Apical Gauging: Do it truthfully
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If someone said one size of shoes will fit all ! or one size of pants will fit all! Will you believe ? But you so easily believe that 2-3 files can successfully do endodontic treatment for 32 teeth of all ages and all population. Marketing People can make you believe anything ? Also read truth behind Single file Endodontics, Wave one and Reciproc

With little bit of commonsense it is easy to understand that in order to achieve clean canal it is essential that we take an instrument size which is slightly larger than the original canal size. (there is unanimous agreement that apical part is most important part of canal to clean). To do this you need to know how much is the apical diameter to start with. Apical gauging can only be done correctly with a non tapered instrument which has a flexible shaft and a tip larger than the shaft. Common Myth propogated is that irrigants can clean, sadly irrigants can only reach apical area once you have done adequate cleaning by proper instrumentation. Endo Gods have vested intersts and make you believe in WRONG funny techniques for apical gauging. Canals are curved, bucco-lingual curvatures are not seen in radiograph, because of curvature, you get a tight Feel and wrong estimate of apical gauging...READ MORE

Once you know correct apical size to startwith then you can clean the canal to 1-3 size larger and then you can feel satisfied that you have done ethical work as per the dictates of science. To see an excellent study published on this aspect of apical gauging CLICK HERE To see more on technique of using LSX CLICK HERE

And now CBCT study also has concluded that flat tip instrument (LSX) is better for apical gauging, FULL PAPER

Endodontic Pain

Once you determine the apical diameter then you can properly debride the critical apical third and you would see that you patients are happy and so not suffer with undue pain as was concluded in this study from America See THIS PAPER

This is also a great study published in 2010. Conclusion was that the most frequent shape of the apical foramen was round(52.9%)or oval (25.2%). The major location of both the root apex(39.7%)and the major foramen(58.4%)was in the center of the root. FULL PAPER

Post op Pain after RCT

Main reason is under preparation in the apical area. If the tooth pulp is not infected right upto apex, you may get away by doing under preparation. But it is in teeth with Periapical lesion you will surely face problems (main if doing single visit endo). Following study clearly shows that apical sizes are larger in infected teeth. Study concluses " In cases with periapical radiolucency, larger instruments should be taken to the working length than in cases without lesions" LINK to full paper

Example of Premolar

See here a Premolar with two canals. First canal was instrumented with Taperd Rotary NiTi (TRNT) and second canals with LSX- LightSpeed as per the manufacturer's recommendations. Carefully see the radiograph and then apical cross section. It is amply evident that only LSX can address and clean the apex correctly giving you great healing and success in every single visit Endo case. I encourage you to do the same experiment on extracted tooth and see it for yourself.

To see how you get false binding of instrument and can not do proper apical gauging, read the example below:

In this maxillary molar, palatal canal was completely prepared with a popular Tapered instrument. The final instrument is F2 (tip size #25) . It gave a tactile sense of being fit in the apical area. But it is clear from this Xray that the apical walls are not touched by the tip of the instrument. Hence the tactile sense is from the binding instrument in a more coronal area. Just to verify this, I inserted a #25 LSX instrument in the same canal

This makes it crystal clear that the apical size is much more than 25 to start with. So, absolutely no cleaning has been accomplished by the tapered instrument. I proceeded to find out the apical size by inserting larger LSX instruments sequentially.

Yes, here it is. #40 LSX was binding. In a canal of # 40 apical diameter, what cleaning and disinfection are being achieved by a tapered instrument of tip size 25?

And if you have cleaned apex well (using non tapered instrument)it is usual to see superb healing, see the case below (Healing took place without systemic antibiotics)in a patient aged 72 years.

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