**Temporisation during Endodontics**
**Major Functions**
* Prevent bacterial ingress during and after treatment
* Provide a sound base for rubber dam placement
* Protect against tooth fracture during treatment
* Provide a stable reference point
* Provide aesthetics where required
## **Major Functions**
- Prevent bacterial ingress during and after treatment
- Provide a sound base for rubber dam placement
- ==This is essential for isolation, especially when treating the last tooth in an arch.==
- Protect against tooth fracture during treatment
- ==However, any tooth structure likely to fracture should ideally be removed during the initial investigation phase.==
- Provide a stable reference point
- ==This provides a consistent point on the occlusal or incisal surface for measuring file lengths (working length) that must not break or change between appointments.==
- Provide aesthetics where required
**Temporisation during Endodontics**
**TWO** Considerations
**Restoration of the:**
ö **Tooth**
ö **Access cavity**
## **Key Considerations**
Temporisation involves the restoration of two distinct areas:
- The **Tooth**
- ==This involves building up the entire coronal portion of the tooth after the investigation phase (removal of old fillings, caries, etc.) is complete. This restoration provides the foundation for the entire treatment period.==
- The **Access cavity**
- ==This refers to the filling placed within the access cavity of the interim restoration at the end of each treatment appointment to seal the canals between visits.==
# **Temporisation during Endodontics**
# **TWO** Considerations
* Interim restoration of the **tooth**
* **After previous restorations removed**
# **I. Interim Restoration of the Tooth**
This section addresses the restoration of the tooth structure itself, typically after previous restorations have been removed.
> [!info]
> This is the foundational build-up of a tooth, typically done at the first appointment following the complete removal of compromised tooth structure.
**Temporisation during Endodontics**
**TWO Considerations**
Ö **Interim restoration of the tooth**
o **After previous restorations removed**
o **Glass ionomer (e.g. Ketac Silver, Ketac Fil)**
x **± SS bands**
## **Materials and Techniques for Posterior Teeth**
> [!info]
> For posterior teeth (molars and premolars), which are subject to significant occlusal forces, a combination of robust materials is required.
### **Glass Ionomer Cements (GICs)**
- Glass ionomer (e.g. Ketac Silver, Ketac Fil) is used for the interim restoration of the tooth, sometimes in conjunction with Stainless Steel (SS) bands.
**SS Orthodontic Bands**
**Main Function**
To retain the interim restoration
### **Stainless Steel (SS) Orthodontic Bands**
#### **Main Function**
- To retain the interim restoration
- ==This is especially important in extensively broken-down teeth where there is insufficient tooth structure for retention.==
**SS Orthodontic Bands**
**Other Functions**
* Prevent tooth fracture - “splint”
* Base for rubber dam placement
* Stable reference point for WL measurement
#### **Other Functions**
- Prevent tooth fracture - “splint”
- Base for rubber dam placement
- Stable reference point for WL measurement
**SS Orthodontic Bands**
**Other Functions**
* Prevent tooth fracture – “splint”
* Base for rubber dam placement
* Stable reference point for WL measurement
* Assist with aesthetics
$x$ **Upper premolars - e.g. Bu cusp missing**
$\textnormal{\text{\textschwa}}$ **Buccal veneer of Ketac Fil over band**
* Some cases: Allow long-term reassessment
Matrix for amalgam core
- Assist with aesthetics
- e.g., For upper premolars with a missing buccal cusp, a buccal veneer of Ketac Fil can be placed over the band.
==This can be improved by cutting retention holes in the buccal aspect of the band before placing the GIC.==
- In some cases: Allow long-term reassessment
- Serve as a matrix for an amalgam core
- ==The band is not suitable for composite cores, as it blocks the curing light.==
Description of a photographic sequence illustrating the restoration of teeth with crowns, and two clinical intraoral views of teeth under rubber dam application.
![]()
Description of a photographic sequence illustrating the restoration of teeth with crowns, and two clinical intraoral views of teeth under rubber dam application.
