#D3/S2/W4
#Endo

Irrigation

Why use antibacterial instead of saline?

• culture can return 100% negative after completion

irrigant also provides cooling, improve cutting efficiency,

NaOCl

• antibacterial
• organic tissues

EDTA

• for inorganic debris
• smear layer and tubules
• last flush after NaOCl irrigation
• leave EDTA for 5 minutes in canals, then clean once more with NaOCl

needle movement

• jiggle and always keep needle loose in canal
• side venting needle

Medication

Objective

• minimise postop pain
• minimise bacteria

CaOH

• pulpdent
• introduced originally for direct pulp capping
• low solubility in water
• pH 12.5-12.8, white odourless powder, strong base
• dissociates slowly into calcium and hydroxyl ions
• antimicrobial activity
  • release of OH ion in an aqeous environment
  • highly oxidant free radicals
  • highly reactive with several biomolecules
  • lethal effects of OH ion on bacterial cells
    • damage cytoplasmic membrane, DNA
    • denature proteins
• used for interappointment dressing
  • use lentulo spiral
  • needs to be in immediate vicinity to work, so fill entire canal
• extrusion is very serious
  • can lead to dysesthesia

Lentulo spiral

• 4 sizes
• use one smaller than canal
• WL known, 3-4mm from WL
• WL unknown, 1-2mm from point of resistance

Meta analysis antibacterial efficacy of calcium hydroxide intracanal dressing

• comparison of pre vs post medication for positive canals
• no significant difference between premed and post med
  • looking at inclusion vs exclusion, only endodontist used
• likely it doesn't make a difference if the bacteria is already gone, but if the bacteria is already there, it will make a difference
• clinically relevant for novice/technical skill

Ledermix/Odontopaste

• used to control inflammation/postop pain (steroid based)
  • have antibiotics mixed in only to counteract the fact that corticosteroids can allow the bacteria to grow
  • 
  • study design
    • patient with no preop pain barely benefits (statistically) from ledermix
  • high risk indicators of postop pain
    • preop pain
    • allergy
    • Hx of flare up
    • ReTx
• best to use if risk of postop pain
• 

Postoperative pain

• pain of any degree that occurs after initiation of RCT
  Flare up
• onset or continuation of pain and/or swelling after endodontic treatment which is of such severity that is disrupts patients lifestyle that the patient requires an unscheduled appointment at which active treatment is undertaken
• basically studies cant influence us for pain control in these cases due to lack of evidence

Temporisation

Cavit

• sets with moisture
• mechanical seal
• 4mm thickness for adequate seal
• no cotton pellet

Fuji VII

• top layer
• wear resistance
• easier to remove