Endo Qs Flashcards
post core crown - no endo, lingual caries, no pain, pt wants no tx
explain options, + and -
- KUO - risk of infection, abscess, tooth breakdown, catastrophic root #
- remove crown & caries, restore with new crown if restorable - removes risk of post removal but does not actually resolve issue of no endo (risk of PA infection)
- remove post core, replace & RCT - removing post core; root #, post/core #, RCT involves series of appts, cleaning out tooth & filling it to prevent infection
- risk of tooth being unrestorable & XLA
options for space replacement - nothing / bridge / denture / implant
risks v benefits of RCT
- instrument separation / failure to get to WL / NaOCl accident / material extrusion / post op pain / swelling / need for analgesia / perforation / root # / file stuck in canal
+ resolution of infection / retain tooth / no loss of bone / abutment potential / no replacement required for missing tooth
putting dam on & using appropriate clamp
correct clamp for correct tooth:
1. anteriors = C / E
2. premolars = E / EW
3. molars = A / AW / FW / K
- use dental floss around clamp
- hole punch dam
- place wedges if > single tooth dam
- opal dam / oro seal around dam & light cure
- place frame outside of face
- check seal using CHX
failed RCT - why has it failed & what are the tx options
failure = overfilled, underfilled, poorly compacted, accessory canals missed, missed canal, inadequately prepared, extrusion of debris, perforation, RCF of incorrect shape, vertical root #, endo file #, blockage or obstruction of canal, poor coronal seal so failed rest
tx options:
1. KUO; no active tx, infection inc abscess may flare up later
2. retx; no surgery needed but chances of success decreased, if post core present may inc root #
3. periradicular surgery if retx not possible, surgery more difficult to tolerate, invasive, time consuming, expensive, nerve damage, reduced support, scarring
4. XLA; tooth loss, needs replacement or non functional & poor aesthetic. risks of XLA
broken file during RCT - temporise & explain what happened
- introduce yourself & your role
- explain thin metal files used to clean out pulp tissue & shape canal, these can separate in tight or curved areas leaving metal tip lodged in canal & this is what has happened
- do what you’re comfortable with & prepared for based on time, access to instruments, illumination, magnification
- do nothing; dress & monitor
- attempt removal with tweezers if you can see file
- bypass fragment by watch winding small file alongside instrument & EDTA to soften dentine
- if removed complete RCT as normal
- if not possible to bypass or remove accept & obturate to file
- retrograde RCT; apicectomy / periradicular surgery
- XLA last resort
- ask if any qs
- check understanding & confirm option
endo rest options for molar
- gold standard cuspal coverage onlay; reduces risk of tooth # / catastrophic failure, less microleakage / better seal
- full coverage crown; gold, comp, porcelain, zirconia, if less tooth structure remaining
- core build up if necessary; gold standard is comp core. need to fill space to retain crown. nayyar core is not favourable. metal cast post if necessary (not favourable)
- direct rest comp / am if only occlusal cavity present. not favourable as more leakage / more likely to #. attempt to extend cavity just past the cusps to provide cuspal coverage
assuming dam has been applied place direct pulp cap on exposed 36 following exposure on mesial axial wall
- explain to pt pulp exposed & requires pulp cap
- address need; vital therapy & risk of death of pulp which could then require RCT
- tooth must be asymptomatic, vital, no hx of pulpitis, exposure must be small & surrounding dentine must be hard or else extirpate
- dam should have already been placed
- arrest bleeding with saline
- irrigate with CHX 0.2% ???
- dry with CW pellets ( do not air dry)
- exposed pulp covered with setting CaOH i.e. dycal
- RMGI lining placed ie. vitrebond & restoration carried out
- continuing vitality monitored i.e. if symptomatic RCT required