**Temporisation during Endodontics**
***Interim Restorations***
M Ideally use traditional “chemical set” GIC’s
$7$ **Do not need to light cure**
$\times$ **Can not light cure through a stainless steel band**
$7$ **Minimal (? no) shrinkage**
$\times$ **Especially in large cavities**
M Recommended materials:
$7$ **Ketac Silver, Ketac Fil**
- Ideally, use traditional “chemical set” GICs for several reasons:
- **Do not need to light cure**
- Can not light cure through a stainless steel band
- **Minimal (? no) shrinkage**
- Especially in large cavities
- ==Chemically-cured GICs do not contain composite resin, thus avoiding the polymerisation shrinkage associated with light-cured materials, which is a significant concern in large cavities.==
### **Recommended GIC Materials**
- Recommended materials:
- Ketac Silver, Ketac Fil
**Temporisation during Endodontics**
***Interim Restorations***
M Ketac Silver - **preferred wherever possible**
7 **Colour contrast helps removal**
x **Can conserve more tooth structure**
7 **Stronger material - less brittle**
x **Esp. during later access cavity preparation**
7 **Less sensitive to moisture loss**
7 **During setting**
7 **Later when isolated with rubber dam**
#### **Ketac Silver**
- **Preferred wherever possible**
- ==Historically this was the preferred material, though it is currently unavailable.==
- **Colour contrast helps removal**
- Can conserve more tooth structure
- **Stronger material - less brittle**
- Esp. during later access cavity preparation
- **Less sensitive to moisture loss**
- During setting
- Later when isolated with rubber dam
**Temporisation during Endodontics**
**Interim Restorations**
**M Ketac Fil - if aesthetic restoration required:**
**x Upper and lower anterior teeth**
![]()
Before and after images of an aesthetic restoration on anterior teeth.
#### **Ketac Fil**
> [!info]
> A tooth-colored GIC, making it the material of choice for aesthetic situations.
- Used if an aesthetic restoration is required in areas such as:
- Upper and lower anterior teeth
**Temporisation during Endodontics**
**Interim Restorations**
$M$ **Ketac Fil - if aesthetic restoration required:**
$x$ Upper and lower anterior teeth
$x$ Upper 1st premolars
$x$ Some lower premolars & upper 2nd premolars
- Buccal “veneer” of Ketac Fil - if using
$SS$ Bands for retention of temporary
- Upper 1st premolars
- Some lower premolars & upper 2nd premolars
- A buccal “veneer” of Ketac Fil can be used if SS Bands are placed for retention of the temporary.
A flow chart illustrating the stages of dental crown preparation.
```mermaid
flowchart LR
A[Dental tooth preparation] --> B[Metal coping try-in on prepared teeth]
B --> C[Finished metal copings]
```
```mermaid
flowchart LR
A[Dental tooth preparation] --> B[Metal coping try-in on prepared teeth]
B --> C[Finished metal copings]
```
![]()
Dental crown and bridge fabrication process with multiple stages of tooth preparation, metal framework, and final prosthetic assembly shown in sequential images with directional arrows.
**Temporisation during Endodontics**
**Interim Restorations**
**Ketac Silver and Ketac Fil**
**M Must follow the manufacturer's instructions**
7 **Use dentine conditioner**
x **Retention: little difference**
x **Sealing: more reliable if conditioned**
7 **Use resin cover (Ketac Glaze) while setting**
x **For moisture control - in and out**
### **Application Guidelines for GICs (Ketac Silver and Ketac Fil)**
- **Must follow the manufacturer's instructions**
- **Use dentine conditioner**
- Retention: little difference
- Sealing: more reliable if conditioned
- **Use resin cover (Ketac Glaze) while setting**
- For moisture control - in and out
- ==**Band Placement (if used):** Coat the inside of the fitted stainless steel band with the GIC material before seating it. The excess acts as a luting cement.==
- ==**Bulk Fill:** Use the remaining GIC to fill the cavity inside the band.==
**Ketac Silver** and **Ketac Fil**
**Using dentine conditioner before applying GIC**
**Applying Ketac Glaze to help shape and protect the GIC**
![]()
Images showing the application process of GIC starting with the conditioning and ending with the glaze
- Using dentine conditioner before applying GIC
- Applying Ketac Glaze to help shape and protect the GIC
- ==Use a cotton pellet held in tweezers and dipped in the glaze to shape and smooth the surface of the restoration. This is superior to using micro-brushes, which can create small 'pock marks'.==
- ==Achieving a smooth, well-contoured surface before the material sets is crucial, as it minimises the need for later trimming.==
![]()
Close-up image of a decayed tooth with an existing amalgam restoration and a new tooth being prepared, likely under a rubber dam.
![]()
A dental image showing the placement of a metallic restoration on a tooth with a close-up inset.
