Very Dental Student: How to Do a Root Canal with Zach and Kevin

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[00:01:27] It's time for a Very Dental Podcast just for students and new dentists. Welcome to the Very Dental Student Podcast. And now, here's your host, Mohamed Aboubasha. Hello, everybody, and welcome to another episode of the Very Dental Student Podcast. First one of 2025. I'm your host, Mohamed Aboubasha. And I'm back again with Kevin and Zach. Kevin and Zach, how are you guys doing? I'm doing great. It's one degree here. How's that?

[00:01:56] Yeah, it is so cold here that my kids did not go to school. I think it was... I think it's like three degrees with a feels like of negative ten or something like that. Even my dog doesn't want to go outside. Wow. You guys have me beat the lowest four degrees today here. We're hovering at zero right now. Just change from one to zero. Oh, okay. I bet it's a good time, though, to be in Ohio. Yeah. Considering what happened yesterday.

[00:02:21] Did you guys watch the game yesterday? First of all, Mohamed Aboubasha, any school you've ever gone to won a national championship in anything? No. Well, OU has won a bunch of national championships just a while. While you're there. No, not while I was there. Me either. So, Kevin, tell us what the emotions were in the game. Obviously, Ohio State ran the score up early and then kind of had to semi-sweat it late. But I wasn't really... I wouldn't have really been that nervous if I were you. Tell me how you were thinking as the game went on.

[00:02:51] You would be nervous if you're a fan of the Cleveland Browns because no matter what, they can seize defeat from the jaws of victory. So, I had my sister and my two nieces over. My niece just graduated from the Ohio State University in December. We had pizza. We had wings. We had good food. And, you know, it was a blowout.

[00:03:14] When it was 31-7, I looked over at my older niece and started singing We Are the Champions. And I stopped myself. I'm like, oh, my God. I'm still a Browns fan. Anything didn't happen. And then Notre Dame came marching back. And, you know, you start doing the calculation in your head. You've got to score three touchdowns and two extra points. Like, go for two each time and make it. And they did it twice.

[00:03:42] I just saw everything just falling apart. And then it didn't. So, that's great. And it, you know. The other part of that was that the first real national championship was 2015. 2015, Charlie was at the Ohio State University. That and my son. And who did we beat? I don't even remember. But we won. You're talking about in 14? Well, I guess it would have been. 15.

[00:04:12] 14, 15, yeah. Yeah. Shoot. Couldn't tell you. That was the Urban Meyer era, right? Mm-hmm. Anyway. Oh, boy. As time was running out, I called Charlie. I'm like, you're going to remember this the rest of your life. Go out. Have fun. Don't get arrested. And he didn't get arrested. So, anyway. It's nice to win something. Yeah, that's awesome.

[00:04:40] I was definitely pulling for Ohio State, like, just because I know you. And I know you were rooting for him. Oh, thanks. As I am, you guys are in Oregon. Kansas City Chiefs as well. Yeah. Chiefs. Chiefs. You know, I mean, we're recording this on a Tuesday after the Chiefs had beat the Texans. Kind of a sloppy game, but they find a way to win, which is what they do. I ended up not getting to go to that game. My dad was sick.

[00:05:09] We are going to go to what is, you know, the game that just happened, which hopefully the Chiefs won and beat the Bills. But I don't know. Bills are tough. I don't know. We'll see. Yeah. This bit won't probably age very well because I don't know what the result of the game is going to be. Who knows? Yeah. That's why we do this. Fingers crossed. All right. Well, so we are planning to kind of pick up where we left off. We're talking through clinical protocols.

[00:05:36] I'm comparing what I'm learning in school to what you guys are doing out in private practice. So the topic for today was going to be endo. So where do you guys want to start with endo? I think we should start with what you've learned. And Zach and I will tell you everything that you're doing wrong. Okay. Perfect. So we have a very condescending way. Yeah. As usual. That's preferable. Yes.

[00:06:03] So what we've been taught is the pro taper pro taper system. So, man, where do I even start? So start at the beginning for real. Like, so let's start it this way. Number 19 is in your clinic or whatever. Patient has symptoms. Don't use a molar. They're not going to let him do a molar. Or go with like, you know, four. All right. Number five.

