Endo

Question 1

explain benefits of endo tx

Answer 1

retain tooth
prevents bone loss
better function and aesthetics
dont require replacement for missing tooth
can use tooth as abutment

Question 2

explain risks of endo tx

Answer 2

risk of failure - infection persists, 80% if necrotic, 90% if irreversible pulpitis
instrument separation - instruments used to clean out space, risk of breaking - specific if roots are narrow or curved
perforation - going through the tooth into tissue, higher chance if root curved
pain persisting
also need to make pt aware - multiple appointments, cost invovled, will require restoration too with cost involved

Question 3

what are alternatives to endo tx

Answer 3

leave and monitor - risk of pain developing in future, abscess forming, spreading infection
surgical RCT - will require referral to specialist for assessment
XLA - need to replace tooth, will have cost involved

Question 4

describe endo tx

Answer 4

nerve inside your tooth is dying (or dead) and needs to be removed, have to go in through crown of tooth (bit you can see in mouth, biting surface), drill down until reach nerve space, then use small instruments to go down the root of tooth, remove nerve and remove debris and create space to put a filling material inside, will use strong solutions to clean out nerve and kill any bugs remaining - need to protect mouth from these so will put a sheet over mouth - called dental dam
once root is thoroughly cleaned out, no more pus or blood, and enough space has been created, will fill space to prevent bacteria coming back in - then will need a filling over the top

Question 5

lingual caries on post core crown - not RCT - explain options

Answer 5

• leave and monitor - risk of infection, abscess, pain, catastrophic fracture
• remove crown and replace - might be unrestorable once crown removed, still not RCT so once crown done, still risk of infection, pain, abscess and removal of new crown
• remove post core crown and replace - can carry out RCT, reduce risk of infection but not guarnteed only 80% chance of success, and might be unrestorable once crown removed
• if tooth unrestorable - XLA and replace space with bridge, denture, or leave

Question 6

a file has broken in the tooth what do you do

Answer 6

if feel comfortable, try to retrieve instrument - if can see it
stop what you are doing, dress the tooth
tell the patient - one of the instruments we use to clean out the nerve has separated inside your tooth
advise patient to take painkillers - as with every RCT, will be painful
advise patient - referral will be made to a specialist to try to retrieve file, more experienced, if they are okay with this
option of XLA or leave and monitor but risk of infection
if specialist can retrieve file - will continue RCT

Question 7

what are restorative options for molar tooth following RCT

Answer 7

gold standard - cuspal coverage onlay - prevent catastrophic fracture and good coronal seal to prevent ingress of bacteria
if insuffucient tooth tissue remaining - core build up and crown - cuspal coverage, less tooth structure but good seal
can do direct restoration but poorer prognosis, hollowed out tooth during RCT - weaker and not as well supported, restoration doesnt provide support - higher chance of fracture