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When Your Size 10 File is not going to length, what is happening?
Your apex locator isn’t giving you a zero reading. Your file is stuck. You’re wondering—have you ledged? Or could something else be at play?
In this must-listen follow-up episode, Dr. Samuel Johnson returns to tackle the biggest endodontic dilemmas left unanswered from part one. If you haven’t checked that out yet, go back and listen—it’s packed with insights on working lengths, apex locators, and even the role of consent in endodontics.
https://youtu.be/1E6pK2iOPjY
Watch PDP217 on Youtube
Now, in part two, we go deeper. We’re talking blockages, ledges, portals of exit, and the mysterious phenomenon of file gripping. Plus, Dr. Johnson takes on your burning questions from the Protrusive community—like how he responds to biological dentists claiming root canals should be avoided entirely. (Yep, we’re addressing that controversy head-on!)
Protrusive Dental Pearl: For a more visual learning experience, dive into the Pre-Endo Build-Up on Protrusive Guidance and see Jaz and Samuel’s insights in action.
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Key Takeaway:
General dentists often overlook the importance of taper.
Removing too much dentin can weaken the tooth.
GP cones can be unstable and affect the procedure.
Reshaping GP cones can often resolve length issues.
Pre-bending GP cones can help navigate tight curves.
Biological dentists have controversial views on root canals.
It's essential to prioritize the patient's best interest.
Using endo frost can aid in manipulating GP cones.
Consent should be informed and comprehensive.
Communication between referring dentists and specialists is vital.
Continuous learning is essential for dental professionals.
Ultrasonic activation improves endodontic outcomes.
Pulpotomy and root canal treatments have distinct indications.
Building a supportive community can alleviate feelings of isolation in dentistry.
Dentists should charge for their time and expertise.
Need to Read it? Check out the Full Episode Transcript below!
Highlight of this Episode:
01:03 Protrusive Dental Pearl
01:49 Common Scenarios and Tips for Young Dentists
05:30 File Gripping and Canal Anatomy
08:30 Master Apical File: The Common Dilemma
11:18 GP Cone Issues and Solutions
17:03 Addressing Root Canal Myths
23:35 Cracks in Teeth: Prognosis and Treatment
25:44 Ninja Access Cavities: Pros and Cons
28:21 Common Mistakes in Emergency Endodontic Treatments
33:51 Obturation: Overextended vs Short
34:41 UltraSonic vs Sonic Irrigants
36:15 Pulpotomy and General Dentistry
39:25 Building a Dental Community
As promised, here are the ESE Guidelines on managing cracked teeth.
Watch and learn from Dr. Samuel Johnson on Instagram and YouTube!
Don't miss the first part of this series: PDP216 – Working Lengths and Troubleshooting Apex Locators
#PDPMainEpisodes #EndoRestorative #BreadandButterDentistry
This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes B and C.
AGD Subject Code: 070 ENDODONTICS (Emerging concepts, techniques, therapies and technology)
This episode aimed to provide deeper insights into troubleshooting endodontic challenges, particularly when files fail to reach working length. It explores common pitfalls, advanced techniques, and expert strategies to improve clinical outcomes in root canal treatments.
Dentists will be able to -
1. Recognize common endodontic challenges and strategies to navigate them effectively.
2. Evaluate the role of master apical files and resolve common dilemmas in achieving optimal shaping.
3. Identify frequent errors in urgent cases and improve treatment approaches.
Click below for full episode transcript:
Teaser: So your size 10 file is stuck. It's not going to length and you're not getting a zero recording on your apex locator. What do you do? Have you ledged? Or could there be another reason for this? This is where we answer that question leftover from part one.
[Jaz]So if you haven't watched or listened to part one yet, check it out. It was a great introductory episode. We talked all things, working lengths, apex locators, career and consent in Endo. So do check out part one.
In this part two with Dr. Samuel Johnson, gosh, he loves Endo, doesn't he? And it's infectious, right? You can totally feel that. We're going to talk about blockages, ledges, different portals of exit and a phenomenon called file gripping. Then Samuel answers all the questions from you guys, the Protrusive Community.
