Clinical conference for Endodontic Procedure Monorooted Case

A. First appointment
Pre-treatment procedure
Diagnosis
B. Second appointment
Access Preparation and Pulp Extirpation
1. Tooth crown build-up
Materials:
4 basic instruments
High-speed Handpiece
Composite syringe light curing unit
Burs
Needle
Composite trimmer
Celluloid strips
Etchant
Applicator tips
Saliva ejector
Lidocanaine
Bonding agent
Plastic filling instrument
Procedure:
a. Remove the caries of the involved tooth
b. Inject anaedthetic solution of the patient cannot resist pain
c. Re-contour the tooth by using composite
2. Access preparation
Materials:
4 basic instruments high-speed handpiece
Rubber dam sheet
Rubber dam frame
Clamp holder
Rubber dam puncher
Burs (carbide #4 and #2)
Procedure:
a. Isolate the tooth using the rubber dam
b. Using the #4 bur start the access prep
c. De-roof the chamber walls to establish a straight line access to the can
al orifice
d. Check the access preparation for the presence of undercats using an eplo
rer
e. Smoothen the preparation
3. Pulp extirpation
Materials:
4 basic instruments
Smooth broach
Irrigating solution
2 disposable syringe
Barbed broach
Glass-bead sterilizer
Procedures:
a. Use a smooth broach to separate the pulp tissue to the canal walls
b. Use a barbed broach to extirpate the pulp tissue completely from the can
al
c. Make sure all instruments inserted into the canal have been sterilized u
sing the glass bead
d. Irrigate the canal with the irrigating solution, then aspirate properly
to remove the debris of the canal
4. Temporization
Materials:
4 basic instruments
Cotton pellets
Woodson filling instrument
Eugenol
Fermin
Paper points
Procedure:
a. After properly drying the canal dipped the cotton pellet at the eugenol
b. Squeeze-out the excess liquid properly
c. Place it into the canal
d. Place a sterilized cotton at the canal orifice
e. Pack the access preparation with fermin, it should be 3mm thick from the
canal orifice to the outer surface of the tooth contour and remove excess
f. Remove the rubber dam isolation
C. Third appointment
Canal preparation
1. Working length determination
Materials:
4 basic instruments
Diagnostic wire
Rubber dam sheet
Rubber dam frame
Clamp holder
Rubber dam puncher
Burs (carbide #4and #2)
Dental floss
Ruler 2 disposable syringe
Rubber stopper
x-ray films
hemostat
irrigating solution
paper points
Procedures:
a. Isolate the tooth
b. Irrigate the canal to flush out debris and then aspirate
c. Insert the diagnostic wire with a rubber stopper in one of the canal the
n take a radiograph
d. Compute for the working length
e. Compute for the working length

*AWL= measurement from the tip of the file/ diagnostic wire to the rubber stoppe
r, outside of the tooth
*TLI=measured on the radiograph, from the external reference point to the apex o
f the tooth
*SW=measured on the radiograph, from the tip of the file or diagnostic wire to t
he rubber stopper
* It always required using the safety factor since the DCJ is located 0.5 to 1 m
m below the radiographic apex
f. Get a ruler to measure the diagnostic wire and image of the radiograph
g. Record the working length
2. Canal enlargement
4basic instrument
Irrigating solution
Cotton pellet
3 disposable syringes
Pro-taper files
Glass-bead sterilizer
Woodson filling instrument
Fermin
Eugenol
Ruler
Paper point
Rubber dam sheet
Rubber dam frame
Clamp holder
Rubber dam puncher
Procedure:
a. Designate the WL on each pro-taper files using the rubber stopper
b. Enlarge the canal with pro-taper
c. Irrigate with sodium hypochlorite solution and then file once trhen aspi
rate to flush out thr debris
d. When a certain pro-taper reach the WL radiograph with the pro-taper insi
de the canal. This will be the ABI or apical binding instrument
e. Every time you file use the step: irrigate, file and aspirate
f. The last instrument (from abi the 3rd file) which can be enlarge the can
al enough is the MAF or master apical file
g. Irrigate the canal properly and aspirate/ dry the canal properly before
closing
h. Put the temporization
i. Remove the isolation
D. Fourth appointment
Check the canal status/ irrigate & aspirate
Materials:
4 basic instruments
Fermin
Rubber dam sheet
Clamp holder
Rubber dam puncher
Glass-bead sterilizer
Irrigating solution
Poaper points
2 disposable syringe
Procedure
a. Isolate the tooth
b. Prepare sterilized paper points mark the WL of the canal
c. Remove temporary filling
d. Insert the paper point one at a time to check the canal status. Observe
whether it is wet or dry, presence of pus, blood, sticky subs, foul odor
e. Irrigate and aspirate the canal
f. Temporization
g. Remove the isolation
E. Fifth appointment
Bacteriologic examination
Materials
4 basic instruments
Dental floss
Rubber dam sheet
Rubber dam frame
Clamp holder
Rubber dam puncher
Cotton pellets
Glass bead
3 disposable syringes
Fermin
Eugenol
Irrigating saolution
Paper points
Test tube
Media-broth
Petri dish
Procedure:
a. Isolate the tooth
b. Prepare sterilized paper points mark the WLK of the canal
c. Remove the temporary fiolling
d. Insert the paper point one at the time to check the canal status. Observ
e whether iut is wet, dry, presence of pus, blood, stricky subs, foul odor.
