Endo: Medicaments

Question 1

Rationale for Medicaments?

Answer 1

• reduce interappointment pain
• decrease bacterial count
• innert canals

Question 2

Medicament Types

Answer 2

• Calcium Hydroxide
• Phenols, aldehydes
• Steroids
• Chlorhexidine

Question 3

Calcium Hydroxide:

Answer 3

• Most commonly used medicament
• High pH Kills bacteria
• might dissolve necrotic tissue remnants
• does not reduce pain
• suggested for teeth with:
  
  • necrotic pulps
  • bacterial contamination
• Powder or paste
• can be dificult to remove in apical portion of canal prep
• Take POST OP PA’s to check for overfilling into inferior alveolar canal, mental foramen
  
  • Refer wiithin 24 hours if overfilled
  • keep confined to root canal system

Question 4

Temp Canal

Answer 4

• used in clinic-Calcium Hydroxide
• Doulbe side vented needle
• can safely place into apical 1/3 and prevents overfills

Question 5

Phenols and Aldehydes:

Answer 5

• Names
  
  • CMCP
  • Formocresol
• Both are toxic
  
  • destroy host tissues
• Aledhydes-tissue fixative
• Systemically distributed when put into canal
• no effect on controling interappointment pain
• NOT USED IN CLINIC

Question 6

Corticosteroids:

Answer 6

• Antiinflammatory agents that Reduce pain

Question 7

Chlorohexidene Gel

Answer 7

• 2% gel recommended
• can be used alone or mixed with calcium hydroxide
  
  • mixed=greater antimicrobial activity han calcium hydroxide alone
• Efficacy
  
  • toxic to stem cells

Question 8

Temporary restorations

Answer 8

• Seal root canal system between appointments-coronally
  
  • prevent oral fluids and bacteria in and intracanal medicaments outs
• Enhance isolation
• Protect tooth structure until final restoration is placed
• Easy to place and remove
• Esthetics
• needs to last several days to weeks
• may replace one surface or multiple surfaces

Question 9

Temporary restoration types:

Answer 9

• Cavit
• IRM
• Glass Ionomer

Question 10

Cavit

Answer 10

• premixed
• sets in presence of moisture
• easy to use
• good sealing properties
• low strength
• rapid occlusal wear
• use with single surface temporary restorations
• Ingredients:
  
  • zinc oxide
  • calcium sulfate
  • Ethylene Bis-Diacetate
  • Zinc Sulfate
  • Polyvinyl Acetate

Question 11

IRM

Answer 11

• Powder ingredients:
  
  • Zinc Oxide
  • Poly-methyl methacrylate
  • Pigment
• Liquid Ingredients:
  
  • Augenol
  • Acetic Acid
• Strength (relative strong)
  
  • lasts up to one ear
• use when proimal surfaces are missing
  
  • alternative to cavet

Question 12

Glass Ionomers:

Answer 12

• Fuji IX
• Fuji Triage-“Pink”
• when used to build up a tooth
  
  • make sure to cover canal orifi and pulp chambber so you can reenter the canals.
  • can flow and block yourself out and cant find canals

Question 14

Intraorifice barriers

Answer 14

• Restorative material placed over canal orifi after obturation
• Protects obturation from being contaminated should temporary or permanent restoration fail
• Vitrebond:
• teeth without intraorifice barrier leaked more

Question 15

Permanent restorations:

Answer 15

• Need good endo with Good restoration=highest success rate of root canal
• 3% of endo treated teeth were lost due to inadequate permanent restoration after 8 years
• Optimaal Restoration:
  
  • Preserve remaining tooth structure
  • minimize cuspal flexure
  • provide coronal seal
  • satisfy function and esthetic requirements

Question 16

Ferule

Answer 16

• Band of metal around tooth
• prevents tooth fracture
  
  • >1mm of tooth structure=more effective

Question 17

coronal seal

Answer 17

• Critical to endodontic success
• permanent restoration needed to protect coronal seal long term

Question 18

Restoration time:

Answer 18

• As soon as possible
• Temporary restoration
  
  • temporary
  • may not protect against occlusal stress

Question 19

Restoration Design:

Answer 19

• Conserve tooth structure
• Retention
  
  • Post is used to retain core if not a lot of tooth is left
• protect remaining tooth structure

Question 20

Anterior Restoration

Answer 20

• Direct restoratoin
• Full coverage
  
  • post and core may be needed

Question 21

Posterior Restorations:

Answer 21

• Cuspal coverage amalgam
• Full coverage restoration
  
  • all metal
  • metal-ceramic (PFM crown)
  • all ceramic (porcealin crown)

Question 22

Post and Core

Answer 22

• Post
  
  • retains the core
  • weakens the tooth
• use correct post system for the tooth
  
  • custom cast post
  • prefabricated post

Question 23

Posts

Answer 23

• Tooth colored for maxillary anteriors
  
  • carbon fiber and quartz fiber
  • less retentive?
• Threaded posts not recomended

Question 24

Post Space Preparation

Answer 24

• Larger the gap, higher chance of post treatment disease b/w gutta purcha and post
• leave 5mm of gutta-percha minimum to ensure apical seal
• Judicious dentin removal
• stay on long axis
• respect root curvature and concavity
• remove gutta purcha at time of obturation if possible
• remove with heated instrume
  
  • carefule if using gates-glidden or peeso