6. Intra Canal Medicaments

Question 1

Should RCT be carried out at single or multi visits?

Answer 1

No answer here

vital cases - suitable for single visits

non vital cases - more complex, greater resistance to end tx so inter appointment dressing is important

Question 2

What are main indications for RCT?

Answer 2

Irreversible pulpitis

Pulpal necrosis

can be caused by caries, tooth cracks, chips, dental trauma

Question 3

What is successful RCT characterised by?

Answer 3

Absence of symptoms - ie no pain

clinical signs - reduced swelling, no sinus tract

Question 4

What is purpose of intra canal medicament?

Answer 4

Used to eliminate residual bacteria or prevent bacteria repopulating the canal system

Question 5

Most popular intra canal medicament?

Answer 5

calcium hydroxide

Question 6

What do some studies say about calcium hydroxide?

Answer 6

It fails to produce sterile root canals and can allow regrowth in some cases

Question 7

What does a one visit RCT aim to do?

Answer 7

Eliminate bacteria or render them harmless by carrying out obturation immediately in one visit to deprive MO form nutrition and the space required to survive and multiply

Question 8

What can GP do to residual bacteria?

Answer 8

The zinc in GP can have antimircobial action which can kill residual bacteria

Question 9

Where are intra canal medicaments placed?

Answer 9

inside root canal between appts in attempt to destroy any remaining MOs and prevent re infection

Question 10

Why do we use intra canal medicaments?

Answer 10

to prevent re infection

destroy remaining MOs

reduce inflammation

Question 11

What intracanal medicaments can we use?

Answer 11

Anti-microbial pastes

Non setting calcium hydroxide

Question 12

What does anti-microbial paste contain?

Answer 12

Steroid - anti inflam

Tetracyclin - anti microbial

Question 13

When can antimicrobial paste be used?

Answer 13

During management of hot pulps - good when LA doesn’t lead to management of discomfort during instrumentation and helps to reduce inflammation which is helpful for second visit for follow up tx

Question 14

How long can antimicrobial paste be left in the canal system?

Answer 14

5-7 days - limited time then needs follow up visit

Question 15

What is non setting calcium hydroxide?

Answer 15

This is an alkaline medicament with pH of 12.5 which has antibacterial activity

Question 16

What do studies show with use of non setting calcium hydroxide?

Answer 16

That there is bacterial reduction after inter appt dressing

Question 17

What does non setting CaOH do?

Answer 17

It removes tissue debris as it disrupts organic tissue and can help to aid NaOCl irrigant

Question 18

How long should NS CaOH be in place for?

Answer 18

7 days - at least a week before pts next appt

Question 19

Why is it good to use NS CaOH in combo with NaOCl?

Answer 19

have an improve cleaning ability and disinfection ability.

Question 20

How do we place non setting calcium hydroxide?

Answer 20

completely fill canal with paste and ensure its in contact with bacterial cell wall to be effective

we place it using small disposable syringe tip after cleaning and shaping canal

Question 21

What can extrusion of intra canal medicaments do?

Answer 21

They can irritate peri-radicular tissues so make sure to use rubber stop

Question 22

How do we seal root canal from contamination?

Answer 22

Cavit

IRM

GICs

Question 23

How do we seal root canal after placing intra-canal medicament?

Answer 23

1. place intra canal medicament
2. place small sterile cotton wool ball
3. place few mm of coltosol
4. place 3mm thickness of self cure GIC

Question 24

What is coltosol?

Answer 24

bright white material that sets hard - acts as an intermediate layer on top of corona wool that we can see easily and remove with ultrasonic - prevents us cutting through very thick GIC

Question 25

How do we ensure restoration is as stable as possible?

Answer 25

cotton wool ball -sterile

coltosol 1-2mm

gic - 3mm

Question 26

What is main cause for coronal leakage?

Answer 26

Fault temproary filling during rct

Question 27

Why can temp filling fail?

Answer 27

If inadequate thickness of materiall

if material isn’t placed properly

if we dont evaluate occlusion after placement