Endodontics
Course Review
Enoch Ng, DDS 2014
Bleach Toxicity
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Toxic effect is 10x greater than antimicrobial effect
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NaOCl cytotoxic to all but heavily keratinized cells
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Very caustic, nonspecific agent – serious consequences from apical passage of NaOCl
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Apical passage of NaOCl
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Excruciating pain for 2-5min
Immediate swelling with spread to surrounding CT
Profuse bleeding either interstitially or intraorally throughout root canal system
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Severe pain replaced with constant discomfort
Potential for permanent paresthesia
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Treatment
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Alleviate swelling with cold packs, warm saline soaks for following days
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Pain control with LA and analgesics
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Rx antibiotics – prevent spread of primary infection, increase susceptibility of secondary infection
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Reassure patient
Smear Layer
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NaOCl does NOT remove smear layer
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REDTA DOES remove smear layer leaving no debris behind
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NaOCl and RCPrep (EDTA + 10% urea peroxide + Carbowax) – smeared surface with more superficial debris
Difficulties with Instrumentation (Case selection)
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Pulpal space
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Calcification
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Chamber size and shape
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Orifice size and shape
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Canal size and shape – may be very complex
Canals may join, separate, and differ in length
Electronic Apical Locator may be helpful
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Number of canals
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Root morphology
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Curvature
Dilacerations
Long roots
Recurvature
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Length
Long
Short
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Occlusal Access
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Looking for MB2 on Mx molars
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Large enough to:
Visualize pulpal floor
Illuminate pulpal floor
Visualize subpulpal groove map
Develop straight line access
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Usually requires removal of dentin shelf on mesial wall