Endodontics
Course Review
Enoch Ng, DDS 2014
Ferric Sulfate
o
15.5% added to orifices 10-15s, flush chamber with distilled water
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Dry with sterile cotton pellets, seal wounds with ZnO-Eugenol
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Restoration, SSC (posterior) or composite (anterior), judicious monitoring/recall
MTA
Improved pulp protection, biocompatible
Small amount of blood/moisture is fine – moisture needed for curing
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Shallow pulpotomy, place MTA, allow 6-24h to cure, place restoration
o
Disadvantages – 2 appointments, expensive
Formal Cresal - BAD
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19-35% formaldehyde – absorbed systemically within minutes
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Severe inflammatory agent, metabolized in liver, RBC, brain, kidney, muscle
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Antigenically alters tissue
Gluteraldehyde, electrosurgery, laser, Ca(OH)
2
– problems with internal resorption
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Primary Pulpectomy
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Difficult cleaning and shaping of bizarre and torturous canal anatomy in primary molars
Especially when molars have open apex due to resorption
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Abscess can negatively affect formation of developing tooth bud
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Consider restorability, extraction with space maintainer
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Maintain tooth free of infection, clean canals, promote physiologic root resorption, hold space
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Indications
IRP or pulpal necrosis
Want to keep tooth instead of using space maintainer
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Contraindications
Severe root resorption
Surrounding bone loss from infection
Non-restorable tooth
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Technique
Local anesthetic, rubber dam
Access, instrument 2-3mm from radiographic apex (no gates glidden), beware of developing bud
Dry with paper points, fill canals with hard setting ZOE or other paste
Restore, cover with SSC
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Apexogenesis
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Vital pulp therapy encouraging continued physiologic development and formation of root end
Deep pulpotomy, success dependent on extent of pulpal damage and restorability
Large caries/traumatic exposure may require pulpotomy – apexogenesis done if pulptomy fails
Usually use Ca(OH)
2
– MTA can be used, but harder to re-enter
After root formation, clinician can reenter and RCT may be completed
o
Pulp capping and pulpotomies in immature teeth essentially apexogenesis