Week 10- Solutions for common Endodontic Problems Flashcards
What are some endodontic problems?
- Access to the pulp chamber
- Location of fine and calcified canals
- Problems with cleaning, shaping and obturation
- Problems with re-treatment
- Problems with post-endodontic treatment
- Endodontic emergencies
- Root-Resorptions
- Perio-Endo Lesions
- Perforation
What should be done before accessing the pulp chamber?
Remove caries and restore tooth with stable restoration (not GIC)
What is the reason for doing a stable CR filling before endo tx?
- If GIC is used it can wash out and the reference points can be lost (would need to start again)
- Helps with rubber dam placement
What are tips for accessing pulp chamber?
- Know anatomy and where to find canal entrances
- Have radiograph visible
- If you need to access through a crown, don’t trust visible anatomy- trust the radiograph. If necessary, get another radiograph with cone shift.
- Get straight line access
- Have loupe/microscope with high magnification
- Clean floor of pulp chamber
What are tips for locating fine and calcified canals?
- Use small instruments #8, #10
- Use special pathfinder instruments (stiffer- better tactile feedback)
- Use sonotrodes for digging
- Rinse with lots of hypochlorite
- move files slowly
- Clean files frequently
- If file is bent, replace it.
- If canal is finally not accessible, leave it and fill accessible ones. Then, reconsider case.
What are tips for eliminating problems with shaping?
- For EAL, recheck lengths after initial shaping
- If unsure, reconfirm with silver points
- Always have stable and reproducible reference points
- Apex and reference point need to be visible on IOPA
- Shape canal entrances (gates glidden or circumferential hand-filing with H file)
- Do not over or under shape
How do you prevent ledge formation during cleaning and shaping?
- Pre-bend steel files
- Use H files
- Use NiTi rotary systems
- Rinse
How can you prevent file fractures with cleaning and shaping?
- Do not push files- lubricate
- Use only for short time
- If file does not want to work, skip to a smaller one
What can overshaping cause?
Strip perforation
What is the issue with undershaping?
Cleaning and obturation is difficult
What is the general rule for rinsing canals?
- 5ml per canal (for molar 3 syringes)
- The cleaning solution needs time to clean: 10-20 mins overall cleaning time
- Preheated solutions and ultrasonic activation are recommended
What are problems with obturation
- Fitting master cone can be difficult
- Cone pulling out during condensation
What should you do if the master cone is too short vs too long from the apex?
- Too short: smaller cone or reshape
- Too long: cut the tip
- No tug back: cut the tip
- Always check with x-ray (cone should be at exact reference point)
Why is tug back required?
Ensures good master cone fit and better control during condensation
What does it mean if master cone pulls out during condensation
- Tug back not sufficient (no friction)
- Condensation force too small
How can we avoid problems with retreatment?
- Use H files >#20
- Frequently check file and replace if damaged.
- Don’t use chloroform or NiTi rotary files
When should posts be placed for RCT?
- If no problems are expected, immediately place a post
- If problems are expected wait at least 1-2 weeks.
How/when should RCT teeth be restored following obturation?
- Apply stable adhesive restoration directly after obturation
- If a crown is required, do it ASAP (2-4 weeks)
What are key factors for treating endo emergencies?
- Sound diagnosis and sufficient LA
- If need to start RCT, do it directly and do it well
- NSAID’s are generally not sufficient for pulpitis
- No antibiotics are required unless special indication.
How should root resorptions be managed?
- Remove cause (infection?) and resorption has a chance to stop
- No lost tissue can redevelop
- Inform pt about limited success probability
How should lateral root-resorptions be managed?
- Remove cause and resorption has chance to stop
- Take IOPA with horizontal tube shift to rule out internal resorption
- Inform pt about limited success probability.
- Use ledermix
How should perio-endo lesions be managed?
- Confirm diagnosis
- RCT and initial perio tx
- Reconsider case after 3-6 months
- Basic idea: both inside and outside must be cleaned sufficiently
- Endo first bc healing of perio tissues will not be possible until infection/inflammation is removed from the root canal system. More predicatble outcome if endo done first.
How should perforations be managed?
- Close perforation with MTA after general cleaning and shaping
- Microscope highly beneficial
What material is used if the perforation is above bone level vs below?
Below bone or in furcation: MTA
Above bone level: GIC
Can you fix perforations with Ca(OH)2?
No, because it doesn’t set
If high bacterial load, how long should dressing be placed?
Ca(OH)2 for time between 1-4 weeks
