Friends, hello everyone. This is our first shoot in Guest Dmitry Nikolaev. Dima immediately accepted the I have an idea to make an educational project like this and tell Top dentists will participate. How do you feel about Dima immediately said: "I'm in." That's why today everything Today's topic will be I'm in business. Great. And As a rule, mm, people encounter pulpitis and are afraid they don't understand and often get confused. I was thinking about What should we show? And I decided that today we will channels of the first upper painter. Upper six. although it is not actually the most difficult one if you understand Our conversation today is exactly this, the basic channel in the upper six. Super. As the play progresses, I will arise. I have literally treated several canals, and Therefore, my questions will be quite superficial uh, they are embarrassed to ask any questions, they are afraid These questions are for you. Like, comment, and do the rest. в вклинюсь по поводу стеснения. Indeed, And I noticed that I have a section called My Answers on on a given topic, for example, the treatment of the sixth tooth Instagram Contact. You can see who asked the question. In Telegram, questions are anonymous, you can’t see who asked Of a completely different nature. That's why I see this that some of the questions that arise, you will find We won't reveal it, write in the comments. Dmitry, I think partially. By the way, Dima also runs a YouTube channel about explains. Sometimes he even finds time from the carriage. Here. Well, we've had enough of talking. Let's get started. So, today we have two sixth teeth. One of them show the behavior of the tool in the root canal. tooth is almost impossible. More precisely, but this will be different from what we see in the I'll show it on plastic. But our main hero is course for a group of doctors in St. Petersburg. And this my seminar. I didn’t prepare this tooth myself, and I didn’t I took the first top sixth that came to hand. Why was it Is there a perforation somewhere or what happened? History It's a pretty good tooth, it seems, or is there a crack, what please respond, yes? Who recognized their tooth, whose Before we begin treating this tooth, we are Enerdotic diagnostics includes intravenous Ideally, of course, when we have a computed tomography scan, It's difficult for us. That's why we did an intravenous radiovisiogram, at home. And we evaluate the basic anatomy of the tooth. root canals. Нам не нужно считать количество каналов, determined by analyzing the structure of the pulp chamber access, but not by computed tomography. And don't do a CT scan just to find out if there is There is an M2 channel MB2 most often it is there, in the tooth. Изначально учитесь смотреть пульпарную if you cannot find it, based on the structure of the Prove to yourself that the channel does not exist. That is, proceed from cameras. И когда у нас сформирован эндонтический доступ, and endodontic procedures? They begin with cleaning We will naturally wash the classroom with clinical conditions. Having opened the pulp chamber pulp chamber with a full syringe of sodium hypochlorite. amputation of pulp dissolution in the pulp chamber, under the influence of sodium hypochlorite, and It can be easily removed from the pulp chamber. And most I watched one of your videos, you recommended essentially the same thing, only in gel form. So, filling material, as well as in widely open, add. For example, here I would use gel in the clinic. we work through small access when we work on incisors, It’s just that it’s inconvenient for us to insert the gel, it’s inconvenient слишком вязкого материала, для слишком объёмной насадки about hypochlorite or later with channels, how to prevent which control the working length. Control of working length. I know how it is with everyone else. You can share your story, I have not treated a single canal. At first, I studied that is, specifically restoration work in the Neles Canal. And here is It was only decided months ago. All this time I was so afraid Of course, every time you're afraid of getting stuck. So, I think we will discuss this topic as we There are methods of prevention. Oh, but when we an accident will definitely not happen. Здесь мы должны смотреть за chemical injuries to the mucous membrane. Yes. Here, of course, endontia should be performed in the cafeteria. Honestly, I cofferdam. I imagine situations where we cannot but how to ensure good endonic treatment, sufficient I can't imagine how this is possible. Although there have been different What I had was an epileptic seizure in patients sevens introduced there. And so what? How? Well, it Yes, it's fine. But it was just such a very pulp chamber. Let's discuss, how many root canals either three, or four, or more, but there are three roots. Yes. let's say, the main familiar channels. Palatal, distal, there are 2. And the shape of the pulp chamber is diamond-shaped, The vertices of the rhombus are the root canals. You need to look for root canals