Speaker Spotlight with: Dr. Omar Ikram
Probably your most asked question as an endodontist, how do you find the MB2 canal? Any tips for increasing visibility and accessibility?
To be able to find this microscopic canal (and most of the time it is microscopic) requires a whole lot of clinical equipment to visualise it and confidently remove dentine in the right area and read what you all know is called the ‘dentine map’ or pulpal floor, without perforating! The LN bur and the Endotracer burs are fabulous. But just drilling in the right area isn’t enough. You also need to be able to visualise the canal. To do this requires at least 4 times magnification, Once you locate the canal, it is not enough to just locate it. It also requires negotiation and this is the challenging difficult part. Because Hess discovered this canal in 1920–and Weine mentioned it in 1969. But dental students weren’t really taught about it until we had the equipment to negotiate it. The canal has an acute coronal curvature in the first 2-3mm meaning that unless you are able to drill past this level the access to the apex is impeded by this acute curve. To the aspiring endodontist- this is the most heart sinking feeling- to be able to locate the mb2 but then create a ledge due to this curvature or not be able to negotiate the canal it’s full length. This acute curvature accounts for about half the referrals we receive. Negotiation usually requires opening access to the straight part of the canal using the XA rotary file and use of C pilot or C+ files to widen the canal, enough to allow instrumentation. The hand filing stage is perhaps the most treacherous stage with the acute curvature in the coronal region being a focal point for torsional fatigue and fracture of the hand file. Negotiation requires knowledge of the various tapers and different rigidity of stainless steel available.
Any recommendations on techniques for extirpation and location of calcified canals?
Use of the white dot technique where a slow speed round bur, such as the endo Tracers or LN bur create dentinal debris to plug the canal helps to locate the orifice. Magnification is essential. I work at around 10 times magnification. This is usually sufficient.
Patients can be extremely anxious about root canal treatment, how do you explain the procedure to them and do you have any advice on how to alleviate anxiety and make them comfortable?
Patients have to be on board if they want root canal treatment. We are essentially performing microsurgery of a tooth. Most of the time an explanation that the procedure will not be uncomfortable due to the use of local anaesthetics will suffice. If the patient is really nervous we can use nitrous oxide. We also have the option of IV sedation or general anaesthesia where I work. If I see nervous adults then IV sedation is usually a good way to treat the patient. General anaesthesia is usually reserved for young children or special needs patients. If in doubt give the patient time to think about the option of root canal treatment they can make that decision for themselves, given all the various options.