**Interim Restorations During Endodontics**
**Molars - 163 teeth**
<table>
<thead>
<tr>
<td></td>
<td>Uppers</td>
<td>Lowers</td>
<td>%</td>
</tr>
</thead>
<tbody>
<tr>
<td>Ketac Silver</td>
<td>12</td>
<td>8</td>
<td>12.2</td>
</tr>
<tr>
<td>Ketac Silver + SS Band</td>
<td>65</td>
<td>77</td>
<td>* 87.2</td>
</tr>
<tr>
<td>Temporary Crown</td>
<td>1</td>
<td>-</td>
<td>0.6</td>
</tr>
</tbody>
</table>
### **Usage Statistics for Interim Restorations**
#### **Molars - 163 teeth**
| | Uppers | Lowers | % |
| :--- | :--- | :--- | :--- |
| Ketac Silver | 12 | 8 | 12.2 |
| Ketac Silver + SS Band | 65 | 77 | * 87.2 |
| Temporary Crown | 1 | - | 0.6 |
> [!note]
> Temporary crowns are rarely used due to instability.
**Interim Restorations During Endodontics**
**Premolars - 52 teeth**
| | Uppers | Lowers | % |
|---|---|---|---|
| Ketac Fil | 3 | - | 5.8 |
| Ketac Silver | 10 | 5 | 28.8 |
| Ketac Fil + SS Band | 21 | 4 | 48.1 |
| Ketac Silver + SS Band | 1 | 8 | 17.3 |
**65.4%**
#### **Premolars - 52 teeth**
| | Uppers | Lowers | % |
| :--- | :--- | :--- | :--- |
| Ketac Fil | 3 | - | 5.8 |
| Ketac Silver | 10 | 5 | 28.8 |
| Ketac Fil + SS Band | 21 | 4 | 48.1 |
| Ketac Silver + SS Band | 1 | 8 | 17.3 |
| **Total with SS Band** | | | **65.4%** |
> [!info] Note
> The majority of 'Ketac Fil + SS Band' cases are upper first premolars requiring an aesthetic veneer. 'Ketac Silver + SS Band' is more typical in the lower arch.
![]()
A close-up image of an extracted tooth placed on a sponge block.
<The figure shows a dental crown or abutment with a cutout section revealing a light-colored core, resting on a green sponge-like material.>
<The figure shows a dental crown or abutment with a cutout section revealing a light-colored core, resting on a green sponge-like material.>
![]()
A split image showing dental procedures.
**Interim Restoration of Anterior Teeth**
**Options after post / crowns removed**
- ̈ **CW / Cavit:** _deep in post hole_
- ̊ **Temp. post / crown - with IRM or ZnPO$_4$ cement**
## **Interim Restoration of Anterior Teeth**
> [!info]
> Temporisation of anterior teeth often prioritises aesthetics and may involve different techniques, especially if a pre-existing crown and post have been removed.
### **Options after Post/Crowns Removed**
- **CW / Cavit: deep in post hole**
- Temp. post / crown - with IRM or ZnPO₄ cement
- ==This is the preferred method. Weak cements like Temp-Bond are avoided as they lack adequate retention.==
Composite image illustrating a dental procedure with diagrams and clinical photographs.
**Dressing**
CW
**Cavit**
**Temporary post**
**Temporary crown**
![]()
A radiograph showing a post and core restoration on an anterior tooth.
![]()
A clinical photograph showing the temporary crown on the anterior tooth and adjacent dentition.