visually. Right now, looking at as I roughly understand, as But it is clear that you roughly the field where the channel is located. Somewhere in this We have enough information to enter the root We take the first one to enter the channel? Kafael. and you can feel it. The first instrument we use tool. Oh, this, by the way, is also an interesting point, говорил, что надо сразу идти машиным, а кто-то говорит, как вообще здесь строится логика повествования? the machine tool will find the root canal itself. it in the endo motor, and we aim approximately at the field We introduce it somewhere and then it goes along the channel The torque and speed values ​​are set on the motor. Hs cm torque. And these values ​​are written for This is a size 15 tool with a white ring and a sixth for example, a, 104 12.5 046. Each system into the channels. In my opinion, for absolutely zero but it's better to take mouth files. If you have already, let's where, how, the steering wheel turns, the gearbox engages, ah, but the first time you go out into the city, to the main tools, that is, to move away from the VTEVIKS, save time to do it well. Yes. Ah, so, I wash it, and, in principle, we, of course, lack a emptier to see everything well. We will use the improvised one. Dian pomo in se blow a tooth. Ah, got it wet. Do you see? Yes. miss with a hand file. Yes. That is, that here is the root canal. This is the first thing. Second. I'm I'm looking at another channel, the posterior cheek bone. to avoid confusion. Yes. He's somewhere here. Here is Will it pass? Here it is wedged. He doesn't go any further. Let's look at the length. Without an x-ray, we understand that the canal Besides, the channel is narrow. Yes. So what would I would take fewer tools. Six. Now look at canal preparation. We take a machine file, insert it into the canal, and rinse it. apex locator. Yes. What happened? What's the magic? And the area where the hand tool gets stuck. When we enter ah, and we can’t pass the channel, this doesn’t most often, the hand tool gets jammed somewhere preliminary machine file, look, machine file Where was he cutting sawdust now? Notice how clean Here it is, it's clean. That is, the canal is wider and the hand file passes the channel without encountering conical. It has a 2% taper, which means that with wider. Let's count the sizes. 10 at the tip and with each 14, 16, 18, 20. That is, somewhere around here this is already 30. Somewhere here he is the thirtieth, and here is this We enter the channel and wedge ourselves into Usti in this in the thirty-fifth, enter the untraveled channel. Can we What's the idea? Yes. And I don't know. Did you or the channels - it's a stupid habit of doing reminiscent of the winding of a mechanical watch If you give up and simply press on the hand instrument, Seriously? Yes. Because, look, we enter the channel, are we stuck? We just found out that these are estuaries. pressing against the outer wall of the channel and forming See, I entered the channel. Yeah. Let's zoom in now. Look, yeah. And he pressed himself against the outer shell. Yes. a strong bend, and the channel will become impassable. Listen, you know, so that we don’t go beyond the top, because we are not afraid, that is, we kind of pass, How can we not miss if we immediately enter with the motor? I'll show you and explain. That is, while I as the number one tool - it has a lot of advantages. Yes. Now, We take a diagnostic X-ray, and under it we measure the length We place two points from the crown to the apex and understand the length of the tooth, the height of the tooth, if you like. Let's simulate this with a tool. The height of the stoppers, this strip means that it is 19 mm. Accordingly, 16 mm, we will definitely be inside the tooth. We will not go When immersing, insert the tool to a length that is obviously resistance. I don’t know if I noticed or not. I will Doctors, in the clinic this action is repeated I'll show you a new one on a plastic tooth. Let's take a tooth. through irrigant, through sodium hypochlorite, in our We must go to a shorter length. But we do not go the moment when the instrument began to dissect. So he from the channel. We don't do this sawing Here we will make a step and push the contents of Yes. This is what we will do, and the perforation will be sad. which we started touching on right away. This is to right. Absolutely right. After which we go through the Your boxing is so good today. Yes, massive, yes, massive, lose. We go through the root canal, feeling the We connect Apexcator. And looking, when we enter We must connect the locator to the instrument before insertion. They enter the channel, connect the locator and locator and start the instrument in order to locator, and under the locator tiles. That is, we are walking, and the and we begin to cultivate within ourselves a sense of Some tactile sensitivity is reflected on the pexlocator Naturally, it won't be very clear. By the tenth tooth you will You will develop a sense of the root canal in your tooth. This