Kenneth S. Serota, DDS, MMSc

Transcription

1 Kenneth S. Serota, DDS, MMSc

2 You are here

3 Genesis, Exodus, Leviticus, Numbers, Deuteronomy Treatment Outcomes, Diagnosis, Anaesthesia,, Access, Ultrasonics,, Irrigation, Instrumentation, Obturation,, MTA

4 Diagnosis - EPT

5 Diagnosis Current radiographs serial radiographs central / mesial / distal be temporal and systematic guide the conversation P A I N chief complaint history, stimulus, severity, frequency, duration, location, spontaneity onset, duration recreate the complaint Article - Warning signs of Pulpal Insult.pdf

6 Diagnosis nowhere near enough endodontics is is done major missing piece in in diagnosis Restorative History analyze and extrapolate tooth function and location affects diagnosis STRESSED PULP

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9 Treatment Outcomes Retrospective studies have shown that the success rate of of teeth without apical periodontitis remaining free of of disease after initial treatment or those with orthograde retreatment is is 92 to 98 percent. The chance of of teeth with apical periodontitis to to completely heal after initial treatment or retreatment is is 74 to 86 percent, and their functionality over time determined to to be 91 to 97 percent. The difference in outcome between initial treatment and orthograde retreatment does not appear to be significant.

10 Effects of 4 Ni-Ti preparation techniques on root canal geometry [assessed by micro-computed computed tomography] Peters OA, Schonenberger K, Laib A. Int Endod J Maxillary molars...all instrumentation techniques left 35% or more of the canals' surface area unchanged..a strong impact of variations of canal anatomy was demonstrated..

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12 Pulpal and Periapical Disease microbiological Irritation of the pulp physical chemical microbiological caries trauma microleakage abfraction/fractures dentinal exposure

13 Endodontics is The Prevention & Treatment of Apical Periodontitis

14 Pulpal and Periapical Disease Oral microorganisms

15 Debridement & Disinfection IS MUCH MORE THAN cleaning and shaping the root canal system

16 Complex Canal Anatomy -

17 Root Canal Therapy Mechanical Instrumentation Irrigation Intra-canal medication Microbial Control Phase R.C. Filling

18 Control of Endodontic Infection 1. Mech. preparation Card et al. JOE 2002 Sjøgren U et al. IEJ 1997 Ørstavik D et al. IEJ 1991 Bystrøm et al. EDT 1987 Kerekes et al. JOE 1979 Volume of Microbial Contents #25 #30 #35 #40 Apical Aperture Preparation

19 Effect of Ca(OH) 2 on Microorganisms in Necrotic Pulp 200µ 1-4 weeks

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22 Endo is not little round holes Thermafil condenser removed from palatal canal floor is not clean nor sealed debridement not achieved with instruments nor irrigation protocol neither straight line nor coronal access adequate

23 Reasons for Shape/Design Convenience form minimize overpreparation gg s - #1, #2, maybe #3 NiTi rotary systems Resistance form taper Retention form avoid apical displacement Apical Control Zone

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26 Goals and Objectives A substantial reduction in post treatment symptoms occurs when using a crown down approach with rotary instruments as they are designed to remove debris coronally

27 Goals and Objectives

28 State of The Art Gutta-Percha + Sealer? entomb existing bacteria prevent coronal and apical leakage strengthen the root

29 Bacteria and Prognosis Success by culturing results +ve culture -ve culture Engstrom et al (1964) 76% 89% Zeldkow & Ingle (1963) 83% 93% Oliet & Sorin (1969) 80% 91% Bystrom et al (1987) 95% Sjögren et al. (1997) 68% 94%

30 Bacteria and Prognosis Success by culturing results +ve culture -ve culture Engstrom et al (1964) 76% 89% If bacteria were entombed, Zeldkow & Ingle (1963) 83% 93% there would be NO difference Oliet & Sorin (1969) 80% 91% in the healing of teeth with PA lesions Bystrom et al (1987) 95% Sjögren et al. (1997) 68% 94%

31 State of The Art Gutta-Percha + Sealer? entomb existing bacteria prevent coronal and apical leakage strengthen the root

