The hardest part of doing a root canal, in my opinion, is achieving patency. Once I get patency, I find endo relatively straightforward (for the most part).
Getting patency is about learning how the canal feels, staying patient, and figuring out what the tooth is telling you.
Here’s what I wish I knew when I first started.
1. Glide Path First, Always
Don’t shove your file straight to the apex. You need a smooth path first. Use small watch-winding motions with a #8 or #10 K-file and let it find its way down. Forcing it just creates ledges and blocks you’ll regret later.
2. Irrigation Is Your Best Friend
NaOCl isn’t just for show — it’s your debris remover. Every time you hit length, irrigate. If your file suddenly won’t go down, it’s probably packed dentin. Flush, recapitulate, and try again.
I find EDTA works even better than NaOCl because it removes the smear layer, which helps remove blockage and helps open the canals.
3. Recapitulation
Every time you shape/clean the canal, there is a dentinal plug of debris that is in the canal. Go back with your 10 file and scrape the walls to remove that layer.
4. Understand your limitations
Understand that sometimes it may not be a clinical skill issue, but rather the equipment in school. As you develop in your career, you may want to tackle maxillary molar endo.
Certain cases require an endodontist as they are better equipped to locate all the canals, navigate patency, and negotiate curved canals.
5. You’ll Miss & That’s Okay
Everyone blocks canals early on. The key is learning how to unblock them — irrigate, recapitulate, and try again. Each mistake teaches your hands how to read a canal.
Final Thought
Patency isn’t about speed or luck — it’s about control, consistency, and patience. Every canal feels different, and the more you practice, the more your hands start to “see” what your eyes can’t. Don’t fear the struggle. That’s where you learn.
