Intra- Canal Medication, Temporization and Non-vital bleeding Flashcards
rubber dam prevents:
- swallowed/aspirated instruments
- loss of your money and time
is there a difference in outcomes between RCT completed in a single visit vs RCT completed in multiple visits
no
describe the single visit
single visit RCT is acceptable as a modern evidence based standard in general; most predictable with vital teeth and no P/R pathoses
is single visit common at UMKC
no, time seldom allows for it
studies show that cases with primary apical periodontitis completed in multiple vists with CaOH as an interim intra-canal medication:
improved the microbiological status of the root canal system
what is one of the primary goals of RCT
to reduce the microbiological status of the root canal system to the extent at which P/R healing can occur
the 2 or even 3 visit protocol RCT is acceptable and may be superior in terms of:
reduction of micro organisms in the canal system in teeth with P/R pathosis as a modern evidence based standard in general
at UMKC teeth with peri radicular pathosis or necrotic pulp will be treated with:
at least one week with intra canal medication with Ca(OH)2 before obturation
- DST should heal
between RCT visits or at any time the canal is not protected by adequate rubber dam isolation the canal must be protected from salivary contamination by:
some type of temporary filling
when is an indication for intra canal medication
anytime obturation is not yet accomplished
any time that a temporary restoration is placed:
it is a good idea to medicate and seal with proper interim temporization
what is the most popular intra canal medication to use for disinfection of canal between RCT visits
CaOH2
why is calcium hydroxide the intracanal medicament of choice
- far less toxic than previous intra canal medications
- unfavorable enivronment for most micro organisms
- bone healing encouraged in basic vs acididc environment
- antimicrobial activity extends over extended periods (up to 3 months)
- helps to dry a weepy canal
- safe and easily removed by irrigation at subsequent appointments
what is the pH of CaOH2
12.4
can you get BC sealer out of canals
no
can you get CaOH2 out of canals
yes
how is CaOH2 used
the tip is palced about 3mm short of WL ( do not allow to bind) and is expressed as the syringe is retracted from the canal
what is the objective in placing CaOH2
fill the canal in its entirety to the cervical line
when do you need to be careful about using CaOH2 and why
if you have a mandibular PM or molar with open apices, it is possible to force CaOH out the apex and into the mandibular canal possibly causing paresthesia and severe and lasting pain to the jaw and face
what do you do after you place CaOH2 in the canal
- clear excess CaOH2 from chamber
- place sterile cotton pellet in chamber to prevent clogging of the canal with temporary filling material
- temporary filling is palced following cotton pellet
how is temporization between visits done
- sterile cotton in chamber over CaOH2
- place cavit, IRM, amalgam or composite over cotton
describe cavit
- comes from the tube or jar ready to place in the tooth
- no mixing
- 1-2 week duration of seal- seals better than IRM but deteriorates rapidly
- best used only for 1 surface access
describe IRM
- 1-4 week duration of seal = stronger
- use when 2 or more surfaces are missing
when do you use composite, amalgam, or temp crown as a temporary
- when considerable tooth structure is compromised or a greater delay to next treatment visit is anticipated
how thick should the temporary filling be
3-4mm
how thick should the cotton be in a temporization
2mm
what is the process of temporization following obtuation
- vitrebond (RMGI) is recommended to seal the obturated canal (GP) against leakage following successful RCT completiion while awaiting permanent restoration
- if saliva remains in contact with GP for 72 hours retreatement will be required
- leave vitrebond when placing final restoration as directed in your team
what do you do if the treatment plan calls for a post
- place cotton over obturation
- no vitrebond
- place substantial IRM, amalgam, or composite or temp crown over cotton - X-ray - completed RCT film without rubber dam
- place rubber dam, remove IRM, amalgam or composite and cotton and proceed with post and planned restoration
what do you do if you are going to place permanent build up same day because the tx plan calls for a crown
- do not place cotton over obturation
- place amalgam or vitrebond and composite as build up - Xray - RCT without rubber dam
- proceed later with crown prep in team
what is the protocol for restoration of anterior teeth
- minimal structural loss: vitrebond and composite
- significant structural loss: crown or post and crown
what is the protocol for restoration of posterior teeth
- cuspal coverage
- minimal structural loss: crown (all posterior)
- significant structural loss: post and crown
do posts strengthen the tooth
no they weaken it
what do posts provide to the coronal restoration
retention
what is vital external bleaching of teeth
- generalized whitening (not associated with RCT)
what stains cant you help
-dental fluorosis
- systemic drugs- tetracycline
- metallic components in sealers or fillings
- intrinsic stains
what alternative treatments might you offer for staining
opaque later and veneer, PJC or PFM crown
which discolorations can be bleached
- pulp necrosis that releases discoloring compounds: bilirubin and biliverdin
- intrapulpal hemorrhage: hemosiderin
what are the treatment options for bleaching
- do nothing
- internal bleaching
- veneer
- PJC or PFM crown
which tx option will patients choose for bleaching and why
internal bleaching because lower cost
what needs to be done before non vital internal bleaching
- informed consent
- patient must be aware so expectations can be met
-disclose all risks
what are the steps to non vital internal bleaching
- take a shade and photos at outset and again at conclusion for documentation
