Restorative+perio/ Tx planning Flashcards
perio dx
stage
severity of disease
1 - <15% bone loss or <2mm attachment loss
2 - coronal 1/3 of root
3 - mid third of root
4 - apical third of root
perio dx
grade
rate of progression
A - %bone loss/pt age < 0.5
B - %bone loss/pt age = 0.5-1.0
C - %bone loss/pt age > 1.0
currently stable
BoP <10%
PPD </=4mm
No BoP at 4mm sites
currenlty in remission
BoP </= 10%
PPD </= 4mm
No BoP at 4mm sites
currently unstable
PPD >/=5mm
PPD >/= 4mm and BoP
<10% BoP
clinical gingival health
10-30% BoP
localised gingivitis
> 30% BoP
generalised gingivitis
BPE 1
black band completely visible
no probing depths >3.5mm, no calculus/overhangs, no BoP
BPE 1
no probing depths >3.5mm, no calculus/overhangs,
but BoP
BPE 2
black band completely visible
no probing depths >3.5mm
supra-sub ginival calculus/overhangs present
BPE 3
probing depth(s) of 3.5-5.5mm present
BPE 4
black band entirely within the pocket
probing depth(s) of 6mm or more present
BPE *
furcation involvement
sytomatic irrversible pulpitis
symps
sharp pain on thermal stimulis
lingering pain
unprovoked/spontaneous
analgesia ineffective
causes: deep caires, extensive restorations, # exposing pulp
NEED RCTx
asymptomatic irrevsible pulpitis
signs
no clinical symptoms
responds to theraml testing
causes: trauma, deep caries, pulpal exposure
RCTx
symptomatic apical periodontitis
painful response to biting
TTP
radiographic changes poss
chronic apical abscess
gradual onset, little/no ttp, intermittent dischange of pus through sinus tract
acute apical abscess
rapid onset
spontanoeus pain
extreme TTP
pus foramtion and swelling
aymptomatic apical periodontitis
no TTP or pain on biting
radiographic changes present
condensing osteitis
diffuse radiopaque lesion at apex of tooth respresenting localised bony reaction to low grade inflammatory stimulus
why need cuspal coverage for endo tx tooth
more prone to fracture after RCTx
cuspal coverage will reduce this risk of fracture/failure and help provide a good coronal seal for the RCTx which will prevent microbial ingress
however - cost, more invasive sometimes (e.g. tooth destruction for crown), more than 1 appt (prep with imps, then fit), aesthetics can not be optimal if metal chosen
CHX
0.2%
NaOCl
3%
EDTA
17%
aims of perio tx
3
arrest the disease process
ideally, regnerate lost tissue
maintain perio health long term
RESULT= prevent tooth loss
perio therapy to aid restorative
- Improves soft tissue management
- Establishes stable gingival margin position
- Contributes to aesthetics
- Reduces tooth mobility
- Informs prognosis
inflammed gingiva description
- Linear band of gingival inflammation
- Loss stippling
- Puffy rolled margin
can be due to poor margins of restorations or plaque accumulation
why cannot do restorative before perio in tx plan
inflammed gingiva will bleed during operative procedures - moisture control issue
will be unstable in apico-coronal location
how long to monitor gingival margin before restorative
once deemed healthy perio (pockets </=4mm and <10% BOP and no BOP at 4mm sites)
monitor for 3-6months to allow gingval margin to stabilise
supracrestal attachment
histologically composed of the junctional epithelium and supracrestal connective tissue attachment
above crest of alveolar bone
average of 2mm – vary between people and sites in mouth
DON’T want to infringe on supracrestal attachment when placing margins
margins should be in gingival sulcus if any (top 0.5-1mm)
need at least 3mm from alveolar crest to margin to prevent inflammation
issue if margins encroach on supracrestal attachment
- persistent inflammation - chronic gingivitis associated with margins
- loss of attachemnet - pocketing and recession (leading to exposure of margin)
respect interdental papilla - follow contour
palatal can be supra
when not enought space between restoration margin and alveolar bone can
surgically crown lengthen
relocate supracrest attachement apically - remove none and manipulate flap
wait 6months to stabilise
Ante’s Law
combined periodontal area of the abutment teeth should be equal to or greater than teh periodontal area of the tooth/teeth being replaced
prevent overloading of abutments
optimal gingival aesthetics
Gingival zenith – most apical point of gingival marginal scallop
Gingival papilla – dip coronally interdentally
Approximation line of zeniths – canine to canine, touching central incisors, lateral incisors generally 1-2mm below
* Parallel to incisal edges of centrals
smile line - ave, high, low
minimising black triangles
acrylic gingival veneer
careful restorations - esp if low smile line - supragingival, make contact point still cleanable but mask black triangle when smiling
favourable post design
3
- Parallel sided (avoids ‘wedging’)
- Non-threaded (avoids incorporating stress)
- Cement retained (buffer between masticatory forces post and tooth)
assessment of RCTz
did you do it? if not check notes
when was it done?
