3BDS: Endodontics = obturation
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- Created by: DianaIspas
- Created on: 02-12-20 15:22
what gives success in Endodontics
- Diagnosis and treatment planning
- Knowledge of anatomy and morphology
- Cleaning and shaping
- Obturation
- Coronal seal
- Knowledge of anatomy and morphology
- Cleaning and shaping
- Obturation
- Coronal seal
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what influences success
• Absence of pre-treatment periapical lesion
• Root canal filling with no voids
• Obturation to within 2mm of apes
• Adequate coronal restoration
• Root canal filling with no voids
• Obturation to within 2mm of apes
• Adequate coronal restoration
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what are some examples of procedural errors
Loss of length (ledging)
Canal transportation
Loss of coronal seal
Vertical root fracture
Perforation
Canal transportation
Loss of coronal seal
Vertical root fracture
Perforation
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what is the objective of obturation
- To achieve a complete seal: apical, lateral and coronal
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why is it essential that endodontic treatment must include sealing of the root canal system
to prevent tissue fluids from percolating into the root canal and prevent toxic by- regressing into the periapical tissues
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what does cleaning and shaping do
removes the microbes and eliminates the cause of periapical pathology.
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why is obturation a important stage
Root canal systems cannot be completely cleaned and disinfected
- remaining bacteria can initiate/perpetuate a lesion
Obturation is necessary to eliminate leakage
- reduced coronal leakage and bacterial contamination
- seals the apex from periapical tiss
- remaining bacteria can initiate/perpetuate a lesion
Obturation is necessary to eliminate leakage
- reduced coronal leakage and bacterial contamination
- seals the apex from periapical tiss
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what type of seal is used
• Fluid tight or bacteria tight seal- a more appropriate term as root canals are evaluated for leakage of fluid
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when should treatment be carried our in single visits
when the patient has:
no significant symptoms
no significant clinical signs (the tooth must not be tender to percussion, TTP)
canal must be clean and dry (no blood, exudate or pus
appointment time must be of sufficient length
if the patient has the pres
no significant symptoms
no significant clinical signs (the tooth must not be tender to percussion, TTP)
canal must be clean and dry (no blood, exudate or pus
appointment time must be of sufficient length
if the patient has the pres
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what is there is acute symptoms/ acute apical abscess with necrotic pulp tissue
- Delay obturation until symptoms have resolved
- Canals must be clean and dry (no exudate on paper points)
- Canals must be clean and dry (no exudate on paper points)
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what if there is a sinus showing chronic abscess,
, do not carry out RCT in a single visit. Clean, shape, dress RCT with sodium hydroxide and brings patient back 2 weeks later. The sinus would have healed so now we can obturate the root canal
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what is the necrotic pulp tissue is with or without asymptomatic periapical pathology
- Asymptomatic apical periodontitis
- Condensing osteitis
is it a single visit treatment or ?
- Asymptomatic apical periodontitis
- Condensing osteitis
is it a single visit treatment or ?
one visit treatment
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why is one visit preferred if patient has vital pulp tissue
- Bacterial contamination is minimal
- Prevents possible contamination via leakage between visits
- Prevents possible contamination via leakage between visits
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when should multiple visit appointments be done?