[00:06:32] There you go. They do let us do mullers. Although I haven't done it. Oh, okay. I stand corrected. Let's take away all the diagnosis. This is an obvious toothache. Decays into the pulp. You know that it needs an endo. Let's take away all sort of, you know. Yeah. The diagnosis is done. You're doing it now. Start. You got to do this now. Go. Okay. So start by getting it numb. All right. Using a... Back up. What? We do have to do a little bit of diagnosis.

[00:07:03] What kind of x-rays are you taking? Oh, well, I would need definitely a PA and probably a bite wing as well. Both. Okay. All right. Let's start. Like, why? Well, the PA in order to, you know, get the full canal system on there and to be able to look at the periapical bone and that space. And then the bite wing. Full canal system. What does that mean?

[00:07:30] Like, so I could actually look at the whole root of the tooth and see. I mean, you can only see so much on a two-dimensional x-ray. Right. That's what I'm getting at. Yes. I would get a CBCT if I had one. Does the school have one? The school does have one, but we don't just get them for every endo. All right. There has to be like... What's harder to get, a second carp of anesthetic or a CBCT? Definitely a CBCT. Oh, sure. All right. So let's...

[00:07:58] I think we should stop right here and talk about that. Zach, what is your experience as a new CBCT owner and endo for number five, obvious number five, and Muhammad said something about full canal system or something like that. Take over. I thought I was getting the full canal system with my PA until you get a cone beam. And then, man, you talk like... Kevin and I have used this phrase. I think Kevin came up with it.

[00:08:27] It's kind of like a GPS for the canal because now you know where that canal system is going to start. And if it has two roots, which it likely does, where it's going to kind of split off. And then you kind of see some curvatures if there is any. And I mean, for a five, it's a little less critical. It's the molars that you really get the benefit on the CT.

[00:08:54] But some of those splits on those pre-molars can be weirder than you think. So it's very nice to have. That's definitely been... It's definitely helped me with endo. And talk about a time saver. All of a sudden with that number five, if it happens to be a one canal or I'm not sitting there looking for a second canal. It's like I know what the canals are before I'm starting into the tooth. I know on a first molar, is there a second canal that I really need to hunt for?

[00:09:24] Is that thing sclerose? It's just really nice to have. But I don't want to get bogged down on that too much because I know you don't have access to it. So I'd rather hear what they're teaching. But it's good stuff to have. But if you were learning and you didn't know... I mean, like... Here's my analogy. I have to drive to New Hampshire.

[00:09:49] And all I have in my possession is an old-fashioned two-dimensional map on a piece of paper. Versus having my... Google Maps. Apple Maps or Google Maps. Like, especially if I'm a beginner driver, it just doesn't... If you have the technology available to you, you need to use it. And the thing that you're probably going to struggle most with... Well, actually.

[00:10:19] But yeah, the thing you're going to struggle most with at the beginning is access and figuring out how many canals are there when you have a piece of magic somewhere at school that you're paying $5 zillion for and they only give you one car below the anesthetic. You should be able to have access to that for every root canal an undergrad is doing. Okay. So we've beaten that dead horse. What's next? Okay.

[00:10:46] So then to actually get started, we would go ahead and numb up the tooth. And then we would start with the rubber dam isolation. Okay. Stop. Stop. No. No. Go ahead, Zach. You've got to think that you've got to put a crown on this thing eventually, unless it's already got one, which we're going to assume it's not. We're assuming that it doesn't. We're going to assume it does not have a crown.

[00:11:11] You've got to get your little pre-op impression to make your temporary with after the fact. You've got to think about what the next phase is going to be. And it's because the first thing you're going to tell me, you're going to put the rubber dam on and then you're going to whack down the occlusion. And now when you have to go make your temporary, I mean, unless this tooth's really messed up. I mean, there's some situations where it's like, you know, there's no sense in taking that impression.

[00:11:40] Number five with a large DO decay. So you're probably at least going to have some kind of buckle and lingual cusp that you can utilize, especially if you put a little wax in there or something like that. But you've got to get that, snap your pre-impression first and save that for later, assuming you're going to, you have any intention of crowning the thing. So what you need to understand is this isn't just a root canal. It's a root canal and crown. Yeah, it's a tooth. And so... You give them a new tooth.

