Intra-canal medicaments

Question 1

Should endo be done over 1 or several visits

Answer 1

• Vital cases are often suitable for single visits but must be decided on a case by case bases
• Non-vital cases are more complex with greater resistance to endodontic treatment - interappointment dressing may be important
Agreement is generally lacking

Question 2

What is the function of intracanal medicaments

Answer 2

Destroy microorganisms and prevent reinfection between appointments
Proper and careful canal preparation will minimize or eliminate the number of bacteria left within the root canal system
Reduce inflammation and exudate
Control of root resorption

Question 3

What is antimicrobial paste

Answer 3

• Containing corticosteroid and tetracycline
Used during management of ‘hot pulps’
• Can aid in reduction of pulpal inflammation
• Can facilitate follow up treatment (usually within a week)
Effective for 5-7 days

Question 4

What is hot pulp

Answer 4

A hot pulp is a pulpal status when LA is delivered appropriately but does not lead to management of discomfort during instrumentation

By applying AM steroid based paste we can make a reduction in pulpal inflammation which may allow a subsequent instrumentation at a following visit

Question 5

What is non setting calcium hydroxide

Answer 5

• pH12.5
• High pH contributes to anti-bacterial activity
• Numerous studies demonstrate bacterial reduction after inter-appointment dressing
• Prolonged anti-bacterial activity
• Hydrolysis of lipopolysaccharide thus reducing its inflammatory potential
• Effective in removing tissue debris so can aid or supplement the irrigant
• Treatment for 7 days
Combination with NaOCl improved cleaning ability

Question 6

What should be done in interrappointment disinfection

Answer 6

Canal should be completely filled with CaOH paste and done typically after cleaning and shaping has been done
Must come into direct contact with bacterial cell wall to be effective
Placed by injection through a small disposable syringe tip (ultracal, optident) and short of the working length
Should be careful not to extrude material as the high pH can be irritating to periradicular tissues

Question 7

What should the inter appointment temporary dressing be

Answer 7

• Must effectively seal the root canal from contamination between visits
	• Should use 
		○ Cavit
		○ IRM
Glass ionomer cements

Question 8

Why is the temp filling important

Answer 8

• A faulty temporary filling during or following RCT is one of the major causes for coronal leakage
  
  • Failure of the temporary restoration can be due to inadequate thickness of material and failure to evaluate the occlusion after placement

Question 9

How should the temp filling be done

Answer 9

• We want the root canal to be completely filled with CaOh, then sterile cotton wool on top, a smaller layer of cortisol on top of that and then GIC on top which should be 3mm thickness to prevent displacement and leakage
The reason for the cotton wool is because it is bright and easily visualised and so can be removed using an ultrasonic