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Endo II > L09- Intra canal Medication, Temporization and Non-Vital Bleaching > Flashcards

L09- Intra canal Medication, Temporization and Non-Vital Bleaching Flashcards

1
Q

rubber dam prevents:

A
  • swallowed/aspirated instruments
  • loss of your money and time
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2
Q

is there a difference in outcomes between RCT completed in a single visit vs RCT completed in multiple visits

A

no

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3
Q

describe the single visit

A

single visit RCT is acceptable as a modern evidence based standard in general; most predictable with vital teeth and no P/R pathoses

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4
Q

is single visit common at UMKC

A

no, time seldom allows for it

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5
Q

studies show that cases with primary apical periodontitis completed in multiple vists with CaOH as an interim intra-canal medication:

A

improved the microbiological status of the root canal system

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6
Q

what is one of the primary goals of RCT

A

to reduce the microbiological status of the root canal system to the extent at which P/R healing can occur

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7
Q

the 2 or even 3 visit protocol RCT is acceptable and may be superior in terms of:

A

reduction of micro organisms in the canal system in teeth with P/R pathosis as a modern evidence based standard in general

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8
Q

at UMKC teeth with peri radicular pathosis or necrotic pulp will be treated with:

A

at least one week with intra canal medication with Ca(OH)2 before obturation
- DST should heal

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9
Q

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:

A

some type of temporary filling

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10
Q

when is an indication for intra canal medication

A

anytime obturation is not yet accomplished

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11
Q

any time that a temporary restoration is placed:

A

it is a good idea to medicate and seal with proper interim temporization

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12
Q

what is the most popular intra canal medication to use for disinfection of canal between RCT visits

A

CaOH2

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13
Q

why is calcium hydroxide the intracanal medicament of choice

A
  • 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
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14
Q

what is the pH of CaOH2

A

12.4

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15
Q

can you get BC sealer out of canals

A

no

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16
Q

can you get CaOH2 out of canals

A

yes

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17
Q

how is CaOH2 used

A

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

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18
Q

what is the objective in placing CaOH2

A

fill the canal in its entirety to the cervical line

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19
Q

when do you need to be careful about using CaOH2 and why

A

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

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20
Q

what do you do after you place CaOH2 in the canal

A
  • 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
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21
Q

how is temporization between visits done

A
  • sterile cotton in chamber over CaOH2
  • place cavit, IRM, amalgam or composite over cotton
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22
Q

describe cavit

A
  • 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
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23
Q

describe IRM

A
  • 1-4 week duration of seal = stronger
  • use when 2 or more surfaces are missing
24
Q

when do you use composite, amalgam, or temp crown as a temporary

A
  • when considerable tooth structure is compromised or a greater delay to next treatment visit is anticipated
25
Q

how thick should the temporary filling be

A

3-4mm

26
Q

how thick should the cotton be in a temporization

A

2mm

27
Q

what is the process of temporization following obtuation

A
  • 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
28
Q

what do you do if the treatment plan calls for a post

A
  • 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
29
Q

what do you do if you are going to place permanent build up same day because the tx plan calls for a crown

A
  • 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
30
Q

what is the protocol for restoration of anterior teeth

A
  • minimal structural loss: vitrebond and composite
  • significant structural loss: crown or post and crown
31
Q

what is the protocol for restoration of posterior teeth

A
  • cuspal coverage
  • minimal structural loss: crown (all posterior)
  • significant structural loss: post and crown
32
Q

do posts strengthen the tooth

A

no they weaken it

33
Q

what do posts provide to the coronal restoration

A

retention

34
Q

what is vital external bleaching of teeth

A
  • generalized whitening (not associated with RCT)
35
Q

what stains cant you help

A

-dental fluorosis
- systemic drugs- tetracycline
- metallic components in sealers or fillings
- intrinsic stains

36
Q

what alternative treatments might you offer for staining

A

opaque later and veneer, PJC or PFM crown

37
Q

which discolorations can be bleached

A
  • pulp necrosis that releases discoloring compounds: bilirubin and biliverdin
  • intrapulpal hemorrhage: hemosiderin
38
Q

what are the treatment options for bleaching

A
  • do nothing
  • internal bleaching
  • veneer
  • PJC or PFM crown
39
Q

which tx option will patients choose for bleaching and why

A

internal bleaching because lower cost

40
Q

what needs to be done before non vital internal bleaching

A
  • informed consent
  • patient must be aware so expectations can be met
    -disclose all risks
41
Q

what are the steps to non vital internal bleaching

A
  • take a shade and photos at outset and again at conclusion for documentation
42
Q

discoloration is likely to ____ following successful bleaching

A

recur

43
Q

for bleaching always agree to _____ visits only

A

2 or 3

44
Q

before starting non-vital (internal) bleaching you must:

A
  • educate the patient
  • discuss alternatives
  • answer all their questions
  • point out all risks
  • obtain informed consent
  • document your shade guide and photos
  • agree upon fees and a stopping point
45
Q

what are the 2 requirements for non vital internal bleaching

A
  • well done conventional RCT: asymptomatic and proven successful outcome
  • additional barrier over RCF
  • no PARL
  • additional seal over GP
46
Q

what will failure to provide an additional seal over the gutta percha when attempting internal bleaching result in

A

recolation of nascent oxygen ( releasde by bleaching agents) through the gutta percha thereby destroying the RCT seal and allowing irritating and toxic bleaching agents to contact the PA tissues
- this is painful

47
Q

what are the results of percolation

A
  • extreme pain
  • irate patient
  • ruined RCT
48
Q

barrier will save you:

A
  • time
  • trouble
  • money
  • loss of patient
  • loss of patients contacts
49
Q

what are the risks with the old techniques for non vital bleachign

A
  • cervical resorption
  • thermo catalytic technique
  • 30% hydrogen peroxide catalyzed by heat with or without sodium perborate
50
Q

what bleach does UMKC use

A
  • “walking bleach”
  • sodium perborate mixed with anesthesia or saline
51
Q

describe walking bleach benefits

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

52
Q

what should you make sure of before you start to bleach

A
  • all metallic materials are out of pulpal space
  • all pulp horns are adequately cleaned out
  • all defective fillings are cleaned and temporized
  • this alone with a light shade of composite may help clear up a lot of the discoloration
  • think prevention when you are accessing and finishing your RCT
  • clean pulp horns
53
Q

what are the steps when using walking bleach

A
  • isolate the tooth
  • 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
54
Q

what is the “walking bleach technique”

A
  • 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
55
Q

what is the inter appointment seal with the “walking bleach technique”

A
  • cover Na perborate with a thin layer of cotton pellets
  • place IRM or cavit temp filling that is well adapted to the cleaned dentin walls at caval surface
  • the idea is that bleaching will occur as the patients walk around between visits
56
Q
A

Endo II (11 decks)

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