Hi, everyone. It's hugh, and if you like
me, Endo dom is a really scary part
of dentistry. Today, I'm joined by doctor. Harry
Mo, specialist endo on, and he walks us
through
workflows in Endo and the importance of stripping
down the retreat before studying root canal.
Doctor Mo is also running a Cp event
where a hundred percent of the ticket goes
to charity and includes fantastic speakers from all
around the country. It's happening really soon on
the seventeenth of August, so be sure to
check it out in our show nights.
I found this discussion really helpful and practical
as I'm facing my first few canals in
Denver school. And I really hope you find
some good tips in it as well. Enjoy.
I guess after I've done sort of my
instrumentation, let's say,
And I'm trying to close backup up getting
ready for the next appointment.
What should I be thinking about in these
moments here? Yeah. I mean, I think I've
probably
even taken a few steps back.
So,
you know, if we really wanna
dive deep ti that rest aspects of Endo.
And I think I think that's 1 of
the things that's overlooked is that Endo is
a rest
specialty. It's it's so
tidy with the rest aspects of dentistry.
The first thing I'm always looking at when
I see my patient,
for a consultation is
endo onyx aside,
can this to be restored? And how can
it be restored?
And so
I guess, we'll start right at the beginning
with the diagnosis.
Even there, I would always tell my, you
know, my fellow practitioners and and students,
you want to take a bite link for
all your posterior.
And you wanna assess the rest prognosis of
that too that is part of your endo
assessment.
So why do we take a bike ring,
not just a Pa, not just an Op
because we wanna know
a good assessment of the rest margin?
In relation to the gen margin and in
relation to the crest bone level
because
that's what's then gonna decide as part of
my treatment planning, Okay.
What's the rest started prognosis for this tooth?
Is it just okay to place a direct
restoration? Does it need crown lengthening
well, I need to do some gin vector
to get access to that. And, of course,
all the other patient specific things like, okay.
I can restore this but then can the
patient maintain it. And so on. So that's
kinda where it all all begins.
And then
the main thing I always
So once we get to the sort of
treatment phase
at the first appointment,
the difficulty is if you have a patient
in pain,
sometimes you've got maybe a
45 minute appointment allocated,
and it's an emergency, and you've gotta to
work out
What's the diagnosis?
You've then got to develop a treatment plan
to get consent,
and then you've got it an ace type
for patient.
And then you gotta to execute the treat
in 45 minutes.
Sometimes you're spending
15 20 minutes
on the diagnosis and treatment plan, then another
15 minutes,
getting the patient adequately in ace.
For example, hot pulp.
Because in some cases the mean time for
pulp anesthesia, it can be up to, you
know, 15, 20 minutes.
What are you left with? Something like 10
minutes to execute your actual
procedure.
So in that situation, you're not gonna be
able to
strip the tooth and remove all the restoration,
remove all, you know, the sort of undermined
enamel and
carries and all that stuff
assess and then reconstruct the tooth and getting
an the bolt. That's that's just not feasible.
Right?
So in that unique situation, you just wanna
do some relief of pain
and get your patient back. But once you're
getting that patient back, or in the patient
who's not in pain,
you really need to allow adequate amount of
time at Vis 1
for the rest side of the endo procedure.
And so for me,
that comes back to how do we do
the dental dam. I will always do multiple
tooth isolation for my first visit of endo.
So most people assume endo, dental dam, 1
hole, 1 tooth, clamp it off we go.
For me, at a minimum, I'm isolating the
teeth either side.
And at that first visit,
and this is a little bit different when
it's an indirect restoration when there's a crown,
but assuming it's a a direct restoration,
removing all the rest started materials I'm removing
all the car,
I'm getting, you know,
leaving nothing at the margin. So if it's
a d box, I'm fully removing that
and this allows me to make sure
I've got no more carries there, so I
can confirm that my new restoration is good
corona seal.
And also I can assess, are there any
cracks
underneath to respiration, which again may affect the
prognosis.
And it's a
very important lesson, and then a lesson I've
learned and others have learned
through
they're basically ignoring the lesson in has.
You know, sometimes you're like,
come on. That looks alright. We'll just... Ignore
that 1. And then, you know, you spend
2, 3 visits. The tooth not settling down.
