W10 - Solutions for Common Endo Problems - Stoll Flashcards
What must be done before endo tx (2)
Removal of ALL caries
Restore tooth with stable restoration (GIC is NOT stable)
Tips when accessing pulp chamber
- Determine tooth axis before rubber dam
- Aim for big roots
- Know the anatomy
- Trust radiograph
- Straight line access
What size files are used for the location of fine and calcified canals
6, 8, 10
or
special pathfinder instruments (stiffer)
If a canal is not accessible, what should be done
Leave it and fill the accessible ones, then reconsider the case (exo, retreat. surgical)
What should be done after initial shaping
Recheck lengths
Always have stable and reproducible reference points
What must be visible in endodontic PA
Apex and reference point
How can you prevent ledges (4)
Prebend steel files
Use small Hedstoem files
Use NiTi rotary (for curved roots)
Rinse frequently
How to prevent file fractures
Do not push - lubricate
Use only for a short time
If file doesn’t want to work, use smaller file
what can overshaping lead to?
Strip Perforation
Strip-perforation
- Overshaping
Consequences of undershaping
Problems with cleaning and obturation
How much NaOCl should be used?
5 mL per canal (3 syringes for a molar)
How to improve efficacy of NaOCl
Preheated solutions
Ultrasonic activation
Common problems during obturation + solution (3)
Almost always relating to master cone
- Cone too short → use smaller cone or reshape
- Cone too long → Cut the tip
- No tug back → Cut the tip
What happens if you have no tug back?
Master cone will most likely come out during condensation
What file should be used for re-treatment
Hedstrom > #20 → #15 will commonly break
- Frequently check file and replace if damaged
- Only use NiTi rotary if really necessary
When should a post be placed (time not indication)
If no problems are expected (low bacterial count) → immediately (most common)
If tooth was heavily infected → wait 1-2 weeks
What should be done directly after obturation
Application of a stable adhesive restoration
How long after endo tx should a crown be placed if indicated?
ASAP → after 2-4 weeks
How to manage pain in emergency patients
If standard infil or block doesn’t work → intraosseous LA
or other direct means of anesthesia (intrapulpal)
Consider starting RCT immediately
What drugs may pts be taking / want for pulpitis, however may not do anything for the pain?
NSAIDS → not sufficient
Antibiotics → pointless and will do nothing unless infection is spreading
Root resorption (tx, what to tell pt)
Remove the cause (infection?) and resorption will have chance to stop
Inform pt about limited success probability and that no lost tissue can redevelop
What is this and how to treat
Lateral root resorption
- Take PA with tube shift to make sure its not internal resorption
- Endo and dress with Ledermix
What is this and how do you treat
Perio-Endo lesion
- Confirm diagnosis
- RCT and initial perio tx
- Review in 3-6 mo
Basic idea: both inside and outside must be cleaned sufficiently to heal
How to close perforation
- General cleaning and shaping
- MTA to seal if below bone, GIC if above
How to treat open apex
Seal lower third with MTA
GP for rest
Why do we usually wait a few weeks before provision of crown or post?
If endo tx’s are to fail, they often fail in the first 1-2 weeks
Why can’t CaOH be sued for perforations?
CaOH does not set → MTA does
