Endodontics
Course Review
Enoch Ng, DDS 2014
Non-Surgical Retreatment
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Gain access to canal system and reach apical foramen via removal/bypass of obturation materials from canal
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Patient usually has high outcome expectations
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Requires greater clinical skill than original NSRCT treatment
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Canal Obstructions – posts, separated instruments
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Reduce retention – loosen with ultrasonics, twist/pull out post, relieve dentin in coronal portion of canal
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Directly cut out post/instrument
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Hazards
Perforation while attempting to ditch around post
Root fracture upon removal
Excessive temperature generation/root perforation while trying to cut through post
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Separated Instruments/carrier systems removal
Technically difficult, requires special equipment
Access – cannot remove what you cannot reach
Visualization – usually can remove what you can see, optimal magnification and illumination
Operating microscope or high powered loupes with light
Microsurgical forceps
Stieglitz pliers
Endo extractor kit
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Obturation materials – pastes, semi-solid materials, solid materials, carrier systems
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Original obturation materials
54% GP
21% pastes/cements
19% silver points
2.4% combination
2.2% broken instruments
0.5% none (periradicular surgery without fill)
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GP removal
Quality of condensation
Shape of root canal
Length of obturation material – short fill, overextension, etc
System B
Gates Gliddens, ProFiles, GPX
Removes GP quickly
Provides reservoir for solvent
Heat and hedstrom removal technique
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Solvents
Chloroform
Methylchloroform, Eucalyptol, Halothane, Xylene, Rectified white turpentine
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Existing restorations – crowns, abutments (FPD, RPD), core materials (amalgam, composite, GI)
Summary
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Technically more difficult that original NSRCT
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Special instruments, materials, techniques required
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Healing outcome less than original treatment in older literature