presence of acute signs, symptoms , swelling
persistent exudate in root canal
anatomical difficulties
technical difficulties
patient or dentist is tired or has lost patience
persistent exudate in root canal
anatomical difficulties
technical difficulties
patient or dentist is tired or has lost patience
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what are the advantages of multiple visit treatment
- Allows medication with an antibacterial dressing
- Calcium hydroxide paste will reduce the number of bacteria remaining following cleaning and shaping
- Calcium hydroxide paste will reduce the number of bacteria remaining following cleaning and shaping
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what is used for inter-appointment disinfection
how long should it bereft in order to disinfect the canals
how long should it bereft in order to disinfect the canals
calcium hydroxide paste
1 week is sufficient
1 week is sufficient
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what is the length of obturation as in: where does AC lie
where does the AC lie in necrotic cases
where does the AC lie in necrotic cases
AC lies 0.5-1mm from radiographic apex
in necrotic cases: 0-2mm from apex
in necrotic cases: 0-2mm from apex
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what is a sealer used for
to fill the spaces between the GP cones and between GP and canal wall to ensure a fluid tight seal
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what are some of the technical properties of obturating materials
no shrinkage on setting
insoluble. in tissue fluids
no water absorption
no. tooth. discolouration
insoluble. in tissue fluids
no water absorption
no. tooth. discolouration
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what are some of the handling properties of obturating materials
radiopaque
adequate setting time
easy to remove
adequate setting time
easy to remove
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what are some of the biological properties of obturating material s
no allergy
sterile
antimicrobial
stimulate periapical healing
no irritation. to local tissues
sterile
antimicrobial
stimulate periapical healing
no irritation. to local tissues
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what obturation technique do we use
Cold lateral compaction
Master apical cone in place and place finger spreader to create a channel to insert small accessory gutta percha cones
Master apical cone in place and place finger spreader to create a channel to insert small accessory gutta percha cones
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what is the sequence of cold lateral compaction technique pt 1
LA
Place rubber dam
Swab tooth with alcohol
Remove dressing and cotton wool
Irrigate with citric acid first to remove calcium hydroxide dressing, then sodium hypochlorite
Place rubber dam
Swab tooth with alcohol
Remove dressing and cotton wool
Irrigate with citric acid first to remove calcium hydroxide dressing, then sodium hypochlorite
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what is the sequence of cold lateral compaction technique pt 2
take a come-fit radiograph
place rubber stop onto a size B finger spreader and check that this can be inserted into canal to within 1-2mm of WL
place rubber stop onto a size B finger spreader and check that this can be inserted into canal to within 1-2mm of WL
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what is the sequence of cold lateral compaction technique pt 3
Master cones lack uniformity and can vary in tip size
dry canal with correct size of paper points measured to WL
Mix sealer and have spreader ready
dry canal with correct size of paper points measured to WL
Mix sealer and have spreader ready
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what is the sequence of cold lateral compaction technique pt 4
Coat MAC lightly in sealer
Insert into canal to correct WL
Use a slow pumping action to allow back flow of sealer
insert spreader twitch stopper
leave in place 10-15 seconds with light lateral pressure
Insert into canal to correct WL
Use a slow pumping action to allow back flow of sealer
insert spreader twitch stopper
leave in place 10-15 seconds with light lateral pressure
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what is the sequence of cold lateral compaction technique pt 5
remove spreader with. a slight rotation and place accessory cone lightly coated in sealer into channel
Repeat this process until no further accessory cones can be fitted
Repeat this process until no further accessory cones can be fitted
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how can you minimise coronal. leakage
resin modified GI (vitrebond)
smart dentine replacement (SDR)
smart dentine replacement (SDR)
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how to provide coronal seal following obturation
• Clean access cavity with alcohol on micro brush
• Etch and bond access cavity
• Place SDR in pulp chamber and access cavity
• Leave 2mm to be filled with conventional composite if an indirect restoration is not prescribed
• Etch and bond access cavity
• Place SDR in pulp chamber and access cavity
• Leave 2mm to be filled with conventional composite if an indirect restoration is not prescribed
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Other cards in this set
Card 2
Front
what influences success
Back
• Absence of pre-treatment periapical lesion
• Root canal filling with no voids
• Obturation to within 2mm of apes
• Adequate coronal restoration
• Root canal filling with no voids
• Obturation to within 2mm of apes
• Adequate coronal restoration
Card 3
Front
what are some examples of procedural errors
Back
Card 4
Front
what is the objective of obturation
Back
Card 5
Front
why is it essential that endodontic treatment must include sealing of the root canal system
Back
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