interim restorations endo Flashcards
What are eight steps to successful endo?
1. Diagnose and remove cause
2. Use aseptic technique
3. Mechanically instrument to enlargen
4. Irrigate w 1 or more antimicrobial solutions
5. Medicate w antibacterial agent
6. Temporarily restore to avoid bacterial ingress
7. Fill once disinfected
8. Restore tooth to normal function
Why is it important to follow these steps?
Risk potential for-
1. Bacteria in tooth to survive and proliferate
2. New organisms to enter tooth and establish colonies
What is an interim restoration?
Placed in tooth after previous restoration/caries/cracks etc were removed starting endo
Will remain during endo and until filled
What is a temporary restoration?
Placed in access cavity
Likely been cut through interim
What are the most common pathways of bacterial entry?
Caries
Cracks
Exposed dentine
Broken down restoration margins
Why are interim restorations placed?
Endo should never happen through a failing/poor restoration or through a temporary
What are the advantages of interim restorations?
1. Structural integrity
2. Weakened cusp support
3. Coronal seal
4. Easier placement of rubber dam
5. Ideal access cavity can be cut
6. No risk of leakage of irrigant
7. Better retention
8. More comfy and functional
9. Can be used as core if indirect definitive
When wouldn’t you place an interim?
If tooth is unrestored
Only small intracoronal restoration
SHOULD REPLACE if any suspicion
What are appropriate materials for an interim?
Composite
RMGIC
Amalgam
How should you manage large restorations or teeth w cracks?
Metal band- copper ring/ortho band
- supports weakened tooth structure esp cusps
- prevents progression of cracks
Rebuild occlusal surface w amalgam/composite (not RMGIC)
How do you use a metal band?
1. Ensure correct size for tooth
2. Use chemically curing cement to lute (RM/GIC)
3. Good margins for adequate OH
4. Restoration harmonises w occlusion
How do you manage a tooth w a full coverage crown?
Remove
Assess underlying structure
Identify hidden pathology
Better orientation for endo
Better coronal seal
Should only be left if no changes of coronal leakage/hidden pathology
How do you remove a crown?
Take sectional putty impression of tooth for stent for temp crown
Make groove through crown (through to tissue/core)
Twist instrument in and twist
If unsuccessful continue groove occlusal, if not, then lingually
How should you make a provisional crown?
ProTemp/Quicktemp (composite material)
OR
Trim/Snap (cold cure acrylic)
Place in putty stent
Cement w zinc phosphate over temp bond
Consider sealing dentinal tubules w bonding agent
How do you do endo on a tooth w a provisional crown?
Remove before and after endo sessions
Restore access w temporary restoration
Once tx finished- definitive crown
How do you manage a tooth w post crown?
Provide no temp post crown
Restore access w adhesive restoration eg. GIC
OR
Temp partial overdenture w restored access
What are ideal properties of temp restorations?
Provide effective and durable seal
Ease of removal
Obvious difference between tooth/interim
Inexpensive
3mm depth
What materials can you use for a temp?
IRM
GIC
RMGIC
Reinforced GIC
Composite
Cavit/coltisol- difficult to remove
How can you protect posterior teeth w weakened structure?
INTERIM-
1. Occlusal adjustment
2. Cusp reduction and overlay restoration
3. Cemented ortho band
4. Interim crown (metal/composite/acrylic)
DEFINITIVE-
1. Cusp reduction and overlay
2. Onlay/overlay indirect
3. Full crown
How can you adjust the occlusion to reduce loading?
Foil to highlight contacts in ICP
Different colour to highlight contacts in lateral excursion
Diamond bur to remove lateral contacts and keep ICP contacts
Need to be careful, every change will affect other teeth
