Claudia Hoffman
 
 

    I had always used K-Files before I started with this practice. K-Files are tightly twisted square stainless steel wire instruments that encounter four points of contact in the canal. Reamers are loosely twisted trianglular wires that make three points of contact. Therefore, I understood the rational for reamers, but I had to experience the difference clinically to fully appreciate it. I started with reamers and switched back to files because I was comfortable with the quarter-turn and pull motion that I had used in my training. After a few weeks with files again, I was experiencing more hand-fatigue, more working time with each case, and more distortion of the canals. I truly realized how much more difficult it was to use files than reamers. The SafeSiders reamers offer an easier alternative; the reamer has a flat surface, decreasing the resistance to dentin in the canal. I can now say that, having experienced and utilized both techniques, I prefer SafeSiders to K-Files.

    This is very hard for me to admit, because I joined this practice as a fan of rotary NiTi instrumentation. I have done many wonderful cases using rotary NiTi, and it was difficult to try another technique. I have only separated one rotary NiTi file in my whole career, but the fear of instrument fracture is always there when using rotary NiTi. I was always careful not to push with the rotary NiTi instruments and therefore rarely took them all the way to the apex. I was doing most of my work with stainless steel hand files. After I started using Dr. Musikant’s technique with the SafeSiders incorporating the Peeso and the Gates, I saw results similar to those from rotary NiTi with less expense and much less anxiety. (You can refer to our website, www.endomail.com, for a full explanation of the SafeSiders technique.) As with anything else the Peeso and Gates Glidden have a learning curve before they feel totally comfortable. I have found that these instruments can do the same shaping as a rotary NiTi in the canals, and if these instruments break, they break at the top of the shank and the broken piece can be removed easily. I have less stress and anxiety and my cases are coming out just as nicely.

    Septocaine is articaine hydrochloride 4 percent with epinephrine 1:100,000.  We all encounter hot teeth, and these situations can be challenging for the doctor and the patient. I have always used 2 percent Lidocaine in most cases for mandibular blocks and infiltration. In some situations where obtaining anesthesia is difficult, I now use Septocaine to infiltrate and in a PDL injection around the hot tooth. I avoid Septocaine usage in patients with any significant medical history or allergy to sulfa drugs. I also do not use Septocaine in Mandibular blocks, due to reports of increased chance of paresthesia, although the chances are still very minimal. I find that using Septocaine in an infiltration and PDL injection will obtain anesthesia in a hot tooth.

    The medical and dental history is crucial. I always start in another quadrant than where I believe the problem lies. It is very easy to focus in on one tooth that the patient suggests, but it is important to examine the whole dentition. Although making multiple radiographs can be time-consuming, they are very helpful. I always take a periapical and bitewing radiograph of the tooth in question. If the correct diagnosis is not obvious or reproducible, schedule another appointment for the patient. Time may make the diagnosis easier and more accurate. Prescribing antibiotics and pain-killers temporarily is better than performing a questionable procedure on a tooth. 

    Knowing when to say enough is a hard thing for all of us.  We all want to be heroes and help save every tooth.  Telling a patient that a tooth cannot be saved is a difficult thing.  The patient’s expectations and the treatment plan have to be compatible.  I have learned that being a hero in every case is not an option.

    These are things I have picked up or changed over the past year, and I hope the process continues; in twenty years I should be doing things differently from the way I’m doing them today.