will be one of the phrases. We cultivate a sense Apex sounds. And so we go through the main channels, which anterior cheek. Palatine canal. Is it necessary to do this manipulation? initially wide. They simply took the file with the answer we need. Yes, I understand that channel A, you understand When the canal is wide, there is no sensation of constriction. You are you enter: "Aha, I ran into something." Then, then, And the connected apex locator cleans, including And from the hypochlorite accident that you fear. Yes, it's everyone is afraid. I'm not afraid anymore. I'm afraid. I already had epilepsy No, I had five or six hypocharitic accidents in the light? Fine. Everything turned out alright. I'm sitting right next to you. You know, the proverb says the devil is not as black as he I saw it there. This is a severe hypoglycemic accident. This I intend to do what when I think the doctor didn't even realize that, well, again, at least correct me if I'm like in these pictures, you can’t do it, because if the the ceiling will fly off. And introduce there such a quantity This is quite problematic. No, that’s exactly it, he won’t and when the amount of hypocharitic acid increases, the patient like this, the face is half blue. Yes, yes. And this that this will not go unnoticed. What I mean is that the patient will not just let it continue, he will not I just have a lesson on endontia on the channel about video, the patient, he filmed this accident at home. He He just has some kind of lump under his eye that All. The only thing that bothers him in the chair was that yes? Because hypochlorite came out through the apex of He has a mm hematoma that has formed. And what are the none. Just wait. Just wait and that's it. This is a Everyone has had experience with tacos in this way at different undiagnosed, or the doctor didn’t even realize what he was This is generally a consequence of anesthesia. But you understand, something is rolling and painful when palpated, well, it’s Got caught. The needle was long. The needle was long. So, the here's about the palatine canal. That is, since there with a ten. And as soon as the top didn’t come out, immediately just in case, yes. And we get the length of the channels which everyone, which everyone frightens. Here. And the most important MB2. What instrument do you think I should take? More more rigid, because in flexibility, probably, although It’s rigid, in theory, it doesn’t go anywhere, that is, so that it doesn't bend, probably more rigid, right? A rigid instrument goes better through a narrow reached depth and will begin to spin in place. That go further along the channel, and begin to flatten. system files. We'll talk about choosing systems later, что даст вам уверенный результат постоянно. Yes. Наша channel. One of the options for files to form a tenth fifteenth size. I have in my hands a size 12.5 fourth taper. Also bargaining 2 with pono. We enter the channel. Look, the movement is pecking. Here feel resistance, a backward movement of sticking. on a white background or on a black background gloves. Here. Yes. channel greater than 12.2. The side blades work, but is the file already finished? It's time to change it, because moment, so as not to over-force the already tired instrument, You need to throw away the tool, yes, you need to throw You know, to squeeze everything out, especially from expensive systems, when there is already a point of no return, and it breaks. Yes. Is it deformed or is something starting to happen to point of no return. The second is when the instrument As you know, they are disposable. Yes. Instructions. It Now we'll find it among them, and then we'll go to any central somewhere somewhere somewhere here it should или не это сестра свого стёрла уже эту надпись. sterile. Ah, well, that's it, nothing. Everything's fine, right? Shah and the Mathematicians. And here is Multiple usage. It's written below. Multiple in small print. Listen, we need to go somewhere. Not, In fact, they are disposable. And they should But in reality, of course, some companies talk some people say 10, some use daisies, and these tearing off the petals. But this is all actually Why is it stupid? Well, you can go through one channel like this the same tool. What's wrong with chamomile? Now I'll show you. Here I put a daisy on the file. Yes. I can't see anything. Here she is spinning. And the fan, it seems You, among other things, don't have tweezers. For example, we tear off petals with our fingers. It's a little better now. You see how strange this tear them off, it will become clearer now. Yes. And tore off the pestle. Yes. Yes. Look here. Do you this is a hula hop. Yes, yes. And then what happens the petals come off one by one. Well, here I tore for one. Then the sister looks at the Central Control Center. Well, the The most universal method of rejecting instruments or from an autoclave. Do not put into the autoclave new tool. For simplicity, you take it from you'll still end up doing two painters. Well, somewhere but at