5 Ways to Never Perforate During Endodontics
It’s happened to most of us.
You’re already running late into the appointment. There’s a crying baby in the waiting room. The patient’s anesthesia is wearing off.
But you’re still there, searching for that mesial-buccal canal you know is there. As you remove more tooth structure, you start to see some bleeding — and you shout EUREKA! You take a radiograph to confirm you’ve found that canal.
But you see this.
You have perforated.
Fortunately with todays dental materials, such as MTA, perforations can be easily repaired and the long term prognosis is not greatly affected. However to avoid that very uncomfortable conversation with your patient — here’s a few ways I’ve avoided perforating during my access preparations.
Take a radiograph beforehand
It’s obvious. Just know what to expect and be prepared mentally that it will be difficult to find those canals. Is the pulp chamber obliterated?
Check your axial alignment
Especially in broken down teeth, its easy to be misguided about how the root is positioned. Use the position of the other teeth to help you.
Find a reference for the pulp chamber floor
The pulp chamber is usually at the level of the CEJ.
Memorize canal orofice patterns
Most canal orofice locations follow a very similar pattern. Before we created www.orosim.com; I created a 3D Dental Book that shows common canal orofice patterns. Get it here: www.orosim.com/blogextras
Take a deep breath
Rushing is the best way to ruin your day and your weekend.
Take that additional radiograph to assess how deep your cavity floor is. Go for that bathroom break and just breathe!
Don’t leave things to chance. If you still can’t find that canal — simply place your calcium hydroxide medicament, Cavit and GIC — and have that patient return another day…or just refer to your endodontist.
