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BDS3 Endodontics > Chemomechanical Disinfection > Flashcards

Chemomechanical Disinfection Flashcards

1
Q

why is chemomechanical disinfection required

A

remove bacteria present
stop development into biofilm which adheres to dentinal surface and embed in extracellular matrix

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2
Q

what are the 2 clinical objectives of endodontic therapy

A
  1. remove canal contents
  2. eliminate infection
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3
Q

what is chemomechanical disinfection

A

mechanical means to debride and shape canal
supplemented with chemicals to enhance biofilm destruction

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4
Q

design objectives of chemomechanical disinfection

A

create a continuously tapering funnel shape, maintian apical foramen in original postion, keep apical opening as small as possible

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5
Q

what is the point in mechanical preparation

A

creates a sapce to allow irrigating solutions and medicaments to eliminate microorganisms more effectively from RC system

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6
Q

what are the 7 stages in mechanical preparation

A
  1. apical preparation
  2. working length determination
  3. coronal flaring
  4. initial negotiation
  5. creating a straight-line access
  6. access cavity preparation
  7. preparation of tooth
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7
Q

how to achieve apical preparation

A

removal of pulp/nerve
filing to create a bigger space

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8
Q

sodium hypochlorite NaOCl use

A

antibacterial activity, dissolves pulp remnants and collagen, dissolves necrotic and vital tissue, helps to disrupt smear layer

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9
Q

why and how would you use mechanical agitation with NaOCl

A

better exchange of irrigatn, improved irrigation, penetration and disruption of biofilm/smear layer

done via endoactivator sinic vibration or manual dynamic irrigation MDI [GP point]

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10
Q

problems with NaOCl

A

effect on dentine properties, cannot remove smear layer alone, effect on organic material

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11
Q

NaOCl and dentine effects

A

a higher concentration reduces elasticity and flexural strength

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12
Q

NaOCl and smear layer

A

inability to remove itself
need sufficient canal preparation before obturation, where smear layer is formed and interferes with disinfection and prevents sealer penetration

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13
Q

how to remove smear layer

A

17% EDTA, 10% citric acid, MTAD and ultrasonic irrgation

ethylenediaminetetraacetic acid = 1 min contact time

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14
Q

NaOCl complications

A

disscolouration of fabrics, ophthalmic injuries due to eye contact, apical extrusion leading to tissue necrosis, allergic reactions

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15
Q

chlorohexidine vs NaOCl

A

less antifungal, active against biofilms but cannot disrupt

interactions forms cytotoxic and carconogenic

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16
Q

proposed protocol cleaning and shaping

A

once canal preparation is complete, should be irrigated with
1. 3% NaOCl throughout instrumentation and at least 30ml after instrumentation complete with MDI - at least 10 mins prior to obturation
2. 17% EDTA 1 min penultimate rinse
3. 3 NaOCl final rinse

dry canal w paper points between irrigants

17
Q

sodium hypochlorite extrusion definition

A

extruded beyond root canal into periradicular tissues, causing effect of chemical burns leading to localised or extensive tissue necrosis

18
Q

NaOCl extrusion symptoms

A

pain, swelling, ecchymosis (bruising), haemorrhage, neurological complications, airway obstruction

ecchymosis can manifest along course of superifical venous vasculature = rare

19
Q

risk factors of NaOCl extrusion

A
  • excessive pressure during irrigation
  • needle locked within canal
  • loss of control of WL
  • larger apical diameters/constriction [root resorption, immature teeth, developmental abnormalities]
  • anatomical factors
  • proximity to sinus
  • higher NaOCl concentration?
20
Q

excessive pressure + NaOCl extrusion

A

leads to needle being locked in canal

patent apical forman facilitated by anatomy of facial venous drainage means pressure at periapex has to exceed venous pressure in superifical veins of neck

flow rate important = 1ml/15secs

21
Q

management of NaOCl extrusion into tissues

A
  • stop tx
  • stay calm, dont alarm pt but advise of what has happened
  • consider LA if pain
  • allow bleeding until haemostasis
  • steroid containing intra-canal medicament (odontopaste) shouldbe placed in RC, ensuring no pressure
  • dont obturate tooth at this visit
  • seal coronal access cavity
  • priotity to pain relief, reduction of swelling and prevention of secondary infection

cold compress 1-2 days, warm compress for resolution of soft tissue swelling, elimination of haemotoma, analgesics, review in 24hrs, prescription of antibiotics case specific
refer if severe

22
Q

pre-op assessment of pt before NaOCl

A

be vigilant of open apices and perforations
restorative state of tooth assesed, pre-build up may be needed

23
Q

what to give pt before NaOCl use

A

disposable bib to cover clothing
eyewear

24
Q

use and test of dental dam and NaOCl

A

used to isolate tooth, ensure seal with oraseal
oral seal should be moulded to tooth conoturs with damp cotton wool
place clamp first for visualisation
ensure floss to secure clamp then remove

test by irrigating with chlorohexidine to ensure no leakage

25
Q

what syringe to use with NaOCl

A

side-vented for irrigation
must all be labelled
Luer-Lok 27G needle, securely attached to 3ml syringe and test before
only fill 3/4 to aid control
silicone stop set to 2mm short of working length

26
Q

use of irrigating needle with NaOCl

A

should not bind canal
depress plunger with index finger not thumb to reduce pressure
pass behing pt head

27
Q

when are inta-canal medicaments used

A

when RCT cannot be completed within a single visit

28
Q

why are intracanal medicaments used

A

placed inside RC between appts to destroy microorganisms and prevent reinfection
[proper preparation will minimise bacteria]
prevents multiplication of bacteria
reduces inflammation and controls root resorption

29
Q

anti-microbial paste as intranal medicament

A

corticosteroid and tetracylcine
management of hot pulps, reudction of pulpal inflammation
effective for 5-7 days

30
Q

non-setting calcium hydroxide as an intracanal medicament

A

pH 12.5 contributes to prolonged antibacterial activity
effective removing tissue debris
7 day treatment
combine with NaOCl for improved cleaning ability
hydrolysis of lipopolysaccharide reduces inflammatory potential

31
Q

inter-appt disinfection

A

completely fill canal with CaOH paste, come into direct contact with bacterial cell well to be effective, placed via injection

32
Q

inter-appt temporary dressing

A

must effectively seal root canal from contamination between visits
- Cavit, IRM, GI cements

33
Q
A

BDS3 Endodontics (10 decks)

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