Sometimes we notice trends. Patterns. I picked up on a trend in a few of my endo cases, and I want to show you something interesting about them. Take a look at these three cases. What is the endodontic failure they all have in common?

Yep. All three of these patients still had the cotton and cavit left in the chamber at their one year recall, AFTER the crown was permanently cemented. (Nooooo!!!!)

That’s not good.

Hang in there with me, because I’m trying to make a point.

It’s up to you, my friend!

Go back and look at the chamber from the postoperative radiograph to the recall. 

Well, most of your patients aren’t going to show up for their one year recall, especially when they are feeling great. (This is part of why you should really, really impress on your patients just how important it is that they truly do come back for this appointment. It’s crucial to make sure they’re healing properly.)

These three patients thankfully DID come back at one year, which is both clinically significant and kind of unusual.

Why? Because their tooth began bothering them again.

Why? Recontamination.


Don’t make this mistake… it’ll lead to endodontic failure.

This sponge or cotton that we place in the tooth under the temporary is a magnet for bacteria, and if you leave it in the chamber and seal it under the crown, you’re looking at an endodontic failure that has made a nice, cozy home for those bugs.

Your patient is going to be in pain, and you’re going to be mega embarrassed.

Let me tell you, this is a very uncomfortable conversation for the endodontist to have with the patient. No endodontist wants to tell a patient, “I’m sorry, but you need to know exactly what happened.”

Perhaps some of you feel that, as the endodontist, we shouldn’t say anything. Right? After all, we’re the specialist, and we should just fix it.

Here’s how it looks from our point of view: At this point, the patient is blaming us that their root canal didn’t work. We get put in the hot seat.

I’ll be honest, most of the time, I don’t say anything unless I have a really inquisitive patient, and I just redo the root canal for free. But don’t assume that will happen, because it’s quite possible that one day your endodontist may not bail you out! ESPECIALLY if it keeps happening!


Here’s what you can do.

So do yourself a favor and take a few seconds to check and make super-duper-double-triple sure the cotton and cavit is out of that tooth. Or ask your endodontist to do the buildup under isolation in order to prevent an endodontic failure like this.

Otherwise, you’ve created an opportunity to look bad and lose a patient, something we want to avoid at all costs. 

And worst of all, you’ve left a patient unknowingly in a bad situation, where they’re going to be in pain… and could need retreatment. In the worst case scenario, they could actually lose their tooth.

So take care of your patients, your specialist, and yourself. Every time!

Remember: C-C-C.

Before it’s time for restoration, remember: C-C-C.

Cotton. Cavit. Crown.

Check to make sure the cotton and cavit are outta there. THEN place the crown.

Put it on a little sticky note on your desk. Tell your dental assistant. Frame it by your diploma. Make it the background on your phone. Repetition really helps!

You can even remember me cheering you on, and reminding you, C-C-C! Whatever it takes!

I’d love to hear your takeaways from this post. What did you learn? Are there any other things you forget? Can you make yourself a system to remind yourself? Let me know in the comments!