Young Bui
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PURPOSE for doing root canal therapy is to remove all the dead tissues
and bacteria in the canals that are causing the inflammatory process in
the jaw bone. You want to isolate the tooth well to prevent
saliva contamination, thus increasing the rate of success. Make
sure all the decay in the tooth is removed before performing RCT.
If the tooth is severely broken down, build it back up with Ketac
cement so that you can place a clamp on the tooth to place a rubber dam
for proper isolation. Doing root canal without a rubber dam is
not defensible in court if the patient aspirates something by accident.
Use a Pulpout Bur® for access if you are not
certain about how deep to drill to get into the chamber without
perforating the floor. The Pulpout Bur is very useful when
drilling through a crown.
Use an apex locator to get the working length
instead of an x-ray with files in the canals. We use the Endex
apex locator by Osada here in the office. It is very
accurate. Different angulations may give you a wrong working
length due to elongation or foreshortening. You might
over-instrument the canal and cause trauma to the PDL which in turn
would give the patient a lot of post-operative pain.
Flood the chamber with NaOCl during the
instrumentation process. Go back with a #10 reamer after every
two larger reamers to break up the debris in the canals and prevent
packing of debris down at the apex. If you instrument the canals
dry, you risk pushing the packed debris at the apex out into the bone
area and creating a flare-up.
Curved canals are pretty challenging to do,
and file separation is a risk. With any technique, the chance of
instrument separation is high when you attempt to take the curve with
the instrument. If you plan to use rotary NiTi files, use new
ones and be sure to go slow. Sterilized NiTi are stiffer, and
there are microcracks in them that will increase the chance of
separation. Open the canals to at least a 25 reamer before using
the rotary NiTi. You might need to go back with a stainless steel
in between the NiTi to open up the canals more to relieve the amount of
stress on the file at the curve. My preference with curved canals
is to use the SafeSiders® reamers because the chance of separating
stainless steel is less than the likelihood of separating NiTi.
With their flat side, the SafeSiders instruments are more flexible, so
they take the curve better, especially when used with the reciprocating
handpiece. Always go back after every two reamers with a #10
reamer to break up the debris. If you have blocked yourself off
in a curved canal, the chance of perforation is high as you try to
break through with an instrument. Straightening the initial part of the
curve with a Gates Glidden and Peeso will also alleviate a lot of the
stress on the reamers.
Once the RCT is done, reduce the occlusion so
that the patient does not have hyper-occlusion. Prescribe an
anti-infammatory and painkiller so that the patient can alternate
between them every three to six hours; if the pain comes back before
the six hours have passed, they can take the medication that was not
recently taken. I like to give my patients Lodine 400 mg and
Vicodin ES to manage their pain. If the tooth is infected or is
nonvital, I like to give them Augmentin 875 mg or Clindamycin 150 mg if
they are allergic to Pen.
November - December 2007
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Make sure all the decay in the tooth is removed before performing RCT.
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