Contacts
Info
These are lectures of The Gulfie Dentist Coaching
18 AUG 2020 · CONTRAINDICATIONS OF RCT
Non-restorable tooth
Vertical root fracture
Tooth with insufficient periodontal support / periodontally weak ones
FILE CALCULATION :-
Length of files available: 21, 25, 31
ISO INSTRUMENTATION IS BY WIDTH OF FILE TIP- Do
TO FILE SIZE 34 CUT 2MM FROM FILE 30
18 AUG 2020 · DISCOLOURATIONS
YELLOWISH- WHITE
- Pulp is inflammed & calcified, non-necrotic
- It is calcific metamorphosis
- No infection here. Tertiary dentine in formed extensively
- Dystrophic calcification, pulp stones may be seen
- If asymptomatic – RCT not required – give crown directly
YELLOWISH GREY TO BROWN / RED
- Pulp is dead & undergoing necrotic changes
- Do RCT, some bleach ( GP up to middle 3rd only then rest fill up with GIC – tight seal, because hydrogen peroxide must not fall into the canal
- Go for crown if needed
TETRACYCLINE STAINS
- Yellow brown stain seen in adults
- If pregnant mothers take tetracycline – child’s primary teeth will be affected
- If child takes tetracycline during early ages – permanent dentition will be affected
- Mechanism – during the stage of tooth formation, tetracycline bonds to teeth instead of Calcium
- Treatment :– if mild bleaching ; if severe veneer / crown
PINK TOOTH OF MURMERY
- Internal resorption
- Pulp is enlarged & hyperactive
- Enamel shell shows off the pulp ( because dentine is resorbed here )
- 90% seen in primary teeth
- Cause is unknown ……….. Due to inflammatory reaction?
- This the reason why DPC is contra-indicated in primary teeth. CaOH is of 12Ph, which will irritate the pulp thus initiating the inflammation
- Irreversible type of pulpitis
- Radiograph – isolated radiolucency, & not moth-eaten appearance
- If asymptomatic, thus usually found during routine radiographs
Treatment – single sitting pulpectomy / RCT
- If symptomatic, pulp extirpation – followed by CaOH
(Pulp chamber which is highly acidic will be neutralized by CaOH)
CYSTIC FIBROSIS
- They are on tetracycline, thus the stains
- They always have a variety of infections
- Key feature - thick secretions
ERYTHROBLASTOSIS FETALIS
- Yellow molars
- Bleaching is the treatment, if required only
- Treatment not necessary
PORPHYRINE STAINS
- Red stains
AMALGAM BLUEING
- Blueish black discoloration due to amalgam
BLEACHING
Bleaching is the removal of stains that has been formed on the organic content of the tooth.
A. NONVITAL TOOTH
1. THERMOCATALYTIC TECHNIQUE
Material used – hydrogen peroxide – 30%
After RCT – remove GP from the coronal top – place GIC filling – about 2mm as protective
cement barrier – Place the oxiding agent – 30% hydrogen peroxide- SUPEROXOL – inside the
chamber & apply heat
Done in office set up
Done intracoronally – because its more effective.
Dangerous – must not fall into the canal, in the oral mucosa, due to high concentration of
hydrogen peroxide
2. WALKING BLEACHING
Material used – sodium perborate
Place mixuture of sodium perborate + water inside the chamber
Changed every 4-7 days
Finish in 2-6 weeks.
In-home bleaching technique
Safer than superoxol
B. VITAL TOOTH
IMMEDIATELY AFTER BLEACHING, COMPOSITE IS CONTRAINDICATED – because the content of bleaching agent will hinder the polymerization of composite – therefore always delay the composite restoration by 1 week – by placing temporary restoration for that time period
18 AUG 2020
18 AUG 2020 · CLASS VII – LUXATION
INTRUSION - Chances of cut-off of blood supply is seen in intrusion – in 6 months – revascularization should happen – therefore the wait & watch scheme
a. PERMANENT
- Wait & watch for 6 months for natural extrusion / eruption
- If not orthodontic extrusion
b. PRIMARY
- Radiograph is must 1st
- If tooth is impinging underlying tooth follicle – Extract
- If no impingement – wait & watch for 6 months
- If impingement on follicle – leads to Turner’s Hypoplasia
- Never extract tooth normally – open flap, split the tooth, the extract
EXTRUSION / LATERAL LUXATION
- Replace into normal position
- Followed by flexible splinting for 2 weeks
SUBLUXATION
- Tooth that is mobile without displacement. Here tooth supporting structure is affected, hence the mobility.
