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3BDS ENDODONTICS > 4 - Obturation > Flashcards

4 - Obturation Flashcards

1
Q

what increases the likelihood of endodontic success?

A
  • absence of a pre-treatment periodical lesion
  • root canal fillings with no voids
  • obturation to within 2mm of radiographic apex
  • adequate coronal restoration
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2
Q

what are the objectives of obturation?

A
  • to achieve a complete seal (apical, lateral and coronal)
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3
Q

why must endodontic treatment include sealing of the root canal system?

A
  • to prevent tissue fluids from percolating in the root canal
  • prevent toxic by-products from necrotic tissue and microorganisms regressing into peri-radicular tissues
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4
Q

role of obturation?

A
  • reduces coronal leakage and bacterial contamination
  • seals the apex from periapical tissue fluids
  • entombs the remaining irritants in the canal (deprives them of nutrients and lets them remain dormant)
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5
Q

what type of seal is ideal?

A
  • fluid tight or bacteria tight seal
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6
Q

challenges of obturation?

A
  • complex canal anatomy
  • removal of microorganisms: mechanical cleaning does not remove all irritants from the canal (many surfaces untouched by file)
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7
Q

process of successful endodontics?

A
  • diagnosis and treatment planning
  • knowledge of anatomy and morphology
  • shaping and disinfection of RCS
  • obturation
  • coronal seal
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8
Q

poor obturated teeth - procedural errors include?

A
  • loss of length (ledging)
  • canal transportation
  • perforation
  • loss of coronal seal
  • vertical root fracture
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9
Q

importance of obturation?

A
  • eliminates leakage
  • seals apex from peri-apical exudate
  • reduces coronal leakage
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10
Q

single visit - when is it acceptable?

A
  • only in certain circumstances

- for teeth with vital pulp tissue, one visit is preferred

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11
Q

why is one visit for obturation preferred for vital pulp tissue?

A
  • bacterial infection is minimal
  • prevents possible contamination between visits
  • observe aseptic conditions during treatment
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12
Q

guidelines for single visit obturation?

A
  • no significant symptoms
  • no significant clinical signs: tooth should not be TTP
  • canal must be clean and dry: no blood, exudate, pus or smell
  • appointment time must be of sufficient length
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13
Q

multiple visit - indications?

A
  • presence of acute signs or symptoms
  • persistent exudate after drying the canal
  • anatomical difficulties
  • technical difficulties
  • patient or dentist become tired or has lost patience
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14
Q

what is the perceived advantage of obturating over multiple visits?

A
  • allows an antibacterial dressing to be placed in canal between visits
  • CaOH paste is known to reduce the number of residual bacteria following cleaning and shaping
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15
Q

interappointment disinfection: what kind of paste used for dressing? how long must dressing be kept?
Cresophene - what kind of compounds does it contain and why should it be avoided?

A
  • CaOH non-setting paste
  • dress for at least one week
  • phenol compounds. they should be avoided as they are not very effective and very toxic if they contact periradicular tissues
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16
Q

checklist before obturating? what to examine?

A
  • is the pt having any symptoms?
  • examine for clinical signs: tooth TTP? sinus healed? temporary dressing still intact?
  • place rubber dam to prevent microbial contamination and disinfect crown
  • check that the canals are dry with no exudate, pus or bleeding
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17
Q

ideal properties of obturating materials - technical?

A
  • no shrinkage on setting
  • no solubility in tissue fluids
  • good adhesion/adaptation to dentine
  • no water absorption
  • no tooth discoloration
18
Q

ideal properties of obturating materials - biological?

A
  • no allergy for patient or dental staff
  • no irritation to local tissues
  • sterile
  • antimicrobial
  • stimulate periradicular healing
19
Q

ideal properties of obturating materials - handling?

A
  • radiopaque
  • sets in adequate time
  • easy to apply and remove using heat, solvents or mechanical instrumentation
20
Q

obturating core materials?

A
  • gutta percha
  • silver points
  • pastes
21
Q

gutta percha: composition?

used in what form?

A
  • 19-22% gutta-percha
    59-75% zinc oxide
    waxes, coloring agents, antioxidants, metallic salts
  • non-standardized gutta-percha cones sizes F1-F5
22
Q

silver points:
how does it make obturation easier?
what are the issues with usage?

A
  • its rigidity makes placement easier
  • canals often not properly disinfected: leakage and corrosion
  • not adaptable to canal therefore seal limited
  • can be difficult to remove
  • never obturate a silver point re-treatment in a single visit because the flare-up rate is too high
23
Q

accessory cones - what sized should be used with finger spreader?

