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Endoclone > ENDO MATERIALS > Flashcards

ENDO MATERIALS Flashcards

1
Q

OBJECTIVE OF ENDO TREATMENT

A

Endodontic treatment is a sequence of treatment of the infected pulp of the tooth to eliminate infection and to prevent the decontaminated tooth from reinfection.

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2
Q

PURPOSE OF INSTRUMENTATION

A

Elimination of pulpal tissue and/or bacteria, allowing effective irrigation and the creation of a root canal configuration suitable for obturation

Preparation of the root canal system is regarded as one of the most important stages in root canal treatment.

Root canal instrumentation: (Hulsmann)

  1. Removes vital and necrotic tissues
  2. Removes infected root dentin
  3. Creates sufficient space of irrigation and medicaments.
  4. Facilitates canal filling
  5. In cases of retreatment- removes root fillings
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3
Q

Aim of instrumentation

A

To prepare a canal space that facilitates disinfection by medicaments and irrigation. Essentially, to eliminate infection within the root canal system.

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4
Q

Techniques of mechanical instrumentation:

A
  1. Hand instrumentation
  2. Automated instrumentation
  3. Hybrid technique
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5
Q

Basic principals of instrumentations:

A
  1. Confine instrumentation to within the root canal
  2. No forcing of necrotic debris beyond the apical foramen
  3. Removal of all vital and necrotic tissue from the root canal space
  4. Creation of sufficient space for disinfection of the root canal system via irrigants and medicaments (Hulsmann).
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6
Q

PURPOSE OF INTRACANAL MEDICAMENT

A

reduce inter-appointment pain, decrease bacterial count and prevent regrowth of bacteria, disinfect the root canals in between appointment

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7
Q

MOST COMMONLY USED intracanal medicament.

A

Caoh
• most widely used
• antimicrobial activity as a result of high pH, dissolves necrotic tissue remnants and bacterial and their by-product.
• long term exposure may weaken radicular root dentine, reducing mechanical properties and reducing fracture resistance. According to Yassen, the reduction in the mechanical properties of radicular dentine occurs with exposure to Ca(OH)2 for 5 weeks or longer.

CORTICOSTEROID
• anti-inflammatory agent. Advocated to decrease post-op pain by suppressing inflammation

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8
Q

Calcium hydroxide

- describe content, characteristic and mechanism of action

A
  • CAOH 50-60%
  • Plasticizer
  • Titanium oxide (filler) 12-14%
  • Alkyl salicyclate
  • Barium sulphate (radiopaque) 32-35%
  • Calcium tungstate or calcium sulphate 14-15%
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9
Q

Calcium hydroxide

- describe characteristic

A
  • White odourless powder
  • Molecular weight 74.08
  • pH 12-12.8
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10
Q

Calcium hydroxide

- describe mechanism of action

A

o Induces mineralisation in tissues
o High pH activates alkaline phosphatase activity which helps hard tissue deposition
o Hydroxyl ion provides an alkaline environment early healing/antimicrobial action
1. Damage to bacterial cytoplasmic membrane
a. Hydroxyl ion induce lipid peroxidation destruction of phospholipid structure of the cell membrane
b. Hydroxyl ion remove hydrogen atoms from unsaturated fatty acids generating free lipidic radical
c. Free lipidic radical + oxygen = lipidic peroxide
2. Protein denaturation
a. Alkalinazation provided with caoh induces the breakdown of ionic bonds that maintains the tertiary structure
b. Results in loss of biologic activity of enzyme and disruption of cellular metabolism
3. Carbon dioxide absorption

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11
Q

properties of caoh

A
  • High pH -> antibacterial
  • Low solubility in water -> sustained released of ca and oh ion over a long period. Reducing number of appointments to replenish caoh medication.
  • Induces mineralisation -> sterile necrosis, inducing dentin bridge formation. The calcified material which is produced appears to be the product of both odontoblasts and connective tissue cells and may be termed osteodentine. The barrier, which is composed of osteodentine, is not always complete and is porous
  • Destruction of bacteria -> high pH damages bacterial cytoplasmic membrane, protein denaturation, damages DNA
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12
Q

Odontopaste

- Describe content

A
  • Triamcinolone acetonide 1% (steroid)
  • Clindamycin hydrochloride (5%)
  • Zinc Oxide based root canal sealer
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13
Q

Odontopaste

- describe properties

A
  • Bacteriostatic

* Reduce inflammation and therefore pain

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14
Q

Purpose of irrigation

A

With MicroCT, it has been shown that the amount of mechanically prepared canal surface and perhaps equally disturbed biofilm in main root canal, depending on canal type, is frequently below 60% of the canal surface (Peters 2010)

Irrigation with antimicrobial solutions is able to disperse into areas in the complex root canal system where mechanical instrumentation is unable to reach

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15
Q

IRRIGATION – ideal properties

A
  • Organic tissue solvent
  • Inorganic tissue solvent
  • Removes smear layer
  • Kill microbes/antimicrobial action
  • Removes microbial by product
  • Non-toxic
  • Low surface tension
  • Lubricant
  • Flush and removes debris generated by mechanical action of instruments
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16
Q

