Root canal treatment

Description

Root canal treatment
TR AS
Mind Map by TR AS, updated more than 1 year ago
TR AS
Created by TR AS almost 3 years ago
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Resource summary

Root canal treatment
  1. Access preparation
    1. Conservation of tooth structure
      1. avoid cusp tips and marginal ridges
      2. Where to drill?
        1. Lingual surface
          1. anterior teeth
          2. Occlusal or biting surface
            1. posterior teeth
            2. What burr?
              1. Round or tapered in high speed handpiece
            3. Deroof chamber to expose pulp horns and orifices
              1. Straight -line acces to orifice and apex
                1. Properly sealed rubberdam before
                  1. Access preparation according the tooth
                    1. Number of canals / Shape
                      1. Incisors
                        1. 1 canal (LLI tends to have 2)
                          1. Triangular
                          2. Canines
                            1. Ovoid/oval
                              1. 1 canal
                              2. Premolars
                                1. 1 or 2 (1st MPM)
                                  1. Oval
                                  2. Upper molars
                                    1. 3 or 4 (MB2)
                                      1. Blunted triangle or romboidal
                                      2. Lower molars
                                        1. 3*

                                          Annotations:

                                          • - The distal root usually has 2 canals - Not so often: 4 canals is possible with 2 canals in each root
                                          1. Trapezoidal
                                    2. Instruments
                                      1. Stainless Steel hand files = .02 taper

                                        Annotations:

                                        • .02 taper means that the file gets .02 milimeters THICKER in diameter for each milimeter you go down from the tip
                                        1. K files (Kerr)
                                          1. Twisted square
                                            1. Watch winding method
                                            2. H files (Hedstrom)
                                              1. Spiral cone
                                                1. Cuts only in retraction
                                                2. Color scheme
                                                  1. File dimensions
                                                    1. D16 = size file + convexity*k (k=16mm)

                                                      Annotations:

                                                      • F.ex: Size file 15, convexity 0.2 --> D16= 0.15 mm + 0.2*16mm = 0.47 mm
                                                  2. NiTi rotary instruments = .04 or .06 taper
                                                    1. Gates Glidden drills
                                                      1. open orifice for straight-line access
                                                      2. Barbed broaches
                                                        1. entangle and remove things that are caught or stuck in the root canal
                                                        2. Reamer
                                                          1. Twisted triangle
                                                        3. Cleaning and shaping tecniques
                                                          1. Crown.-down
                                                            1. Step-back
                                                            2. Irrigation and medicaments
                                                              1. Sodium hypochlorite (NaOCl)
                                                                1. irrigant
                                                                2. Citric acid
                                                                  1. Chloroform

                                                                    Annotations:

                                                                    • dissolves GP in retreatment
                                                                  2. Endodontic microbiology
                                                                    1. Primry endodontic infection
                                                                      1. Bacteroides

                                                                        Annotations:

                                                                        • GM obligated anaerobes
                                                                      2. Failed endodontic treatment
                                                                        1. Enterococcus faecalis

                                                                          Annotations:

                                                                          • GP facultative anaerobic
                                                                      3. Obturation
                                                                        1. To seal canal system
                                                                          1. Gutta-percha (GP)
                                                                            1. Match the size of the GP to the last file you used (color)
                                                                            2. Sealer (ZOE)
                                                                              1. Condensation tecniques
                                                                                1. Warm vertical
                                                                                  1. Plugger
                                                                                  2. Cold lateral
                                                                                    1. FInger spreader and tiny accessory cones
                                                                              2. Temporary restoration
                                                                                1. Avoid ingress of the bacteria from the oral cavity
                                                                                2. Surgical Treatment
                                                                                  1. Incision and drainage
                                                                                    1. Surgical opening in SOFT tissue
                                                                                      1. Realeases exudate and pressure
                                                                                    2. Trephination
                                                                                      1. SUrgicsl opening in HARD tissue
                                                                                      2. Periapical microsurgery
                                                                                        1. Achieving acces through the apex to seal anterograde
                                                                                          1. Apicoectomy: Resect 3 mm of root tip
                                                                                            1. Use ultrasonic tip to instrument the canal 3 mm
                                                                                              1. Mineral Trioxide Aggregate (MTA)
                                                                                                1. Suture soft tissue and let the bone heal
                                                                                      3. Endodontic treatment planning
                                                                                        1. RCT > retreatment > surgical RCT
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