STEPS IN PULPECTOMY AND ROOT
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.
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
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.
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 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
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