[00:12:07] Yeah, so those two things on a posterior tooth go hand in hand every single time. Root canal and crown. Hand buildup. But I'm sure, Muhammad, you've heard this phrase, begin with the end in mind. What is the end of this? It's a restored tooth. Yeah, a restored tooth with a crown on it. So Zach's right.

[00:12:35] It just makes your temporary life so much easier if you snap that impression before you start. And then I'm going to go one further. How are you going to isolate this tooth with your rubber dam? Well, if I'm doing number five, I would probably isolate from number three till number eight. That's great. Okay, excellent. That's great. That's not how they taught us in school, but that's great. Yeah, that is great. And now let's talk about why that's great.

[00:13:07] I was taught, and Zach, I'm sure you were too, the single tooth isolation for a root canal, which is great for keeping saliva and everything out of it. But also for someone who doesn't really know what they're doing yet, Muhammad, it can disorient you. Because you don't know that that tooth with the clamp on it with one single tooth isolated. Is it tilted towards the buckle, lingual? Is it rotated slightly?

[00:13:37] You don't have the adjacent teeth, the other teeth in the arch to orient you properly to gain access to the long axis of the tooth where the pulp is. And also, if you're like Zach and I, I'm going to do my crown prep first. So I need access to that area by isolating the quadrant.

[00:14:04] So I'm not going to do my crown prep first because I don't have hepseric and I haven't gotten there. But even if I'm not, not having that tooth single clamped means it's going to be easier to put a toffelmeyer or something on at the end and do my buildup. So even if I'm not doing it Kevin's way, I'm still going to derive a benefit from doing exactly what you said. So that's cool they taught you that because I definitely did not learn it that way for sure.

[00:14:33] Okay, so you have a quadrant rubber dam on. What's next? So then I would work on getting my, well, if there's decay, then I would do caries excavation. Why? And because you don't want to be instrumenting a tooth with decay still in there. You'd be just spreading it down the canal system, right? I'll agree to disagree on that. But what's your first move? You're going to remove the decay first? I think removing the decay.

[00:15:03] That's a, that's a, there's nothing. There's nothing wrong with doing it that way. We were, that's the way the school is going to make him do it anyway. Okay. I'll concede that. But before you even do that, I would reduce the occlusion. Oh, yes. I would flat top. Whack the top of it. Yes, for sure. Why? It just makes, uh, instrumenting easier. I would imagine since you can. Yeah.

[00:15:28] You just, I know, I like, I know you don't have a cone beam, but I want you to imagine that you do have your cone beam on the axial view where you're going from the occlusal and you're just slicing down at some point on that slice of like you started at the cuss tips and you're slicing through the tooth to the apex. At some point, you're going to be right on top of the pulp chamber. Does that make sense? Yes.

[00:15:55] So if you reduce your occlusion and flat top the tooth, the pulp is going to be right there. Like it, it, you can't not get into it if you do it that way. Like, and I think. Also, it's just, it's easier to instrument a short, the shorter the root, the easier it is. Like we all complain about like the 30 millimeter canine or the unusually long, you know, pre-molar root.

[00:16:23] And if you can take, if you can whack a couple millimeters from that, that's better. Also, you have a flat stop for your rubber stoppers. Also true. You're not going to be on any inclines or. Also, when you're not doing the crown that day, keeping that tooth out of occlusion is going to be better for healing and less likelihood of getting a post-op call of like, you know, this tooth hurts to bite on or something like that. So there's like a multitude of reasons why.

[00:16:51] So go ahead and remove your decay, but flat top this thing. Yeah, for sure. Do that. All right. Now what? So if, if the decay removal has caused any issue with like the isolation now, like if the rubber dam is not staying inverted or whatever, I'll add a little liquid dam. That's a good, that's a good move. And then from there we get our ideal access. What does that mean?

[00:17:18] So for number five, it would be an, an oval shaped access about two thirds up each cusp, um, which we don't have cusps anymore because we flatten the tooth, but, um, you know, an oval access where you can have straight line access to both canals. Right. Okay. And then, um, and you, once you have the ideal access and you're able to see into both canals, um, then you'd start with the hand files.

[00:17:48] Um, get, you start with a 10 or, or, and then go to a 15 and then take our, you're, you're assuming you've located both canals with like a canal, like a little, you know, the endo or something like that. Okay. What are you putting on your files when you first enter into the canals? RC prep. Okay. Okay. That's cool. That's important. Yes. Yeah, absolutely. Um, putting in RC prep and then you're. Why is it important?

