Intra-Canal Medication, Temporization and Non-Vital Bleaching

Question 1

Can you choose to not use a rubber dam?

Answer 1

NO! You must use a rubber dam

Question 2

Many studies show _____ statistical difference in outcomes between RCT completed in a single visit vs. RCT completed in multiple visits

Answer 2

no

Question 3

True/false

Single visit RCT is acceptable as a modern evidenced-based standard in general

Answer 3

True

Question 4

Cases with primary apical periodontitis completed in multiple visits with _______ as an interim intra-canal medication improved the microbiological status of the root canal system

Answer 4

CaOH

Question 5

One of the primary goals of RCT is to reduce the ___________________ of the root canal system to the extent at which P/R healing can occur

Answer 5

microbiological status

Question 6

Therefore the _________ 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 evidenced-based standard in general

Answer 6

2 or even 3

Question 7

AT UMKC-SoD, Teeth with Peri-Radicular Pathosis or Necrotic Pulp will be treated…

Answer 7

at least one week with intracanal medication with Ca(OH)2 before Obturation

Question 8

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 (micro-organisms) by some type of…

Answer 8

temporary filling

Question 9

Anytime obturation is not yet accomplished, this is an indication for…

Answer 9

intra-canal medication

Question 10

Any Time that a Temporary Restoration is placed, it is a good idea to Medicate & Seal with Proper…

Answer 10

Interim Temporization

Question 11

______ is currently the singular most popular intra-canal medication to use for disinfection of canal between RCT visits

Answer 11

CaOH2

calcium hydroxide

Question 12

Why is calcium hydroxide (CaOH2) the most popular intra-canal medication for disinfection?

Answer 12

– 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

Question 13

CaOH2 tip is placed about ___mm short of WL (do NOT allow to BIND) and is expressed as the syringe is retracted from the canal

Answer 13

3 mm

Question 14

What is the objective of using calcium hydroxide as an interim placement?

Answer 14

fill the canal in its entirety to Cervical Line

Question 15

How do you use calcium hydroxide as an interim placement?

Answer 15

• fill the canal in its entirety to Cervical Line
• clear excess CaOH2 from chamber
• place sterile cotton pellet in chamber to prevent clogging of the canal with temporary filling material
• Temporary filling is placed following the cotton pellet

Question 16

What types of temporization are placed over the cotton pellet?

Answer 16

• Cavit
• IRM
• Amalgam, Composite or temporary crown

Question 17

What are the features of cavit for temporization??

Answer 17

• 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

Question 18

What are the features of IRM for temporization??

Answer 18

• 1-4 week duration of seal = stronger
• use when 2 surfaces or more are missing

Question 19

What are the features of composite, amalgam, and temporary crown for temporization?

Answer 19

when considerable tooth structure is compromised or a greater delay to next treatment visit is anticipated

Question 20

What is vitrebond?

Answer 20

• (resin modified glass ionomer)
• recommended to seal the obturated canal (G.P.) against leakage following successful RCT completion while awaiting permanent restoration

Question 21

If Saliva remains in contact with GP for ____ hrs retreatment will be required

Answer 21

72

Question 22

Leave ____________ when placing final restoration as directed in your team.

Answer 22

Vitrebond

Question 23

What should you do for a temporization if the RCT needs a post?

Answer 23

• 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 & planned restoration in your Team.

Question 24

What should you do for a permanent buildup for a future crown?

Answer 24

• Do NOT place cotton over obturation
• Place Amalgam or Vitrebond & Composite as Build-up – X-Ray – RCT without Rubber Dam
• Proceed later with crown preparation in your Team

Question 25

What type of restoration of RCT teeth for anteriors?

Answer 25

– Minimal structural loss: Vitrebond & Composite – Significant structural loss: Crown or Post & Crown

Question 26

What type of restoration of RCT teeth for posteriors?

