W10 - Solutions for Common Endo Problems - Stoll

Question 1

What must be done before endo tx (2)

Answer 1

Removal of ALL caries

Restore tooth with stable restoration (GIC is NOT stable)

Question 2

Tips when accessing pulp chamber

Answer 2

• Determine tooth axis before rubber dam
• Aim for big roots
• Know the anatomy
• Trust radiograph
• Straight line access

Question 3

What size files are used for the location of fine and calcified canals

Answer 3

6, 8, 10

or

special pathfinder instruments (stiffer)

Question 4

If a canal is not accessible, what should be done

Answer 4

Leave it and fill the accessible ones, then reconsider the case (exo, retreat. surgical)

Question 5

What should be done after initial shaping

Answer 5

Recheck lengths

Always have stable and reproducible reference points

Question 6

What must be visible in endodontic PA

Answer 6

Apex and reference point

Question 7

How can you prevent ledges (4)

Answer 7

Prebend steel files

Use small Hedstoem files

Use NiTi rotary (for curved roots)

Rinse frequently

Question 8

How to prevent file fractures

Answer 8

Do not push - lubricate

Use only for a short time

If file doesn’t want to work, use smaller file

Question 9

what can overshaping lead to?

Answer 9

Strip Perforation

Question 10

Answer 10

Strip-perforation

• Overshaping

Question 11

Consequences of undershaping

Answer 11

Problems with cleaning and obturation

Question 12

How much NaOCl should be used?

Answer 12

5 mL per canal (3 syringes for a molar)

Question 13

How to improve efficacy of NaOCl

Answer 13

Preheated solutions

Ultrasonic activation

Question 14

Common problems during obturation + solution (3)

Answer 14

Almost always relating to master cone

1. Cone too short → use smaller cone or reshape
2. Cone too long → Cut the tip
3. No tug back → Cut the tip

Question 15

What happens if you have no tug back?

Answer 15

Master cone will most likely come out during condensation

Question 16

What file should be used for re-treatment

Answer 16

Hedstrom > #20 → #15 will commonly break

• Frequently check file and replace if damaged
• Only use NiTi rotary if really necessary

Question 17

When should a post be placed (time not indication)

Answer 17

If no problems are expected (low bacterial count) → immediately (most common)

If tooth was heavily infected → wait 1-2 weeks

Question 18

What should be done directly after obturation

Answer 18

Application of a stable adhesive restoration

Question 19

How long after endo tx should a crown be placed if indicated?

Answer 19

ASAP → after 2-4 weeks

Question 20

How to manage pain in emergency patients

Answer 20

If standard infil or block doesn’t work → intraosseous LA

or other direct means of anesthesia (intrapulpal)

Consider starting RCT immediately

Question 21

What drugs may pts be taking / want for pulpitis, however may not do anything for the pain?

Answer 21

NSAIDS → not sufficient

Antibiotics → pointless and will do nothing unless infection is spreading

Question 22

Root resorption (tx, what to tell pt)

Answer 22

Remove the cause (infection?) and resorption will have chance to stop

Inform pt about limited success probability and that no lost tissue can redevelop

Question 23

What is this and how to treat

Answer 23

Lateral root resorption

• Take PA with tube shift to make sure its not internal resorption
• Endo and dress with Ledermix

Question 24

What is this and how do you treat

Answer 24

Perio-Endo lesion

1. Confirm diagnosis
2. RCT and initial perio tx
3. Review in 3-6 mo

Basic idea: both inside and outside must be cleaned sufficiently to heal

Question 25

How to close perforation

Answer 25

1. General cleaning and shaping
2. MTA to seal if below bone, GIC if above

Question 26

How to treat open apex

Answer 26

Seal lower third with MTA

GP for rest

Question 27

Why do we usually wait a few weeks before provision of crown or post?

Answer 27

If endo tx’s are to fail, they often fail in the first 1-2 weeks

Question 28

Why can’t CaOH be sued for perforations?

Answer 28

CaOH does not set → MTA does