Intra-Canal Medication, Temporization and Non-Vital Bleaching

Question 1

Is the microbiological status better for one visit Rct or multiple visits?

Answer 1

Multiple visits

Question 2

What will you put in the canal between visits?

Answer 2

CaOH

Question 3

_____ 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)

Answer 3

CaOH

Question 4

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

Answer 4

2 mm

Question 5

Temporary Filling

Material should be __-__mm)

Answer 5

(3-4 m

Question 6

Should you place vitrebond and cotton if tx plan is post?

Answer 6

Cotton no vitrebond

Question 7

DO you place cotton over obturation if placing crown?

Answer 7

No

Question 8

Do you crown anterior RCT teeth?

Answer 8

Yes if signifcant loss

Question 9

Do you crown posterior RCT teeth?

Answer 9

Yes

Question 10

•Teeth which are discolored and esthetically
unsatisfactory to patient (usually
individual tooth) either following
RCT or previously treated RCT.

Answer 10

Bleaching of non-vital Teeth

Question 11

Stains you can or can't help help:
–Dental Fluorosis
–Systemic drugs (tetracycline, 
etc.)
–Metallic components in 
sealers or fillings
–INTRINSIC stains

Answer 11

Can’t help

Question 12

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

Answer 12

Veneer or full coverage crown

Question 13

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.

Answer 13

Can

Question 14

T/F; Patient will often choose
internal bleaching due to
the lower cost factor.

Answer 14

true

Question 15

T/F: •Do NOT promise anything you can’t deliver.
•Don’t guarantee RESULTS.
•Be sure patient expectations are REASONABLE regarding the proposed procedure.

Answer 15

True

Question 16

Always agree to __ or ____ visits ONLY for bleaching

Answer 16

2 or 3 visits

Question 17

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)

Answer 17

Can’t

Question 18

Do you. need an additional seal over GP for bleaching

Answer 18

yes to not compromise the GP

Question 19

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***

Answer 19

percolation

Question 20

_____ Results:
•Extreme PAIN
•Irate Patient
•Ruined RCT

Answer 20

Percolation

Question 21

30% Hydrogen Peroxide catalyzed by HEAT

with or without Sodium Perborate can cause ______

Answer 21

Resoprtion: don’t use Hydrogen peroxide

Question 22

____________ 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

Answer 22

• “Superoxol” (30% Hydrogen Peroxide)

Question 23

_____________ 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.

Answer 23

30% Hydrogen Peroxide (Superoxol)

Question 24

•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.

Answer 24

Sodium Perborate `

Question 25

•Mix FRESH Sodium
Perborate USP with _____ or _____ to a
thick consistency.

Answer 25

sterile

water or anesthetic

Question 26

Cover Na Perborate with a ______

Answer 26

thin

layer of cotton pellets