.
-Sonia
Such a valuable tip! Thankyou so much Dr.Sonia for sharing this. Can it be applied in multirooted teeth also in which periapical lesion is sometimes confined to one of the roots?
You can think of it like that, but in my opinion, I would think that all canals were infected at that point.
-Sonia
Thanks Sonia for sharing valuable tips. !
Though small, but means great success at the end of treatment.
I finally got to your blog on 2 teeth at once. I have done this the way you described. Moving bacteria from one tooth to another is always a concern in endo and perio.
Glad to hear that you find this content valuable, Khalida! Feel free to share the blog with your dentist friends.
-Sonia
Hi Steve – thank you for reading. You raise a good point about the importance of preventing the spread of bacteria during specialty procedures. -Sonia
Amazing! I never thought about that. This is easy, yet effective tip. Thank you for sharing!
Hi Ruby – thank you for reading! I’m glad you found the tip helpful. -Sonia