SODIUM HYPOCHLORIDE

- discuss advantage, disadvantage and properties

A
  • Advantages -> mechanical flushing of debris from the canal;, ability to dissolve vital and necrotic tissue, antimicrobial action, lubrications, inexpensive, readily available.
  • Free chlorine in NaOCl dissolves necrotic tissue by breaking down protein into amino acid
  • NaoCl is used in concentration of 0.5%- 5.25%.
  • 2.5% NaOcl is commonly used due to its decreased cytotoxic potential whilst maintaining its tissue dissolving capacity and antimicrobial activity.
  • Because the active ingredient in NaOCl is the free chlorine, increasing the volume of irrigant and warming of the solution can improve the efficacy of NaOCl.
  • Heated NaOCl enhance tissue dissolution capacity but not proven to enhance antimicrobial activities.
  • Because of its high toxicity, side venting irrigation needle must be used, placed loosely into the canal, 2mm short of the WL.
  • Hypochloride accident can occur with extrusion of hypochloride beyond the apical region.

Pros-
- High pulp-dissolving capacity, able to dissolve both vital and necrotic organic matter
- Potent antibacterial effect
Cons-
- high surface tension 48.90 mJ/ limits penetration into irregularities of the root canals and dentinal tubules.

17
Q

SODIUM HYPOCHLORIDE

- mechanism of action

A

Irreversibly inactivates bacterial enzymes

Oxidizes, hydrolyzes and osmotically draws fluids out of tissues

Free chlorine in NaOCl dissolves vital and necrotic tissue by breaking down proteins into amino acids

18
Q

CHLORHEXIDINE

- discuss advantage, disadvantage and properties

A
  • Advantages broad spectrum antimicrobial activity, sustained action, little toxicity.
  • Disadvantage unable to dissolve necrotic tissue and to remove smear layer
  • 2% CHX has similar antimicrobial action as 5.25% of NaOCl
  • CHX more effective against E.faecalis. Which is more prevalent in re-infected root canal system.
19
Q

CHLORHEXIDINE

- mechanism of action

A

At low concentrations, small-molecular-weight substances leak out, resulting in a bacteriostatic effect

At higher concentrations, precipitation and/or coagulation of the cytoplasm, by protein cross-linking, resulting in bactericidal effect

20
Q

What is a smear layer

A
  • Organic pulpal materials and inorganic dentinal debris accumulates on the canal wall during cleaning and shaping. They produce an amorphous irregular smear layer. Smear layer in necrotic pulp may be contaminated with bacteria and their metabolic by-product.
  • 1 to 5m thickness and can be packed into the dentinal tubules

• smear layer in dentinal tubules can function as nutrients for bacterial growth, prohibits smear layer sealer contact with canal wall, permits leakage, interferes with action and effectiveness of root canal irrigants and interappointmnet disinfectants.

17% EDTA (ethylenediamine tetraacetic acid), 1 minute followed y final rinse with NaOCl

21
Q

role of irrigant activation

A
  • Irrigant agitation has been proposed to facilitate dispersion and replenishment of the solutions beyond the confines of the prepared canal space, and to enhance debris removal from the apical region and other morphological and pathological extremities of canals (Heithersay 2007, Gulabivala et al. 2010).
  • Sonic activation generates mechanical agitation primarily on the tip of files
  • Ultrasonic activation generates microstreaming around the file and a secondary acoustic streaming
  • activation improved tissue dissolution
  • Ultrasonic agitation also increases temp of solution which then enhances efficacy of NaOCl (larger #s more than smaller #s). Good adjunct to irrigation (Zeltner M. & Peters O.A. 2009)
  • Heated NaOCl - Equilibrium is usually achieved at 240s with body temperature of 35, despite low or high heat used (Hemptinne F. et al 2015).
22
Q

EDTA

- discuss advantage, disadvantage and properties

A

Ethylene diaminetetraacetic acid
• removal of the inorganic portion of the smear layer.
• The EDTA is an organic acid which eliminates the mineral part of pulp tissue, the surface tension inhibitor will allow a better contact with the dentin for a higher efficiency of the product.
• The EDTA, by eliminating the smear layer and opening the dentinal tubuli will permit an easy flow of NaOCl or chlorhexidine for a better disinfection of the endodontic system.
• It is advised to alternate the use of EDTA from the beginning of the preparation in order to eliminate the mineral layer before its thickening and condensing it inside the canal systems which will close the entrances of lateral and accessory canals and dentinal tubules.

23
Q

what is the irrigation protocol

A
  • Irrigation with 17% EDTA for one minute
  • followed by a final rinse with NaOCl
  • Longer exposures can cause excessive removal of both peritubular and intratubular dentin.
  • EDTA has little or no antibacterial effect
24
Q

MTAD

- what is it?function

A
  • An alternative solution to EDTA for removing the smear layer is the use of BioPureTM MTADTM (DENTSPLY Tulsa Dental Specialties, Tulsa, Okla.)
  • a mixture of a tetracycline isomer, an acid (citric acid) and a detergent.
  • MTAD was developed as a final rinse to disinfect the root canal system and remove the smear layer.
  • The effectiveness of MTAD to completely remove the smear layer is enhanced when a low concentration of NaOCl (1.3%) is used as an intracanal irrigant before placing 1 ml of MTAD in a canal for 5 minutes and rinsing it with an additional 4 ml of MTAD as the final rinse

Endoclone (10 decks)

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