[00:18:18] I don't know. To be honest. Never go in dry. Yeah. You always want it lubed up when you get in the canal, Muhammad. That's right. Okay. Trust Zach and I. Yeah. We're more experienced than the matters, but what you run the risk of, uh, if you do go in dry of pushing that pulp, uh, material into the apex and then blocking yourself out

[00:18:46] right from the beginning, like you, you're never going to get through that. And what the RC prep does not only provides lubrication, but it also is a chelating agent and is going to start breaking up the organic material. So that is a fundamental, often overlooked for a beginner key. Okay. And if you're non-vital, then it's just helpful because you get a dry canal. Yeah.

[00:19:13] Now you're, you're just, you know, you're going in, you're going in lubed, you know? Yeah. Yeah. So, um, so then also another thing that before we get, before we measure our working length, we're taught to use a Gates Glidden and, um, SX, which is, I guess like an orifice opener. So you're using an orifice opener. Yes. Whatever, whatever you're using, that's fine. Yeah. Yeah. I'm, I'm on ProTaper.

[00:19:39] ProTaper is one of the oldest and most readily available file systems on, on the market. And it's, it's the most, uh, used and most cloned system worldwide, you know, for sure. So, you know, NSX is a good file and yes, you know, opening that up before you, you know, put your apex locator on there is a great move. And I assume you're some, you know, you've taken your PA and somehow done like a, like a pre-measurement to get like a general idea of what you're going for. Yes. At least that's the idea.

[00:20:09] Kevin probably does something similar. Yeah. And then, um, and then once we've done that, we go ahead and get our working length using the, um, apex locator. Okay. And then we confirm it with a, we do confirm it with a PA. Okay. You're going to have to do that because you're in school. Zach and I have bills to pay, so we're not going to do that. Yeah. I've moved, I've moved past that. Um, but I, but yes, in school. Yeah. I'm okay with that in school. Yeah. Sure. Okay.

[00:20:38] And then, um, once we have okay with it, if you're somehow your apex locator is not giving you a consistent, you know, easy, easy measurement. Okay. And then, um, once we have our working links, uh, we write them down. Um, and then we start going down the, uh, well, we would also get, we would size the files as well or size the canals.

[00:21:04] So we have like these little hand files we use to size the canals. Um, like before you move past SX. No, we would hold on. Let me make sure I don't misspeak. That's okay. Um, I'm not a hundred percent sure. I think you do. I think there's an S1 and an S2. There is. When you size your files or your size, your canals before you start using the F. Okay. Before you start using the F files. Okay.

[00:21:34] All right. Yes. Because they only want us going to the side, the size that we, that we size the canal at. So like there's like a, a 30 and if that's the one that stops two millimeters short of the, of the working length, then we would stop at F3. Oh, they're not even letting you take the files down to the end. Huh? Okay. No, we do. We do instrument when we use the hand or the, when we use the, um, rotary, actual rotary

[00:22:03] files, we do go to working length. Um, but when we size them, we see what just already is stopping two millimeters short of working length before you get in there. So that's, that's where, when you, when you get out of school, you're going to do it. You're just going to do it by feel, you know, like you've got like F1, F2, F3. When it starts to feel like it's starting to bind a little bit, that's where you're going to stop. Or you can just categorize canals, small, medium, and large.

[00:22:30] Large would be a palatal root of an upper molar or distal root of a lower molar. Those are large canals or, um, central incisor. Medium would be likely a bicuspid upper or lower. Small would be, uh, mesial buccal canal of an upper molar, uh, mesial, uh, or yeah, mesial buccal canal and distal buccal or distal lingual canal of the lower molar, that sort of thing. Also true.

[00:22:58] You're like, I go in with a preconceived notion. Yeah. Based on experience. I'm going to stop. Of what I'm going to, of what I'm going to use before I even, you know, before I even start. And then usually I'm only off by, you know, one size in one direction or the other. Right. But if you stick with that system, the answer is F2 on most of the small canals and then either F3, 4, or 5 on the, on the big canals. Yeah. That just depends. Yes.

