Endodontics
Course Review
Enoch Ng, DDS 2014
Temporization, Restoration, Internal Bleaching
Intracanal Medicaments
o
Ca(OH)
2
Intra-appointment canal dressing
High pH inhibits bacterial growth, deactivates toxins
Supports apical healing
Prevents re-infection
o
Calasept, pulpdent, vitapex, ultracal
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Place after instrumented to WL, place tip 1-2mm short of WL
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Do not place in wet canal, do not bind tip, practice before depositing in canal
Temporary Restoration
-
Obtain fluid tight seal, maintain occlusal and proximal contacts
Cavit
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Slight expansion (seals margins)
o
Water absorption, expansion
-
Non-vital teeth only
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Class I preps
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Minimum thickness 3.5mm for seal
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Seal lasts <3 weeks
IRM
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ZnO powder mixed with eugenol
o
Better compressive strength
o
Antimicrobial properties
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Marginal ridges not intact
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Long than 3 weeks if used as part of “double seal”
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Procedure
o
Final NaOCl rinse
o
Dry canals with paper points
o
Place Ca(OH)
2
o
Place small dry cotton pellet
o
Place double seal temporary restoration, use incremental (not blog) technique
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RMGIC – Fuji
o
Long term temporization
o
Expensive, rebuild areas to control coronal leakage prior to treatment
o
Remove caries
matrix band
place cotton pellet
place fuji
light cure
adjust occlusion
Restorations of Endo Treated Teeth
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Protect from fracture, prevent reinfection, replace missing structure
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Placement of final restoration is FINAL STEP in RCT
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Biggest factor of long term prognosis = remaining dentin amount
o
No restorative material can substitute for intact dentin
o
Is tooth restorable? Determine before RCT
o
Anterior – <½ residual tooth or remaining walls <1mm on ¾ of tooth circumference, need post and core
o
Posterior – walls >3-4mm from chamber floor, >1.5-2mm thick only need core, <60% tooth left = post
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Successful debridement and apical sealing essential for restoration of non-vital tooth
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Sealing of coronal restoration vital to long term tooth health
o
97% of endo treated teeth retained after 8 years
o
85% of failed teeth did not have proper final restoration