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.
2TheApex: It’s PermaFlo Purple, a colored flowable composite.
Coronal seal has been shown to be critical in the long-term success of endodontic treatment. (click on “Coronal Seal” for flagship research on this subject) PermaFlo Purple is a flowable composite that will provide an excellent seal and is easily identifiable for when the Cavit is removed after treatment for the final restoration or if retreatment should needed in the future. It is useful in teeth that have deep caries or small crack making a coronal seal with Cavit questionable, or in patients that may have difficulty returning for a final restoration within the 30 days recommended following root canal treatment. It is bonded and placed as a thin layer, so does not need to be removed and can be bonded to just like any other composite restoration.
2TheApex: Use an Endo Z bur or another non-endcutting bur
A non-endcutting bur can still cut through Cavit or IRM easily. The bur smooths the walls of the access and is a safe way to remove the restoration and any cotton pellets. Here’s short video of it being done. It’s not recommended to run the handpiece for very long with the cotton pellet wrapped around it. The Endo Z bur is from Tulsa Dentsply. I use it on most cases for access once I know I have entered the pulp chamber.