Endo - techniques Flashcards
In what patient groups do you have to exercise caution with in regards to endodontic treatment? (4)
1st trimester
Diabetics - poor healing/outcomes
Use of bisphosphonates
Cancer - chemo/radiotherapy compromises healing
In what patients is endodontic treatment contraindicated? (1)
myocardial infarction within last 6 months
what are the complications of endodontic treatment? (4)
perforation
broken instruments/separation
extrusion of the irritant NaOCl
Pain
what chemicals are used for irrigation? (2)
sodium hypochlorite 3%
EDTA 17%
what are the advantages of irrigation? (5)
cools the file and the tooth prevents packing disinfectant as it is antimicrobial reduces friction dissolves tissue
why do we irrigate the canal with saline in-between the use of sodium hypochlorite and EDTA?
EDTA reduces the effectiveness of the sodium hypochlorite
when can Endo treatment not be carried out in one visit? (1)
If the patient has an acute infection and has symptoms
- need to use intra-canal medicaments
what inter canal medicaments can be used between visits? (2)
GOLD STANDARD = NS calcium hydroxide
odontopaste - contains steroids
When would we opt to use odontopaste over NSCaOH (medicament)?
if the patient has a hot pulp which doesn’t respond to LA
what are the advantages of using NSCaOH as medicament? (3)
Easy to remove since doesn’t set
Antimicrobial since very alkaline
removes tissues debris
what are the DISADVANTAGES of using sodium hypochlorite as irrigation? (6)
allergy apical extrusion modifies the organic content of dentine doesn't remove the smear layer ophthalmic injury discolouration of clothes
what irritant removes the smear layer?
EDTA
list the constituents of GP. (4)
gutta percha 20%
zinc oxide 65%
plasticisers 5%
radio pacifiers 10%
Describe the Herb Schilder principle for Endodontics treatment (2)
smooth continuously tapering funnel shaped canal
With an apical restriction that remains at the same point and the same size
list the ideal properties of sealers (7)
tacky radiopacity bacteriostatic insoluble in tissue fluids slow set easily mixed no shrink when set
list the uses of sealers (3)
lubricates
seals the spaces between the dentine wall and the core
seals voids and irregularities
define estimated working length
the estimated length from the reference point that instrumentation is limited to
define corrected working length
The length in which the instrumentation and obturation should be limited to.
What is the function of a NaOCl irrigant? (3)
- Dissolves: organic matter, necrotic tissue and vital tissue i.e. pulp remnants and collagen.
- Helps disrupt the smear layer (but doesn’t entirely remove)
- Hypochlorite = antibacterial action.
What are important factors to consider in NaOCl use? (5)
Concentration - 3%
Volume - 30ml
Contact - for 10 mins
Mechanical agitation - manual dynamic irrigation using gutta percha points and pumping motion.
Exchange - improved by mechanical agitation
How would we manage NaOCl/irrigant extrusion? (7)
- Stop all treatment
- Inform patient
- If patient in pain - use block local anaesthetic at the site
- If there is bleeding - allow it to continue until haemostats occurs
- Place a steroid-containing intracanal medicament (Odontopaste) in the root canal - do not use pressure to apply.
- Do not obturate but seal the coronal access cavity
- Review after 24 hours
What is the aim of obturating? (2)
To fill the whole canal to prevent the passage of microorganisms and fluid.
To block the apical foramen, accessory canals and dentinal tubules
when is it ok to obturate?
No symptoms or signs of active disease
- If the patient has acute infection with symptoms present the chemomechanical disinfection and obturation will have to be done in separate visits.
What are the ideal properties of an obturation material? (8)
- Biocompatible
- Dimensionally stable
- Able to seal
- Unaffected by tissue fluids
- Insoluble
- Non-supportive of bacterial growth
- radiopaque
- Removable from the canal in the need for pretreatment
what material do we use to obturate? what is it?
Gutta Percha- Polymer of isoprene
what obturation technique do we use with GP cones?
cold lateral compaction
what sealer do we typically use?
GI sealer - bonds to dentine
