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Asepsis is Everything!!

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. Below Orifice Level. Flush With Orifice Level. Where to Place Restorative Material.

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Asepsis is Everything!!

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  1. Asepsis is Everything!! “The Seal is the Deal” “Everything Eventually Leaks”

  2. 11 week Recall Eric M. Rivera, DDS, MS

  3. Where to Sear Root Canal Filling Material VS Below Orifice Level Flush With Orifice Level

  4. Where to Place Restorative Material Amalgam as Final Restoratuion - Sufficient Remaining Tooth Structure VS Below Orifice Level Flush With Orifice Level “Amalgam Plug Not Needed(?)”

  5. Where to Place Restorative Material Amalgam as Final Restoratuion - Insufficient Remaining Tooth Structure VS Below Orifice Level Flush With Orifice Level “Amalgam Plug Needed(?)”

  6. 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.

  7. 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%.

  8. 34mo Recall Eric M. Rivera, DDS, MS

  9. Chlorhexidine Pellet LuxaCore Blue Shade Resin Eric M. Rivera, DDS, MS

  10. Root Canal Filling Material (Resilon/Gutta Percha) Flowable Composite 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 • 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)

  11. Intraorifice Barrier/Sealing Intraorifice barriers should be considered immediately after Root Canal filling as a secondary seal to prevent infection/reinfection by microleakage.

  12. Intraorifice Barrier/Sealing Intraorifice barriers should be placed immediately after Root Canal filling as a secondary seal to prevent infection/reinfection by microleakage.

  13. Experimental Procedure Instrumentation/Obturation Placement of Orifice Plug Removal of G/S Plug (IRM or Composite) ~2 mm 8 months Histology

  14. Evaluation of periapical inflammation No inflammation Mild inflammation Severe inflammation

  15. Results: Periapical inflammation rate Without plug (G+S) With Plug 89% (16/18) M=7, S=9 G + S +IRM G + S +Comp 38% (5/13) 39% (7/18) M=mild M=5 M=6, S=1 S=severe G +NS+ Comp 58% (7/12) M=5, S=2

  16. 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 or “Plug” Needed

  17. 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

  18. Placement of the Coronal Restoration After Completion of RC Fill is Variable, but Based mainly on Asepsis. We Strive To Please theReferring Dentist!! • Communication • Biological Principles • Communication • Asepsis • Communication • Literature Support • Communication

  19. 2mo Recall 34mo Recall Eric M. Rivera, DDS, MS

  20. 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

  21. Root Canal Filling Material (Resilon/Gutta Percha) Flowable Composite Cotton Pellet IRM Glass Ionomer/Composite Amalgam Returned to Restorative Dentist

  22. 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.

  23. 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

  24. 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

  25. 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

  26. 8mm probing defect DL 6 week Re-Evaluation No probing > 3mm Eric M. Rivera, DDS, MS

  27. Thank You!

  28. Questions?? I appreciate your feedback!!

  29. 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) first_last@dentistry.unc.edu

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