Amy Dukoff
 |
 ROPER
endodontic access is crucial to the success of the final treatment.
The access openings can help the practitioner overcome many technical difficulties
that he or she may encounter during treatment. Before access is gained,
isolation is essential. This crucial step is often overlooked or
not given its proper attention.
Isolation is attained with the placement of a rubber
dam. Ideally, the dam is placed only on the treatment tooth.
However, in cases where there is gross subgingival decay and placement
is precarious, it is better to use the two adjacent teeth as anchors.
This method of anchoring the dam will facilitate the practitioner’s removing
the gross decay, controlling gingival bleeding, and performing the procedure.
The rubber dam, of course, is designed to help prevent the entrance of
germs into the pulp cavity, assuring the safety of the patient.
The Endodontic access opening can be affected by
the rubber dam placement. It is important to evaluate the inclination
of the tooth and projected root structure before placing the rubber dam.
Getting a visual orientation of the tooth in its position in the arch is
critical before initiating the access opening. Often, the practitioner
will lose sight of vital information and clues to the location of the canal
once the rubber dam is placed. This is especially true with calcified
or inclined teeth. It is sometimes necessary to make small reference
marks on the tooth for orientation to facilitate the access-opening procedure.
At times, other procedures—such as crown lengthening,
periodontal evaluation or treatment, or removal of a wisdom tooth—may be
needed before the access opening. If the decay is subgingival, crown
lengthening may be needed. Many times periodontal treatment—such
as osseous recontouring, gingival recontouring, root resection, or hemisection—is
needed as part of therapy. Wisdom tooth extraction may be needed
if there is a pericoronitis, swelling that limits mandibular opening, or
swelling with an inclined tooth. These are just a few situations
in which other treatments are needed before beginning the isolation procedure.
The importance of isolation in an endodontic procedure
is often overlooked. Yet it is an important factor in the outcome
of the treatment. Isolation is required before initiating the treatment.
January-February 2002
|
This
crucial step is often overlooked or not given its proper attention.
|