[00:23:26] So then, um, during this whole process, switching between rotary files, we're taught to go back to the hand file, um, and recap, irrigate and recapitulate in between each step. So we irrigate, recapitulate, irrigate. Um, and we're using, um, yeah, we're, we're using the, uh, lubricant on every step as well. So until you're on pro tapered gold, are you on one of the little like, like firewire

[00:23:56] type files? Is it pretty bendy? I'm pretty sure it's pro tapered gold. Okay. All right. Yeah. Yeah. That makes more sense. And then, uh, and then, yeah, we just go till we hit the F file that we were sized to. Um, and then we will do a cone fit. So we'll try, we'll take in the cones that corresponds to the F file. Yep. Um, see, see that it's actually going to the working link that we would expect it to.

[00:24:24] What's in the cow when you do your cone fit? Um, I mean, some bleach presumably. Okay. Still is in the. Hypochlorite. Don't use it. Get it. The patients don't like bleach. Yeah. Some hypochlorite would still be in there for sure. Well, when are you introducing the hypochlorite?

[00:24:54] Not sure. Okay. Okay. Force? I've changed how I've done this since, since talking to Kevin about it. Cause in school it was early and often. As soon as you, you know, got a, got an opening, it's start that, start getting that juice in there. And then now I've changed it after talking to Kevin to, after I get a measurement. So I don't introduce it until I have a confirmed working link that I've got a file to the apex.

[00:25:24] Yep. It's like a rotary file to the apex. But I've changed it. That is something I've changed within the last three years, you know, for sure. Is that to avoid a hypochlorite accident? It's to avoid, um, pushing pulp material into the apex and screwing yourself. Okay. Because if you introduce it too early, like, I don't even know what the right term is. It collagenizes or whatever. It gets hard. That's what she said.

[00:25:51] And it's, then you've got to try to get past that. You can't. So if I've got the majority, I would assume my first rotary canal that goes to the apex on most canals, I've removed the bulk of the organic material out of the canal. I'm assuming that. That may not always be true. But then if I... Yeah, but it's going to be true enough. Yeah.

[00:26:16] If I introduce the sodium hypochloric after that, I've eliminated the chance of me pushing organic debris into the apex and blocking myself out. That's from Steve Buchanan. Okay. That's a... So... I'll keep that in there. And then if the sodium hypochlorite is still in the canal, when you're doing your cone fit,

[00:26:43] that's acting like a piston and pushing that liquid into the accessory or lateral canals. Because to me, that's the only way that you're really going to clean any of that stuff out. You're not cleaning that out with files. You need the irrigant to be in there to do its... To quote, do its job. So are you like... Are you adding some irrigant in there? Yes. Then doing the same shit? Yeah. I'll fill up...

[00:27:12] Let's assume I can fill up the pulp chamber in this tooth with sodium hypochlorite. And then I've already filed everything. I've got my final file. And whatever the matching gutta-percha is to that, I'm going to go push that through the sodium hypochlorite that's inside of the pulp chamber to try to push that through the system. So... Zach, same? Yeah. Yep.

[00:27:42] Spot on. No debates there. No. Absolutely spot on. Definitely makes sense. And then assuming everything's not bleeding, no pus straining, then you're drying it up and how are you filling it up? So we have... So we're actually taught to disinfect the gutta-percha. So we soak it and have the fluorite for a while. Cool.

[00:28:10] And then get the canal dry with paper points. Yep. And then we have Grossman Sealer. Is the sealer we use? Hold on. Back up one. Oh, wow. That's old school. Back up one step here. Do you use any liquid EDTA before you use your paper points? Um, no. I don't know what that is, actually. Okay.

[00:28:35] So the liquid EDTA will remove the smear layer that's created by the sodium hypochlorite in the canal. And that is a very important thing to do prior to obturation. Otherwise, you're leaving, inadvertently, leaving a bunch of gunk in there. Yeah. You're going to get taught, and I didn't learn this in school either, but you're going to get taught there's a secondary rinse you can use. There's a variety of them.

[00:29:05] I think I use one called Smearoff. Smearoff? That sounds interesting. Yeah. Smearoff. That's what I would have needed. It's a generic of an EDTA. Yeah. It's the same thing, you know? Okay. But you're going to hear a lot about secondary rinses. Yeah. And I think they're a good idea. I, you know... It raises your success rate. Almost every time. Yeah. Allegedly. I have heard of a...