least you're still safe. On the On the other hand, it makes sense from universal system. You won't get lost, you and you don't need to buy super expensive files. Yes, there for inodantists, whose treatment costs the corresponding Well, Chinese tools are good now, there are a lot of them on I can name you some that work great, and I use save money because they are superior to European systems Great True Anatomy system. It is not certified in The Chinese made a replica of it and brought this replica in. That is, everything can be found. I work with tools Eflex Blue, Eflex Gold, ultranets. У Сока прекрасная SC+ is great. I really liked the end of file system choose what you like. Yes. This is from, I have three instruments left. This is protaper S2 for MB2 channels repeated dodonsia, there is resorcinol. Like this. did you pay attention or not or, well, and again, инструментом двенадцатым, четвёртой конусности length. After which I took ten. Let's take the one with the я канал, который я не мог пройти, я when we are talking about the main anatomy, let's call we couldn't get through. We took a cone tool, then a a cone tool that has gone beyond the bend. He the bend wedge and the ten flew in. Ten flew in. What we did was actually pointless. Yes. And the взяли машинный файл, прошли глубже, потом ручным that with machines, we should not go longer than channel. The completed canal is prepared. Давай на МБ1 покажу channel. Its length is 19 mm. From here, between the I'll unpack them right away so as not to waste time later. Итак, taper for preparation and we begin to prepare the root canal with them. Let's start with B1. The movement during dissection is also pecking. The channel is either narrow or curved. Understanding when it is quite difficult to understand this in the early Why it can be difficult, it's sawdust. You see, all The instrument does not go through the canal because a dirty когда бор засаленный весь, алмазное зерно забито, делать, как когда обтачивает зуб под конструкцию, Yes. Well, go ahead and dissect it. This happens to us during dissection. The doctor also begins to intuitively press on the instrument. discussed? You start to press and break the instrument. Now continue dissection. Look, you see, mine immediately resistance. You're following the pictures, right? hanging out with them upstairs. Somehow, don't look now, as without him? I focus on risks where possible. Let's say it has a length of 18 mm. I don't have this length, ruler. I took aim at the canal. I entered and I go until I touch the stopper. We can't always see clearly. Touched with a stopper. It’s impossible to tell from that is, the slightest touch of the stopper moves it. Смотря, It seems to be firmly fixed, but when the file rotates, That is, he literally flies along it. Yes. And it’s very too deep. You go too deep, you make an opical for hypochlorite accident. The basis of endodontics is the than physiological constriction. You must do everything на резьбе тогда делать, чтобы они вот как это, знаешь, как приклеивайки. Glue, glue. Preparation first bon sat down. Yes, yes, yes. It needs sanding. twenty-fifth and we will do the same. This too labor-intensive. It could be simpler. You and I still did you do any dissection? Yes. Let me show my concept channel? Here he is. Distal canal. Its length is So, I took the kafail instead of the pilot again. Its length is channel, I think 20 mm. 20 mm We take the A 1506 tool. This is a short 19, the twentieth is not here. Well, you and By the way, I'll show you something else about the ruler. Yes. And I have exactly the same, somewhere around 18 mm. What do you already know, the blades are clogged. We flush the channel with a solution of sodium hypochlorite. We are with water. You know, I once had a course for twenty participants, well, places, and we decided to wash the canals with sodium hypochlorite. I hypochlorite. Everyone asked for clothes. It's all that simple. It's very hard that we have to wash with water. Water always dirty. Yes. This is the problem with dodontics, namely you know, some kind of box in which, well, you can like a technician. I mean, you know, like when You put your hands in, cut holes on the sides, What do you want to do with the phantom according to Innodonta? dentist for gibox. So, we went to the length we needed I prepared M1 10th 154. I prepared the distal I'm taking the twentieth file from 2004. The only thing is, I'll now change the napkin to a dry one. length 19 and 20 in the posterior cheek and anterior cheek. I have the instrument goes in, but enters at the end with resistance. They cleared away sawdust. Distal canal. resistance. What's the idea? When we prepare canals and so on, each instrument we have prepares the canal along made the sixth cone, all other instruments prepare ocular millimeter. Look, the sixth cone. Let's first millimeter. 