2TheApex: Right Here!!
This is a great summary of techniques that can help with that “Hot Tooth.” And a good source for what does NOT add to successful anesthesia. CLICK HERE
This is a post I found interesting from Summit Practice Solutions. Enjoy and have a Safe and Happy New Year!! -Derek
Last June the FDA approved an anesthetic nasal spray (Kovanaze) for use in restorative procedures on teeth #4 through #13. It takes two squirts 5 minutes apart (a third squirt may be needed sometimes). One big advantage, in addition to calming patients with a needle phobia, could be pulpal anesthesia without lip numbness for esthetic cases. Use for root canal treatment or biopsy has not been studied yet. Kovanaze is reported to be available sometime this fall. Recent Study Manufacturer Press Release
2TheApex: Roughly 10%
One statistic you may want to share with patients is that 1 in 10 teeth with crowns end up requiring root canal therapy. Here is the Study. Not a bad statistic for patients to know prior to a crown prep. There is always a risk. The more highly the tooth is restored increases the chances.
2TheApex: The Guide(click)
Just a reminder post since it’s the trauma season. This is a great reference. It gives both patients and parents proper expectations following treatment that you can print out.
2TheApex: Use a bite block
Whenever a patient can tolerate a bite block/mouth prop, aka “tooth pillow”, we use one. Since using them routinely, I perceive a decrease in post-op myofascial pain complaints. And it also makes the access easier and the treatment more smooth when the patient doesn’t need to be constantly reminded to open their mouth. We explain to the patient that, “We plan to use a mouth pillow for your comfort. This way you can relax your jaw and you don’t need to hold your mouth open for the entire procedure. If you don’t like it just let us know and we can always take it out.” We tie a piece of floss to it so it can be removed quickly if needed.
Mixing chlorhexidine and sodium hypochlorite forms a precipitate called parachloroaniline (PCA). It is orange-brown in color and, in theory, could compromise the treatment. The compound has also been shown to be toxic and classified as a carcinogen.
Can you irrigate with both of these solutions in one tooth? Sure, just don’t mix them directly. You can irrigate with EDTA or alcohol after the sodium hypochlorite and prior to the chlorhexidine.
The point is to avoid chlorhexidine and hypochlorite from coming in direct contact.
More info here.
Thank you for Dr. McCormick in Mauston for posing the question. We felt it was worth sharing. If you have a particular topic or question don’t hesitate to ask. Thanks Mick!
2TheApex: When a conventional periapical radiograph is inadequate. (the uber simplified answer)
The AAE has published a revised position paper on the use of CBCT. You can find it HERE(click). This is the complete answer of when CBCT is indicated. It’s a quick and easy 7 pages.
CBCT Vs. Conventional Periapical radiograph. (recent case from Dr. Nordeen)
Pre-op periapical Image of Maxillary right
Obvious Findings: Radiolucent lesion tooth #4. Possible lesion tooth #2???
CBCT (mid-retreatment of tooth #4) of the same area using a custom curve. Note apex of tooth #7 caught in the field.
Video while scrolling through CBCT. (from cervical to apices and back) Video is slightly zoomed in, so the detail we view images is better than this normally.
Obvious findings with Cone Beam: Radiolucent lesions on teeth #2, #4 and #7. Almost complete furcal bone loss on tooth #2.
In our practice we use it routinely for surgery, retreatment, resorptive defects, inconclusive diagnosis and trauma. This technology has become as important in our practice as the microscope in providing the best care possible for our patients. We have gone from using it only several times a month to almost daily. This has been the next “game changer” in endodontics.
2TheApex: Similar to an extraction
The average blood lost during root end surgery is 9.5ml according to Messer. This is similar to a single tooth extraction. Time is the biggest factor. Buckley reported that by using 1:50,000 epi. (vs. 1:100,000) blood loss is cut in half during periodontal surgical procedures.
2TheApex: 65% Zinc Oxide; 20% Gutta-Percha; 10% metal sulfites; 5% waxes and resins (Friedman)
It’s mostly Zinc Oxide. We call it Gutta-Percha since that is what gives it unique properties we enjoy, like plasticity. The material was used as an obturation material over 100 years ago. It comes from the sap of a tree that grows in Malaysia. It is also safe to use in patients that are allergic to latex. (American Latex Allergy Association) Gutta-percha has stood the test of time and it still the standard by which all obturation materials are judged.