32 October / 05 JOE Susceptibility of a Polycaprolactone-Based Root Canal Filling Material to Degradation. II. Gravimetric Evaluation of Enzymatic Hydrolysis..Tay et al Polycaprolactone is susceptible to enzymatic biodegradation via ester bond cleavage. This study examined the susceptibility of Resilon, a polycaprolactone-based root filling material to enzymatic hydrolysis. Resilon, gutta-percha, and polycaprolactone disks, prepared by compression molding, were incubated in phosphatebuffered saline, lipase PS or cholesterol esterase at 37 C for 96 h. They were retrieved at different time intervals for gravimetric analysis and scanning electron microscopy. The materials exhibited slight weight gains when incubated in phosphate-buffered saline that can be attributed to water sorption. Gutta-percha showed similar weight gains in the two enzymes. Conversely, Resilon and polycaprolactone exhibited extensive surface thinning and weight losses after incubation inlipase PS and cholesterol esterase. Glass filler particles in Resilon were exposed following surface dissolution of the polymer matrix, creating rough surface topography. Biodegradation of Resilon by bacterial and salivary enzymes warrants further investigation of their activities using cultures of endodontically relevant microbes and human saliva extracts.

33 Coronal Leakage Swanson et al Dye leakage to apex Torabinejad et al Bacteria to apex Khayat et al Bacteria to apex Trope et al Endotoxins to apex

34 Permaflo Purple

35 CLP

36 Tricks of the Trade Locate root canal orifices stains, caries detection agents

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38 Tricks of the Trade Dentin of floor is darker than axial dentin Assess wet, never dry

39 Tricks of the Trade > flare of mesial wall of molars by extension into marginal ridge with > o of apical curvature bevel cavo surface angle to improve optics

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41 X-Tip

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44 Uses disassemble restorations UNcover hidden or calcified canals! remove canal obstructions post/core removal separated instrument removal agitate/energize irrigants apical surgical preparations

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46 Trough the Line!

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53 Think Z Even the world spins on an axis

54 Root Canal SYSTEM

55 Three Dimensions X, Y, Z

56 Straight Line Access Reproducible Glide Path access the apical terminus NOT the orifice align cusp tip + pulp horn + orifice of the root canal space + the apical constriction

57 G.V. Black he da man!

58 Maxillary Anterior Teeth extension into incisal edge minimizes apical misadventure and maximizes debridement Lingual Triangle Initial Penetration Incisal Triangle

59 Maxillary Anterior Teeth

60 Mandibular Anterior Teeth

61 Mandibular Incisor Teeth must prepare access into incisal edge will miss lingual canal if straight line access not developed

62 Maxillary Premolar Teeth

63 Maxillary Premolar Teeth

64 Maxillary Premolar Teeth

65 Mandibular Premolar Teeth

66 Mandibular Premolar Teeth

67 Mandibular Premolar Teeth

68 Chromatic Topography A road map exists, floor of the pulp chamber dentin is darker than axial walls, fusion lines map the location of the orifices..hypochlorite soak, etch, caries detection agents..a road map exists beneath the layers

69 Maxillary Molar Teeth

70 The spatial orientation of orifices is asymmetrical

71 Relocation of the canal orifices

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75 Mandibular Molar Teeth

76 Mandibular Molar Teeth

77 Middle Mesial 0 to 15%

78 Middle Mesial 0 to 15%

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82 Apexification Clinical Procedures apply MTA confirm with x-rayx moist pellet 4 hours setting time seal canal with gutta-percha

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86 Pulp Cap

87 Pulpotomy Indications large pulp exposure no symptoms

88 Pulpotomy Clinical Procedures MTA moist pellet temp filling 1 week perm filling check vitality every 3 to 6 months

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90 Internal Resorption Repair

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92 Extra-radicular Perforation Repair

93 Pre-Op Dr. Lisa Germain

94 5 month follow-up

95 Iatrogenic Perforation MTA repair 4 6 hour setting time NEVER USE RCPREP, PROLUBE OR GLYDE WITH MTA

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97 Furcation Perforation

98 Furcation Perforation Repair Procedures MTA moist pellet temp filling complete RCT perm filling

99 Furcal Misadventure

100 Furcal Misadventure

101 Furcal Misadventure

102 Furcal Misadventure

103 Root End Repair flap osteotomy root-end resection root-end preparation control bleeding lack of moisture control makes MTA unmanageable

104 Root End Repair Place MTA with small carrier condense moist pellet do not rinse! suture

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