I'm Really Into Teeth

Despite the topics of most of my posts I actually spend most of my time in school and I really do enjoy it.  Probably the most enjoyable thing we have done yet is endodontics.  This is the study of the inside of the tooth or more simply put, root canals.  In all my years working in the dental field I have only assisted with one partial root canal and that was during my first year of hygiene school some seven years ago.  While this has probably been the most difficult procedure we have yet to learn, it has certainly been the most rewarding.  Fillings were cool, but once you got the hang of it they were pretty straightforward.  Dental anatomy and perio were actually painfully boring.  I try to keep the fact that I am a hygienist under wraps as it decreases expectations, but it makes it hard when a professor is spending days repeating pointless exercises incorrectly.

Endo was cool in that it was something totally new to me and the faculty was incredible.  There are two retired military guys as the primary professors, but the rest of the faculty in lab are their older retired endodontist buddies who just come up and hang out with us.  There is no shortage of faculty and they are all extremely knowledgeable and helpful.  The first few teeth we did were very straighforward and I thought I would breeze right through this section.  However, as the complexity increased I realized I was struggling more than anticipated.  Thankfully we've had a lot of time to practice and I feel like I'm finally hitting my stride.

X-ray of mounted tooth to locate canal

 Just memorizing the process was probably the hardest part.  First you mount extracted teeth into the manikin patient's head.

Tooth mounted in fake jaw that can then go into manikin head (access hole already drilled)

Then you take a highspeed drill and make an access hole in the top of the tooth down to the pulp chamber.  Pretty straightforward.  Next you take these small files of incremental sizes keep working them down the canals of the teeth until you can get one to reach the bottom of the root.

Assortment of hand files right and center, drill mounted files left

You know when it has reached the bottom because you take x-rays throughout the procedure to track progress.  Once you get there you measure the file and record the length.

Different x-rays tracking length and position of canals

File to full length of canal

Then you take another drill set to a slow speed and work probably 10 different flexible drill files down the length of each root starting largest to smallest.  Between each file you have to flush out the canal and run a small hand file all the way down.  After this you reverse and work through all the files again this time smallest to largest.  These steps are then repeated as many times as needed until the canal is cleaned and cleared and worked large enough to fill.  Yay! We're now about halfway done.  See why not many general dentists take the time to do root canals.  Oh and if you mess up any step or the file breaks, you get to explain to the patient why you messed up and they need an extraction now.

Canals cleaned, shaped, and measured, ready to begin filling

The next half of the procedure involves packing multiple rods of medically treated rubber down each canal and burning off the excess. Doesn't smell too great.  Finally you are done and the patient would go for a crown...if they were real...which they aren't.  All that being said it really is neat and can be done in relatively short order if things go smoothly.  I think my shortest time for a tooth was about an hour and a half and my longest over 8 hours.  I just can't wait to get into a real tooth.  Who needs a root canal?

 

 This tooth was my low point during the course. Notice perforations through the tooth between the roots and out the front of the tooth.  These were patched with filling material and work proceeded.  I then spent several hours casing a phantom third canal.  Finally I had a massive blow out of filling material out the bottom of the canal.  This necessitated removing all filling material and refilling to the proper length.  From start to finish it took over eight hours.

 

A few decent examples of completed and filled root canals.  The rubber fill material is impregnated with a radiopaque material so that it shows up vividly on x-rays.  The bright white streaks and swirls above the canals are where excess filler was melted and scraped off.  These teeth would next be built up and capped.

~Buzzy