- Place back into normal position
- Flexible splint for 2 weeks
- Wait & watch, then decide if RCT required
CLASS VIII – CROWN-EN-MASSE FRACTURE
- Treatment – RCT + Post & core build-up of crown
CLASS IX – PRIMARY TOOTH FRACTURE
- Avulsion in pedo
- Never place it back, Discard the tooth
- Give space maintainer if needed
18 AUG 2020 · After 60 mins
1. Rinse/soak in 2.4% acidulated fluoride solution at pH 5.5 (citric acid + sodium fluoride) (helps prevent root resorption )
2. Extra-oral RCT is performed by holding the tooth in fluoride soaked gauze.
3. The socket clot is suctioned and irrigated with saline to remove the clot.
4. Replant with digital pressure, the Splint with flexible splint for 4 weeks
5. Possible complications –
a. Here we expect either ankyloses or replacemental root resorption – which will happen within 2 years
b. inflammatory external root resorption (IERR) – which is the main reason for failure of reimplantation Therefore can displace the tooth i.e. possibility of avulsion again
c. Ankyloses will give better prognosis than ERR, which will lead to failure.
Once ankylosed, chances for IERR decreases over time.
CLASS VI – ROOT FRACTURE
Vertical Root Fracture
Causes
- Post & core cases
- Warm GP / vertical condensation cases
- Bite / chewing
- Accidental trauma
Diagnosis
- J-shaped radiographic appearance
- Tear-drop shape
- Isolated PDL pocket
[Other causes for isolated pockets
o Endoperio lesion – pathological
o Developmental groove (max LI) – normal variant ]
Horizontal Root Fracture
Apical 1/3rd
- Treatment is wait & watch
- Small fragment may get resorbed by cementoblasts & odontoblasts
- Later do RCT
- Best prognosis
Middle 2/3rd
- Wait & watch
- May get resorbed
- Then go for RCT for rest of the coronal root
- Lesser prognosis
Cervical 3rd
- Prognosis is very poor
- Splint to adjacent teeth with rigid splint such as metallic band / wire
- Wait & watch
- Extraction if no re-attachment seen
18 AUG 2020 · ELLIS CLASSIFICATION OF FRACTURE
CLASS I – ENAMEL FRACTURE
CLASS II – ENAMEL + DENTINE FRACTURE
Treatment – Re-attachment of fractured fragment
Or CaOH base (if sensitivity present) + composite build-up
CLASS III – ENAMEL + DENTINE FRACTURE + PULP EXPOSURE
a) Within 24 hrs
o Or if only pin-point exposure (less than 0.5mm) - DPC
b) More than 48 hrs / 2 days
o Or if exposure more than 0.5- 3mm - Pulpotomy
o Consider the age also i.e. young permanent tooth
c) More than 72 hrs / 3 days
o If young permanent tooth - Apexification
o If fully formed permanent tooth - RCT
NB: No IPC in fractured / trauma cases
CLASS IV – NON-VITAL DISCOLOURED TOOTH
a. If young permanent tooth - Apexification
b. If fully formed permanent tooth – RCT
CALSS V – AVULSION
FIVE FACTORS THAT DETERMINE THE SUCCESS
a. TIME
i. 30 MINS-1 HOUR – best prognosis
ii. MORE THAN 1 HOUR - ERR
b. STORAGE MEDIA (NB : Never use tap water)
iii. Viaspan - best option ( used in heart transplantation )
iv. HBBS - best option in clinical setup
v. Cold milk – most commonly used & readily available
vi. Physiologic saliva and saline
c. TOOTH SOCKET
vii. Should not be curetted or disrupted
Q. Should you irrigate the socket?
Ans. No irrigation required, but if necessary only mild irrigation acceptable. Vigorous irrigation is contraindicated.
d. SPLINT STABILIZATION
viii. Splint type – flexible splint – that will allow physiologic movement.
ix. Splint time – 2 weeks or 1-2 weeks – 7-10 days is ideal*
e. ROOT SURFACE
x. Should not be dried
xi. Should not be scrapped or manipulated with any chemicals
Q. How should the tooth be held?
Ans. Only at the crown portion. Never touch the root – might hamper the natural PDL.