Finally, you think, maybe, I should strip it
all back, and there's a big crack underneath.
And that explains why it didn't work
how you need to approach things differently and
so on.
So that first is that I'm always suggesting
that you
allocate little bit extra,
time for the rest respective side of things
and that you really spend time stripping the
tooth down,
and then
building up a good interim restoration.
So
there's a few... You you'll notice is the
term interim restoration.
It's not a temporary
restoration. So why do we call that an
interim restoration? What's the purpose of the interim
restoration Is that I wanna have I wanna
ensure I have a good colonel seal.
I wanna ensure I have some reproducible stable
reference points, so it's not gonna change throughout
my procedures.
I want it to be strong enough to
last for several months in case I want
to review the patient. So it has guarded
prognosis, for example,
I'm not just gonna go bang bang bang
straight through Wack a crown on it. We're
done, not that Id crown. But as an
dentist right?
I'm gonna wanna see some healing, so that
takes time that takes 3 to 6 months
minimum.
So these restoration have to last that amount
of time.
So
again, there, you got so many options for
your interim restoration. So you could do... You
may be familiar with stainless steel bands.
So,
I actually... Let's take a step back. So
what was 1 of the other important things
of the interim restoration is to provide cusp
coverage protection.
So reduce the likelihood of that tooth fracturing.
So it's gonna have to last me 3
to 6 months while I review the tooth.
Well, I don't want to develop cracks or
fracture during that time.
So all these things are considerations.
So, you know, there's some really good literature
that that shows us that you know, once
we lose a marginal ridge on a posterior
to a model or or a prem mold,
it becomes very
susceptible to fracture.
However, if we were then to overlay those
cusp, so build them with composite overlay or
what called a Gi dome, which is effectively
a Gi overlay or if we cement a
stainless steel band around the tooth.
That then reinforces
those cusp, and it provides some fracture resistance.
So when we're planning our interim restoration, we
wanna have 1 of those 3 things, either
at composite Overlay,
a Gi overlay or a stainless steel band.
In my practice, and in in my experience,
I'm much more comfortable with composite overlays.
Because they're strong.
They look nice, they're easy to keep clean.
Gi overlays, they can be quite brittle and
over time that I last that 6 to
12 months I might need sometimes we'll review.
Stainless steel baths.
They're very hard to keep clean.
And also, I feel like sometimes these interim
restoration like, you know, best practices,
you know, we do the Rc, and we
say please see a dentist and have a
definitive restoration, you, you know, indirect placed within
next couple of months.
5 years later, the patient turns are they're
still got a stainless steel brand on. It's
retained food and plaque for the last 5
years. You know, they've got ginger dividers or
period old disease or adjacent care or secondary
carries.
So for those reasons, I I'm not... I've
moved away from using stainless steel bands in
my personal practice, and I've shifted towards
a composite ob. So at my first appointment,
I actually allow adequate time to strip that
tooth right back
build it up with a composite overlay and
then get right back into the tooth and
actually start my my procedures. I see
Yeah. Right. Okay. So that's what you mean.
Stripping down the tooth, getting rid of everything
that
carries anything, having a look a good look
at the tooth.
Is that when you take that bite wing
then or you take it beforehand,
and then you see... Oh, no. So my
bike wing? I'm taking at my my diagnosis?
So what, you know, It's gonna aid me
my diagnosis, taking that bite then and there.
Once I've started the actual treatment is when
I'm doing that process. So I've got my
multiple tooth isolation.
I've removed all the restoration from the tooth.
Got, you know,
naked it. And then at that point, actually,
you gotta make a decision. So once you've
removed all the carries and so on, you
kinda have to decide, do I go into
the pulp chamber
Or do I build up and then go
back into the pulp chamber? Mh.
How do you decide between which 1 you
go for? Yeah. So in kinda, a few
things plays into it. 1 is the quality
of your isolation. So did your 3 hole
or 4 hole or multi isolation? Is it
holding up? So, you know, no saliva would
get in there if you went in there.
Ideally, that should be a tick. So let's
say it is holding up. I'm always gonna
try and going in first.
Because again, it's about learning all those informations
as fast as I can. So
I then I've strip the tooth.
I could see. I'm at I'm very close
to the pulp chamber.