how was it done - dam, NaOCl
is it radiographically acceptable - length, condensed, missing canals
has it been leaking/ how long? (>3months needs redone)
masticatory load transfer of posts
- Tapered posts act as wedges leading to root fracture
- Parallel sided posts do not cause wedging
- Posts retained solely by cement tend to distribute masticatory forces
when assessing tooth for indirect with core/post
options
3
- Build up core (anterior or posterior teeth)
- Fibre post – some dentine, so can build core chairside around it
- Cast post – so little dentine left and non-optimal ferrule
ferrule effect
place crown on, get some bracing in coronal portion of tooth where crown meets ferrule preparation and cement retains the crown in place
* Resistance to rotational force and leakage
core design
taper and length important
* 6 degree taper
* Length required - to allow 2mm clearance incisally for MCC
parapost kit
Provisional post (titanium)
* Use in conjunction with protemp and putty matrix to construct provisional post crown
* cut from apical end - leave nail head in place to retain temp; want 2mm short of incisal edge
Burn out post (not important)
Para post drill (colour coded)
* narrowest size is 0.9mm = GG3
Impression post
* Smooth sided
* Placed into the tooth when taking definitive impression for indirect cast post (put adhesive on)
why cuspal coverage for posterior RCTx teeth
Prevent catastrophic fracture
E.g. furcation
Maintain coronal seal
Prevents microbial ingress
subalveolar fracture is unrestorable because
4
unable to get adequate moisture control
restoration margins are subcrestal - impression margins for indirect not possible
tooth excessively mobile
pt maintainance difficult - access to cleaning
factors for bridge to debond
5
- poor moisture control when cementing
- unfavourable occlusion
- parafunction (bruxism)
- trauma
- poor OH
NaOCl accident
how
Extrusion of the irrigant through the apical foramen to the surrounding soft tissues
* Could be due high pressure injection,
* locking syringe in the canal
* not measuring needle prior to use against radiograph (EWL -2mm)
onto tissue if dam seal inadequate
Causes inflammation in the surrounding tissues – swelling and increased blood flow and possible necrosis of tissue due to high pH (11)
NaOCl accident
management
Stop all tx
keep calm and try not to alarm pt, advise them what has happened
if out of dam - sit pt up and ask them to rinse multiple time with water (with dam in situ)
if there is pain - give LA as a block to area (not directly into area)
let canal bleed till haemostasis achieved
place steroid containing intracanal medicament (Ledermix) in canal with no pressure and temporarise
if acute respirartory or circulatory issues -> 999
if eye issues -> refer to hospital opthamology dept
report on DATIX
NaOCl accident
post op advice
alternative cold and warm compress to minimise swelling
analgesia (NSAIDs/Paracetamol)
review in 24hrs
review as may develop symptoms - haemotoma, mucosal/bone necrosis, suppuration, changes to nerve function, trismus, crepitus, eye bain
possible antiobiotcs is involvement of sinus, IDC, high risk bone necrosis
inhalation of foreign body
stop
keep calm and keep pt seated, inspect mouth to see if there
ask pt if aware of swallowing it
symptoms - difficulty or pain on swallowing, vomitting, retching, hypersalivation
