Very often, when a canal is reopened in the second sitting of root canal treatment for cleaning or obturation; remnant pulp tissue in the apical part of root canal becomes a problem. The patient experiences pain when the instrument is taken to the full working length, sometimes accompanied by minor bleeding as well. The question then becomes whether to keep the instrumentation and obturation short to the point of patient comfort or administer local anesthetic and continue instrumentation.
Short instrumentation, though not advocated, is common. It is frequently justified as "partial pulpectomy". And I cannot deny the merits completely - clinical results are good and patient comfort wins you his trust. However, as a young endodontist, I cannot vouch for its long term results.
I usually use a broach to the full working length in such situations to try and remove the apical tissue tag in one go. My canal has already been prepared and I am aware of the canal anatomy to safely use a broach here. In most cases this suffices to solve the problem of remnant apical pulp tissue in the root canal.
Where it doesn't, I prefer to administer local anesthetic and clean and shape the canal again to the full working length. I will use the local anesthetic without even trying to remove the apical pulp tag with a broach in some cases. Such cases are when the patient experiences pain in the middle third of the root itself, or when I encounter patient reaction in more than one canal in the same tooth. Another consideration is that the larger canals are usually more difficult to tackle successfully with a broach.
The only practical problem with this approach is that usually you have not scheduled the patient for a longer sitting, and the sitting becomes longer also because you have discovered the need for anesthesia after having opened the canals and removed the inter-appointment dressings. But then, the endodontic adage - what is taken out first is more important than what is put in later- holds true here also. The seconds and minutes of time taken out from your tight schedule for a good root canal treatment, are more important than the time put in for your next appointment.
Additional reading: Do procedural errors cause endodontic treatment failure?
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JADA February 2005 136(2): 187-193
Short instrumentation, though not advocated, is common. It is frequently justified as "partial pulpectomy". And I cannot deny the merits completely - clinical results are good and patient comfort wins you his trust. However, as a young endodontist, I cannot vouch for its long term results.
I usually use a broach to the full working length in such situations to try and remove the apical tissue tag in one go. My canal has already been prepared and I am aware of the canal anatomy to safely use a broach here. In most cases this suffices to solve the problem of remnant apical pulp tissue in the root canal.
Where it doesn't, I prefer to administer local anesthetic and clean and shape the canal again to the full working length. I will use the local anesthetic without even trying to remove the apical pulp tag with a broach in some cases. Such cases are when the patient experiences pain in the middle third of the root itself, or when I encounter patient reaction in more than one canal in the same tooth. Another consideration is that the larger canals are usually more difficult to tackle successfully with a broach.
The only practical problem with this approach is that usually you have not scheduled the patient for a longer sitting, and the sitting becomes longer also because you have discovered the need for anesthesia after having opened the canals and removed the inter-appointment dressings. But then, the endodontic adage - what is taken out first is more important than what is put in later- holds true here also. The seconds and minutes of time taken out from your tight schedule for a good root canal treatment, are more important than the time put in for your next appointment.
Additional reading: Do procedural errors cause endodontic treatment failure?
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