[00:29:30] I sat in on Endo Lecture where they were talking about, like, using, like, something that looked like a stick of deodorant. It was, like, called Titan or something. Do you guys know what that is? What? It comes in this little, like... It comes in this package that looks very similar to a stick of deodorant. Okay. And it's liquid, obviously. Oh, I know what you're talking about. And the brand name is Titan. Yeah. And it's apparently, like, what endodontists like to use. I don't know.

[00:30:00] I know what you're talking about. Who uses that at home? It's, like, a mix, so you don't have to... Because he was saying... Yeah. Most general dentists switch between two irrigants, and this has both of them in there. I don't know. Just a little... Anecdote. Okay. Sounds good to me. So, yeah. Then we would be... Once it's dry, we would be mixed... And we've confirmed that the gutta percha and everything goes all the way. We'd be mixing some Grossman sealer. Kind of covering the canal in that. And then we...

[00:30:28] How are you covering the canal with that? So, we'd take the... Well, we'd take it on the gutta percha. We'd, like, lather the gutta percha up with it. And then when we're actually introducing the gutta percha, we'd go about halfway and then pull out and then finish going down. That's what the... No lie. That's what they taught us to do. That's how I like this. You know, I think that's what Kevin does, too.

[00:30:58] Yeah. That's right here. It's like one pump. But... So, here's an idea. You could put your files into the sealer and run them backwards. Spin those backwards in there. Yep. So, if you can reverse your motor, what's going to happen is that sealer... How many pumps of that do you do usually, Kevin? How many... I'm still, like, a one or two pump guy.

[00:31:28] Two pump... Two... The double reverse? The old double reverse? Double reverse. What was the Seinfeld with the twist? You used my move, Jerry! That's my move! But, yeah, if you run it in reverse, it's going to coat the walls. And then you can do the same thing with your gutta percha and get more coating in there. But having...

[00:31:56] You know, I used to teach an undo course, I guess. Used to. I don't know. I don't know if I still do or not. But when you do this on a clear plastic tooth and you run it backwards, it's fascinating. The canal gets lined with sealer. You can see it happen. You can't see it in real life. But you can see it on a plastic tooth. And it's a great sort of object lesson of that's what it looks like when it's coated.

[00:32:25] If you just coat your gutta percha and do that, some of it's going to get coated on the walls, but not all of it. Okay. Because think about it. If you take the very last file, your final file, and you're running that backwards in the canal, it's a form fit to that shape that you have. Yeah. Yeah. So the hydraulic pressure of the sealer is going to... Across the whole canal. Yeah.

[00:32:55] I think that makes a ton of sense. I'll definitely... That's something I can definitely do, introduce to my technique. Mm-hmm. So I'll definitely do that. Easy to add. Yeah. Easy to add. As is flattening off your tooth and... Yeah. You know, get... And if you're getting your pre-op, it's just going to make your crown prep appointment so much easier for yourself. Well, we... As soon as you do it. So if we're...

[00:33:17] If we're building the tooth back up, sometimes they want us to just build it back up and not take it out of occlusion if it's going to be a crown here pretty soon. It's weird. That sucks. They're weird with... Those are people that don't take call. Right. You know, it's weird with instructions. Like, usually it's fine to take it out of occlusion if there's still other dentistry to be done. But sometimes they want us to do, like, an ideal buildup. It's... That sucks. Depending on the faculty.

[00:33:46] And a lot of times we'll... We have to take models anyway. We have to pour models on every patient. So for making the temporary, they'll just make us do a putty guide on the model. And we'll use that. But... It's still... Okay. Are you taking that allergen before you start your root canal? We would have taken it, like, before the patient ever got... Oh, okay. You know? Okay. I still say in private practice you're going to get less post-op calls if that thing's out of occlusion. I agree. Yeah.

[00:34:17] That makes perfect sense. And I've had some faculty that prefer that and other faculty who would prefer us to do an ideal buildup and just, like, barely take it out of occlusion. Yeah. Okay. Well, they're nerds and don't listen to them. Except if you need to for your grades. Yeah. I was going to say, get... Just... Yeah. That's cool. And then, finally, we have... We do have a down pack and a backfill, a Calamus backfill that we're taught. Okay. Yeah. That's good. All right.

