Working Lengths and Troubleshooting Apex Locators – PDP216

What makes apex locators reliable—or completely misleading? How do you determine the true working length of a root canal? Why is relying solely on radiographs for endo success a risky move? Dr. Samuel Johnson joins Jaz for a game-changing episode that will make you rethink everything you know about endodontics. In this first part of a two-part special, they dive into the nuances of apex locators, the difference between the radiographic apex and apical constriction, and why our radiographs might be lying to us. They also explore the power of glide path files, how to improve your endodontics workflow, and an incredible way to consent patients—something that extends beyond just root canals. Because mastering endodontics isn’t just about technique—it’s about communication, precision, and making the right calls for long-term success. Stay tuned for Part 2, where we go even deeper into endo essentials! https://youtu.be/M2z8Dl_g4XY Watch PDP216 on Youtube Protrusive Dental Pearl:  Buy a small whiteboard and marker for patient communication. Draw details, highlight the treatment plans, and list pros, cons, and fees. This builds trust, improves consent, and makes treatment clearer. Snap a photo and upload it to the patient’s records. https://amzn.to/3DzUJfn Key Takeaway: Understanding the difference between radiographic and anatomical apex is crucial. Apex locators are essential tools for accurate working length measurements. The anatomy of the root canal system is complex and requires careful navigation. A well-informed patient is more likely to have realistic expectations about treatment. Glide path files can significantly reduce treatment time. Avoid forcing files into hard stops to prevent damage. Complicated anatomy can lead to unexpected challenges during treatment. Taking radiographs can help clarify uncertain situations. Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 01:40 Protrusive Dental Pearl: Patient Communication 02:39 Welcoming Dr. Samuel Johnson 04:36 Samuel's Passion for Endodontics 07:07 Reliability of Radiographic Measurements vs. Apex Locators 11:15 Canal Anatomy 14:30 Overextension vs Overfilling 16:23 Combining Apex Locators and Radiographs 20:52 Apex Locators and Hypochlorite: The Perfect Combination? 24:00 Efficiency in NHS Dentistry 26:10 Transitioning from NHS to Private Practice 27:42 Understanding Radiographic vs Anatomical Apex 29:26 The Importance of Consent in Endodontics 33:07 Mastering Apex Locators: Tips and Tricks 37:07 The Role of Glide Path Files in Endodontics 39:19 Troubleshooting Endodontic Challenges Watch and learn from Dr. Samuel Johnson on Instagram and YouTube! If you loved this episode, be sure to watch Elective Endodontics? It’s all about Communication – PDP202 #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 enhance clinicians' understanding of endodontic diagnostics and workflow, focusing on apex locators, working length determination, and effective patient communication. By refining these skills, practitioners can improve treatment accuracy, efficiency, and patient outcomes. Dentists will be able to - 1. Differentiate between the radiographic apex and the apical constriction and understand why radiographs alone can be misleading. 2. Evaluate the reliability of apex locators and recognize factors that affect their accuracy. 3. Apply the use of glide path files to improve efficiency and reduce treatment time in root canal procedures. Want More Clinical Gems? Join the Protrusive Guidance App to get access to masterclasses, premium videos, and exclusive Q&As with experts. Head over to protrusive.co.uk/ultimate to sign up and take your endodontic skills to the next level. If you found this episode valuable, subscribe to our YouTube channel, leave a review on Spotify or Apple Podcasts, and share it with your colleagues. We appreciate your support! Click below for full episode transcript: Teaser: This is the best tip I could give you with root canal. If you're new starting out, if you are getting, say you're 18 on a canal and you know it's probably about 20, 22, the best thing for you to do, if you're getting stuck, the best thing to do is not to jam it down there, you're going to pull your hand file out. Teaser:In fact, you're going to measure first, how far you've got with a rubber stopper. You're going to take it out, you're going to measure it, it's 18. You're then going to get a higher diameter file. Really what you want to be thinking about is the apex locator is the daddy. They're the key. You're going to be trusting that one person. Essentially you're just creating that kind of circuit. Do you want to be tickling those periodontal tissues and they said, they're extremely, extremely