- **Dressing Options:**
- CW
- **Cavit**
- **Temporary post**
- **Temporary crown**
**Interim Restoration of Anterior Teeth**
**Options after post / crowns removed**
* **CW / Cavit: deep in post hole**
* Temp. post / crown - with IRM or ZnPO₄ cement
* **CW / Cavit in pulp chamber**
* GIC over exposed dentine
* Temporary overlay denture
- **CW / Cavit in pulp chamber**
- GIC over exposed dentine
- Temporary overlay denture
- ==This is often used when multiple anterior teeth are being treated.==
**Interim Restoration of Anterior Teeth**
**Options after post / crowns removed**
<ul>
<li>CW / Cavit: *deep in post hole*
<ul>
<li>Temp. post / crown - with IRM or ZnPO$_{4}$ cement</li>
</ul>
</li>
<li>CW / Cavit in pulp chamber
<ul>
<li>GIC over exposed dentine</li>
<li>Temporary overlay denture</li>
</ul>
</li>
<li>CW / Cavit in pulp chamber
<ul>
<li>**Temporary composite bridge bonded to root and to the adjacent teeth**</li>
</ul>
</li>
</ul>
- **CW / Cavit in pulp chamber**
- **Temporary composite bridge bonded to root and to the adjacent teeth**
![]()
Dental treatment process with dressing material, infected upper front tooth area, and post-treatment restoration outcomes
**Interim Restorations During Endodontics**
**Anterior teeth - 30 teeth**
| | Uppers | Lowers | % |
|---|---|---|---|
| Ketac Fil | 11 | 4 | 50 |
| Temporary Crown | 14 | 1 | 50 |
### **Usage Statistics for Anterior Teeth - 30 teeth**
| | Uppers | Lowers | % |
| :--- | :--- | :--- | :--- |
| Ketac Fil | 11 | 4 | 50 |
| Temporary Crown | 14 | 1 | 50 |
> [!tip]
> The choice of restoration depends on the amount of remaining tooth structure.
![]()
Tooth preparation sequence with metal restoration removal and cavity exposure
An image showing the sequence of steps for a dental filling procedure, from initial restoration to the final prepared cavity for filling.
![]()
showing a sequence of three smaller images demonstrating steps in a dental procedure (likely decay removal and cavity preparation), leading to a larger image showing the prepared tooth and adjacent teeth
# **II. Temporary Restoration of the Access Cavity ("Access Temporaries")**
Temporisation during Endodontics
**TWO Considerations**
* **Temporary restoration of the access cavity**
* **Subsequent appointments**
* **Cavit**
* **IRM**
This section addresses the temporary restoration of the access cavity between subsequent appointments.
> [!info]
> At the end of each appointment (after the initial one), the access cavity created through the interim restoration must be sealed. This is typically achieved using a 'double seal' technique.
- **Materials:**
- Cavit
- IRM
**Temporisation during Endodontics**
**ACCESS Temporaries**
**Cavit**
* **Calcium sulphate**
* Zinc oxide
* Glycol acetate
* Polyvinyl acetate
* Polyvinyl chloride acetate
* Triethanolamine
* Red pigment
![]()
Image of Cavit temporary filling material packaging.
## **Material Analysis: Cavit**
### **Composition**
- Calcium sulphate
- Zinc oxide
- Glycol acetate
- Polyvinyl acetate
- Polyvinyl chloride acetate
- Triethanolamine
- Red pigment
**Temporisation during Endodontics**
**ACCESS Temporaries**
**Cavit**
7 **Prevents moisture penetration**
![]()
Jar and box of ESPE CAVIT temporary filling material.
### **Properties and Performance**
- **Advantage:**
- ==Convenience: Ready to use, no mixing required.==
- Prevents moisture penetration
- ==A thickness of at least 2mm is required for an effective seal.==
**Temporisation during Endodontics**
**ACCESS Temporaries**
**Cavit**
7 **Prevents moisture penetration**
**CAVIT**
**T.E.R.M.**
Teplitsky & Meimaris - J Endod 1988
- Materials include CAVIT and T.E.R.M. (Teplitsky & Meimaris - J Endod 1988)
**Temporisation during Endodontics**
**ACCESS Temporaries**
**Cavit**
7 Prevents moisture penetration
x **NO research reported about its ability**
**to prevent bacterial penetration**
![]()
A picture of two jars of ESPE CAVIT Temporary Filling Material.
- **Disadvantages:**
- **NO research reported about its ability to prevent bacterial penetration**
**Temporisation during Endodontics**
**ACCESS Temporaries**
**Cavit**
7 Prevents moisture penetration
* **NO research reported about its ability to prevent bacterial penetration**
9 **Poor strength**
9 **Poor wear resistance**
9 **High solubility**
![]()
A small container of Cavit temporary filling material with its description and logo.
- Poor strength
- Poor wear resistance
- High solubility
**Effect of repeated vertical loads on
microleakage of IRM and calcium
sulphate-based temporary fillings**
Liberman R, Ben-Amar A, Frayberg E.
