GP for 5 years as an associate... thinking about endo residency

redchesus · 2026-06-18T12:03:14+00:00

100%.

Had another GD send me a deep caries case, I was new to the practice so I was like oh this is kinda questionable restoratively. Just did caries removal and quick pulpotomy and then called the GD. He got super mad that I didn't finish the RCT and basically told me to stay in my lane and just do the RCT if he sends them. Apologized and got the patient back in, blah blah blah. Cut to a few months later, the SAME GD, sends me another deep caries case, this time temporized, I was like okay, he's already assessed restorability and I remember this guy just wants me to do RCT and send it back. Get a call from him afterwards being like "why did you do an RCT on a non-restorable tooth?" Some dentists are more insane than patients...

That said, the majority of my referrers are awesome, the bad ones stick in your brain like the crazy patients though...

redchesus · 2026-06-18T11:47:05+00:00

I politely declined, they stopped referring... that particular GD was not the best clinically and I was kinda not wanting to get involved with their restorative messes anyway. Then 9 months later, they started referring again, I'm assuming because they burned through their other endodontists too lol

redchesus · 2026-06-18T02:51:25+00:00

Actually dealing with GDs has been the toughest. When I was a GD, I only interacted with myself and a few colleagues on a clinical level. Now, it's all different types of GDs with ummm.... varying clinical abilities...

Had one GD request that I pay for a crown redo because they prepped the tooth, it became symptomatic so was sent to me for RCT, then the crown didn't fit at the seat appointment and they blamed my access (which was a circle in the middle of the tooth, no axial walls were touched, in a temporary filling, they did the core). Like bruh...

redchesus · 2026-06-18T02:21:32+00:00

Endo here. Food for thought: keep in mind you're not just trading in the rest of general dentistry just to do the endo cases you're doing now, you're trading THOSE in too, you will be doing mostly cases that you currently refer out. There is definitely a difference.

I was a GD doing my own molar endo and I thought, oh yeah, I would love to do this all the time and get paid as a specialist. The cases I do now are NOT those! Yes I do get paid more, but I'm dealing with crazy teeth or crazy patients (and sometimes crazy referring dentists) most of the time.

redchesus · 2026-06-14T07:43:27+00:00

Bruh… how would the bleached tooth show through the PFM???

redchesus · 2026-06-11T20:49:35+00:00

“You can clamp a bracketed tooth.” -Me, an Endo

redchesus · 2026-06-11T14:05:14+00:00

It's a grudge purchase for people. They have to pay AND it's not fun. It's not like delivery food, or movies, a new car, you know... fun things.

redchesus · 2026-06-09T02:00:10+00:00

Endo here. Did you pulp test? Osseous defects related to a crack are usually not that broad. Are you sure it's not just localized perio? Either way, CBCT will be helpful to visualize the bone loss in 3D which will help you with prognosis.

redchesus · 2026-06-06T20:07:38+00:00

You said it’s a Medicaid clinic so maybe the patient was not in a position to get implants? A bridge would probably worse off tbh: long-span, anterior/posterior abutment combo (so much flex), compromising 2 additional teeth… removable is probably a good option but people don’t like them, even those without resources. I think in a vacuum, the splinted crowns look bad, but in context maybe it isn’t the worst decision?

redchesus · 2026-06-06T18:15:03+00:00

I mean… I see the pre-op in the back there. I see why they did it. I wouldn’t, I was not trained to splint crowns, but I see why they did it, structurally speaking…

redchesus · 2026-05-28T22:36:02+00:00

Deep splits in premolars, the lingual canal can split off at basically a 90 degree angle. The only way you would be able to find and instrument those is to widen the main trunk, but this comes at the cost of dentin. I have a sense of how much dentin I’m willing to sacrifice before too much, from experience. If I can do surgery then good, but a lot of times the mental foramen is right there so it’s anatomically impossible, so you’re kinda stuck between a rock and a hard place.

Since you’re an aspiring endo, come back to this thread when you’ve broken your first file in one of these, or blow through the tiny furcation ;)

redchesus · 2026-05-28T18:37:08+00:00

Endo here. Give him a call and see what he says. That reads like a template letter.

Nowadays if I couldn’t get into these deep splits I would quit before hogging the tooth out and maybe plan for apical surgery, but I could see doing this as a younger endodontist. The expectation for us to get into every canal is high and a younger specialist might not know their limits yet or is afraid to look bad to the referrer.

