I bet you never thought of this one before. I sure hadn’t… until, one day, one of my attendings in residency brought this up.  (We’ll call him Dr .G). It made my lightbulb go off!

If you are ever doing two root canals together side by side, did you know that your diagnosis of each tooth could have an impact on each other?

A Case for Two Root Canals at One Time

I thought the best way to answer this question was to give you an example, so here’s a case we can look at. Tooth #8 was diagnosed with Asymptomatic Irreversible Pulpitis and Normal Periapex, and Tooth #9 was diagnosed with Necrotic Pulp and Asymptomatic Apical Periodontitis.

This patient was scheduled to have both teeth #8 and 9 root canalled together. I love these cases because they are a slam dunk for me. But, even though they are clinically straight forward, there is still a strategy I use to instrument these cases.

Tooth #9 has a periapical radiolucency and is necrotic, while tooth #8 is about to have a pulp exposure, and the tooth is still vital. Because tooth #8 is still vital, the bacterial load is much greater in tooth #9 than in #8. For the sake of time and efficiency, I will be treating these teeth together, but I will sequence my instrumentation a certain way.

Instrumentation When Doing Two Root Canals at One Time

I want to make sure that my files are used in tooth #8 first before tooth #9 because I don’t want to carry the bacteria from #9 into tooth #8. That said, you could either instrument #8 to completion, or you could use each file first in tooth #8. (You’d want to use it before you ever use it on tooth #9 so that you don’t contaminate tooth #8 with bacteria that it never had in the first place.)

This is such a simple concept that Dr. G taught me, something I had never thought of on my own.  So simple, so sweet!

Here’s the Big Tip

When you have more than one root canal that you are doing together, make sure you always keep in mind the diagnosis for those teeth. Make sure you clean your cleaner teeth first!!!


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