**J Endod 2001; 27: 724-9.**
### **Supporting Research: Liberman et al. (2001)**
- **Study:** Effect of repeated vertical loads on microleakage of IRM and calcium sulphate-based temporary fillings. Liberman R, Ben-Amar A, Frayberg E. **J Endod 2001; 27: 724-9.**
*Effect of repeated vertical loads on microleakage of IRM and calcium sulphate-based temporary fillings. Liberman et al JoE 2001*
**M “Passive” temporaries:**
* **No difference in “seal” against radioactive tracer**
- **Findings:**
- **“Passive” temporaries:**
- No difference in “seal” against radioactive tracer between IRM and calcium sulphate materials.
Effect of repeated vertical loads on microleakage of IRM and calcium sulphate-based temporary fillings. Liberman et al JoE 2001
M **“Passive” temporaries:**
o **No difference in “seal” against radioactive tracer**
M **With repeated occlusal loading:**
o **IRM - no change**
![]()
A product box for Caulk Dentsply IRM Intermediate Restorative Material.
- **With repeated occlusal loading:**
- **IRM** - no change
**Effect of repeated vertical loads on microleakage of IRM and
calcium sulphate-based temporary fillings. Liberman et al JoE 2001**
M **"Passive" temporaries:**
o **No difference in "seal" against radioactive tracer**
M **With repeated occlusal loading:**
o **IRM - no change**
o **Calcium sulphate materials "deteriorated rapidly"**
$\times$ **Penetration was "total and immediate"**
**ú "Equivalent to an open access cavity"**
- **Calcium sulphate materials** "deteriorated rapidly"
- Penetration was "total and immediate"
- "Equivalent to an open access cavity"
**Effect of repeated vertical loads on microleakage of IRM and calcium sulphate-based temporary fillings. Liberman et al JoE 2001**
M “Passive” temporaries:
$\circ$ No difference in “seal” against radioactive tracer
M With repeated occlusal loading:
$\circ$ IRM - no change
$\circ$ Calcium sulphate materials “deteriorated rapidly”
$\times$ Penetration was “total and immediate”
Û “Equivalent to an open access cavity”
M **Also showed that penetration tests without occlusal loading are of limited, or no, value**
- **Conclusion:**
- Also showed that penetration tests without occlusal loading are of limited, or no, value.
- ==This demonstrates that Cavit is not suitable as a standalone temporary restoration.==
**Temporisation during Endodontics**
**ACCESS Temporaries**
**IRM**
| | |
|---|---|
| Caulk Dentsply IRM | ú **Zinc oxide** |
| INTERMEDIATE RESTORATIVE MATERIAL | ú **Eugenol** |
| IVORY ELFENBEIN IVOIRE MARFIL | o **Reinforced** |
| REORDER #610007 | |
| FOR DENTAL USE ONLY | |
| CONTENTS: 1 POWDER (38 G) 1 LIQUID (14 ML) | |
## **Material Analysis: IRM (Intermediate Restorative Material)**
### **Composition**
> [!info]
> Cavit is primarily composed of calcium sulfate (the main component of plaster). It is a single-paste material that sets upon contact with moisture.
> [!info]
> IRM is a reinforced zinc oxide eugenol (ZOE) material.
- **Caulk Dentsply IRM**
- **Zinc oxide**
- **Eugenol**
- **Reinforced**
- **CONTENTS:** 1 POWDER (38 G) 1 LIQUID (14 ML)
- REORDER #610007
- FOR DENTAL USE ONLY
**Temporisation during Endodontics**
**ACCESS Temporaries**
**IRM**
7 **Prevent bacterial penetration**
$\times$ **Hume’s diffusion studies**
$\times$ **Brannström’s “upside down restorations”**
![]()
Image showing a Caulk Dentsply IRM Intermediate Restorative Material package label.
### **Mechanism of Action & Supporting Research**
The ability of IRM to prevent bacterial penetration is supported by the following studies:
- Hume’s diffusion studies
- Brannström’s “upside down restorations”
**Eugenol is released by progressive hydrolysis**
**Hydrolysis occurs at:**
- **External surface (saliva)**
- **Cavity floor (dentinal fluid)**
**ZOE**
**Pulp**
$10^{-2}$ $\rightarrow$ **Anti-bacterial**
$10^{-3}$ **M**
$10^{-4}$ $\rightarrow$ **Reduces inflammation**
**ZOE Diffusion**
(Hume '84, '86, '87).
![]()
A diagram illustrating the diffusion of eugenol from ZOE into the pulp, showing concentrations for anti-bacterial and anti-inflammatory effects
#### **Hume's Diffusion Studies ('84, '86, '87)**
- Eugenol is released by progressive hydrolysis.