Answer 26

– Minimal structural loss: Crown (ALL posteriors) – Significant structural loss: Post & Crown

Question 27

# True/false POSTS do NOT strengthen tooth (they weaken it)

Answer 27

true

Question 28

POSTS provide ONLY ___________ of coronal restoration

Answer 28

RETENTION

Question 29

What teeth can recieve bleaching of a non-vital tooth?

Answer 29

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

Question 30

What is vital external bleaching of teeth associated with?

Answer 30

Generalized Whitening (Not associated with RCT)

Question 31

Don't waste your time bleaching teeth of teeth that it won't help such as...

Answer 31

– Dental Fluorosis – Systemic drugs (tetracycline, etc.) – Metallic components in sealers or fillings – INTRINSIC stains | alternate treatment: Opaque layer + Veneer, PJC or PFM Crown

Question 32

Which discolorations can be bleached?

Answer 32

- Pulp necrosis that releases discoloring compounds --- Bilirubin & Biliverdin - Intrapulpal hemorrhage --- Hemosiderin

Question 33

What are the treatment options for a discolored tooth?

Answer 33

* Do Nothing * Internal Bleaching * Veneer * PJC or PFM Crown

Question 34

Why do most patients choose internal bleaching over other options?

Answer 34

lower cost factor

Question 35

Before you undertake to perform internal bleaching for any patient, you must fully disclose all ______ which will become evident to you as this lecture progresses

Answer 35

risks

Question 36

What is important to tell patients about non-vital (internal) bleaching?

Answer 36

* Do NOTpromise anything you can’t deliver * Don’t guarantee RESULTS * Be sure patient expectations are REASONABLE regarding the proposed procedure

Question 37

Why should you take a shade AND photos at beginning of internal bleaching treatment and again at conclusion for documentation?

Answer 37

– Pt. will forget how bad it was to start with – Result may not meet their expectations – Patients often forget the original agreement in the heat of expected payment

Question 38

_________ likely to recur following successful bleaching

Answer 38

Discoloration

Question 39

# True/false Always agree to 2 or 3 visits ONLY for internal bleaching

Answer 39

True

Question 40

What all do you need to do before non-vital (internal) bleaching?

Answer 40

– Educated the patient – Discussed alternatives – Answered all their questions – Pointed out all risks – Obtained informed consent – Documented your shade guide & photos – Agreed upon fees and a Stopping Point

Question 41

What are the requirements during non-vital (internal) bleaching?

Answer 41

- 1. Well done Conventional RCT --- Asymptomatic --- Proven successful outcome - 2. Additional Barrier over RCF - 3. Additional Sealover GP

Question 42

How much additional seal should be placed over GP?

Answer 42

2 mm

Question 43

What are the results of percolation?

Answer 43

* Extreme PAIN * Irate Patient * Ruined RCT

Question 44

What were the risks with the thermo-catalytic technique (old)?

Answer 44

associated with Cervical Resorption - 30% Hydrogen Peroxide catalyzed by HEAT with or without Sodium Perborate = BAD

Question 45

What kind of bleach does UMKC use?

Answer 45

- "Walking bleach" - Sodium Perborate mixed w/anesthesia or saline - 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

Question 46

Before you start to bleach, make sure...

Answer 46

– All metallic materials are out of pulpal space – All pulp horns are adequately cleaned out – All defective fillings are cleaned & temporized – This alone with a light shade of composite may help clear up a lot of the discoloration

Question 47

What are the steps for internal bleaching using walking bleach?

Answer 47

- perfect access - Remove caries - Remove pulp horns - Brush up dentin surface to remove any filling remnants - Reduce GP at least 2mm apical to cervical line - Make sure RCT is well done - Add sealing material to cover GP up to cervical line - Finish with cotton pellet and Cavit - Final restoration with composite

Question 48

What is the "walking bleach technique"

Answer 48

* Mix FRESH Sodium Perborate USP with sterile water or anesthetic to a thick consistency * Place into the chamber with an amalgam carrier * Remove excess and clean axial walls of access * Inter-appointment seal --- Cover Na Perborate with a thin layer of cotton pellets --- Place IRM or Cavittemp. filling that is well adapted to the cleaned dentin walls at caval surface