I'm just gonna go straight in and assess
because what if I go in and then
I find a big crack in the tooth.
Well, then I'm not gonna bother spending ages
making a beautiful composite and going back in.
I'm just gonna
you know, pop on a satisfactory, Gi
restoration and say, hey,
actually, I'm updating the prognosis to paul, and
I really think instead of this, we should
be looking at removing it tooth. So at
that point, I would say get into the
chamber,
and then you have to put some sort
of barrier in the chamber so that when
you do your...
What we call a pre endo buildup concert
builder.
You don't
feel the chamber composite, which should be a
nightmare there. So once I've gotten into the
chamber and assessed
happy.
I'll then put some cabo on.
In the chamber and then build it up.
And for you guys as, you know,
students,
you know, early clinicians, general dentists,
that's actually a good stage to determine
case complexity as well. Because you get into
the chamber and you're like, oh, this is
really cal.
Or, like, or, I I can't find anything.
Well, that might be a a point where
he's say okay. Well, you know what? I've
learned really early in the case.
That maybe this is 1 I need a
hand with, or maybe this is 1 I
need to refer.
Because again, from a patient management standpoint,
the more you sort of
screw around in a tooth before you realize
this is too hard.
Then when the patient sees me or whoever
it is they see, but they're kinda like,
oh man. I already spent 3 visits on
this thing and now you're telling me you
have to spend another 2 visits, like,
it just develops this sort of frustrated mentality
for the patient. So, again, it's it's sort
of about getting all those assessments early on,
like,
same thing, Why do we strip the tooth
at the beginning. Why do we take that
bite wing? So I know... Okay.
Oh, wow. We can do this, but we
don't need surgical Crown lint?
But that's not my area of expertise. Okay.
I need to employ the assistance of
someone else who does surgical crown lengthening either
in my office or a period on or
nothing like that.
So again, I wanna find that out early
because I don't wanna then go through and
do all endo
Then I send it to the surgical crown
lengthening person and and because they know more
about surgical crown lengthening than I do, they
came around and say, we can't do surgical
crown lengthening on this too. It has to
be extracted.
So these are the things, you know, in
terms of your workflow, you kinda wanna find
these things out early,
get assessments done early by any other parties
that you need to involve and then move
on.
Another reason why we strip the tooth is
if we strip it right back and we're
like, more, this carries as way worse than
it looked on the bike.
It can't be restored.
Again, Wanna know that before I've just wasted
the patients 2 and 3 visits on an
Rc,
then they go and see the dentist and
the dentist like,
what do you want me to do with
this?
So
that's kind of the mentality and the approach
to workflows
and why it's you know, the earlier, you
can you can get all this stuff
sort of found out
the better. Right?
Okay.
Very nice. So we've done the composite or
in your preference, the composite overlay
and where
go back into the tooth now and do
our instrumentation now, and then we're doing our
interim, I guess, temp
interim
restoration. Is that just with a G over,
like the access cavity? And then when we're
doing is that always a covered in Gi
for, like, the interim stages, like, between appointments?
Yeah. So it's a really good question.
So
We've
stripped the tooth. We decided to take a
peek at the pulp chamber, put some cabo
there and we've done out build up.
We have sort of adjusted it and got
a nice flat, stable reference table that we
can use for all our measurements.
We then go back into the tooth and
take that cabo out.
And we're we're ready to to rock and
roll.
We find all our canals we take our
lens. We do whatever
instrumentation we need to. We've then dressed the
the canals.
How do you temp it at this point?
Again, what is the point of the temporary
restoration?
It should be?
And it should
again,
maintain our seal. That's the primary concern here.
Is between appointments I do not want contamination
getting in there.
So
I would never ever ever place a cotton
pellet in the pulp chamber.
We got we got we gotta think of
2 things we're the thing of what we're
gonna put in the pulp chamber and what
are we gonna put in the access cavity.
So in the pulp chamber, common things people
are putting in there is cotton pellets,
teflon tape,
sponge
and
cabo.
Alright?
Of all of the ones I mentioned,
only 1 of them is a rest restarted
material.
The others are just kinda space pillars. Where
did this cotton and pellet thing come from?
Because I've heard of it, and I'm surely
a dental school you should be at the
forefront of, like,
Danielle Yeah. Well, here
you're a university you're sydney student, so you
would never use a cotton fill, of course.
