When I qualified, we used endomethasone for root fillings, as SPAD was a bit toxic. I remember an article on a review of the 100% success rate of endomethasone being spun through the apex in anterior teeth of 24 RAF personnel. This is the closest paper on a comparison with laterally condensed GP I could find. It's from my dental tutor who is the current president of the European Society of Endodontology. If I was good at statistics, I'd say there was no difference, but perhaps we ought to contact the ex RAF personnel and advise they have their teeth removed in case of a potential problem.
Fortunately, I never witnessed an air embolism and in all my time, I never seem to have extruded any hypochlorite. The best advice I received was in the pub about twenty years ago from a physics PHD student who was writing his thesis on the movement of fluids in confined spaces. Fluid always follows the path of least resistance, so unless you have jammed in your needle or not in the pulp chamber, it should be safe. Once the hypochlorite is visible around the needle, why put in any more. There will be displacement when you place your rotary file. The excess will flow into the floor of the access cavity. Applying more pressure when applying the hypochlorite at best fills up the access cavity, and at worse could extrude. Why bother? The files should carry the hypochlorite around the root canal surface. There is no need to fill it. I used to wash out the hypochlorite with hypochlorous, and if you could dry the canal, I'd fill it.
As you wash with a 3 in one and high volume suction, and air dry over the tooth, then cotton wool balls and paper points. I didn't get an air embolus which was a real concern for about twenty-five years of my practising life, and far more likely on those complicated extractions when you had to separate roots.
And it would seem if ever there was any loss of the hypochlorite into the oral cavity, it would be rapidly less than 0.2%. So apart from the taste. No harm done.
I know of crowns being at best swallowed, and worse inhaled—the same with bristle brushes, teeth, and rubber dam clamps. Last year I saw a patient as an emergency as he woke up one morning with something in his mouth. He handed me his implant. It definitely wasn't one of mine.
I don't do implants.
We used a rubber dam for hand files. Am I the only one who never uses hand files, everything is rotary and firmly attached to my reduction handpiece? I take a working length with Gp Points, and the preformed GP isn't quite the same as the GP we used in the past. The results I had over the last ten years were as good, and probably better than with silver points, or Gp placed with endomethasone in the 80's.
I used thermafill about twenty-five years ago and like a few other dentists I know, found while they looked great on the radiograph, the patients didn't like them. Or put another way they had poorer outcomes, than with a single preformed GP point.
If you want to fill some lateral canals, then smartseal seems to fit the bill. I had success with this. But we will never clean all the pulp tissue, we just need to clean enough. How much is enough? In my experience it seems to vary from person to person. A bit like the reaction some of the public have to covid.
I clearly am not a specialist endodontist, I was a GDP and I was at an age where if a root filling failed, and a patient complained, and an expert witness said I'd missed the 2mb canal, or a lawyer said the notes didn't have the expiry date of the Gp on. I would have done what the defence organisation would advise, and give the patient their financial compensation. And I would have retired.
The three radiographs above could make up a few more blogs.
This is in the Ethics section. So is it ethically right that we are passively deskilling to protect ourselves. The reason to work is to stretch ourselves, not to refer to some non-existent NHS specialist. We need to change our health delivery system to help the public, and start to enjoy the career you trained for.