reliable. That is the greatest thing about my job in dentistry. You never, ever, ever, ever stop learning. Jaz's Introduction:Protruserati, you're in for an absolute treat. My guest today, Dr. Samuel Johnson, will actually make endodontics fun. Look, I don't do as many root canals as I used to, and to be fair it's really not my favorite thing but seeing the wonderful things that Samuel is doing is really making me excited and enthusiastic about Endo, which is why I'm so excited to finally bring him on the show. Not only are you going to enjoy his geekiness and how passionate he is about Endo, he's also going to charm the pants off you. Just such a lovely guy. This is part one of a two part special. So in this part one, we look at apex locators and we look at the difference between the radiographic apex and the apical constriction. So basically when you see a radiograph of a root canal and you think, Ooh, that looks short, or, oh yeah, that looks to length quite often, we are wrong. And if you use our radiograph alone as a metric of success, then that might be lying to us. Along with that, we'll talk about what makes apex locators reliable and what makes them unreliable. The power of glide path files, which Samuel's really big fan of. And Samuel will share with you the ultimate way to consent a patient. And this could be used for anything, not just for endo. And I am convinced that this way of consenting patients and then taking a photo of this way of communicating, uploading it to the patient's notes is just absolutely phenomenal. So whilst you're going to level up your endo in this two part episode, you're also going to be better at consent and communication. And as ever, I always like to dive in about the journey of our guests. And Samuel's got such a fascinating story about being in the army, an engineer, then the endo MSC, he's got three kids, it's all happening and he is just brilliant. Dental PearlEvery PDP episode I give you a Protrusive Dental Pearl and it's taken from this episode thanks to Samuel. Look, do yourself a favor, go on Amazon and buy a small whiteboard with a marker pen. Then you're going to use that whiteboard in all your communication with your patients. Every time they have a crack, you're going to draw a tooth with a crack. You're going to show the patient all the details, draw it for them, highlight it, write the pros and cons, write the fees on this whiteboard. This is a powerful way to communicate and consent. You take a photo of that, then you upload it to the patient's notes. I know many of the protrusive community have also used this technique before, and those who use the whiteboard in surgery absolutely swear by this technique. I appreciate it's not for everyone, but some of you will really resonate with this and I truly think it builds a nice connection and high level consent for your patients. This episode is eligible for CPD or CE credits because we are PACE approved. So once you finish this episode on the Protrusive Guidance app, scroll down, get 80% of the quiz and you'll get your CPD. Let's now join Samuel for a fantastic geeky endo discussion. You'll love it. Main Episode:Dr. Samuel Johnson. Oh my goodness. I love the pulp. It is so, so great to have you on the podcast today. How are you? [Samuel]I am super, super excited for today. Really excited. [Jaz]You make endo tangible. This is why I wanted to connect with you. This is why I wanted to bring you on the show, cause everything we do in the podcast about making dentistry tangible and what you do with endo is the best I've seen. Like if I were straight off the bat, I want to say everyone needs to check out your channel and your videos and your Instagram. Just beautiful. [Samuel]We drop a live video of a root canal every Friday, and each Friday we do kind of, it's like a theme. Okay. So last week was minimal opening. The week before that was pulling out silver points. And essentially what I like to do is I record every single root canal I ever do, ever. I've got this huge kind of cloud based system at home, which has got a 40 terabytes of footage. And then sometimes when I'm doing a root canal, I'm feeling the magic. I'm feeling something's happening. I'm feeling maybe this will be a great learning experience. And that's what essentially every Friday, we try and drop something exciting for you. For sure. [Jaz]I'm so glad that you do this. It's a real service and you see from the love that you get on the comments that people really needed this. Right? Okay. So I'm so, so, so happy to connect with you and talk about a topic that's very dear to your heart, which is working lens, right? Working lens, figuring them out. Apex locators and troubleshooting. But actually, I'm so tempted to go off piste, off script.