But, yeah. You know, it's it is a
common thing because people
want something that can put in and take
it out easy,
and, you know, it's not gonna block they
can say are, what if it blocks my
canals blah blah but.
My concern is, what if your Gi
excess seal?
Your class 1 Gi,
d bonds or fractures or whatever,
you know, if I got Cabo, that's a
double seal.
If I've got cotton pellet. I mean, that's
just a sponge that's gonna fill up with
saliva and food and and so on, You
know? Same thing with Teflon. I mean, what's
Teflon tape? It's not a restoring material. It's
just a space filler. There's each the space
around it? It's not gonna provide any corona
seal. It's just
providing space.
Same thing with any form of sponge that
you put in there. So I would I
would have always advise use started material that
can be retrieved, so that's gonna be Cabo
in my view. And that's easy to retrieve.
You just break it up with an ultrasonic.
The common question I get is all, but
what if it went down the canal and
block the canal. So, you know, you're gonna
you're gonna use some common sense, and you
gotta roll your c into a sausage that
sort of suits the access cavity size. So
if you gotta a if you got a
upper central inc, which would be the time
where the cabin might go down with a
b massive canal. And you roll a teeny
tiny sausage. Yeah. It's gonna go down the
canal. So you're not gonna do that. You're
gonna roll it an appropriately size 1 that
have some resistance when you push it, it's
gonna hit the walls, and it's gonna stay
it. And then when you come back with
your ultra ultrasonic it, you're just gonna break
it up and it'll wash out.
So that's my my view on what you
put in the chamber?
What you put in the access cavity itself.
I mean, in Australia, typically, we're just gonna
use Gi.
If you wanna make it really easy for
yourself, you're gonna use a colored Gi. That's
different to the rest of the 2. So
when next time would you come. It's just
obvious.
What to remove you might use a fruity
pink, for example, you might use Ir
restart material. There's no real right or wrong
as long as it's a rest restrictive material.
That's can't get a hold up to oc
cl forces and and, sort of,
corona seal insult like
fusion so on. I wouldn't just do straight
cabo because again,
cabo seals,
but over time, over 6 months over 12
months. It's gonna break down. So if that
patient disappears,
whatever reason they got sick or they forgot
their appointments or whatever,
I wanna know that when they come back,
I don't need to start again. I can
just pick up where I left off because
it's all sealed up.
So, yeah, most of the time I'm doing
Cabo,
and then Gi in the class 1. Cool.
Okay.
Anything else that I guess we move to
the observation now following that restoring that now.
I I think 1 other thing. When you're
planning your pre build up? 1 other question
I get is,
is it okay to just seal that
class 1 with composite at the end, and
then just have a big build with a
tiny composite in the middle, You know?
So I think the question is where did
your margin prep come to.
So if you're if you were to prep
that tooth,
and then you would
after you've finished everything you prep it, and
then you're left with a very thin wall
of composite that would fracture easily.
I would advise
you would need to redo the whole thing.
So in that situation, it wouldn't make sense
to spend a lot of time doing a
beautiful
pre endo composite buildup. In that situation, you
might do, Stainless steel band and then come
back and do it at the final visit
lit.
You know? So you kinda got to think
strategically. Again miss. It's just more a time
sake, You you you can do a beautiful
pre end up build up every visit that
if you want. But you're gonna be wasting
your time, so you need don't wanna do
that. Okay.
Beautiful,
my friends were telling me the other day.
So they were finishing off their observation,
and
they didn't know what to put between
the Gp
and then their restoration. And different shooters were
telling them different things. So Ir
or Fuji or like a Gi,
there was 1 friend in particular, I said
that there was an air bubble that start
happening because, you know, there's the canal, and
then you're trying to seal that, and then
the nozzle can't fit down or how do
you restore that part then when you get
to that point? And your
holding on, you've done the. You put your
blood sweat and tears into this, and then
you don't know when this tooth is gonna
be
definitively restored how should we approach this final
step of restoring the endo?
Yeah. Great question. The area ton of ways
you can approach this? Like you know, so
many approaches. Right? The things you gotta think
is we're working quite deep now.
There's no enamel. It's just dent.
