Top 10 endodontic errors

July 1, 2003
Welcome to July! Real World Endo wishes everyone a relaxing and fun-filled summer. Grab yourself some sunscreen and a cold drink. Sit back and relax while we present our "Top 10 Endodontic Errors."

Dennis Brave, DDS & Kenneth Koch, DMD

Welcome to July! Real World Endo wishes everyone a relaxing and fun-filled summer. Grab yourself some sunscreen and a cold drink. Sit back and relax while we present our "Top 10 Endodontic Errors."

10Lack of a coronal seal — Coronal leakage is more sinister than apical leakage. Make sure that you have a good, tight temporary filling and close that margin on the crown. Coronal leakage causes more failures than apical leakage.

9 Nonrubber dam isolation —You need to do endodontics with a rubber dam. Simple! To make isolation easy, try the "all in one" dam (HandiDam by Aseptico).

Additionally, limit your clamp selection to four or five clamps.

8 Inadequate anesthesia — You must get patients profoundly numb to perform big-time endodontics. Try this trick for your blocks. Use one carpule of 3 percent mepivacaine followed by one carpule of regular lidocaine with epinephrine (1/100,000). Works great!

7Missed canals — This is the number one cause of retreatment! Piezo electric ultrasonics will help you find many of these "missed canals." Endodontic therapy is becoming more difficult, and piezo electric ultrasonics are a "must have" for all clinicians.

6Improper irrigation — You should be using sodium hypochlorite (bleach) in the range of 2.6 percent to 5.25 percent. The new ultra bleach is 6 percent concentrate, so you should dilute it before use. Remember, "instruments shape, irrigants clean."

5Poor cone fit — This is a real source of frustration for many clinicians. A cone that matches the endodontic preparation will make your life easier. This will help all obturation techniques. Try our Real World Endo Galaxy cones, which are precisely matched to a fully tapered .06 and .04 preparation.

4Staying too long in canals — You should only be in a root canal with a rotary file seven to 10 seconds. After that, bad things happen. Cyclic fatigue will accumulate and break the file.

3Missed diagnosis — Diagnosis is the most difficult part of endodontics. Always take angled X-rays and try to trace the periodontal ligament. Percussion and thermal tests are most reliable. Single, deep probings (perio probe) often indicate a fracture.

2Insufficient access — Access is the key to excellent clinical results. Most clinicians make access that is too conservative! Remember to remove sufficient tooth structure from the MB cusp on maxillary molars and the mesial wall on lower molars.

A good trick is to close one eye and still be able to see all the orifices when looking into the access cavity.

1Separation of rotary files — Two things cause separation: Excessive torque and cyclic fatigue. There is no difference in separation between stainless steel hand files and NiTi rotary files if you know what causes separation. A continuing education course can be a big help in understanding separation. Never force a rotary file and trash a file after use in a difficult canal. When a clinician can manage both torque and cyclic fatigue, life becomes sweet.

Now, apply that sunscreen and enjoy the summer!

Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years. Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at

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