encourage pt to cough - BLS; if uable to speak 999
pt unsure - search area
if object more than 5cm in length or sharp/long/pointed/inflexible -> refer to A&E
record on DATIX
give example of object with them for Doc to see
prevention of NaOCl accident
- careful pre op radiographic assessment
- PPE for pt – bib and eyewear; rubber dam
- Ensure all syringes are labelled correctly
- Use CHX to test seal of dam and possible use of Opaldam
- Use of index finger for plunging syring
- Do not fill syring to top (2/3-3/4 max)
- Do not wedge the needle in the canal
- Use of rubber stop on syringe so not going beyond EWL
size of post indications
4
- No more than 1/3 root width
- No more than 2/3 root length
- At least ratio 1:1 with crown
- 4-5mm GP apical remaining
methods of removing fractured post
6
- Moskito forceps
- Masseran kit
- Ultrasonic
- Eggler post removal
- Sliding hammer
- anthogyr
how to check to see bridge debonded
- Press on it to see if there is movement or bubbles of saliva around wing
- Probe around wing
factors to consider before placing a bridge
Health of abutment tooth
* Perio status
* Caries
* Root length
Occlusion
Length of span of proposed bridge
OHI of pt /motivation
clincial assessment pre post placement
o Ferrule
o Coronal seal – any leakage/caries
o Is tooth restorable? Isolation possible
o Swelling
o Sinus
o TTP
o Mobility
o Increased pocketing – perio disease or root #
radiographic assessment pre post placement
o Bone levels – mild, moderate, severe
o Root filling – length quality, quality of obturation
o Canals – shape (ideally straight), any missed canals
o Fractured instruments
o Crown to root ration 1:1.5
o Pathology -perforations, radiolucencies
cavity prep principles
Access to carious
Remove the caries to see extent at the ACJ and smooth enamel margins
Once established extent peripherally, remove deeper caries over pulp
Modify cavity prep for restorative material and Outline form modification
* No sharp angles
* Possible bevel
* Retentive undercuts needed for amalgam
criteria before can obturate
3
need to be able to dry canal
need to be asymptomatic
need to be fully biomechanically cleaned to working length
how to assess RCTx on radiograph
- Check to length – no more than 2mm short of radiographic apex
- Condensed, No voids
- Not extruded out apex
- All canals filled
GP constituents
6
- gutta percha
- Zinc oxide
- Radiopacifies – barium salts
- Waxes
- Platisciers
- Colouring agents
function of sealer in RCTx
fill space between GP and root canal and go into lateral canals
provide a fluid tight seal
common RCTx sealers
- Zinc oxide eugenol
- - Resin based
- Calcium hydroxide
- Calcium silicate
methods of obturation
4
- **Cold lateral compaction **
- Warm vertical compaction
- Thermoplastic injection
- Thermofil
% of upper 6s with MB2
93%
design objectives of endodontics
3
- Continuously tapering funnel
- Keep apical foramen size
- Maintain apical location
advantages of crown down technique
5
- Removes bulk of infected tissue,
- reservoir for irrigant,
- keeps reference point for WL,
- makes straight line access easier,
- limits spread of infected material at apical foramen
laws of pulpal floor anatomy
- law of colour change – pulp floor is darker
- law of symmetry 1 – orifices lie equidistant from MD line through chamber (expect max. molars),
- law of symmetry 2 – orifices lie perpendicular on MD line (except max.molars).