And also,
you know, as
as you sort of get more and more
advanced in your Endo, you're probably gonna be
quite
aiming or we hope. You'll be aiming to
be more and more conservative.
So your access cavities might be quite
fairly modest, not not tiny, but, you know,
conservative.
And so there are limitations to
access to... When's that deep? Like, like you
said, do the nozzle on the attack ones
that you use go that b, do the...
You know? So it really depends what you
have available to you.
The simplest thing you can do, I guess,
in, for example, student clinic
is Cabo.
You could just get Cabo and introduce it
into the space and packet it we define
endo plug, and you should always be able
to to work with that. And that'll do
what's called the Or first barrier or base
layer.
We've gathered you do need to have a
certain thickness. Typically 3 to 4 millimeters thickness
of cabo for it to actually work as
a ceiling.
Thing. The the benefit of Cabo, of course
is it's.
So let's say, you know, we're humans are
living a lot longer So this may not
be the only endo of treatment that that
tooth gets. It might need a retreat 1
thing. Well, Cabo can be retrieved quite easily.
That's that's good.
And the color is obviously different from dent,
which again makes it good. So there are
people who will use cabo as that lit.
In my office, we use glass, so we
use fuji g 7 pink,
and
that brand actually has an extrusion nozzle Oh,
that clips onto the capsule,
which allows you to introduce the Gi very
deep
at the Or level and avoid the air
bubbles or voids that you talked about.
Another way is, you know, some form of
flow
or
dual cure composite.
Again, you may need a special tip on
it. So there are things called pac tips
or centric tips where you actually
introduce the composite, and there's an extra long
tip that allows you to go deep. I
can send send you some links you can
add it to the notes or something if
you want for the show. But
but these sort of things enable you to
deliver the material deeper.
Personally, I'm not a huge fan of using
composite of that depth.
As I mentioned, it's
no enamel. So it's just dent bonding at
that depth.
It's ci
dent, so a fairly high c factor.
And also,
Once you've done a lot of endo, you'll
see that, you know you can dry the
pulp chamber. And for whatever reason, it's just
hydrate again, be some very moist environment at
that depth. It doesn't stay dry. Come back
in a minute later and you look at
it and like, yeah. I just tried that.
What's up?
So I'm not sure entirely why that is.
In my view, it could be, you know,
we just spent 90 minutes,
hydrating that tooth. Like soaking it in all
these solutions. Maybe it's just
saturated.
I'm not sure, But that's just what I've
observed in my experience and that's what sort
of makes me feel not too comfortable about
using bad depth. So in my office, we
would typically use Gi with that extrusion nozzle,
place that as a base and then build
composite higher up where we got enamel and
intent to bond to.
Another 1, at some schools they teach,
the name escapes me. I'll come back to
it. But there's a another type of Gi
style
material that you can... A dura on. Dura
is a
box cement that you can
mix and you can actually attach it to
a... Because it's kinda liquid liquidy. You can
spin it in with a lent spiral or
another paste filler style, so we can get
it a little bit deep.
Again, it's
so many ways you can approach it. So
it really just depends what you've got in
your
armament mater material.
So for dental students or people working in
your standard stock and and clinic without, you
know, you don't have access to these delivery
tips and so on and, you know, someone's,
you, the clinic manager saying that and we're
not getting those.
At a minimum, you can deliver catheter it
and just pop packet it and avoid get
rid of the v. Yeah. Yeah. Nice. I
didn't know you could just use cover. For
that. And that's for the defendant well...
Yeah. You can leave that in for however
long. Yeah. It's it's a base layer. I
mean, it's not it's not it's not as
good as if you were to use other
materials because it doesn't have that sort of
strength. It's not bonding.
It's just
filling the space, but it's appropriate in the
absence of anything else. Alright? Yeah. Sure.
Alright. And then
I guess now that that's there, you've closed
up with your composite and you're leaving this
tooth now, can we restore it straight away
with, crown or full cost coverage or Yeah,
Kinda kinda depends. So
of course, you know, your comment there crown
or full customer coverage. So we gotta to
think what what are we trying to achieve
yet. Of course, for posterior teeth, that's where
we want full custom coverage. For anterior teeth,
the literature does not support indirect restoration, for
up endo antibiotic treatments. So that's a common
misconception.
