What is the aetiology of endodontic disease? (3)
It is of microbial origin:
- Bacterial invasion
- Development of bacterial ecosystem
- Biofilm formation
What are the clinical objectives of RCT? (2)
- Removing canal contents
- Eliminating infection
- Spectrum of possibilities exist from non-instrument techniques to extraction
What is chemo-mechanical disinfection?
- Use of mechanical means of shaping and debriding the root canal space and the use of chemical agents to further disrupt the biofilm and disinfect the root canal space
What are the design objectives for endodontics? (3)
- Create a continuously tapering funnel shape
- Maintain apical foramen in original position
- Keep apical opening as small as possible
What do the design objectives for endodontics allow you to do?
- They allow you to create space for introduction of irrigants whilst whilst balancing this to maintain sufficient tooth structure so that we don’t weaken the tooth
- Create lots of space coronally then tapering down towards the foramen
What is the sequential process of endodontics? (5)
- Coronal access to the root canal system
- Root canal instrumentation and preparation
- Obturation of the root canal system
- Coronal seal (prevents ingress of bacteria from the oral cavity back into the root canal system therefore causing re-infection)
- Final restoration (could be crown or onlay)
What must be taken as pre-treatment for endo?
- An undistorted peri-apical radiograph must be taken to show all the root and 2-3mm of surrounding peri-radicular structures
- (this will ensure that we can determine the potential pathogenic status of this tooth from a periradicular stand point but also understand the relationship of the tooth with vital structures e.g. ID nerve, maxillary sinus for example)
What are we looking for in a pre-treatment radiograph for endo? (6)
- Is there peri-radicular pathology and how far does it extend? (this will have implications on prognosis)
- The anatomy of the root canal system
- Canal calcifications (is the pulp chamber compressed from the laying down of reactive dentine, are the canals narrow or wide)
- Check angulation of root in relation to adjacent teeth (will guide us in our access to safely enter the root canal space)
- Number, length and morphology of roots
- Proximity of vital structures
All caries and defective restorations must be removed from the crown prior to carrying out RCT. Why is this?
- Allows assessment of restorability and creates and environment suitable for obtaining adequate isolation
- Also prevents tooth from being re-infected by caries
What is the process of pre-endodontic build-up? (5)
- Assess restorability
- Clamp placement
- Four walled access cavity
- Control irrigant
- Control Saliva
Dental dam is mandatory for all procedures involving the pulp. Why is this? (5)
- To eliminate bacterial contamination
- To prevent inhalation of instruments etc
- Retracts and protects soft tissues and tongue
- Prevents patient from rinsing, chatting
- Reduces chairside time and operator stress
Why might you cut most of your access cavity without dental dam? (BUT best practice is to place dental dam before)
- So you do not lose your orientation
Give a list of endodontic instruments? (7)
- Mirror (front facing)
- Locking tweezers
- Probe
- DG 16
- Excavator
- Flat plastic
- Burnisher
What is a DG 16?
- This is a double ended probe with a long tip, this allows us to explore the pulp chamber and identify the orifices of the access of the root canal itself
What is other equipment (other than endo equipment) that we might need for endo treatment? (3)
- LA equipment
- Examination kit
- Handpieces and burs
What are common burs used for endo treatment? (4)
- Air rotor, fissure bur, endo-Z or similar
- Slow speed - long shanked round bur
What is a Tuscan carbide bur with non-cutting tip used for?
This allows us to refine our access cavity preparation safely without the risk of cutting the floor of the chamber
What is a long neck bur used for?
- Improves visualisation
- Can modify access or remove calcifications within the chamber
What is the anatomy of the canal of an upper central incisor like?
23mm, little apical curvature
What is the anatomy of the canal of an upper lateral incisor like?
21-22mm, 1 canal inclined palatially, distal apical curvature
What is the anatomy of the canal of an upper canine like?
- 26.5mm
- Distal and labial apical curvature
- Narrow apex
What is the anatomy of the canal of an lower central incisor like?
- 21mm
- 41% have 2 canals
- Distal apical curvature
What is the anatomy of the canal of an lower lateral incisor like?
- 21mm
- 41% have 2 canals
- Distal apical curvature
What is the anatomy of the canal of an lower canine like?
- 22.5mm
- 14% have 2 canals
- Distal and sometimes labial apical curvature