A

should be used with the same size finger spreader

24
Q

obturating pastes - types?

A
  • zinc oxide & eugenol + formaldehyde (toxic material)

- plastics: resin based

25
Q

obturating pastes - paraformaldehyde: why was it thought to be beneficial? what happens if extruded?

A
  • it mummifies and fixes pulpal tissue

- causes severe neurotoxicity if extruded

26
Q

obturating pastes - resins:

A
  • resorcinol-formalin

- epiphany/realseal: polycaprolactone core and sealer material

27
Q

obturating pastes - resins - resorcinol-formalin:
commonly used where?
sets very hard where? + what does this mean?
what happens if overfilled?

A
  • used commonly in russia, china, india
  • sets very hard in coronal part of canal. therefore it will be hard to retreat
  • can cause neurotoxicity if over-filled
28
Q

obturating pastes - resins - epiphany/realseal:
what kind of material?
develop to do what?

A
  • a polycaprolactone core and sealer material

- developed to bond with each other and canal wall to produce a bacteria tight seal with reinforcement of the root

29
Q

sealers:
- must be used to fill the spaces between what?
- aim for?

A
  • fill the spaces between the gutta-percha cones and between the canal wall to ensure a fluid tight seal
  • aim for maximum gutta percha and minimum sealer
30
Q

cold lateral compaction (obturation) technique?

A
  • LA
  • Rubber dam
  • disinfect tooth with chx, alcohol
  • remove dressing and cotton wool
  • irrigate with citric acid to remove CaOH then sodium hypochlorite
31
Q

cold lateral compaction (obturation) technique - canals are filled with what?

A
  • gutta percha master apical cone
  • protaper next matched to apical size
  • X2-X5
  • 0.02 taper master apical cone (for apical sizes >50)
  • sealer
32
Q

cold lateral compaction with 0.02 taper cones - spreader must fit within how much of working length?
what should be done if this cannot be achieved? why?

A
  • spreader must be within 1-2mm of working length
  • preparation should be refined
  • as lateral compaction in the apical third will be inadequate
33
Q

cold lateral compaction: technique?

A
  • dry canal (correct size of paper points)
  • mix sealer, have spreader ready (rubber stop slightly short of WL)
  • measure MAC to WL and coat in sealer
  • insert slowly in canal to WL
  • leave 10-15 secs with light lateral pressure
  • remove spreader with slight rotation, place accessory cone into channel created
  • repeat until no more accessory cones can be fitted
  • take obturation verification radiograph
  • cut off excess gutta-percha and compact coronal GP using endodontic plugger
34
Q

cold lateral compaction: except for the apical few mm, the root canal will be more tapered than the gutta percha cone - this space is filled by?

A

compacting accessory cones that have been lightly coated in sealer

35
Q

alternative obturation techniques?

A
  • thermoplastic gutta-percha (continuous wave of obturation)

- obturators: thermalfill, guttacore

36
Q

finishing, sealing access cavity - how?

A
  • remove all sealer and GP from access cavity to amelocemental junction: prevents discoloration of crown
  • use cotton wool pledget soaked in alcohol
37
Q

finishing, sealing access cavity - what is placed over gutta-percha and pulpal floor to minimize coronal leakage? what are the bactericidal by-products?

A
  • vitrebond
  • benzene bromine
  • benzene iodine
38
Q

coronal seal - possible reasons why obturated root canals may become reinfected?

A
  • delay in placing permanent restoration
  • fracture of coronal restoration or tooth
  • cracks within tooth structure or exposed deninal tubules
  • poor margins
  • recurrent decay
39
Q

reinfection of the root canal space will lead to?

A

periradicular periodontitis

40
Q

definitive restoration: what is used on anterior teeth? and posterior teeth?

A
  • light coloured composite
  • restoration on posterior teeth depends on what is needed: crown/onlay?
  • usually requires a core buildup in amalgam or composite
41
Q

classification of endodontic outcomes?

A
  • healed: no clinical signs/symptoms, no radiolucency
  • healing: in progress, clinically no signs or symptoms, reduced radiolucency (follow up 4 yrs)
  • persistent/recurrent/emerged disease: periapical periodontitis with/without clinical signs/symptoms
42
Q

what affects periradicular healing?

A
  • accuracy of periapical preparation
  • removal of microbes by effective irrigation
  • control of obturation
  • coronal seal
    (success ultimately depends on control of apical infection)

3BDS ENDODONTICS (4 decks)

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