Transcript Slide 1

Asepsis is Everything!!
“The Seal is the Deal”
“Everything Eventually Leaks”
11 week Recall
Eric M. Rivera, DDS, MS
Where to Sear Root Canal Filling Material
VS
Flush With Orifice Level
Below Orifice Level
Where to Place Restorative Material
Amalgam as Final Restoratuion - Sufficient Remaining Tooth Structure
VS
Flush With Orifice Level
Below Orifice Level
“Amalgam Plug Not Needed(?)”
Where to Place Restorative Material
Amalgam as Final Restoratuion - Insufficient Remaining Tooth Structure
VS
Flush With Orifice Level
Below Orifice Level
“Amalgam Plug Needed(?)”
IntraCoronal Amalgam Use
• With respect to depth of amalgam in the canal space, it is
speculated that it is not necessary to use amalgam as a
coronal-radicular core material if adequate volume of
chamber exists. If minimal chamber volume exists, may
gain additional retention and seal.
– Nayyar A, Walton RE, and Leonard LA. An amalgam coronal-radicular
dowel and core technique for endodontically treated posterior teeth. J
Prosthet Dent, 1980. 43(5): p. 511-5.
– Ulusoy N, Nayyar A, Morris CF, Fairhurst CW. Fracture durability of
restored functional cusps on maxillary nonvital premolar teeth. J Prosthet
Dent, 1991. 66(3): p. 330-5.
Coronal Restoration
• Just as important and many times more important than
Root Canal Filling due to coronal microleakage
– Ray, H.A. and M. Trope, Periapical status of endodontically treated teeth in
relation to the technical quality of the root filling and the coronal restoration.
Int Endod J, 1995. 28(1): p. 12-8.
• The purpose of this study was to evaluate the relationship of the quality of the
coronal restoration and of the root canal obturation on the radiographic
periapical status of endodontically treated teeth.
• Full-mouth radiographs from randomly selected new patient folders at Temple
University Dental School were examined. The first 1010 endodontically treated
teeth restored with a permanent restoration were evaluated independently by
two examiners. Post and core type restorations were excluded. According to a
predetermined radiographic standard set of criteria, the technical quality of the
root filling of each tooth was scored as either good (GE) or poor (PE), and the
quality of the coronal restoration similarly good (GR) or poor (PR). The apical
one-third of the root and surrounding structures were then evaluated
radiographically and the periradicular status categorized as (a) absence of
periradicular inflammation (API) or (b) presence of periradicular inflammation
(PPI).
• The rate of API for all endodontically treated teeth was 61.07%. GR resulted in
significantly more API cases than GE, 80% versus 75.7%. PR resulted in
significantly more PPI cases than PE, 30.2% versus 48.6%. The combination of
GR and GE had the highest API rate of 91.4%, significantly higher than PR and
PE with a API rate of 18.1%.
34mo Recall
Eric M. Rivera, DDS, MS
Chlorhexidine Pellet
LuxaCore Blue Shade Resin
Eric M. Rivera, DDS, MS
Flowable Composite
•
May provide added protection against bacterial contamination, especially if:
– Temporary restoration leaks or is lost
– Restorative procedures are not performed under rubber dam isolation
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Not recommended as build-up material due to strength and dimensional stability
concerns
Fills the difficult to access intracoronal space (due to magnification and
illumination under Dental Operating Microscope)
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Intraorifice Barrier/Sealing
Intraorifice barriers should be
considered immediately after
Root Canal filling as a
secondary seal to prevent
infection/reinfection by
microleakage.
Name
Yr
Type Study
Amt IO
Barrier
Results
Roghanizad &
Jones
1996
Leakage – Dye
3.0 mm
Amal w Varnish > Cavit = Term > Control
Pisano et al
1998
Leakage – Microbes
3.5 mm
Cavit > IRM = Super EBA > Control
(all leaked in < 49 days)
Wolcott et al
1999
Leakage – Microbes
3.0 mm
GI (Vitrebond=GC America=Ketac bond)
> No Barrier
Belli et al
2001
Leakage – Fluid Filtration
?
