My First Case in Private Practice
By Dr. Samar AlHashimi, BDS, DDS, MSD
My first Thermafill retreatment was done at Loma Linda University: tooth #30 with three metal carriers; no gutta percha (gp) at all in the canals, only a bunch of gp coronally. The carriers were stacked all the way behind the apex with a big RL on both roots. Dr. John Munce taught me his way in retreating such carriers or removing broken instruments by using a B.O.A. technique (Basic Obstruction Acquisition device) for obstruction removal which is a tube (Appli-Vac Tips-Vista Dental products), using finger diamond, cut window approximately 3-4 mm long. We grasped the tube with cotton plier from the cut and place two bends and we inserted GT file, reverse rotate the tube, reverse rotate the entire B.O.A with the Metal carrier. I really enjoyed trying this method for the first time and I removed all three carriers. This was my first experience; I took my time and finished the case in two visits.
My first day after I got to private practice (here we goooo!), I had just moved to another state and started practicing there. The whole place was new for me, and the office was new for me. The material that they were using was kind of different than what I was originally using, and I was too shy to ask for different instruments or materials. My first patient that day had a mandibular molar which was previously treated with Thermafill metal carriers. Patient wanted to start and finish in the same visit since he was traveling. I just remember how my blood was cold that time, and I was thinking about how I must prove myself. I know the program taught me enough to be confident, but it was still different — and this was my first case! I started drilling through the crown; and there we go, I found the metal carriers hanging there. I used Chloroform to melt the GP coronally and around the carriers. I didn’t have tube or GT file to do a B.O.A, so I took the fine ultrasonic tip to wiggle the carriers out. The assistant thought that I would finish the case in 30 to 40 minutes just like my coworker, but unfortunately I took 2.5 hours and I kept overthinking that I was not going to finish it that day (whew!). I took several x-rays to make sure everything looked fantastic (it was my first case in the private clinic!). Finally, all the work paid off; we were all happy, thinking, “yes, we are finally done!”
After that, I created my own technique on how to retreat Thermafill (Plastic and Metal) since I knew which instrument I should use, which ultrasonic tip and which files. Now, the retreatment of these cases is something that I am a big fan of. I enjoyed doing them a lot and it takes me less time than before. The more experience I had resulted in better and easier cases. A good tip that I learned was that in the residency you should take your time to discover different techniques that would work well for your cases; make sure you always — and always — learn. It’s your golden time; no one will be mad if you are taking your time. If faculty wants to help, ask them about their experience and you will ROCK. I’m a part-time clinical instructor at UT Health/Endodontics; I’m now trying my best getting involved in the residents’ cases — I’m offering help before they would ask.
I’m enjoying the time spent around the residents these days!
Dr. AlHashimi is an AAE member and part-time clinical instructor at the University of Texas Health Science Center at Houston (UTHealth) School of Dentistry. She is also a practicing endodontist.