- **Hydrolysis occurs at:**
- External surface (saliva)
- Cavity floor (dentinal fluid)
- **ZOE Diffusion Concentrations:**
- ==The concentration is highest near the restoration (10⁻² to 10⁻³ M), which is antibacterial.==
- ==The concentration drops as it nears the pulp (10⁻⁴ M), where it has an anti-inflammatory effect.==
- 10⁻² M → **Anti-bacterial**
- 10⁻⁴ M → **Reduces inflammation**
**Brännström et al J Prosthet Dent 1979**
**Brännström’s “upside down restorations”**
#### **Brännström’s “Upside Down Restorations” (1979)**
- **Study:** Brännström et al J Prosthet Dent 1979
Brännström et al J Prosthet Dent 1979
* **Human teeth in vivo**
A diagram of a tooth structure, including the crown (white line) and the pulp chamber and root canal (red/orange lines).
- **Method:**
- Human teeth *in vivo*
Brännström et al J Prosthet Dent 1979
- Human teeth *in vivo*
- **Class V cavities**
- $\check{S}$ Restored
- $\check{S}$ Teeth extracted
- $\check{S}$ Examined histologically
<img style="max-width: 100%; height: auto;" src="https://i.imgur.com/uW9Uf3W.png" alt="Outline drawing of a tooth cross-section with a cavity preparation (yellow box) and pulp chamber (red outline)."/>
- Class V cavities were restored.
- Teeth were extracted.
- Examined histologically.
Brännström et al J Prosthet Dent 1979
* Human teeth *in vivo*
* Class V cavities
* **Silicate restorations**
– No lining
? Acid effect on pulp
Silicate
- **Experiment:**
- Silicate restorations were placed to test the acid effect on the pulp.
**Brännström et al J Prosthet Dent 1979**
* Human teeth *in vivo*
* Class V cavities
* Silicate restorations
– No lining
? Acid effect on pulp
Ö **Silicate alone**
9 Pulp inflamed
9 Bacteria under restoration
& in the tubules
<img Silicate *>
- **Silicate alone:**
- Pulp inflamed
- Bacteria under restoration & in the tubules
- ==This showed that bacterial leakage, not the material's acidity, caused the pulpitis.==
Brännström et al *J Prosthet Dent 1979*
* Human teeth *in vivo*
* Class V cavities
* Silicate restorations
– No lining
? Acid effect on pulp
* Silicate alone
* Pulp inflamed
* Bacteria under restoration & in the tubules
* ZO-E cover
* **No pulp inflammation**
* **No bacteria seen**
ZO-E Sil.
7
- **ZO-E cover over Silicate:**
- **No pulp inflammation**
- **No bacteria seen**
ZO-E Sil.
Brännström et al J Prosthet Dent 1979
Brännström's "upside down restorations"
**Ú ZO-E prevented entry of bacteria into the cavities**
- **Conclusion:**
- ZO-E prevented entry of bacteria into the cavities.
**Temporisation during Endodontics**
**ACCESS Temporaries**
**IRM**
* Prevent bacterial penetration
* **Brannström's "upside down restorations"**
* **Hume's diffusion studies**
* High wear resistance
* Low solubility
![]()
Image of a box of Caulk Dentsply IRM Intermediate Restorative Material.
### **Properties and Performance**
- **Advantages:**
- Prevent bacterial penetration
- High wear resistance
- Low solubility
- ==These properties overcome the primary weaknesses of Cavit.==
Temporisation during Endodontics
**ACCESS Temporaries**
**IRM**
| 7 | **Prevent bacterial penetration** |
| :--- | :--- |
| $\times$ | **Brannström's “upside down restorations”** |
| $\times$ | **Hume's diffusion studies** |
| 7 | **High wear resistance** |
| 7 | **Low solubility** |
| 9 | **Does not prevent moisture penetration** |
![]()
A close-up of the IRM product packaging
- **Disadvantage:**
- Does not prevent moisture penetration
**Temporisation during Endodontics**
**ACCESS Temporaries**
M There is *NO SINGLE IDEAL*
temporary filling material available
for endodontic access cavities
M All of the available materials have:
7
Advantages
and
9 **Disadvantages**
## **The "Double Seal" Technique**
### **Rationale**
- There is **NO SINGLE IDEAL** temporary filling material available for endodontic access cavities.