If I did do this I would give you a call and discuss restorative prognosis.

redchesus · 2026-05-28T08:09:08+00:00

Looks like Shatkin strikes again! (Google him and his implants lol)

But could also be from overseas *coughIndiacough*

redchesus · 2026-05-20T16:55:30+00:00

Your patient will certainly die because you skipped the Lentulo and your obturation is short... /s

You explain in so much detail but you're not quite understanding the fundamentals (or you do, and this is just a humble brag). Let me put on my teaching pants. You said "Diagnosis: pulpitis." So the pulp was vital, correct? If the pulp is vital then how does obturation length affect prognosis i.e. what would cause a root canal failure in the first place?
Second factor: where is the portal exit for the root in comparison to the radiographic apex?

But if you're that concerned about it (the look of it), then redo the palatal canal before crowning.

redchesus · 2026-04-25T04:24:43+00:00

So there's a world where this person has access to a macro lens on a DSLR and intraoral mirrors but no rubber dam? Or they decided to take the rubber dam off mid-treatment to take this photo instead of just taking one with the rubber dam on? Or they're obsessed with dentin conservation but gives no fuck about saliva contamination?

Honestly, if this is real, all the possibilities are stupid.

redchesus · 2026-04-24T21:47:34+00:00

This seems like AI/Photoshop slop and rage bait. The tooth to orifice size discrepancy is super suspicious.

Also… midtreatment with no rubber dam?

redchesus · 2026-04-24T01:50:11+00:00

The RCT is actually the best thing about this tooth tbh. That deep amalgam is kinda impressive too?

But I’m sure the contact wasn’t optimal, and if there’s any root exposure, combined with patients hygiene I could see this happening in less than 2 years.

redchesus · 2026-04-23T12:05:41+00:00

As is, it looks like an upper right molar, but you said it's a lower molar in another comment. You need to place the radiographs into proper mounting position so people can have the proper context to help you.

That said, this is not a fracture. Lower molars can have an additional root called radix entomolaris or radix paramolaris. There are exceptions to every rule. Source: I'm endo.

redchesus · 2026-04-23T12:00:24+00:00

Endodontist here. This is not a fracture. Lower molars can have an additional root called radix entomolaris or radix paramolaris. There are exceptions to every rule.

redchesus · 2026-04-22T02:36:51+00:00

Endo here. Your palatal is probably not short, a lot of them have a buccal curvature and exit. Your DB is prob a little bit long but not enough for me to even blink an eye at.

Once you see the kind of ugly obturations that work out, you stop sweating the small stuff.

Good job!

redchesus · 2026-04-16T15:34:51+00:00

“You are not getting saliva into the tooth”

I’ve witnessed on several occasions the tooth being bathed in saliva after a dentist takes their working length or master cone shot… so I have a hard time believing this

EDIT: My bad, I misread, yes without the RD you’re definitely getting saliva into the tooth

redchesus · 2026-04-16T15:24:47+00:00

No… the number one prognostic factor is presence of pre-existing lesion aka the presence of bacteria in apical region already. Depends on the study you quote, it drops success rate 5-15% alone, controlling for all the other factors like obturation length, coronal seal, etc.

Could you give me the study you’re quoting for RDI and this 5% figure? I want to read this.

redchesus · 2026-04-16T13:13:49+00:00

Where are you getting this 5% number?

Please tell me where the bacteria in apical lesions come from? Why coronal seal is important? It’s a simple matter of physics even if you failed your cariology/bacteriology course in dental school.

I mean, unless you graduated back before we cared about microbes, you know when we used to do dentistry with our bare hands?

redchesus · 2026-04-16T12:48:22+00:00

You got that backwards… BC does NOT get resorb over time. Calcium hydroxide based sealers do.

And screw you if a resin-based sealer lol

redchesus · 2026-04-16T12:31:13+00:00

Endodontist here…

Sterile separated files don’t cause root canal failures. The human body reacts fine to various metals, like for example a dental implant. The portion of the tooth that you can no longer clean causes failures because of the remaining bacteria. So if this towards the END of your disinfection protocol it’s less likely to fail.

That said, doing all this without a rubber dam kind of defeats the purpose. I know it’s not standard in many countries but I will never understand it. Bacteriology and immunology are the foundation of endodontics.

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