STEPS IN PULPECTOMY AND ROOT CANAL TREATMENT

As in all efficient assisting, you will need to anticipate the dentist's needs. In endodontics, your duties consist of such tasks as performing infection control procedures, preparing for the treatment, aiding in the placement of the rubber clam, irrigating and aspirating to flush the area, mixing materials, and passing instruments. You will need to have knowledge of the treatment procedure and sequence to effectively anticipate the dentist's needs and to schedule appointments.

APPOINTMENT SCHEDULING

Root canal therapy may take one or more appointments based on the number of canals and severity of infection. Before a canal can be filled, the canals must be completely cleaned. Filling the canal while infective organisms are still present may result in non-healing. A patient suffering from an acute periapical abscess may experience severe pain. The pain is due to inflammation in the pulp canal, and/or periapical tissues. The pressure, and therefore the pain, is relieved during the first step of endodontics when the pulp canal is opened. Once the pulp canal is opened, broaches can be used to remove intact pulp tissue from the canal. The canal is then irrigated, and debrided with files and reamers. Dry the canal and place small medicated cotton pellets into the pulp chamber to help clear up the infection. Then, the dentist may place a temporary restoration.

During a second appointment, if necessary, the temporary restoration is removed, the canals irrigated, and root canal reamers and files are used to enlarge, shape, and smooth the pulp canal. If infection continues to be a problem, placement of medication into the canal, and placing a temporary restoration will be required. Schedule the patient for another appointment. When all instrumentation is complete and infection is eliminated, gutta-percha is placed into the canals with a sealer that acts as a cement. Then a temporary restoration can be placed.

After root canal treatment is completed, a permanent restoration is placed, usually at a later appointment. At this time, the tooth may be evaluated for possible prosthodoiltics treatment to replace the restoration with an artificial crown.

During all appointments, use a rubber dam to isolate the tooth, prevent contamination of the root canal, and prevent the small endodontic instruments from going down the patient's throat.

ENDODONTIC MATERIALS

The main materials used in root canal therapy are various liquid antiseptics, paste, paper points, gutta-percha points, and sealers. The dentist uses these to treat and fill a properly prepared root canal from which the pulp has been removed.

Paper Points

Paper points are primarily used during the treatment phase of endodontics to dry out root canals. They are highly absorbent, rolled sterile paper that are long and narrow with a tapered point to fit into the root canal. Paper points are available in assorted sizes, from coarse to X-fine, depending on the size of the canal into which they are being inserted.

Root Canal Restorative Materials

Root canal restorative materials are used to fill the previously prepared root canals and complete the root canal or endodontic therapy. Root canal restorative materials consist of tapered gutta-percha points in a variety of sizes and root canal sealers or cements. A good root canal restorative material should be insoluble in tissue fluids, opaque to the passage of X-rays, easy to remove, nonirritating to periapical tissues, nonabsorbent, and dimensionally stable after its insertion into a root canal.

GUTTA-PERCHA. - Gutta-percha is used as a temporary restoration and as a root canal restorative material. Gutta-percha is the refined, coagulated, milky exudate of certain trees. It is pink or gray in color, softens when heated, and is easily molded. When it is cool, it maintains its shape well. Gutta-percha points have been a choice for root canal restorative materials for many years. The many advantages of the material are as follows: High thermal expansion Will not shrink unless used with a solvent Radiopaque Can be kept sterile in an antiseptic solution Resistant to moisture and bacteriostatic A poor heat conductor The disadvantages of gutta-percha are as follows: Shrinks when used with a solvent Is not always easily inserted into the root canal