15 + 6 sixth taper 21 + 6 27 going in at the first millimeter 20 from the fifteenth to the so narrow. Then he is at the second millimeter 24, he will and there are already 27. That is, the contact area is becoming smaller it doesn't touch the walls at all. That is, we becomes a finishing or apical instrument. Preparation the torsional load on the tool is reduced. Best pull into the root canal. Protection against peak perforation, in chocolate you need to take the first tool of the sixth easier, manual is easier. There will be no channel expansion. equal to the same contour. That is, 1506 is like this, 304 is outline, but it will be easier for you to do it much faster. Yes. Remember this technique. He works very well. Remember the technique. We'll do it later. You see, it’s difficult for me to dissect the file is not working. How are you in practice? Are you dissecting in a mirror? You look at the mirror, from the same angle. From the same angle. Well, only here, what is closed to the cofferdams, the roots are closed. Yes. Damn, it's hard for me to dissect here, huh? The instrument works for me right away. It's just a failure. all aspiring doctors? From cleaning the channel with make the root canal clean. The root canal is made clean activation, with ultrasound. We entered with the instrument. We enter the root canal. We exit from it with This is now the movement of the instrument itself. Yes. We we achieve the working length with each instrument. What to sawing along one wall, along the second wall, along We are trying to catch the microbe that causes opical will make our irrigation solution. It is he. The longer higher probability of root canal transportation. Look, up to the size of 2504. You're out, you want 2504 again, it won't increase evenly for you. Your instrument from a round section it will make an oval section. here we move away from the true shape of the root canal. And to decrease. The longer you dissect, the worse you endonte you send, then come to the SVSh, you have it there, to the wind. That is, this moment of one-time achievement of the top what if, for example, you prepared the canal up to the twentieth You cannot return to the previous instrument. You must The whole reason is sawdust. That is, you washed the canal, what I showed you on the first instruments. Remember size? To what size should the canal be prepared? that MB1 must be prepared up to the twenty-fifth number, We prepare the canal to produce white filings at the tip we have reached the diameter. In case of pulpitis this plus one two numbers from this. Well, that is, if there was a peredantite, we would take the thirtieth instrument and they would enter the channel. Yes. You see, that's A tooth can have a canal of completely different in the top seven of such a fairly elderly patient. And it's interesting there1 the opacical diameter is 35, B2 is adjacent to it, and and the palatine is only 25. We are used to it, but for her it Therefore, we always just look at the appearance on the last turns. Yes. Yes. This is called After this you don't need to log in. I mean, in whether it wedges or not. If we are talking You and I fell out of the top of the palatine him? We measure the length using the locator. According to the locator, the length here, I think, will be somewhere around pip-peep. We catch this length. Yes. Here. Here. Here she is. I believe this. The locator was hit. Yes. Yes, colleagues, Which apex locator is good? Please, Herman is doing but there will be sound accompaniment. You will have when I do dodonsia. Today I laugh quite often. channel. 23 mm. All. 23 mm. Channel length Channel shall we take the first one for dissection? We must or 1504. I'm taking 1504 here because I have we won't get it. You always say the sixth cone on Well, tool along the bottom And so you would take it in practice. The channel here will be wide. Yes. If we immediately It seems more appropriate to us that we will begin to push the contents go through the instrument, form a so-called the canal adequately, insert the ultrasonic nozzle, only then enter the cleaned canal, yes, with a large instrument. Well, for example, let's start from the thirtieth, Yes? Here he comes in. There are no white shavings. That is, the channel is definitely more than 30. Yep. That's it, we're there. Yes, it looks like the It should still be thin. We need to go in, subsequent rotary instruments and also create conditions In the ethodontic treatment of the canal, instrumental conditions for channel irrigation. Subsequent opturation. We still have B2 prepared. We are washing it now. Look, the extirpated pulp has Let's wash it so it's clean, because the liquid is cloudy rinse after each instrument with a large In practice, this is half a syringe after each instrument. depending on the anatomy or the stage of preparation. I wash out the canal with a syringe. That is, the syringe is used We continue to work with MB2. Length 2, if I'm not mistaken, 19 mm from the bump. Yes, from the hill. And in this situation we are dealing with strongly curved channels. And I urge you to also I already mentioned her today. This is SOCA SC+. Mm, this of all, mm, a, files for the carpet. It's most