People say, oh, all teeth after endo need
a crown. No. It's only posterior teeth, and
it's not that they need a crown. It's
that they need full cost coverage. So in
the modern era of high quality composites and
high quality bonded restoration, you know, the putting
a full crown on the truth is gonna
sacrifice a lot more tooth structure then if
you were to do an on an overlay
or something like that. So that's a very
good point that you make. In terms of
when it really has to tick a few
boxes.
So
is the patient asymptomatic
sweet
can... That's a good tick. Am I confident
I found all the canals?
That's another good day. So for example, upper
first mo
notoriously have
NB2 canal. In the majority of teeth and
that can be very difficult to locate. So
am I confident I I got that down
pat. Okay. Great.
For the canals, was Able to get all
the way down each canal? Okay. I'm I'm
pleased with that great.
If it had a lesion Is that lesion
getting a little bit smaller. Now for that,
you're gonna have to wait about 3 months
typically, to be able to observe,
a, distinct change in the size of the
lesion.
So that 1,
no, hard and fast rule just depends how
brisk ave you are, really?
Other ones though that happened a lot faster
is, okay. This tooth had a sinus tracked
when we first started,
has that gone, and that typically disappears within
4 to 6 weeks of either a disinfection
of the canal system. So if all these
things are ticked, you can go ahead with
the restoration.
What I normally say to my patient is,
you know,
give it about a month.
If you feel really comfortable, you know, not
troubling you, feels like it, you know, really
happy with that tooth. Go ahead and... Anytime
after that, go ahead and get the.
The supervisor, of course, is that
I've taken all those steps we talked about
so that my interim restoration is good. So
that I can wait a month, but I
can wait 3 months. I can wait 6
months. I can wait 12 months, and I'm
confident there's good seal and cost coverage protection.
So I always place that core
restoration with Overlay to make sure the patient
is protected,
till date, get around to getting the the
crap. Because in the real world, how many
patients turn around to me and say, hey,
you know, my health fund benefit doesn't tick
over till January 1. I wait till January
1? And I'm, you know what you can
because I gave you a good interim restoration?
No problem. See you dentist January second and
get that crown. That's cool. Nice.
Okay. I think that was a really good
overview of everything with
restoration in between interim
appointments.
Think all of my questions have been answered
and just like little practical things have been
really awesome to hear about.
I guess just for, like, dental students in
general as they're beginning their endo journey. It's
kind of
for me, Endo really
stressful I find because I'd...
This is very small and you're, like, looking
down these tiny canals and then There's always
this fear in dental school they're, like, you're
gonna per and all these things like the
file is gonna,
like,
crack everything's gonna happen.
What do you think we should, like, be
working through at dental students in particular?
Like starting our endo? What should we really
be looking out for and how do we
sort of
set ourselves up for, like, a good general
endo Career.
Yeah. I couldn't agree with you more. It
is really hard. It's 1 of the
harder,
disciplines of our of our profession. I per
my first end.
It's so.
So What, I would like to hear about
that. It was a dental school.
As you, no. Sorry. My first endo is
at as a clinician. Oh.
Yeah. So my coast cool endo.
Oh, wow. And look where I am now.
So, yeah. Do don't lose, don't don't get
too upset about it. You know, own new
mistakes, but they happen.
I think
kinda... It all comes back to what I
saying about is just
plan everything out. Plan everything out so that
you find out everything about that tooth as
early as possible.
So for example,
Okay. You gotta you gotta to use it.
Sd has a cone beam Ct.
Order a com,
you know, find out more about that tooth,
before you need to get in there so
you can sit at home or, home, but
you can set up this clinic,
you know, you can look at that too.
If you can know how many routes You
can know how many canals. You can have
an estimated length,
you can
talk to your supervisor before the patients in
the chair, learn as have as much information
on hand as possible.
Seth, why do I say strip the tooth.
Get as much information about the tooth as
possible as early on,
so that you don't have any ugly surprises
later on. You know? So I think it's
just following a logical sequence of steps. And
In endo,
it's not a, you know, there's like you
said, a lot of small canals and this
and that. But what's the crux of it?
Is get the bugs out
and keep them out.