Resins (ClearfilSEBond=OneStep=C&B
Metabond) > IRM >GP No Sealer
Galvan et al
2002
Leakage – Fluid Filtration
3.0 mm
Amalgambond > C&B Metabond > (IRM =
Eliteflo = Palfique) > Control
Howdle et al
2002
Leakage – Dye
Transparency
?
Bonded Tytin (Vitrebond=SuperbondD
Liner II=Panavia 21) > Unbonded Tytin
Shindo et al
2004
Leakage – Dye
4.0 mm
Advantageous sealing ability of Adhesive
and Flowable Materials
Shimada et al
2004
Histology – Monkey
?
No necrosis in any groups. No bacterial
penetration along cavity walls in Flowable
Composite or Glass Ionomer Cement.
Amalgam without Adhesive Liner showed
slight bacterial penetration along wall
Yamauchi et al
2005
Histology – Dog left open
2.0 mm
Significant periapical inflammation in 90%
of samples when plugs not placed.
Reduced to 47% w Composite or 37% w
IRM Plug.
Abstract
Intraorifice Barrier/Sealing
Intraorifice barriers should be
placed immediately after
Root Canal filling as a
secondary seal to prevent
infection/reinfection by
microleakage.
Experimental Procedure
Instrumentation/
Obturation
Removal of G/S
Placement of Orifice Plug
Plug (IRM or Composite)
~2 mm
8 months
Histology
Evaluation of periapical inflammation
No inflammation
Mild inflammation
Severe inflammation
Results: Periapical inflammation rate
Without plug (G+S)
With Plug
G + S + IRM
38% (5/13)
89% (16/18)
M=7, S=9
M=5
G + S + Comp
39% (7/18)
M=6, S=1
G + NS + Comp
58% (7/12)
M=5, S=2
M=mild
S=severe
Flowable Composite
Flowable Composite Not Placed In Canals Where Post or “Plug” Needed
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
Flowable Composite
Flowable Composite Not Placed In Canals Where Post Needed
Post Space Preferably Created with Heated Plugger (do not allow to cool)
May also use Rotary Instruments, Carefully!!
Endodontist will provide Post Space if Requested
We Strive To Please the
Referring Dentist!!
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Communication
Biological Principles
Communication
Asepsis
Communication
Literature Support
Communication
Placement of the
Coronal Restoration
After Completion of
RC Fill is Variable, but
Based mainly on Asepsis.
34mo Recall
2mo Recall
Eric M. Rivera, DDS, MS
Returned to Restorative Dentist
• Please Read Chart and/or Referral Letter
– Root Canal Filling Material Used
– Restoration Placed
– Cotton Pellet Placed
• Please Review Postoperative Radiograph
– Level of Root Canal Fill
– “Space” between Root Canal Fill and
Restoration
Returned to Restorative Dentist
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
Returned to Restorative Dentist
If it were possible to place a material
to the anatomic apex that prevented
leakage and had dimensional
stability, we would use this material.
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
Returned to Restorative Dentist
Significant Loss of Tooth Structure
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
Returned to Restorative Dentist
Significant Loss of Tooth Structure
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
Returned to Restorative Dentist
Amalgam placed when Access is through Intact Crown/Onlay Restoration
Root Canal Filling Material (Resilon/Gutta Percha)
Flowable Composite
Cotton Pellet
IRM
Glass Ionomer/Composite
Amalgam
8mm probing defect DL
6 week Re-Evaluation
No probing > 3mm
Eric M. Rivera, DDS, MS
Thank You!
I appreciate your feedback!!
How To Contact Us
University of North Carolina
School of Dentistry
Department of Endodontics
and
Endodontic Dental Faculty Practice
1098 Old Dental Building, CB #7450
Chapel Hill, NC 27599-7450
919-966-2707 (Office)
919-966-6344 (Fax)
919-966-2115 (Dental Faculty Practice)
[email protected]