L1.Pulp Root Canal and Peri-radicular Conditions - Part 1 - DMD2 - Handout - 2023_formatted_text
What are the 6 steps when dealing with pulp and root canal conditions
1. Idnetify the disease and its cause
2. Remove the cause of the disease
3. Treat the effect of the disease
4. prevent further disease complicaitons
5. Restore to normal function
6. Monitor healing and stability over time
What are the four things you need to asses and record when diagnosing pulp, root canal and periapical conditions
What are the Abbot and Yu diagnosing categories
- Clinically normal pulp
- Reversible pulpitis → Acute → Chronic
- Irreversible pulpitis → Acute → Chronic → Symptomatic → Asymptomatic
- Pulp necrobiosis
- Pulp necrosis → Infected → No sign of Infection
- Pulpless and infected root canal system
- Previous Endodontic Treatment → Infected RCS → No signs of infection
- Pulp atrophy
- Pulp canal calcification
- Pulp hyperplasia
- Internal resorption → Surface → Inflammatory → Replacement
2. Pulp Root Canal and Peri-Radicular conditions
Endodontic Instruments
- pretty simple stuff
Instrumentation and Preparation of Root
Give an example First and second appointment for the mesiobuccal canal of a molar
==Initial Negotiation (First Appointment): - Use a size 10 file to negotiate partway down the canal. The goal is not to reach the apex, but to open up the canal and create coronal flare. - Follow with a size 15 file to further flare the coronal portion. - Place medicament and a temporary restoration.==
- ==Preparation (Second Appointment):==
- ==Negotiate to the estimated working length with a size 10 file, then a size 15 file.==
- ==Take the working length radiograph with the size 15 file in place and confirm the final working length.==
- ==Continue working the size 15 file at the full working length with push-pull/circumferential filing until it is very loose. Irrigate.==
- ==Introduce the size 20 file. It should go to within 1-1.5 mm of the working length. Use a slight rotation to advance it the final distance, then use push-pull/circumferential filing until it is loose. Irrigate.==
- ==Introduce the size 25 file in the same manner. Work it at the full working length until loose. Irrigate.==
- ==Use a Gates Glidden #2 bur in the coronal and middle third of the canal to create the final flare, being careful not to create a ledge.==
What about after canal prep is complete?
Note
After the canal preparation is complete, the final steps at the appointment are:
- ==Final Irrigation Sequence:==
- ==Irrigate with EDTAC to remove the smear layer.==
- ==Irrigate with Sodium Hypochlorite (NaOCl) to disinfect.==
- ==Perform a final rinse with EDTAC.==
- ==Drying: Dry the canal thoroughly using absorbent paper points.==
- ==Medicament Placement: Place an intracanal medicament into the dried canal.==
L3 Anti-bacterial Strategies
what is the correct sequence of irrigation?
-
EDTAC 17% (brief, to condition / open / help files i.e. until working length )
-
NaOCl 1%(throughout instrumentation)
-
EDTAC (proper 1-min final rinse to remove smear)
L4 Anti-bacterial Strategies - 2 - Medicaments - 2023 - Handout_formatted_text
what are the Eight essential steps to reducing endodontic microbial flora
- Identify and remove the cause
-
- Aseptic procedures
-
- Instrumentation / Mechanical instrumentation
-
- Irrigants / Anti-bacterial irrigants
-
- Medicaments / Intracanal medicaments
-
- Interim and temporary restorations
-
- Root canal filling
-
- Coronal restoration
outline the main medicament choices and their major functions
| Function | Indication | Recommended Medicament |
|---|---|---|
| Anti-inflammatory | e.g. Acute Irreversible Pulpitis; Acute Apical Periodontitis | Ledermix paste |
| Anti-bacterial | e.g. Root-filled + infected RCS; Pulpless, infected RCS | Ledermix paste, Calcium hydroxide - Ca(OH)2 |
| Stimulate hard tissue repair | e.g. Apexification | Calcium hydroxide - Ca(OH)2 |
- Choices:
- Corticosteroid / antibiotic - CS / Ab
- e.g. Ledermix paste
- Calcium hydroxide - Ca(OH)2
- e.g. Calasept Plus paste
- 50:50 mixture - CS / Ab + Ca(OH)2
- e.g. Ledermix + Calasept Plus
- e.g. Ledermix + Pulpdent
- Corticosteroid / antibiotic - CS / Ab
What are the components of Ledermix paste?
- 1% Triamcinolone -
- 3% Demeclocycline along with:
- Triethanolamine NF
- Calcium chloride USP
- Zinc oxide
- Sodium sulphite (anhydrous)
- Polyethylene glycol 4,000 USP
- Distilled water
How long is triamcinolone clinically effective, what is the rate of release
- Effective for up to 6 weeks in mature teeth and 4 weeks in immature teeth
- intially a very rapid release then a slow and steady release
Wat are the properties of CaOH?
- Anti - bacterial
- Stimulates hard tissue formatoin
- Helps dissolve necrotic tissue
- Detoxifiies bacterial endotoxin (LPS)
What are the appropriate durations of medicament use?
- Absolute MINIMUM time: 2 weeks
- Since inflammation takes 10-14 days to resolve
- Most BENEFICAL and MAXIMUM times:
- Ledermix paste:
- Calcium hydroxide:
- 50:50 Cs-Ab / Ca(OH) mixtures:
What are the recommended medications for pulpitis and for infected canals in the ifrst 2 visits of the optimal 3 visit approach
- Visit 1:
- Pulpitis: Ledermix paste
- Infected canal: 50:50 mix Ledetermix + CaOH2
- Vist 2:
- pulpitis: 50:50 mix Ledermix + CaOH2
- Infected canal: CaOH2 alone
L5 Prep for treat + temp’s - 2018_formatted_text
What material is used in the interim restoration of the tooth
GIC (ex. ketac Silver, Ketac Fil) with/without SS bands
- used in the first appoint ment
What material is used for temporary restoration of the Access Cavity
- subsequent appointments = cavit and IRM
L6 Abbot Pulp + Root Morphology, Access - 2018_formatted_text
What should you be aware of in terms of root morphology of Lower Incisors?
- ==Anatomy: Typically one root, but a high percentage (50-70%) have two canals (labial and lingual). Lateral incisors are slightly more likely to have two canals than centrals.==
- ==Access: An oval shape on the lingual surface, elongated inciso-gingivally. In cases of severe attrition, access may be made directly through the incisal edge.==
Clinical Pearl Always assume and search for two canals. The lingual canal is frequently missed as it is tucked under the cingulum. The access may need to be extended gingivally to locate it.