- All of the available materials have:
- Advantages
- and **Disadvantages**
**Temporisation during Endodontics**
**ACCESS Temporaries**
<img src="Temporisation during Endodontics ACCESS Temporaries “Double Seal”.png" alt="Double Seal">
**To use the advantages**
**and to**
**Overcome the disadvantages**
**of the materials available**
<img src="IRM and Cavit packaging.png" alt="IRM and Cavit packaging">
- The "Double Seal" technique is used to combine the advantages and overcome the disadvantages of the materials available.
**Temporisation during Endodontics**
**"ACCESS Temporaries"**
<br>
<br>
<br>
**IRM**
**CAVIT**
**Cotton wool**
**Medicament**
<br>
<br>
**"Double Seal"**
<br>
<br>
**<img src="IRM product box image">**
<br>
**<img src="CAVIT product boxes image">**
![]()
Illustration of a tooth with temporary filling materials
### **Layering**
The
> [!success] Rationale
> The outer IRM layer resists wear and stops bacteria, while the inner Cavit layer stops any moisture that may get past the IRM from reaching the root canal system.
"Double Seal" is structured as follows from the base of the pulp chamber upwards:
1. **Medicament**
2. **Cotton wool**
3. **CAVIT**
4. **IRM*
> [!tip]
> Ideally, the restoration should be approximately 50% Cavit and 50% IRM by thickness.
*
<p><b>Temporisation during Endodontics</b></p>
<p><b><i>ACCESS Temporaries</i></b></p>
<p></p>
![]()
A close-up view of a tooth with temporary filling material, surrounded by a rubber dam.
Temporisation during Endodontics
**Cotton Wool**
7 Place a **VERY SMALL** pellet of CW over canal orifices
$\hat{A}$ **Prevents temporary filling going into the canals**
x During placement of temporary, and
x During removal of temporary
$\hat{A}$ **Provides “matrix” / “stop” against which the Cavit**
**can be placed**
### **Role of Cotton Wool**
- Place a **VERY SMALL** pellet of CW over canal orifices.
- **Purpose:**
- **Prevents temporary filling going into the canals:**
- During placement of temporary, and
- During removal of temporary
- **Provides “matrix” / “stop” against which the Cavit can be placed**
- ==Failure to use cotton wool can lead to large gaps under the restoration or extrusion of material deep into the canals, complicating subsequent treatment.==
![]()
A radiograph showing teeth with restorative work and an arrow pointing to a periradicular lesion.
![]()
Dental radiographs with red arrows indicating areas of concern such as potential root canal treatment or abnormalities.
# **III. Summary of Required Materials**
* **For Interim Restorations (Whole Tooth Build-up):**
* ==**Glass Ionomer Cements:** Chemically-cured GICs like *Ketac Silver* (for strength and contrast) and *Ketac Fil* (for aesthetics).==
* ==**Stainless Steel Orthodontic Bands:** For retention in posterior teeth.==
* ==**Temporary Crown Materials:** For anterior teeth, including crown forms and materials like *Luxatemp*.==
* **For Temporary Restorations (Access Cavity Seal):**
* ==**Cavit:** As the inner layer for its moisture seal.==
* ==**IRM:** As the outer layer for its wear resistance and antibacterial properties.==
* ==**Sterile Cotton Pellets:** As a crucial barrier over canal orifices.==
**Temporisation during Endodontics**
**Cotton Wool**
7 Place a **VERY SMALL** pellet of CW over canal orifices
$\hat{A}$ **Prevents temporary filling going into the canals:**
x **During placement of temporary, and**
x **During removal of temporary**
$\hat{A}$ **Provides “matrix” / “stop” against which the Cavit can be placed**
9 **NO evidence that sterile CW allows bacterial penetration if adequate temporary placed**
- **Note:**
- **NO evidence that sterile CW allows bacterial penetration if adequate temporary placed**
**Temporisation during Endodontics**
**Materials Required**
M Cavit
M IRM
M Ketac Silver
M Ketac Fil
M St. steel orthodontic bands
M Temporary crown forms
M Cold cure acrylic resin
M Temporary posts
- Cavit
- IRM
- Ketac Silver
- Ketac Fil
- St. steel orthodontic bands
- Temporary crown forms
- Cold cure acrylic resin
- Temporary posts
[[L17 Temporary.pdf#page=1|L17 Temporary, p.1]]
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