Professional Documents
Culture Documents
- DIAGNOSIS AND TREATMENT PLANNING - NEWER TRENDS IN ANESTHESIA - ODDITIES IN TOOTH MORPHOLOGY - ACCESS PREPARATION - INSTRUMENTATION - IRRIGATION - OBTURATION - CONCLUSION
03/05/12
03/05/12
- Pulp tesing - post endodontic disease - vertical root fracture - non ododntogenic lesions - trauma
03/05/12
PULP TESTING
03/05/12
Thermal Tests
CO2 Snow
Ice stick
03/05/12
Thermal Tests
Cold always used Heat rarely used Compare reaction with adjacent and contra lateral
teeth Refractory period of at least 10 minutes before pulp can be retested accurately
03/05/12
Normal Pulp: Moderate transient pain Reversible Pulpitis: Sharp pain; subsides quickly Irreversible pulpitis: Pain lingers Necrosis: No response
Vital or non-vital In multi-rooted teeth, where one canal is vital tooth usually tests vital False positives and false negatives may occur
Electrode contact with metal restoration or gingiva Patient anxiety Liquefaction necrosis Failure to isolate and dry teeth prior to testing
Endodontic Failure
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Diagnosis
Patient
Complaint ( if any) Clinical Examination Radiographic Examination Elimination of Other Possible Etiologies
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Patient Complaint
Can
patient localize symptoms to a particular tooth Temperature sensitivity Previous swelling or drainage Sensitivity to pressure chewing
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Radiographic Examination
Evaluation
of previous endodontic
treatment Periapical radiolucent lesion Bone loss on lateral aspect of root root fracture Tracing of sinus tract
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Etiology
Inadequate Fractures Coronal
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canal-MB root Max Molars most common - D roots Mand Molars, Mand Incisors, Max Premolars
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Treatment Options
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Apical surgery
PATIENT SAYS HISTORY OF BITING SOMETHING HARD AND FEELING OF SHARP PAIN IMMEDIATELY
(a) Mandibular right first molar which has been root filled and restored with a large amalgam restoration. Note the diffuse V-shaped bone loss (arrows) around the mesial root which is a classic sign that a root fracture is present. (b) Periapical radiograph taken four months later clearly shows a major fracture with wide separation of fragments
PERIAPICAL RADIOLUCENY
broad-based swelling
PERIAPICAL LESION
Transillumination
Multiple
EPT positive
History to be taken
TRAUMA
NO ENDODONTIC TERATMENT
Treatment Planning
root canal therapy indicated? Should I carry out this treatment myself or should I refer the case?
03/05/12
Patient
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Patient Considerations
Medical
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Diagnosis Radiographic
findings
03/05/12
Additional Conditions
Restorability Existing restoration Fractured tooth Resorptions Endo-perio lesions Trauma Previous endodontic treatment Perforations
03/05/12
71%
Always
Pulpal Inflammation
Worsens
the scenario
23%
Adjunctive Strategies
PDL Injection Intraosseous Buccal
Injection
Pregnant Patients
Which
Articaine
4% 1:200 000 FDA category C Lidocaine 2% 1:100 000 FDA category B Mepivacaine 2% 1:20 000 FDA category C Mepivacaine 3% plain FDA category C
PDL Injection
Technique:
needle inserted into the gingival sulcus at a 30 degree
angle towards the tooth bevel placed towards bone advanced until resistance felt anaesthetic injected with continuous force for about 15 seconds. approx. 0.2 mL of solution 25 vs. 30 gauge needle
Adjunctive Strategies
Additional Anaesthetic PDL Injection Intraosseous
Intraosseous Injection
Technique
for mandibular infiltration Perforate the cortical plate to introduce LA in medullary bone Bathes the periradicular region in LA 2 commercial systems available:
Stabident (Patterson) X-Tip (Tulsa Dentsply)
Stabident
Stabident
Stabident
Stabident
X-Tip
86%
Intrapulpal Anaesthesia
back-pressure
Topical Anaesthetic
Benzocaine
or Lidocaine Effectiveness?
Gill and Orr 1979: 15
second application no more effective than placebo Stern and Giddon 1975: 2-3 minutes=profound soft tissue anaesthesia
Conclusions:
If patient says it hurts, it hurts
Rubber Dam
03/05/12
Protection of patient's soft tissue Huge time saver Improved access and visibility Very high patient acceptance
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Lack of axial orientation of the teeth Possible damage to the papillas More difficulties in taking Rx Allergic reactions are possible (alternative: rubber dam
composed of silicone)
Fast and easy placement by one person Very high level of patient comfort as no metal clamps are required Both arches are fully exposed and a completely dry field is achieved simultaneously