Stages in Endodontic Treatment

 

  1. Restorability assessment +|- Orthoband placement. Isolation – Access. Use a parrallel diamond  and Endo Z to locate and unroof the pulp chamber prepare straight line access, conserve dentine, planning for resistance and retention form of the temporary dressing and final restoration.
  2. Locate and Scout canals 6/8/10 Ss file – DG16 Probe.
  3. Coronal flaring – gates glidens 4/3/2/4 or Sx,S1,S1 (or WaveOne Gold) or hand files (hedstrom or K-flexo files). upto canal curvature.
  4. Achieve Patency upto a size 10 K-flexo file. Maintain patency filing  from now on to prevent debris and blockage.
  5. Establish a Zero reading with electronic apex locator. Record a Diagnostic radiograph.
  6. Correct your Working Length (CWL) 0.5-1mm back from ZERO. Confirm and maintain a reproducible reference point.
  7. Apical preparation with hand K-Flexo files  using a filing or rotational technique  upto a master apical file size (dependent upon anatomy but as small as practicable to conserve apical anatomy and dentine – size 25 or 30) or F2 (ProtaperGOLD), or X2(ProtaperNEXT) or WaveOneGOLD to CWL.
  8. Maintain patency filing with a small K-flexo file. Use copious NaOCl 2.5% throughout and patency filing after each file. Continue to confirm lengths and  use your apex locator.
  9. Apical gauging with your Ss corresponding to finshing file used. (F2=25 X2=25 F3=35 X3=35 etc.) Adjust as necessary if a firm apical stop not achieved by using larger finishing file.
  10. If using a pure hand file techniques,  perform a 1mm step back (0.05 taper using 02 Ss. Files) or a 0.5mm step back (0.10 taper) from your Master apical file (MAF). Irrigate, check patency, dry canals. Confirm your MAF after performing your step back and record an MAF radiograph.
  11. Perform a penultimate EDTA 17% rinse to remove smear layer in a 3 x 1min NaOCl 2.5% rinse protocol with GP pumping and/or endoactivation. Ensure your canals are rinsed free from EDTA with saline before a final hypochlorite rinse to prevent inactivation of the irrigants. Avoid cycling the two chemicals as this has been shown to significantly affect the properties of dentine and may weaken the tooth structure.
  12. Dry the canals with paper points. Try in master GP with sealer (ROTH/AH plus) based on MAF and system used and modify as necessary based on your predetermined lengths. If using a cold lateral technique, place and compact a number of accessory points matched to your finger spreader size and appropriate to the canal anatomy.
  13. Take check mid-fill PA and confirm length and position – adjust at this point if GP extruded or voids present.
  14. Complete cold lateral compaction or obturate with your chosen technique – warm vertical down pack and back fill.
  15. Cut back GP below canal orifice and Place IRM over GP stumps +/- Nayyar core.
  16. Review and prepare for appropriate direct cuspal coverage restoration or indirect restoration.

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