发布时间:2018-08-30 23:37  |  文章分类:内科浏览次数:  |  评论:  | 推荐数:13




Good Manners for Good Endodontists


Not one dentist I know who doesnt find, in his daily practice, teeth that are earmarked for RCT (e.g. emergency, destructive caries, prothesis treatment planning) or that have had an RCT and need further treatment (e.g. post-endodontic build-up, fiber post positioning, prosthetic abutment preparation, orthodontic extrusion and so on).



For this reason even if Endodontics is a specialty that requires a lot of studying, long learning curve and specific armamentarium, each one of us has to deal with this discipline following some simple basic rules, in order to increase the success rates in RCT and the patients comfort, while decreasing the operative times of the endodontic treatment together with the patients stress. 出于这个原因,即使牙髓病学是一门需要大量学习,长期学习和特定装备的专业,我们每个人都必须遵循一些简单的基本规则来处理这个学科,以提高RCT的成功率和 患者的舒适度,同时减少牙髓治疗的手术时间以及患者的压力。

On the other hand, its advisable for the endodontist to be able to do  a proper composite restoration, crown lengthening, etcand he must facilitate the work of the colleagues that will follow the patient after the endodontic treatment.


In order to facilitate a comprehensive treatment, it is very important to follow these simple rules.为了促进联合治疗,遵循这些简单的规则是非常重要的。


Img. 1  Presence of plaque and calculus. Patients come into the dental office, sometimes to begin a restorative treatment or with pain. Obviously, even when it come to endodontics, working with healthy tissues is better than inflamed tissues; working in a clean manner without plaque is even better. Placement of the rubber dam and restoration procedures are much easier in a healthy mouth thus providing a cleaner and safer environment for the operator. In case of emergencies, even if the primary aim of the appointment is, obviously, to eliminate the pain, we always have to think of the next steps to be taken: scaling of the area only requires a few minutes and improves workflow. Of course, an appointment with the hygienist is mandatory to decrease the amount of bacteria. This simple step plays a fundamental role in the following restorative procedures.



Img. 2 Caries elimination. Its imperative to remove caries prior to performing an endodontic treatment. A thorough cleaning of the cavity before starting an RCT is mandatory in order to work in an environment that is as clean as possible.



Img. 3 Pre-endodontic restoration. In general pre-endodontic restorations can be avoided if you complete the treatment in one visit. If you think that you cant finish the endodontic therapy in one session or a complication occurs during treatment, you must create a perfect sealing of the access. Schilder said: its more important what you keep out than what you put in; the evolution of this concept is: its better to protect the endodontic space than putting a paste inside it.

3-牙髓前修复。 一般来说,如果您在一次就诊中完成治疗,可以避免牙髓前修复。 如果您认为您无法在一次治疗中完成牙髓治疗或治疗期间出现并发症,您必须创建一个完美的通道密封。 施里尔说:“你所保留的比你投入的更重要”; 这个概念的演变是:保护牙髓空间比在其内部粘贴更好。


Img. 4 Leaving a tooth open only in case of pulpitis or necrosis is a really wrong approach; bacteria can enter the Root Canal System and the biofilm can be then very hard to remove.

4-在牙髓炎或坏死的情况下保持根管开放是一种非常错误的方法; 细菌可以进入根管系统,然后形成很难去除生物膜。


Img. 5 A poor temporary restoration is the same as leaving a tooth open.



Img. 6 Cuspal reduction is mandatory in case of cracks, and it is the first step. The risk of crack creation and/or propagation between two appointments is very high. In general, all endodontically treated teeth require an indirect restoration or a crown: for this reason, having a flat surface as a reference point may make it easier to young colleagues to measure the working length, when compared to cuspidate teeth.



Img. 7 Pulp chamber cleaning. It sometimes happens that, when I restore teeth treated by a colleague, I find a dirty pulp chamber. My only thought about these situations is: WHY?



Img. 8 Pulp chamber walls have to be cleaned by instruments, air abrasion or burs. The prosthodontist or the following colleague has to work in a clean space. It's necessary to pass a simple silicone tip to renew the surface. The tooth is then ready for adhesion procedures. About post placement, please follow the endodontists instructions.



Img. 9 It's advisable to prepare the post space after Root Canal Treatment; in this manner, prosthodontists only have to try the post and, only if necessary, renew the dentin and start with adhesive procedures.



Img. 10 In this case, my advice was to place only one post. After the appointment with the prosthodontist, the patient came back because of pain. I noticed a perforation in the MB2 canal, due to incorrect post space preparation. I treated this perforation with MTA and the pain was resolved in one week.



Img. 11 Cotton Pellets and temporary materials. About 90% of my cases end with a definitive restoration that allows the colleagues that will follow to prepare the tooth for a composite restoration or a prosthetic crown. In the other 10% of the cases, I only use cured materials that are able to perfectly adapt to margins thus preventing plaque from entering the prepared space.



Img. 12 Outer sealing of the endodontic space. The most common mistake at the end of the endodontic treatment, even if a second session scheduled, is the lack of sealing of your own work.



Img. 13 Temporary margin adaptation. The same concept is to be taken into consideration for the restorative phase: overlapping and invasion of the operative space by the gingiva and rough surface adaptation with the temporary restoration create an ideal hollow for bacterial growth.



Img. 14 Together with a cured temporary sealing, I prefer teflon as a temporary filling, as it is easier than cottons pallets to completely remove before adhesive procedures.



Img. 15 Even if youre not an endodontist, as a dentist you have to know the basic rules for treating a patient with pain, by respecting the endodontic space and correctly (from an endodontic perspective, obviously) opening the pulp chamber and by not laving the tooth with a poor restoration.


16.jpgImg. 16 If you, in fact, are an Endodontist, you have to know which the next clinical step will be. In this case the tooth was prepared for a crown the day after, so there was non sense in creating an accurate occlusal anatomy during restoration, nor a correct contact point with the neighboring teeth. After the endodontic treatment, only 15 minutes were needed to restore the tooth properly for prosthodontics.



Dentists sometimes work hard but forget the basic rules to decrease the operative time, for themselves and for the other colleagues. In the next article we will describe, step by step, the clinical procedures to increase success in these steps of the treatment.








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