Within 60mins
- Viability of PDL cells stays max up to 60mins only – that is the 1st priority of the treatment, re-implantation
- If dried beyond that time, pdl dies off
- Success rate depends on pdl viability i.e. extra-oral dry time
1. Rinse in tetracycline
2. Replace in socket & splint with adjacent teeth
3. Splint type – flexible splint
4. Splint time – 2 weeks or 1-2 weeks – 7-10 days
5. Start RCT after 2 weeks – if not external root resorption may happen
6. Here we expect normal PDL attachment over a period of 1 year
7. Until then CaOH is placed into the canals, which is replaced every 3 months for 1 year.
8. Possible complication here –– ankyloses or replacement resorption
9. But usually good prognosis
18 AUG 2020 · APICOCECTOMY
Apex removal
RETROGRADE FILLING / ROOT END FILLING
Done if re-infection seen even after re-RCT
Indication
o To gain access to are of pathosis – like say a cyst
o Poorly filled apical portion
o Severe root curvature / non- negotiable canal ends / blockage
o Infection after post & core cases – most common cause of opting for apicocectomy
o cyst formation cases
o Complications happened during RCT –
Instrument separation / ledging /
perforation
o Biopsy
Method: raise flap – curette the apical area – root end resection – condition with EDTA – fill with MTA – then place flap – suture tightly
Grey MTA ( with ferric content, as its not moisture sensitive ) is the material of choice
Success lies in
o proper placement of flap
o type of flap
Root end resection:
o Can cut up to middle 3rd
o Flap-- full mucoperiosteal – best flap
o 3mm retrograde filling into canal
o Usually ideal measurement is about 3-4mm
o Ideal angulation is 10° or acute angle
o Commonly cut at 45°
o Condition – clean – MTA pack – flap – suture
18 AUG 2020 · POST & CORE
When there isn’t enough crown structure
Can put on same day as OBT
Depends on the remaining coronal structure of the nature tooth – indication
Function – retention of core
PIEZO REAMER is used to make post space inside the canal
Continuous wave / sectional GP / system B technique
Resin – modified GIC is ideal to cement post
Factors that affect its efficiency:-
a. Length :-
2/3rd of the canal – most imp
4-5mm length from apex
4mm- minimum GP to be left
5mm- ideal GP to be left in the canal
b. Diameter :-
Greater the diameter, more the efficiency
c. Surface Texture :-
Rough surface is preferable than smooth ones. Roughened / serrated
d. Post material :-
Pre-fabricated posts such as fibre posts & metallic posts
Custom made posts such as casted posts
e. Post shape :-
Parallel is preferred than tapered ones
More retention
CASTED POSTS
Indicated in anteriors & flared canals
FIBRE POSTS
Can absorb shock
Best in posteriors
Can withstand masticatory forces
METAL POSTS
Least preferred
May fracture the tooth
CORE BUILD-UP
Core should take the shape of natural tooth
Should extend to contra-bevel to produce ferrule effect
NB: Management of re-infected post & core treated tooth:
- Apicocectomy
- If not possible go for extraction
- Can’t do re-RCT here usually
18 AUG 2020 · LEDGE FORMATION
Ledge is a nick formed on the wall surface of a root canal, especially at the curves that prevent the instrument going further towards the apex- because it gets stuck there.
Caused when instrument that is not pre-curved is inserted into the canal with excessive pressure
Take a small size file – apply EDTA & do circumferential filing for long time- it will help
smoothen out the ledge by cutting away excessive dentine.
Thereby bypass the ledge
EDTA helps dissolve & soften the area - chelation property
After correction of ledge & bypass, the wall becomes very thin, therefore chances of perforation - most important complication
Correction at furcation
a) Stop RCT
b) Place MTA / CaOH / GIC
c) Thus the form of a barrier
d) Continue with RCT
e) Or OBT only after healing
Management of perforation is done after BMP & before OBT
PERFORATION
a. At furcation / coronal 3rd – good prognosis
b. At middle 3rd / apical 3rd – poor prognosis
c. If perforation at apical 3rd – poor prognosis
d. If at furcation – best prognosis
STRIPPING
Danger zone
Mand – mesial aspect of distal root canal- inside aspect
of the curved area
Treated with MTA
Rotary instruments
Due to excessive flaring of canals
18 AUG 2020 · Correction at furcation
a) Stop RCT
b) Place MTA / CaOH / GIC
c) Thus the form of a barrier
d) Continue with RCT
e) Or OBT only after healing
Management of perforation is done after BMP & before OBT
PERFORATION
a. At furcation / coronal 3rd – good prognosis
b. At middle 3rd / apical 3rd – poor prognosis
c. If perforation at apical 3rd – poor prognosis
d. If at furcation – best prognosis
These are lectures of The Gulfie Dentist Coaching
Information
| Author | DrMayakha Mariam |
| Organization | DrMayakha Mariam |
| Categories | Courses |
| Website | - |
| thegulfiedentist@gmail.com |
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