rules for locating orifices in pulpal floor
3
always at junction of pulp floor and wall
always at angle of floor and wall
always at terminals of developmental fusion lines
reasons for chemical irrigation during endo tx
6
- Chemical disinfection is needed as mechanical doesn’t remove all debris
- Reaches areas files cannot reach
- Flush out debris made during instrumentation
- Dissolves organic and non organic matter
- Removes smear layer (EDTA)
- Lubrication
sodium hypochlorite properties
3%
Dissolves inorganic and organic tissue (pulp, collagen, vital and necrotic debris)
Ledermix
antibiotic and steroid mix, used when there is inflammation/hyperaemia pulp, works for 5-7days
non setting CaOH (ultracal)
antibacterial, cannot be left in pulp long periods as can weaken tooth structure
landmarks for IDB
- Pterygomandibular raphe
- 1cm occlusal plane
- Thumb on coronoid notch
- Fingers on outer border of ramus mandible
- Angulation over contralateral premolars
management if into parotid when IDB
- Check if they can raise their brown – assess if stroke
- Explain the situation, apologise and reassure,
- Give eye patch advise on eyedrops possibly to prevent drying out
- Advice on length of time of paralysis (likely 3-5hrs soft tissue)
- Refer/ got to A&E if longer than this
too far posteiror injection
RCP
retruded contact position
- Reproducible mandibular position when condyles are in their most posterior superior position in the mandibular/glenoid fossa
- Used as can be repeated for different appointments when checking occlusion for indirects/dentures
new composite but has senstivity why
5
High in occlusion
* Check with articulating paper
Monomer not cured sufficient at base
* Ensure correct light cure used for material and time (2mm depth)
Encroaching on pulp with prep
* Use of liner e.g. CaOH vitrebond (RMGI)
Polymerisation contraction stress
* Use small increments that do not bond more than 2 walls together
Cracked tooth syndrome
* If large restoration plan in advance for indirect to prevent possible # with cuspal coverage
overhang amalgam
why
issues
how to fix
why - poor matrix band adapation, wedge not used, inadequate condensing of amalgam
problems - plaque trap (secondary caries), gingval issues -perio bone loss
management -remove amalgam section and repair or removal of all and replace
functions of facebow
- Transfers relationship of maxillary teeth to mandibular condyles (axis of rotation)
- Positions casts accurately when pt not present (in correct anatomic relationship for pt)
- Measure intercondylar distance
- Transfers the angulation of the maxillary occlusal plane in relation to a horizontal reference plane
principles of crown prep
6
- Preservation of tooth structure
- Renetion and resistance
- Structural durability
- Marginal integrity
- Prevsation of periodontium
- Aesthetic considerations
acquacem
for
glass ionomer cement
MCC, metal post+core, zirconia crown, gold crown, stainless steel crown
glass ionomer cement
reaction
mix
acquacem
acid base reaction
1 scoop to 2 drops water
mix on glass slab ideally as exothermic reaction
mix 15secs
set- 3.5-9mins (approx 5mins); fully set over 24hrs
properties of GI luting cement
5
acquacem
- high compressive strength
- low solubility
- biocomplatible
- fluoride release
- chemically bonds to tooth
why RMGI not as good for luting cement
polymersiation contraction stress, and HEMA absorbs and swells
panavia
what
use
anaerobic cure compoiste
used for adhessive resin bridge (RBB)
how to use panavia
Own kit with etch and bond kept in fridge
Bonds to enamel
- Use Opaque panavia,
- have sandblasted wing