e. On the third paper point after placing and removing ot on thr canal inse
rt it on 1 of the test tube (all containing media)
f. Place them on the incubator for 24hrs
g. Irrigate and aspirate thje canal
h. Temporization
i. Remove the isolation
F. Sixth appointment
Obturation
1. Evaluation for obturation.
Procedure:
a. Check the test tube for change in color or presence of precipitate, if a
ll dont have any change obturation follows
2. Obturation
Materials:
4 basic instruments gutta percha
Rubber dam sheet
Rubber dam frame
Rubber dam puncher
Clamp holder
Denatured alcohol
Glass bead sterilizer
Woodson filling instruments
ZOE cement
Glass slab
Cement spatula
Dental floss
Alcohol lamp
Lentullo filler
X-ray film
Procedure:
a. Choose the size of the master cone size of the MAF at it WL
b. A tug-back should be felt as the gutta percha have reached the WL in ord
er to do this reduce the length of the gutta percha by cutting 1mm to its end un
til a tug-backis achieve
c. Radiograph the tooth to check if gutta percha have reached the apex
d. Lateral condensation technique:
e. Mix ZOE (slow setting) on a glass slab dip the lentullo filler on the ce
ment and spread it on the canal
f. Insert the next possible size of the gutta perch apt into the canal
g. Use the finger spreader to condense the gutta percha
h. Continue until the canal is completely filled with gutta percha pts
i. Take a radiograph to see if there is still a space inside the canal
j. Do the same procedure to other canals
k. If it iscompletley sealed, cut the excess gutta percha using a headted w
oodson filling instrument
l. Heat the spoon excavator to get the excess gutta percha. The gutta perch
a should be at the level of canal orifice
m. Temporization
n. Remove the isolation
G. Seventh appointment
Canal impression
1. Apical cone reduction
Material:
4 basic instrument
2 disposable syringe
Rubber dam sheet
Rubber dam frame
Rubber dam puncher
Clamp holder
Chloroform
Irrigating solution
x-ray films
k-files
fermin
cotton pellets
procedure:
a. Remove the isolation
b. From the WL minus 5 and designate it on the smallest K-file by using a r
ubber stopper
c. Place a cotton on the K-file
d. Dip the file on the chloroform and proceed to reducing the set gutta-per
cha
e. Do this until it reaches the rubber stopper
f. Radiograph the tooth to check if the reduction is enough
g. If the reduction is already finished irrigate the canal with the irrigat
ing solution to remove excess chloroform
h. Properly dry the canal by aspirating properly and placing paper points
2. Canal impression
Materials:
4 basic instrument
Tooth pick
Rubber dam sheet
Rubber dam frame
Rubber dam puncher
Clamp holder
Dropper lentullo-filler
Self-cured acrylic resin
Glass slab
Petroleum jelly
Procedure:
a. If tooth build-up has been done (G.I. or composite) remove it
b. Prepare the tooth (same as how to prepare the tooth for a jacket crown)
c. From the radiograph designate the width of the tooth pick so that it can
be inserted into the canal and also have the sufficient space for the acrylic t
o be placed
d. Using a lentullo-filler place a petroleum jelly into the canal so that t
he acrylic would not sick and the impression can be removed easily. Petroleum je
lly also on the tooth surface
e. Insert the trimmed tooth pick into the canal carefully
f. Using salt and pepper techniques place acrylic on the tooth-pick and whe
n in the sticky stage insert it into the canal for it to be in the rubber stage
so upon removal the impression would still have the impression of the canal
g. After the canal impression is finished, if the build-up of tooth has bee
n done and removed restoration but it should be shape as a P.F.J.C
h. Remove the impression check for excess and if there is place again on th
e tooth and remove and smoothen it
i. Remove the impression
j. Insert the temporary crown and adjust it so that there is no contact dur
ing bitting
k. Place a dry cotton pellet into the orifice of the canal
l. Place temporary cement on the crown and insert it properly, remove exces
s and check the bite again
H. Eight appointment
Crown restoration
1. Post and core
2. Porcelain jacket crown
I. Final appointment
Recall system
1. Recall
2. A. the patientis advice to return after a montyh for the recall.
(make sure you pray, and ask God to convince your patient to come backheheheheheh
)