[00:34:46] You guys down packing? No. No. Okay. Searing it off at the orphan. At the... Yep. Searing it off. Just heating up, heating up like a little plugger and just... I have a... They still teach posts at all? They still teach posts? Not so much on posterior teeth. So, sometimes... I think sometimes they do use them on anterior teeth. I don't know. I don't know what the... You haven't gotten there. You haven't gotten that lecture yet. But we've gotten the lecture.

[00:35:15] But I didn't really pay attention, to be honest. It's better... You can learn that on YouTube. It's all good. Yeah. Do you guys use posts usually on that? On your posterior endos? Go ahead, Zach. Some premolars. You know, especially if it's blown out in the center enough. And then... I mean, I don't use them routinely. But let me... There's more scenarios in my... I think I'm a little bit more pro-post. I think you're going to read...

[00:35:45] If you read enough internet forums, there's going to be some... I haven't gotten my post kit out since, you know, Obama first term or something like that. You know, I mean, you're going to hear those people. I hate seeing teeth snapped off with the gum line. And, you know, if you think about how much you're going to prep after the fact, and then how much you boarded to the out interior, you need to be... You know, I don't put very many in molars.

[00:36:13] But premolars and Ford, I'm at least thinking about it. I'm at least considering it. You know? I believe in adhesive dentistry, but I also believe in, you know, overbuilding some of those things. Okay. You know? That's just my take on posts. Posts are controversial. For sure. Interesting. Yep. Yeah, I know. We got a lecture on it, but I've never seen anybody get out a post kit.

[00:36:39] But I was with some pretty pro post instructors in school, and so I got my reps doing my pair of posts. Kevin, what do you like on this? I'm more posty than I used to be, but still a rarity. Okay. Yeah, it's not... It's not... You know, if I do 10, I'm probably... You know, one of them's going to get a post, probably. Right. I'd probably do a handful a year.

[00:37:09] Five or less. All right. That's fine. Yeah. Okay. Something for everyone. Yep. Something for... I think Kevin's slightly more likely to take a tooth that I would put a post in and probably put an implant in it, and I'm probably more likely to, you know... Yep. You know, do a post. That's just me. Yep. Great. You use the tools that are in your tool bag. That's how it goes. Yeah. Perfect. I do have one kind of follow-up question from earlier.

[00:37:37] Kevin, when you say you do the crown prep first, how are you... So, I've never understood people who say they prep crowns under rubber dam, which I know you do on the podcast. I've heard you say that. So, how is it... How are you not cutting up the rubber dam or, like, ruining your isolation? Is it just, like, you're trying to keep everything super gingival? Like, I just...

[00:38:03] I can't picture, like, the dam staying inverted and not being affected. No, Kevin's using it for, like, total... I think he's just trying to keep the cheek and tongue out of the way. Yeah, I don't really care about the isolation. Keep her a hermetic seal. Yeah. But if you are going to do a root canal right afterwards... Mm-hmm. I... I mean, how much is it really going to leak? So, one of the ways I can avoid that is by putting a clamp on the tooth I'm doing the crown prep on.

[00:38:32] That just keeps everything out of the way. It's not like... I'd have to show you... I'd have to show you some photos. He's got photos. We'll put them in very clinical. You'll see. We'll throw them up. Okay. Yeah. Yeah. I would like to see that. I do nearly every crown with a rubber dam on because I'm a freak. Okay. Yeah, I would love to see those photos. I guess the listeners will have to hop on the very clinical to check them out.

[00:39:02] They're teaching you a mostly pretty sound technique. I'm glad they're teaching you rotary. I'm glad they're teaching you. I'm glad you got Firewire files. And I'm glad... You know, ProTaper... You know, there's plenty of new file systems, and Kevin's talked about a lot of them. But, you know, ProTaper still works enough that I've never switched off of it. You know, I'm 20 years using it. Perfect. So, good to know. But it's a... I want to see...

[00:39:28] And when these file systems get old and heavily used like that, they're heavily cloned, which means the price comes down too. Right. Yeah. Anyway. Perfect. All right. Well, for the listeners, thank you for listening, and you'll have to tune in next time for our take on comprehensive exams. See you guys. See you!