- Etch tooth lingual surface for 30s, wash dry, Re-etch for 60s, wash dry
- Mix A and B primer for 3-5secs, Apply to tooth and evaporate after 60s with gently air
- One full turn of Panavia paste until it clicks, mix 20-30secs
- Place panavia onto metal wing and apply to the tooth with finger pressure, after 60secs release pressure and remove excess with brush tip
- OXYGUARD at margins 3mins then wash off, remove excess and polish with pumice (enables complete curing)
panavia properties
high bond strength
low working strength
easy removal of excesss
most aesthetics
NX3
what
use
dual cure composite
fibre post, veneer, composite inlay, porcelain inlay
resin so can bond to composite
NX3
properties
excellent aesthetics
good mechanical properties
low solubility
high bond strength
bonding to porcelain
Prep porcelain
* Porcelain needs etched with HF acid to roughen surface – this allows micromechanical retention
* Silane coupling agent is applied to porcelain - This is a bifunctional molecule. Inc surface energy of porcelain to allow resin bonding
* One binds to roughened porcelain whereas other binds to the comp resin cement
Tooth
* Etch tooth, wash away, apply bond
Apply resin to restoration, place, clean excess and light cure
RelyX unicem
yellow
Self etching comp resin cement
* Easy to use
* Requires good moisture control
* Doubt about bond strength to enamel due to inadequate etching
Porcelain or composite
RelyX Luting+
pink
For: composite onlay, metal,
* As it’s a resin it bond to composite
Resin modified luting cement
Easy to use
MCC properties
Stronger than all
More aesthetics compared to all metal
More durable
Cheaper
Less destructive to tooth tissue compared all ceramic
Metal may became visible
bond with acquacem (GI cement)
all metal crown properties
Gold or Stainless steel
Least amount of prep
Aesthetics
Strongest
bond with acquacem (GI cement)
all ceramic crowns properties
Lithium disilicate – zirconia (stronger)
Good aesthetics
More likely to fracture
Can be abrasive
£££
Most destructive to tooth tissue
bond with nexcus (dual cure composite)
RBB properties
Minimal/ nil prep
Debond
Secondary caries
Jeopordises health of retainer tooth
Heavier on occlusal load on abutment
Mesial cantilever preferred, distal abutment
conventional bridge properties
Tooth prep
Needs to parallel
Non vital risk in 20% 5 years
onlay material options
3
ceramic
metal
composite
pre-cementaion checks
out of mouth
check correct pt
check pt cast - right tooth
check on cast
* rocking
* contact points - ensure adj teeth are in tact
* marginal integrity - ensure adj teeth are in tact
* aestheics
* occlusion - check natural contacts without crown and with crown are the same
* metal defects - cracks, breakages, blebs
remove from cast and check with callipers
* metal 0.5mm
* porcelain 1mm
check if tooth underprepped (functional cusp will need extra 0.5mm palatal upper, buccal lower)
pre-cementation checks
try in
LA if vital tooth
remove provisional restoration and cement (US)
sit pt up, protect airway with butterfly spong or gauze
passive fit - don’t force; no tissu blanching
check contact points
check margins flush
check occlusion
post cementation checks
excess cement removed
no space around margins
interporximal contact point exists and is clear
occlusion checked with articulating paper (in excursion as well)
restoration cleansable
confirm pt happy with aesthetics and feel
indirect fails to seat
management
clinical faults - incolplete removal of temporary, gingival tissue encroachment (poor temp), distortion of impression (tray/time/storage)
lab faults - interproximal overextension, marginal overextension, resin epxansion, bleb on fitting surface
