Intra-Canal Medication, Temporization and Non-Vital Bleaching Flashcards
Is the microbiological status better for one visit Rct or multiple visits?
Multiple visits
What will you put in the canal between visits?
CaOH
_____ is currently the singular most popular
intra-canal medication to use for disinfection of
canal between RCT visits*
–Far less toxic than previous intra-canal medications
–Unfavorable environment for most micro-organisms (pH 12.4)
–Bone healing encouraged in a basic vs. acidic environment
–Antimicrobial activity extends over extended periods (up to 3 mos.)
–Helps to dry a “weepy” canal
–Safe & easily removed by irrigation at subsequent appointment
–DO NOT CONFUSE WITH BC SEALER
–(You will never get set BC SEALER OUT of the canal(s)
CaOH
CaOH tip is placed about ___ mm short of WL (do NOT allow to BIND)
and the CaOH is expressed as the syringe is retracted from the canal.
Objective: fill the canal in its entirety to Cervical Line
2 mm
Temporary Filling
Material should be __-__mm)
(3-4 m
Should you place vitrebond and cotton if tx plan is post?
Cotton no vitrebond
DO you place cotton over obturation if placing crown?
No
Do you crown anterior RCT teeth?
Yes if signifcant loss
Do you crown posterior RCT teeth?
Yes
•Teeth which are discolored and esthetically
unsatisfactory to patient (usually
individual tooth) either following
RCT or previously treated RCT.
Bleaching of non-vital Teeth
Stains you can or can't help help: –Dental Fluorosis –Systemic drugs (tetracycline, etc.) –Metallic components in sealers or fillings –INTRINSIC stains
Can’t help
What do you do in the case of Stains you can’t help: –Dental Fluorosis –Systemic drugs (tetracycline, etc.) –Metallic components in sealers or fillings –INTRINSIC stains
Veneer or full coverage crown
Can or can't leach in Cases involving: –Pulp necrosis that releases discoloring compounds •Bilirubin & Biliverdin –Intrapulpal hemorrhage •Hemosiderin –Extrinsic stains that have not become chronically established in dentinal tubules.
Can
T/F; Patient will often choose
internal bleaching due to
the lower cost factor.
true
T/F: •Do NOT promise anything you can’t deliver.
•Don’t guarantee RESULTS.
•Be sure patient expectations are REASONABLE regarding the proposed procedure.
True
Always agree to __ or ____ visits ONLY for bleaching
2 or 3 visits
Can’t or can easily treat w bleaching: • RCT with post • Thermafil® • Silver Point RCT • Untreated teeth w/ PAR • RCT tooth with pathology • Teeth w/ composites (replace)
Can’t
Do you. need an additional seal over GP for bleaching
yes to not compromise the GP
Failure to provide an additional seal
(barrier) over the gutta percha of the RCT
when attempting internal bleaching will
result in ______of nascent oxygen
(released by bleaching agents) through the
gutta percha thereby destroying the RCT
seal and allowing irritating and toxic
bleaching agents to contact the periapical
tissues. . . OUCH***
percolation
_____ Results:
•Extreme PAIN
•Irate Patient
•Ruined RCT
Percolation
30% Hydrogen Peroxide catalyzed by HEAT
with or without Sodium Perborate can cause ______
Resoprtion: don’t use Hydrogen peroxide
____________ is
apparently the culprit (especially when
heated with Warmed instrument or Heat of
focused bulb)
• Apparently it may follow the
poorly sealed dentinal tubules to attack the
PDL at the cervical extent of the tubules.
• Result is similar to external resorption with
similar hopeless prognosis. Cannot be
repaired.
• The occurrence is not rare:
–Unheated = 6-8% chance
–Heated = 18-25% chance
• “Superoxol” (30% Hydrogen Peroxide)
_____________ is
caustic & dangerous as its use can quickly
create acute topical injury to gingiva and lips
as well as hands and in the eye can cause
blindness***
Can severely burn all soft tissue and cause
severe pain and loss of tooth. Can destroy
bone.
Although Superoxol is effective for internal
bleaching, it’s use is Contraindicated at
UMKC-SOD due to the many dangers and the
serious possibilities of damage from its use.
30% Hydrogen Peroxide (Superoxol)
•is a far safer chemical to use and it can yield reasonably comparable results when sealed in the tooth over a period of 2-3 visits.
Sodium Perborate `
•Mix FRESH Sodium
Perborate USP with _____ or _____ to a
thick consistency.
sterile
water or anesthetic
Cover Na Perborate with a ______
thin
layer of cotton pellets