So get a good corona seal, so they
don't get can't come back in,
And then when you're in there, try and
get find all the canals
and get down all the canals and get
them as clean as you can. That that's
it that's the crux of it all.
And the main things I see clinicians not
just suited. So in student cli, we see
it too, but even even in general practice,
the patients are I referred to our care?
What are some of the things that are
overlooked is
seal? People not stripping the tooth.
People spending 2 free visits and they send
the patient to me and still I can
see
there's remnants
carries on, you know, old restoration. And when
I take... When I take it out, they're
still carries underneath. What else people getting in
and not finding all the canals what's the
main reason
is because typically they're not in the pulp
chamber. Often it may be the
there's some degree of cal classification. And so,
you know, the pulp chamber floor is here.
There's still somewhere up here. And there's a
whole bunch of cal classification here the canals
are always in the top chamber floor. So
I think it's just understanding some
principles even learnt at University,
and then following through on the on every
case, not skipping steps. Now, of course, as
I said, that first visit the emergency appointment
where you're left with like 10:15 minutes to
work miracles.
Of course, you you do what you can
to get the patient out of pain.
But the rest of the time, you know,
once you've done that, you've then got time
to set aside enough time to to get
it all done.
And then once you do it enough times,
you it it automate things and your your
workflow becomes faster and and you become faster,
but don't try and and sort of race
through things. So, you know, for for students,
I think, you know, if it's if it's
mo or or prem mo endo,
allocate the whole session session. You know, I've
seen some students.
I'm gonna I'm gonna take this impression for
my patient, and then I'll... In the rest
of the session, I'm gonna do a mo.
I mean,
you end up doing,
half of a mall, you know, the first...
You just don't have the adequate amount of
time.
And particularly at at a student level, you
know, not only are you guys a bit
slower because, you know, you're learning.
But, you know, the clinic has all these
limitations. You gotta spend 5 minutes queuing up
for x rays, another 5 minutes queuing up
for Gp points. So as a student, I
think you need to give yourself time. Perfect.
Thank you so much, Doctor. Harry Mo. I
know you also have an event coming up
that you're
organizing, I believe?
Would you like to talk a little bit
about that for our listeners?
Before we head off for the day. Yeah.
I love too. So I run an annual
event. It's called Dental Aid. It's a not
for profit Cp event. It's a whole day
of lectures where we invite speakers from all
disciplines of dentistry and sometimes,
non dental disciplines as well.
It's a live event in Sydney, but it's
also live streamed around the world, and all
our attendees get access to the material for
4 months to review in their own time
of the recording. So if you're not free
on the day, it's kinda cool. You can
watch it later. And
it's unique in the sense that 100 percent
of your registration fee goes to addressing poverty
in Asia.
So,
yeah. It's it's a it's a really unique
not a property event been doing some good
work. And over the years, we've raised over
a hundred thousand dollars so far, and we
hope to raise another 50 or 60000 dollars
this year.
Thanks for students. And for recent graduates in
the first 4 years out. It's just 90
dollars for the for the day, and,
you join us Obviously, you get the whole
day lectures plus
meals. But otherwise, yeah, you can watch it
online from wherever you are. Awesome. And when's
that happening. It's soon isn't it. Yeah. So
it is soon. That's August 17. So on
midway through August.
It's
you can check it out at
try booking dot com
slash CRC
zed x, but I'll I'll I'll send you
a link.
We'll have the link in now, and I'll
show nice. This year me.
Professor Ortho from U. Lane mit Gun.
Got 2 fantastic pros.
I'm Lewis Kaye,
And Chris Small. We've got an endo, Sally
Cochran,
and we've also
got a a really interesting
speaker
from outside the dental industry who is 1
of Australia's leading wealth investors, and he's gonna
be talking about the sort of relationship between
money and happiness
and also sort of, you know, generating wealth,
but feeling good about it and and and
how that makes it feel.
And we've got Joe Ryan and an Oral
medicine specialist will be talking about T.
So, yeah. It's just it's a really it's
a really nice day. Seems really good. Yeah.
Alright. Awesome. Well, we're looking forward to it
and all the best for it as it
comes closer,
Thank you so much for your time coming
on the Dental Head stop Podcast. We really
appreciate it. That's my pleasure.
Thank you so much for listening to the
Dental Head podcast
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