1 - check IP with floss for overextension or underextension - want good to prevent food pack
2 - check and adjust fitting surface (occlude spra)
3 - assess marginal fit - check for marginal leakage, overhang, remake
articulating paper thickness
millers forceps
40micron
shimstock thickness
8microns
resorption types
internal inflammatory
internal replacemtn
external inflammatory
external surface resorption
external replacement resoprtion
external cevical resorption
internal inflammatory resorption
incidental finding
coronal part necrotic, apical part vital bit will progress to necrotic
(inflammatory giant cells)
tx - orthograde RCTx
inernal replacement
pulp chamber has radiopacities - being replaced by bondy mineralised tissue (dentine, cementum mix)
hard to tx 0 accept and monitor
external surface resorption
mobile teeth
PDL intact, no PA radiolucency
RCTx not indicated as pulp healthy
splint mobile teeth
90% of ortho tx teeth
external inflammatory resorption
pulp is necrotic so inflammation going on around it
persistent periapical radiolucnecy - apex nibbled away by chronic inflammation
tx - orthograde RCTx, surgical endo
external replacement resorption
high pitch/metallic notes
no mobility
root disappearing and getting filled with bone
loss of PDL
trauma common aetiology
Tx - decoronation if infraocclusion >1mm in growing pt to perserve bone volume
or if stopped growing - mask with comp
external cervical resorption
profuse BOP
pink spot
subgingival cavity hard to probe
radiographically - apple cores out from CEJ, can still see tramlines
Tx - monitor, resorption will cont
internal repair and orthograde endo
XLA and replace
perio abscess in perio pt
(pre-existing pocket)
acute exacerbation
* untx perio disease
* non resposive to perio therapy
* supportive perio therapy
after tx exacerbation
* post scale
* post surgery
* post medication
perio abscess in non-perio pt
- impaction (Dental floss, ortho elastic, tooth pick, rubber dam etc)
- harmful habits - nail biting
- orthodonitc factors - ortho forces or crossbite
- gingival overgrowth
- alteration of root surface (root damage, resorption, invaginated tooth, developmental grooved, perforation)
perio endo lesions
classifcations
ENDO PERIO LESIONS WITH ROOT DAMAGE
* ROOT FRACTURE OR CRACKING
* ROOT CANAL OR PULP CHAMBER PERF
* EXTERNAL ROOT RESOPRTION
ENDO-PERIO LESION WITHOUT ROOT DAMAGE
* ENDO PERIO LESIONS IN PERIODONTITIS PTS
GRADE 1 – NARROW DEEP PERIO POCKET IN ONE TOOTH SURFACE
GRADE II – WIDE DEEP PERIO POCKET IN ONE TOOTH SURFACE
GRADE III – DEEP PERIO POCKET IN MORE THAN 1 TOOTH SURFACE
* ENDO PERIO LESIONS IN NON PERIO PT
GRADE I – NARROW DEEP PERIO POCKET IN 1 TOOTH SURFACE
GARDE II – WIDE DEEP PERIO POCKET IN 1 TOOTH SURFACE
GRADE III – DEEP POCKET IN MORE THAN 1 TOOTH SURFACE
MPBS
ramfjord teeth - 16, 21,24, 36,41,44
MBS - want less than 35%
MPS - want less than 30%
or >50% improvement
6PPC records
- gingival margin (-ve inflammation, +ve for recession)
- pocket depth
- BOP
- mobitily
- furcation
- missing teeth
LOA= pocket depth + gingival margin
review 6PPC
dots in sites <4mm
record sites >/=4mm, BOP, mobility, furcation
implant care re perio
Baseline PAs for comparison
BPE not appropriate for peri-implantitis
* Examine for inflammation, BOP, suppuration, sub-mucosal deposits
* baseline probing depths measured with fix landmark
SDCEP prevention and tx of perio disease in primary care 2014
notes and consent for perio
detail all findings,
* Pt C/O,
* provisional and final dx,
* tx options - BRAN,
* advice – risks of disease etc, referrals, recall interval.
