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Endodontology (Stages of an RCT (Access Cavity ("a cavity which…
Endodontology
Stages of an RCT
- Endo Assessment w/ preoperative radiographs
"a cavity which allows straight-line access and clear visibility of the entire coronal pulp space + into the orifice of the root canals"
patient prep: good depth of anesthesia
nb. if an infection is present this may require a large dose as the area becomes hyperaemic and acidic
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IRRIGATE BETWEEN EVERY STEP
- Pathfinding = use small k-files to explore and locate all the canals
- Coronal flaring = using Gates Glidden/ Ni-Ti rotary and the step/crown-down technique
- Working length(WL) determination = From a point of reference, i.e cusp, to 0.5 - 1mm from the root apex
- textbook reference
- estimate working length (EWL) = preoperative radiograph
- electronic apex locator (EAL) = w/ #10/#15 k file inside
- radiographic working length = PA radiograph w/ #10/#15 k file
- Termination of Preparation (MAF) = largest file that binds to determined WL is the MAF (usually #25 or #30)
- Apical Flare = using the step-back technique, beginning at the WL w/ MAF we flare, then move coronally by 1mm and increase to the next size and repeat.
- circumferential filing = make contact w/ all surfaces
- recapitalisation = passing a small file back to WL to smooth out steps and keep irrigant moving
- Medicament = place CaOH into the canals w/ pastinject, minimum of 1 week, then place cavit and Fuji to seal the cavity
- Medicament needs to be irrigated out of the canals
- Dry canals with paper points accordingly
- Select the Gutta-percha (GP) that is theoretically same size as MAF (usually one up/down too) to establish your master GP point
- master GP point is the biggest GP that goes to WL while achieving tug-back
- squeeze the master GP with tweezers to mark it
- take a radiograph to confirm
- place sealer on your master GP and accessory points
- Using the lateral condensation of cold GP technique, insert the spreader to condense the master GP to termination
- repeat with accessory GPs working out
- Cut excess off at the level of Al. bone, place orifice barrier and seal w/ final restoration
- @ 6months
- @ 12months for 4 years
Materials
Irrigants/Lubricants
- NaOCl
- 0.5 - 6% conc. w/ broad spectrum antimicrobial activity, capable of dissolving necrotic & vital pulpal tissues and the organic components of dentine (collagen) and biofilms
- contraindication for open apexes due to risk of periodontal tissue necrosis.
- CHX
- 0.12 - 2%, more effective antimicrobial in vitro than NaOCl, no tissue dissolving abilities and is unable to neutralize LPS, and antimicrobial effect reduced in the presence of organic matter like dentine, exudate, ablumin
- EDTA/RC prep
- lubricates and removes the smear layer, demin most effective in the coronal and middle third.
- IKI
- solution of 2-5% iodine in 4% potassium iodide, potential hypoallergenic reactions
Medicaments
- Ca(OH)2
- Hydroxyl ions exert an antimicrobial effect on bacterial lipids, proteins, DNA and even inactivate some bacterial virulence factors.
- CHX
- In vitro more effective the Ca(OH)2, however postop pain issues
- Ledermix
- non-setting corticosteroid-antibiotic paste. It contains 1% triamcinolone acetonide as an anti-inflammatory agent and 3% demeclocycline as an antibiotic agent. nb. a tetracycline agent
- Odontopaste
- this zinc-oxide-based paste is a non-setting corticosteroid-antibiotic paste. It contains 1% triamcinolone acetonide as an antiinflammatory agent and 5% clindamycin hydrochloride as an antibiotic agent. Cannot be mixed with Ca(OH)2
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Orifice Barrier
- Provisional restoration
- grey cavit (ZOE)
- GIC (fluoride release)
- IRM (ZOE)
- Final restoration
- GIC (anterior teeth)
- IRM (posterior teeth)
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Endodontic Anatomy
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Canal Configurations
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(VII) One canal that divides, reunites and exits through two foramina
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