You guys asked some fantastic questions and it was a great pleasure to ask him all those. One of which what does Samuel think about those biological dentists who are suggesting that root canals are bad and that no one should have a root canal? I know, it's crazy, but how does Samuel handle those kind of patients? We go deep in all the little facets and details of all things endo. Thanks again for all your questions, guys.
Dental PearlThe Protrusive Dental Pearl for this episode is you need to see, if you haven't already, you need to watch my pre endo build up video. It's so relevant to everything that me and Samuel are discussing.
And that video was published just a few weeks ago as part of my POV clinical walkthrough series. You see my full video walkthrough of a couple of cases where I do a pre endo build up and do like a screen recording and interjection and running commentary of everything I'm doing. Very similar to wonderful videos that Samuel makes.
So I'll put the link to that in the show notes if you haven't already seen that. If you happen to be listening on Spotify or Apple, then do check out the video on the Protrusive Guidance app or just type in on YouTube, Pre Endo Build Up Protrusive. You will find it. Let's not delay getting to the main part of the episode. I know you're going to love this just as much as you loved part one. Let's go with Samuel Johnson.
Main Episode:Just talk about the common scenario that you want a young dentist to appreciate that when they feel encountered scenario. A great tip there is don't force it. Slow down, retract because you don't want to make it worse. And that's a top tip already.
[Samuel]So I would say, have you reached zero or not? Cause you can get a canal. I've had one yesterday. I did distal buccal, which was 17 millimeters and in length. So if you have already reached zero and then at 18, you're getting this hard stop. You have probably likely ledged it, but don't panic.
I think we might move on later on to talk about managing ledges, but if you haven't already reached zero with your apex locator, I think the best thing to do first is just estimate where you are actually within the tooth. So, you can estimate the working length in many ways.
You can use a radiograph, although, sometimes if you can learn how to draw how long it is on your radiographic software. It's not perfect, but it kind of gets you in that kind. It's a useful estimate, isn't it? Another thing as well is, if you've got a multi rooted tooth, you say you've got a lower six and you've got a mesial buccal and you've got a mesial lingual.
If the mesial lingual is 19 millimeters or say the mesial lingual is 22 millimeters and you're getting stuck at 18, you're probably short. And also take a working length radiograph. I did say I don't take them, but I do, do take them. Cause sometimes my apex locator is all over the place. And I don't know why. And sometimes it's good.
[Jaz]This is the one that you said is not routinely advocated by FGDP, but sometimes when you're getting erratic measurements and just to verify. That's when you would take it with and you are doing it with a size 10 because obviously you're stuck there. Is that right?
[Samuel]Yes. Yeah, absolutely. So say you are near to the end. Okay, this could be a ledge. It could also be complicated anatomy that the x ray is not going to show these many portals of exit. And I would say a really really common sign that it is complicated anatomy, not a ledge is that you get that kind of sticky feeling.
So it's a hard concept to kind of explain, but if you've got a hand file and you're just sort of negotiating it to length and you're hitting that hard stop, but then you get in that kind of sort of sticking feeling that is more likely complicated anatomy because you know that the file is sort of getting stuck, in the jammed in the hole.
[Jaz]It could have been preempted by a Cone Beam CT, you think?
[Samuel]No. So, the cone beam CT scan has many, many uses. And a great thing about a Cone Beam CT scan is that you can measure the tooth really, really well. It's very, very accurate. But with a cone beam CT scan, it doesn't show detail very well.
That might blow people's heads, but it's not the panacea of diagnosis, a Cone Beam CT scan. Although I take a lot of Cone Beam CT scans, we've got one in all three practices that work out. Very, very useful. What I would say as well is if you're getting that hard stop feeling and you are near to the end, it's probably likely that maybe the end of the tooth goes off to a 90 degree angle.
So you see this a lot with palatal canals and distal canals in lower molars. You can kind of sometimes see it on radiograph, where you see the large canal and it kind of flicks off to the end, or you don't see the flick. You kind of see that kind of apical radiolucency where it's kind of off to the side of the tooth or laterally to the tooth.
That's essentially where the portal of exit is, again, to talk about how to manage those things. Maybe we'll talk about that later, but if you're not near to the end, it's probably either a join or a split.
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