* If pt declines tx or is uncooperative record
Consent to perio tx – explain disease process, their role, chronic condition, perio stable before advanced tx
Risk Factors – smoking, stress, poorly controlled diabetes, alcohol
RCTx procedure
- multiple appts
- LA - topical gel, injection
- rubber dam - isolation, moisture control, airway protection, prevents NaOCl incident, test with CHX
- radiographs required - pre, during and post tx
- access with high speed and slow speed - remove any caries
- files - to clean and shape
- irrigation - NaOCl (bleach) throughout and EDTA at the end
- canal dried with paper points
- intracanal medicament - resolves infection/symptoms
- obturation - GP root canal filling, coated in sealer packded with accessory points and heat used to seal off
- lining material placed to seal the canal
- restoration - temporary or permanent (ideally cuspal coverage)
prognosis for RCTx
90% over 10 years for teeth with irrversible pulpitis
80% over 10years for teeth with necrosis
every time reRCTx go down by 10%
be specific for case
alternatives for RCTX
no tx
XLA
orthograde RCTx
retrograde RCTx
RCTx risks
- instrument separation
- failure to negotiate canals to WL
- NaOCl accident
- material extrusion
- post-op pain
- post-op swelling
- need for pain control/analgesia after appts
- perforation - out the side of the tooth
- root #
- failure to resolve symptoms
- £££
benefits of RCTx
- resolution of infection and symptoms
- retain tooth
- no loss of abutment potential
direct pulp capping
closed apex
vital symptom free tooth
* isolate under rubber dam if anticipate close to pulp
* irrigate with saline
* cleanse with CHX 0.2%
* blot dry with cotton wool pledgets
* cover exposure with hard setting calcium hydroxide (Dycal)
* cover with RMGI (Vitrebond), cure, place restoration
* KUO if any pulpal symptoms arise -> RCTx
perforation what to do
stop - explain to pt want to asses how prep going and possible perforation may have occured
take PA to assess position and size of perf
determine why it has happened
explain when doing tx a hole was made at side of tooth adn now going to assess if we can seall off
pulp chamber
* small - stop bleeding, MTA and GIC
* larger - still restorable - MTA and GIC; unrestoratbel - XLA, hemisection
lateral perf
* gingival 1/3 - restore temporarily then crown/ onlay as normal (Subging on sound tooth)
* middle 1/3 - clean and shape from opposite side of perforation, cold lateral compaction to occlude
* larger - XLA, hemisection
apical 1/3
* apicetomy
DWP options to replace the space
fractured instruments
introduce self and designation
explain - file separated in canal of tooth, thin metal file used to clean out pulp tissue and shape canal, can separate in tight/curved areas
do what you feel comfortable with and able to do
* dress, monitor and refer
* attempt to remove with tweezers
* dislodge adn remove the broken file with US
* bypass by watch winding small file alongside and EDTA to soften
* RCTx and monitor
* retrograde RCTx - apecitomy, peri-radicular
* XLA
any Qs?
do you understand?
protaper hand files sequence
S1
Sx
S1
S2
F1 = 20k
F2 = 25k
F3 = 30k
F4 = 40k
F5 = 50k
protaper gold are rotary - 300rpm, 2nm torque
when to use rotary files
used to widen canals after being intially explored with k files - glide path created
failed RCTx why
3 categories
GP
* overfilled
* underfilled
* poorly compacted
prep
* canals missed
* inadequately prepped (short)
* perforation
* extrusion of debris
* file fracture
other
* traumatic root fracture
* poor coronal seal
tx options for failed RCTx
- KUO - infection may flare up later
- retreatment - success chance decreased, if post present increased risk of fracture
- periradicular surgery - if retreatment not possible, invasive, time consuming, £££, specialist
- XLA - tooth loss, need replacement or nonfunctional
non setting CaOH
properties
pH 12.5
high pH contributes to antibacterial activity
prolonged anti-bacterial
anti-inflammatory
Ultracal
setting - Dycal
ledermix
is antibacterial and steroidal
used for hot pulps
Kalzinol
ZOE
cannot place composite after
antibacterial
analgesic
drugs which cause gingival hyperplasia
anticonvulsant (phenytoin),
immunosuppressant (cyclosporine A)
various calcium channel blockers (nifedipine, verapamil, diltiazem).
tx plan stages
imediate - pain
initial - disease control
re-eval - assess disaese activity
recon - once disease under control can do indirects etc
maintenance - on going care
