Endodontics
Course Review
Enoch Ng, DDS 2014
Access Cavity Prep
Rubber Dam
-
Rubber dam required for all endo cases – standard of care
o
Protection of patient
o
Creates aseptic environment, infection control
o
Enhances vision, makes treatment more efficient
o
Retracts tissue, soft tissues are protected from laceration chemical agents and medicaments
o
Irrigation solutions confined to the operating field
o
Protects patient from swallowing aspirating instruments and/or materials
o
Generally, medium weight non-latex type
-
Rubber Dam Retainers
o
Anterior –#9 or #212
o
Premolars - # 0 or 2
o
Molars - # 14, 14A, 56
-
Dam Placement
o
Evaluate ability to isolate – oraseal caulking can be used to seal, prevent saliva from getting into access
o
Periodontal support
o
Restorability, caries, defective restorations/leaking margins
o
Crown lengthening
o
Cost/tx plan, consent
Access Prep
-
Objectives
o
Remove all caries, conserve tooth structure
o
Completely unroof pulp chamber, remove all coronal pulp tissue
o
Local all root canal orifices
o
Achieve straight line access to apical constriction or initial curvature of canal
o
Establish restorative margins to minimize marginal leakage of restored tooth
o
Consider multiple tooth isolation – short clinical crown, retainers not in way of radiographs, etc
-
Other Considerations
o
Until RD is in place, broaches and files CANNOT be used
o
All unsupported tooth/restorative structure must be removed
o
Radiographs may include off angle bitewings and Pas
Estimated access length