Here as a patient! :) What causes the sharp pain when Endodontist was flushing the canal, soaking up excess moisture from the canal using a paper points and when filling in gutta percha? The nerves in the root is gone, but there's constant sharp pain. Was informed that it's the surround tissues and nerves that's in pain as solution could have leak out from the apex.
Sir, i have one question to ask! How about we do a second visit endodontic treatment. In this case, actually the pulp tissue is removed thoroughly. But why sometimes patient feel a little bit of pain while we are inserting the master cone? Does it mean that we are overfilling? Or other possibility.
Fantastic video, thank you for putting it together. I have wondered for a while about this. Question: why would an intrapulpal injection not work to eliminate the receptors in the periapex?
Sorry for the late reply. Intrapulpal is a pressure anesthesia and once you've unroofed the pulp chamber to access the apex and the patient is feeling the anesthesia will not work due to inability to create adequate intrapulpal pressure for anesthesia. Also it hurts like hell! So, no good! You would be better off with an intrasulcular injection or intraosseous injection. Cheers!
yisser mentioned this below - is there any negative effects of using intra-pulpal injections? You mentioned they are contraindicated. I would say I quite frequently use this injection when anesthesia with traditional techniques have failed (which is infrequently - usually only for very symptomatic irr. pulpitis cases). I generally find immediate success using a 30 gauge under pressure down the offending canals. Curious if there are negative effects of doing this. Thanks!
The negative effects of an intrapulpal are obviously a patient who's likely traumatized by the experience. That's negative enough for me. I never use the intrapulpal as a primary source of anesthesia. It's very painful and breaks the patient's confidence in your ability to provide painless care, which is possible if you follow the proper algorithm of care even in hot teeth. If you find out the patient is not adequately anesthetized during access you should remove the Rdam and do an intrasulcular shot or an intraosseous shot. Yes, it's easier to do the intrapulpal but it comes at a great cost to your patient. You can even give a little intrapulpal after you've given the intrasulcular or intraosseous but at that point the intrapulpal would be painless since they should be numb by the then. In those cases intrapulpal is what I call "insurance anesthesia" that makes sure the patient will remain numb but it's not used as a primary mode of anesthesia after they report pain. Also, intrapulpal only works if the roof of the pulp chamber is intact and if you've unroofed the pulp during access it won't work. You can't create the pressure to cause anesthesia and it will only be a source of pain to the patient without any actual anesthesia effect. Hope this helps. Cheers! (BTW, great comment for a video response! Thank you! ;)
If you're talking about dentinal sensitivity pain then yes, replacing leaking fillings and recreating the appropriate seal may avoid root canal therapy.
When you obturate you create hydraulic forces that push air and sealer out of the apex when you have patency and create pain from PDL nociceptors. They should still be anesthetized if you have and use the patency technique.
The video explains that because Pulpal anesthesia is different than tissue anesthesia and because pulpal anesthesia duration is much shorter than tissue anesthesia (45min vs. 120min), it can wear off towards the end of the procedure if you have a long procedure whereas the patient still claims to be numb (tissue anesthesia). This is why procedures should be efficient.
Pradeep Yadav U y oh should always anesthetize, first or last visit. The patient should not have pain during obturation! Any incidence of pain can cause a significant memory of pain that will act has habit memory pathways for pain referral to that tooth in the future. This has been shown through research by Wolf, et al in the 1080’s.
