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Conservation > Biomechanical Preparation - Irrigation > Flashcards

Biomechanical Preparation - Irrigation Flashcards

1
Q

Name 3 reasons to use L.A.

A
  1. Vital pulpal tissue
    2, Placement of rubber dam is painful
  2. Tooth is TTP
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2
Q

What is the most common type of L.A used?

A

Lignocaine with adrenaline

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3
Q

What may be used if the patient’s PMH contraindicates use of adrenaline?

A

Scandonest (lignocaine with no adrenaline)

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4
Q

Name 3 functions of irrigation during canal negotiation and enlargement

A
  1. Lubricate instruments
  2. Flush out debris
  3. Dissolve organic matter
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5
Q

Name 2 functions of irrigation during mechanical shaping to final taper

A
  1. Flush out debris

2. Dissolve attached inorganic matter (Smear layer)

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6
Q

Name 2 functions of irrigation after mechanical shaping

A
  1. Dynamic irrigation

2. Penetrate canal peripheries

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7
Q

What are 3 commonly used irrigants in endodontics?

A
  1. Sodium Hypochlorite (NaOCl) 2%
  2. Chlorhexidine 2%
  3. Ethylene-diamine tetracetic acid (EDTA) 17%
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8
Q

Describe NaOCl mode of action

A
  • Forms nitrogen, formaldehyde and acetaldehyde on contact with tissue proteins
  • Proteins dissolve and hydrogen replaced by chlorine forming chloramines
  • Chloramines have antimicrobial action
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9
Q

Describe the delivery of NaOCl

A
  • Capable of dissolving inorganic tissue
  • Safety sided syringes with Luer Lock design used
  • Prevent extrusion in periapical tissues (2mm short of WL)
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10
Q

Describe the 3 common potential symptoms of a hypochlorite incident, if maxillary antrum is not involved

A
  1. Severe immediate pain
  2. Swelling
  3. Profuse bleeding interstitially and through the tooth
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11
Q

Name 4 potential ways to tell if a hypochlorite incident involves the maxillary antrum

A
  1. Haemolysis
  2. Ulceration
  3. Inhibits neutrophil migration
  4. Damages endothelial cells
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12
Q

Name 5 ways to prevent hypochlorite incidents

A
  1. Pre-op IOPA and determining correct WL
  2. Straight line access
  3. Side vented, screw on needles
  4. Needles should be passive and not reach WL
  5. Deliver irrigant with minimal pressure
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13
Q

Describe the management of hypochlorite incidents

A
  • Stop irrigation and reassure patient
  • Irrigate canal with copious amounts of saline or water
  • Dry, dress and temporarily restore
  • Adverse incident (IR1) form must be completed
  • Follow up is essential at 1 day, 1 week and there-after as necessary
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14
Q

Describe chlorhexidine as an irrigant

A
  • Low level toxicity
  • Binds to hard and soft tissue increasing substantivity
  • Lacks tissue dissolving property and does not remove smear layer
  • Possible allergic reactions
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15
Q

Describe the mixing of NaOCl and chlorhexidine as irrigants

A
  • Avoid
  • Impairs disinfection and seal of root filling
  • Precipitate forms which is potentially carcinogenic
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16
Q

Describe EDTA as an irrigant

A
  • Dissolves inorganic tissue
  • Chelates heavy metal ions in biofilm and degrades biofilm on un-instrumented walls of root canal system
  • Mild antibacterial effect
  • Extended use may weaken the tooth
17
Q

What is the Smear Layer?

A

A surface film of debris retained on dentin and other surfaces after instrumentation with either rotary instruments of endodontic files

18
Q

What does the Smear Layer consist of?

A

Dentin particles, remnants of vital or necrotic pulp tissue, bacterial components and retained irrigant

19
Q

Name 3 types of irrigation techniques

A
  1. Manual agitation
  2. Mechanical agitation
  3. Fluid delivery
20
Q

Describe how the patient should be cared for between visits during RCT

A
  • Tooth should be dressed to protect canals
  • Intra-canal medicaments are necessary
  • Cotton wool should be used to prevent temporary dressing getting into canal
  • Temporary restorations may be used
21
Q

What is the medicament of choice between appointments?

A

Calcium hydroxide

22
Q

Name 4 reasons hypocal is a good inter-appointment medication

A
  1. Alkaline so good antimicrobial
  2. Dissolve organic tissue
  3. Easy to remove
  4. Osteogenic effect
23
Q

Name 2 inter-appointment medications which are less commonly used than hypocal

A
  1. Steroids

2. Iodine Potassium Iodide

24
Q

When is iodine potassium iodide useful as an inter-appointment medication?

A

Refractory cases as iodine has effects on E. Faecalis which is prevalent in recurrent cases

25
Q

Name the 3 components of odontopaste

A
  1. 5% clindamycin
  2. 1% Triamcinolone acetonide
  3. 0.5% CaOH
26
Q

Name 2 reasons to use systemic antibiotics in endodontics

A
  1. Refractory cases

2. Extra-oral swelling

27
Q

Why is periapical disease not cured by systemic antibiotics alone?

A

There is no blood supply to necrotic pulp

Conservation (27 decks)

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