Root Canal Therapy: To file or not to file!
September 6, 2013
For some dentists, doing RCT would be a breeze. They do their routine like clock work, quick and flawless. I on the other hand are among the many clinicians who shun this procedure because of the meticulous task of cleaning the canals dry and so forth.
Amazingly, I was confronted by the same scenario where I had to open a lower right molar (46) that had a periapical lesion located at the apex of the tooth. I took the xray and to my surprise, the canals showed several root canals. How many do you say? 4 to be exact. Opening the tooth was taxing because it was filled with amalgam so approximately 30 mins was procured from our appointment and another 30 minutes to locate all 4 canals. I know that if I were a certified endodontist it would take me less than the amount of time I consumed in doing the procedure, but give me break. I don't often do root canal treatment in the office. But given the dilemma and prior request from my patient that I do the procedure, I modestly obliged.
Happily, when I was able to locate, clean and shape the canals, I was relieved. Like a happy clinician who just finished his requirement as a prerequisite for graduation, I felt like that person again. Confident and relieved that I was able to confront and perform the case on my own. Bravo to me! Now how was I able to handle this case given the situation?
I guess the answer lies on being diligent and using your basic knowledge in endodontics. No matter how difficult the procedure is, patience is imperative because you have to be keen in locating all canals before closing the tooth. Failure to do so can lead to recurrence of the infection. Although I wanted to refer the patient to an endodontist, I took it as a challenge and fortunately I was able to do it successfully. I am not implying that you should be daring in tackling these matters that is way beyond your capacity as a dentist that will compromise the health of your patients. ( I hope I am not stepping on someone else's toes here) But endodontics is among the specializations we learned during our internship in college so I assume we all know how to file. Another reason is, it is less complicated compared to specializations such as implants and orthognathic surgeries. These specializations require rigid training in hospitals to hone and perfect the skill.
So i took it upon my judgement, based it on my skill (if I can do it or not) and made the decision of performing the procedure. I guess, even after 10 years of being a dentist, we are still in the process of learning and developing our skill. For this experience, I choose to file. Maybe next time, I wont!
Amazingly, I was confronted by the same scenario where I had to open a lower right molar (46) that had a periapical lesion located at the apex of the tooth. I took the xray and to my surprise, the canals showed several root canals. How many do you say? 4 to be exact. Opening the tooth was taxing because it was filled with amalgam so approximately 30 mins was procured from our appointment and another 30 minutes to locate all 4 canals. I know that if I were a certified endodontist it would take me less than the amount of time I consumed in doing the procedure, but give me break. I don't often do root canal treatment in the office. But given the dilemma and prior request from my patient that I do the procedure, I modestly obliged.
Happily, when I was able to locate, clean and shape the canals, I was relieved. Like a happy clinician who just finished his requirement as a prerequisite for graduation, I felt like that person again. Confident and relieved that I was able to confront and perform the case on my own. Bravo to me! Now how was I able to handle this case given the situation?
I guess the answer lies on being diligent and using your basic knowledge in endodontics. No matter how difficult the procedure is, patience is imperative because you have to be keen in locating all canals before closing the tooth. Failure to do so can lead to recurrence of the infection. Although I wanted to refer the patient to an endodontist, I took it as a challenge and fortunately I was able to do it successfully. I am not implying that you should be daring in tackling these matters that is way beyond your capacity as a dentist that will compromise the health of your patients. ( I hope I am not stepping on someone else's toes here) But endodontics is among the specializations we learned during our internship in college so I assume we all know how to file. Another reason is, it is less complicated compared to specializations such as implants and orthognathic surgeries. These specializations require rigid training in hospitals to hone and perfect the skill.
So i took it upon my judgement, based it on my skill (if I can do it or not) and made the decision of performing the procedure. I guess, even after 10 years of being a dentist, we are still in the process of learning and developing our skill. For this experience, I choose to file. Maybe next time, I wont!
Posted by Dr Armi Cabero.
Dr Armi is past editor of Dental Asia magazine. After her numerous feats, she returns and handles a private practice in the country and is considered as one of the most respected dental professionals in the dental association.
Now she continues her editorial crusade as Editor in Chief of Dental News Philippines to help empower every Filipino dentist with updated knowledge and skills straight from the "libraries" of renowned authors in the world.
