For more on this topic, go to www.dentaleconomics.com and search using the following key words: Dead Stuck, cave diving experience, predicament, Dr. Richard Mounce, Endo File.
The excerpt below describes a true event in my cave diving experience and is reprinted from my book, “Dead Stuck.”
“As a novice on the advanced side of cave diving, without undue trepidation, I watched my dive guru move through a minor restriction, pushing one of his cylinders ahead of him. I was to follow. As I approached it, also pushing one of my tanks ahead of me, my first impression was that of a slam–dunk. My surge of confidence evaporated instantly. The restriction became rapidly smaller, as if I were watching videotape played at increasingly higher speeds. In the blink of an eye the ever–narrowing space closed around me. With each inch I pushed forward, the cave seemingly grew arms and grabbed me. I propelled myself forward using my knees, heels, and elbows. All my exertions to gain linear inches in the restriction only more forcefully wedged me into the rock walls. Finally, I could not move. I was dead stuck 123 feet underwater. Not just dead stuck at 123 feet underwater, but at least 1,100 linear feet back in the cave dead stuck. Hoping I would wake up from this bad dream, I did not. It was all too real. I was near hyperventilation. Consuming my air far too quickly, passing out was a real possibility.”
How I got into this predicament is detailed in “Dead Stuck,” but despite our best intentions in a host of arenas, as humans we manage to get ourselves a long way from where we intend. This change in our intended direction can be either something that gets us into “deep” trouble, or propels us to deeper maturity, skill, and understanding.
For me, the event in the cave made me a better cave diver. In a similar fashion, learning from my endodontic mistakes makes me a much stronger clinician and also is the genesis of my writing and teaching in the specialty.
When rotary nickel titanium (RNT) files were initially introduced into the marketplace, I was fracturing them at an alarming rate. As I began to integrate my tactile and clinical experience with the endodontic literature, I eventually learned not only how to use the files but how to explain and write about their utilization. In essence, I was able to turn a huge frustration into something of value. My journey is discussed here.
First, I took every training class I could to learn the clinical use of as many systems as possible. Second, I did numerous extracted teeth and sectioned them to see the results. Third, I tried as many different systems as possible to compare and contrast them. Fourth, I studied the optimal desired final shape of the prepared root canal.
This is actually more complex than it might sound. Preparing an optimal canal shape involves creating the correct taper for the root form in order to avoid iatrogenic events and optimize irrigation and obturation hydraulics, maintaining the original position of the canal within the tooth, maintaining the initial size and position of the minor constriction of the apical foramen (MC), and shaping the orifice properly.
Understanding, for example, that the initial diameter of the minor constriction is approximately .28 mm across, the endodontic literature tells the clinician that apical preparations below a minimum ISO size 30 are generally too small in that the walls of the canal at the MC are not predictably being touched. Ultimately this will lead to less–than–optimal final canal cleanliness unless larger apical preparations are made, a concept validated in the endodontic literature.
In an endodontic context, a lack of proper case assessment mixed with a lack of familiarity with a RNT file system can easily lead to unwanted outcomes that manifest as the clinician giving up endodontics altogether, or provide a series of unsatisfactory results.
Alternatively, clinicians may use hand files and Gates Glidden drills to shape root canal systems instead of RNT and lose the benefit of the technology. While these clinicians may be happy with these outcomes, there is a more efficient way to prepare root canal systems, with the Twisted File* being the optimal one in my hands.
I still cave dive, now more enthusiastically than ever. While I've not been “Dead Stuck” since the events described occurred, I've been through a few tight spots since this first happened. It matters not so much which mistakes we make, be it in cave diving or endodontics, but rather that we learn from them and move forward to even greater capabilities.
I welcome your feedback.
*SybronEndo (Orange, Calif.)
Dr. Mounce is the author of the nonfiction book Dead Stuck, “one man's stories of adventure, parenting, and marriage told without heaping platitudes of political correctness,” available at Pacific Sky Publishing or DeadStuck.com. Dr. Mounce lectures globally and is widely published. He is in private practice in endodontics in Vancouver, Wash.