Endodontic Medicaments Flashcards
What are the aims of endodontic treatment?
Remove all microorganisms from the root canal system
Remove all canal contents that may lead to growth of micro-organisms or the breakdown of toxic products and their release into periapical tissues
To prepare the canal for its disinfection and to develop a shape that permits a simple and effective root canal filling to be placed
To prevent micro-organisms from entering the tooth again and re-establishing infection in the root canal system as this causes apical periodontitis
Why are inter-appointment antibacterial dressings necessary?
Bystrom and sundqvist + Sjogren and Sundqvist observed that there were increased bacterial numbers in the empty canals between appointments.
Why are medicaments used?
Anti-bacterial action: Residual bacteria in the canals, tubules, fins, etc, contaminants between visits, periapical region contamination, periodontal tissues.
Reduce periapical inflammation
Prevent or reduce pain
Stimulate periapical repair
Prevent or inhibit inflammatory resorption
- Inactivating endotoxins and killing bacteria is why medicaments are so important for treatment during RCT *
What did microbiological analysis of teeth with failed endodontic treatment reveal?
ONE STUDY: 12% of microbes were present at the time of root filling only 33% of the cases healed.
88% no microbes were present and in these 80% healed.
The 47% difference was statistically significant
ANOTHER STUDY: All teeth were initially infected and 40% still had bacteria after instrumentation.
94% of the negative culture RCFs completely healed after 5 years and 68% of cases with positive culture RCF completely healed.
The 26% difference was statistically significant.
CONCLUSION: If there are organisms in the canals at time of treatment they will likely still be there after preparation and irrigation and so there is an emphasis on eliminating the bacteria from canals prior to placing the RCF.
Why should root canal treatment be done over several visits?
Canals need to be removed from canals prior to placing RCF.
This cannot be reliably achieved in one visit.
This demonstrates that it is not possible to remove all organisms from root canals without the support of inter-appointment anti-microbial dressings.
NOTE:
Some root canals heal after initial treatment with one visit
What has ledermix been shown to do to post-op pain?
Significantly less post-operative pain than the Ca(OH)2 group and the control group. (Ehrmann et al - IEJ 2003)
Why is bacteria removed from the canal?
Direct result of bacteria in the canal is inflammation. Removing them will reduce that. 2 type of inflammatory resorption internal and external.
Why is ledermix paste used?
Ledermix paste is an effective intracanal medicament for control of post-operative pain associated with acute apical periodontitis. (better than treatment with calcium hydroxide only and better than control group)
Reducing inflammation and killing bacteria with steroid + Antibiotic.
How long is ledermix paste used on the canal for?
3 to 4 months
Why are 2 or more visits used for treatment of teeth in need of RCT?
To increase the predictability of periapical healing by destroying more bacteria and by changing the environment within the canal and to reduce post-operative pain and external inflammatory root resorption.
Why should multiple visits still be used in cases of “elective endodontics” or pulpitis treatment?
Canals were found to be infected with bacteria in 29% of samples taken from root canal and pulp tissue.
Irreversible pulpitis often has primary acute apical periodontitis associated with it.
Why is there still pain following removal of pulp in a RCT?
Removing pulp implies severing the nerve fivers which will invoke periapical inflammation.
Neural response to removing the pulp is a derangement of the plexus of the nerves around the apical third of the root and axon sprouting/branching.
Inflammatory and neural changes continue for at least one year after RCT. (in cats)
This can explain the different sensation/discomfort reported by patients following endodontic treatment.
How can amount of nerve sprouting be reduced?
Corticosteroids can reduce the amount of nerve sprouting considerably but not totally.
How effective are corticosteroids for reducing pain?
C-Sts are even more effective than NSAIDs at reducing pain.
What is the purpose for using ledermix and calcium hydroxide?
Ledermix paste is a good agent to reduce inflammation while also having antibiotic properties.
Antibacterial action is mostly controlled by the calcium hydroxide.
Hard tissue repair is assisted heavily by calcium hydroxide.
