Category: Conservative Dentistry And Endodontics

PRINCIPLES OF ENDODONTIC TREATMENT

ashtinder0224Leave a comment

ASEPSIS : By rubber dam placement or isolation or by sterilization of instruments.

  1. APPLICATION OF RUBBER DAM :
  • To maintain a safe and aseptic operating field .
  • Only safeguard against the bacterial contamination from saliva and swallowing of root canal instruments.

2. STERILIZATION :

  • Cold sterilization
  • Hot salt sterilization
  • Glass bead sterilization
  • Direct flaming
  • Autoclaving
  • Dry heat oven

a) DEBRIDEMENT OF ROOT CANAL :

  • Infected root canal must be cleaned of debris .
  • All the necrotic tissue should be removed from the root canal as it encourages bacterial growth.
  • Instrumentation and irrigation is required for complete debridement .
  • Sodium hypochlorite or any other irrigant should be used for irrigation.

b)DRAINAGE :

  • Drainage should be done when gross infection or swelling is present.
  • In case of acute alveolar abscess drainage should be done either through root canal or by incision or both .
  • Drainage is established by preparing a cavity lingually on anterior teeth and occlusally on posterior teeth.

c) IMMOBILIZATION :

  • Done to allay pain and promote healing .
  • It reduces the potential for spreading of microorganisms.
  • Also reduces trauma to PDL.

d)ATRAUMATIC PROCEDURES :

  • All traumas should be avoided.
  • Soft tissues should be handled carefully and gently.
  • Instrument should not be passed beyond apical foramen.
  • Radiograph should be carefully studied.

e)TERPHINATION:

  • Means relieving pain.
  • Biterphination means creating of a surgical passage in the region of the root apex for escape of pus or blood to relieve the pressure of accumulated pus or gas in jaw bone.
  • Done in case of acute alveolar abscess .

f)CHEMO PROPHYLAXIS:

  • If the patient has history of rheumatic fever or valvular heart disease , an antibiotic such as phenoxy -methyl penicillin 2 g 1 hour before and 1 g 6 hour after the operation should be given.

References: GROSSMANS TEXBOOK

PULP CAPPING

Gerlyn BraganzaLeave a comment

So what is the pulp – in simple words it’s a tissue that forms the inner tooth structure along with the blood vessels and contains nerves .

Pulp capping is the process of placing a specialized agent in contact with or in a close proximity to the pulp with the intention to encourage formation of new dentin ( secondary dentin) and also promote healing of the pulp.

Even before the discovery  pulp capping agents, exposure lead to pulpitis or pulpal infection and ultimately pulp necrosis.

Examples of a very common pulp capping agent used – calcium hydroxide cement.

Source- slideshare

What’s the criteria for pulp capping?

  1. When the pulp is healthy and non infected.
  2. When the area of exposure is not more than 0.5mm.
  3. After exposure the dentist should make all attempts and isolate the tooth and prevent infection.

Types of pulp capping –

  1. Direct pulp capping
  2. Indirect pulp capping

What is direct pulp capping? When is it done?

Placement of an agent directly on the exposed pulp is direct pulp capping.

It is done in the following situations-

  • Traumatic fracture of the tooth .
  • Iatrogenic exposure during cavity preparation.
  • Exposure when the tooth is under rubber dam isolation.
  • When bleeding is controlled at the exposure site.

Note- direct pulp capping is considered oy for immature permanent teeth or for future permanent teeth

Direct pulp capping

Source – Google

What is indirect pulp capping ? When is it done?

Procedure where gross caries are removed from the lesions and cavity is sealed for a time with a biocompatible material.

And secondary dentin formation is induced even when pulp is not exposed but is near exposure.

This induces new dentin formation.

It is done in the following situations-

  • When deep caries lesions are close to the pulp.
  • Exposure exposure of the pulp when there is traumatic fracture of the tooth.
  • During excessive crown preparation the pulp is visible through the remaining dentin .

Note – it promotes formation of reparative dentin, promotes dental sclerosis and remineralizing the carious dentin.

Indirect pulp capping

Source-google

Requirements of an ideal pulp capping material.-

•Stimulate reparative dentin formation.

•Preserve pulp vitality

•Release fluoride to prevent secondary caries .

•Bactericidal or bacteriostatic

• Adhere to dentin and restorative material

•Resist forces during mastication .

•Provide bacterial seal.

Materials used in pulp capping-

•Calcium hydroxide

•Zinc-Oxide – Eugenol

• GIC and adhesive resins

• MTA

• Biodentine

•Tricalcium phosphate ceramic

•Polycarboxylate cements

Source – Sturdevant’s art and science of operative dentistry ,slide share and manappallil

Image source – Google and slide share

RUBBER DAM ISOLATION

Dr.Urusa InamdarLeave a comment

Written by – Dr.Urusa I Inamdar

In 1864, S.C. Barnum, introduced the rubber dam into dentistry. It is used to define the operating field by isolating one or more teeth from the oral environment. The dam eliminates saliva from the operating site and retracts the soft tissue.

Advantages

  • A dry and clean operating field
  • Improved access and visibility
  • Potentially improved properties of dental materials
  • protection of the patient and operator
  • Operating efficiency

Disadvantages

Time consumption and patient objection are the most frequently quoted disadvantages of the rubber dam.

Certain oral conditions may preclude the use of the rubber dam , these include :

  • Teeth that have not erupted sufficiently to support a retainer
  • Some third molars
  • Extremely malpositioned teeth

In addition, patients suffering from asthma may not tolerate the rubber dam if breathing through the nose is difficult. Latex allergy.

However, latex free rubber dam material is currently available.

Materials

  • Holder
  • Retainer
  • Punch
  • Retainer forceps
  • Napkin
  • Lubricant
  • Modeling compound
  • Anchors

Hole size and position

Placement

  • Testing and lubricating the proximal contacts.
  • Punching the holes.
  • Lubricating the dam.
  • Selecting the retainer.
  • Testing the retainers stability and retention.
  • Positioning the dam over the retainer.
  • Applying the Napkin.
  • Positioning the Napkin.
  • Attaching the frame.
  • Attaching the neck strap ( optional )
  • Passing the dam through posterior contact.
  • Applying low fusing modelling compound ( optional )
  • Applying the anterior anchor ( if needed)
  • Passing the septa through the contacts without tape.
  • Passing the septa through the contacts with tape.
  • Inverting the dam interproximally.
  • Inverting the dam faciolingually.
  • Using a Saliva ejector ( optional )
  • Confirming a properly applied rubber dam .
  • Checking for access and visibility.
  • Inserting the wedges.

Removal

  • Cutting the septa.
  • Removing the retainer.
  • Removing the dam.
  • Wiping the lips.
  • Rinsing the mouth and massaging the tissue.
  • Examining the dam.

Alternate / additional methods and factors

The procedure just detailed describes the method of sequentially placing the retainer and rubber dam on the anchor tooth.

  • Applying the dam and retainer simultaneously.
  • Applying the dam before the retainer.
  • Cervical retainer placement.
  • Fixed bridge isolation.
  • Substitution of a retainer with a matrix.

Errors in application and removal

  • Off center arch form
  • Inappropriate distance between the holes
  • Incorrect arch form of holes
  • Inappropriate retainer
  • Retainer pinched tissue
  • Shredded or torn dam
  • Incorrect location of hole for class v lesions
  • Sharp tips on no. 212 retainer
  • Incorrect technique for cutting septa

Reference:

Sturdevant’s – Art and science of Operative Dentistry (4th edition)