GOOD MORNING

PRINCIPLES OF ENDODONTIC TREATMENT

PRESENTED BY NOREEN QAZIROLL NO: 59

CONTENTS

INTRODUCTION RUBBER DAM ISOLATION COMPONENTS OF RUBBER DAM KIT TECHNIQUE OF RUBBER DAM APPLICATION STERILIZATION OF INSTRUMENTS STERILIZATION RECOMMENDATION COLD STERILIZATION GLASS BEAD STERILIZERS

INTRODUCTION The basic principles underlying the treatment of teeth with

endodontic problems are those underlying surgery in general

An antiseptic technique, debridement of the wound, drainage and gentle treatment of the tissues with both instruments and drugs “Cardinal principles of surgery”

Specifically, pain must be controlled if present

During treatment, all pulp tissue must be removed, the root canal enlarged and irrigated , the canal surface rendered sterile as determined by bacteriologic examination, and root canal well obturated to prevent the possibility of reinfection.

RUBBER DAM ISOLATION To achieve the first principle of endodontic treatment a safe and

septic operating technique needs to be maintained.

Application of rubber dam is imperative to achieve a safe and aseptic operating technique for endodontic treatment

It is the only sure safeguard against bacterial contamination from saliva and accidental swallowing of root canal instruments.

All endodontic operations should be performed under the rubber dam. A rubber dam or dental dam is a rectangular sheet of latex used by dentists, especially for root canal treatment, but also for things like tooth-coloured fillings. If you are allergic to latex, there are non-latex versions available.

Introduced by Dr. S C Burman in the year 1864 and he stated that “the most time consuming thing about a rubber dam is the time required to convince a dentist to use it.

Advantages

Dry aseptic field

Protects patients soft tissue from sodium hypochlorite irrigation and other caustic medicaments

Prevention of aspirating endodontic instruments

Access and visibility are improved

Prevention of contamination of root canal with oral microbial flora

COMPONENTS OF RUBBER DAM KIT Rubber dam material Rubber dam clamps Rubber dam clamp carrying forceps Rubber dam punch Rubber dam frames Rubber dam templates Wedgets cord Dental silk floss Rubber dam napkinApart from the above, recently introduced systems include the Optradam which is considered to be an anatomically shaped rubber dam which can be used with or without clamps. Instidam is a disposable rubber dam system available in both latex and non latex materials

Rubber Dam Material

The rubber dam material is available as heavy, medium and light, and in different colours and standard sizes.

Readymade sheets are available in sizes 5 5”&

6 6”and rolls according to need. Has a shiny and a dull side. Dull side is less

light reflective, placed facing the occlusal side of the isolated teeth.

Rubber dam is usually made of latex material. However for patients with known allergy ,non latex rubber dam material should be made available in the clinic.

Medium weight thickness is usually recommended for endodontic purpose.

Rubber Dam Clamps Different types of clamps are

available according to the tooth to be isolated.

Clamps with wings lead to more rapidity of work and efficiency.

Plastic clamps are available from MOYCO Union Broach in two sizes, large and small, basically to see that the radiographs are not overlapped by the shadow of metal clamps.

Most anterior teeth may be clamped satisfactorily with the Ivory No.9 or No.9 ON clamp. Whenever the tooth is small, as the upper/lower lateral incisor Ivory No.12 or its equivalent may be used.

In posterior teeth, Ivory No.27 clamp (wingless)/HF No. 26 may be used.

PARTS OF A CLAMP

BOW CENTRAL WING, ANTERIOR WING JAWS PRONGS NOTCH HOLE WINGED CLAMPS WINGLESS CLAMPS

RUBBER DAM CLAMP CARRYING FORCEPS Available from different

companies like Ash, Ivory and Hu-Freidy.

Used to carry the rubber dam clamp on the tooth.

RUBBER DAM PUNCH

This is used to punch the rubber dam for application on specific tooth or teeth.

The rubber dam punch has a moving table with holes of different diameters.

The smallest one is for the lower anterior and the largest is for the posterior teeth

RUBBER DAM TEMPLATE It is provided to the clinician to

make an exact punch on the tooth in question for both upper and lower teeth.

The holes in the rubber dam should be punched approximately over the centre of the incisal or occlusal surface of the teeth to be engaged using a rubber dam template under the rubber dam sheet.

DENTAL SILK FLOSS Silk floss is required for the

rubber dam application especially for endodontic procedures.

Two additional holes are provided by the manufacturer for securing the rubber dam clamp by passing silk floss and holding the free end of the floss outside the patients mouth.

This is a safety measure while removing the rubber dam clamp if it snaps.

WEDGET CHORD It is used to stabilize the

interproximal area of the rubber dam.

It is flexible material that can be passed over the dam interproximally below the contact area.

RUBBER DAM HOLDER or FRAME

The type of rubber dam holder one uses is a matter of individual preference but whichever one chooses,it should not interfere with the endodontic operation.

Some operators prefer one that lies flat against the patients face because it permits easy access to the operating field around the tooth.

Other prefer the frame type of holders made of stainless steel ( Young) or plastic (Nygaard- Ostby,Brave) because they can be applied quickly and have additional advantage of being radiolucent and do not have to be removed when taking working radiographs of the tooth during treatment.

Maintains the borders of rubber dam in position U-shaped metal frame Small metal projections

RUBBER DAM NAPKIN Placed between rubber dam and patient’s

skin Advantages : Prevents skin contact with rubber to reduce

possible allergic reactions. Absorbs any saliva seeping at corners of

mouth. Acts as cushion Convenient method wiping patient’s lip on

removal of the dam

TECHNIQUE OF RUBBER DAM APPLICATION

Application of rubber dam with high power suction when used in conjunction with totally sterile instruments may take care of infection control to a greater extent.

Placement of Rubber Dam : Before placing the rubber dam the dental chair

adjusted for optimal patient comfort. Usually, administering aesthetic precedes

application of rubber dam. Rubber dam and retainer can be placed sequentially

provides maximal visibility when placing retainer, reduces risk of impinging on gingival tissue.

When a clamp is used on an anterior tooth, the rubber dam should first be slipped over the tooth , one should stretch the dam, over the tooth between the thumb and the index finger of the left hand, while the clamp is adjusted with the right hand.

In posterior teeth, the clamp is preferably inserted half way into the previously punched hole on the rubber dam , and the arms of the clamp are then spread apart with the forceps

STERILIZATION OF INSTRUMENTS

It is significant to ensure optimal patient care, eradication of existing infectious diseases and preventing any new infections.

The instruments directly come in contact with tissues, blood and tissue fluids, saliva which may sweep through the rubber dam, if not properly placed.

To maintain the cycle of asepsis, processing and sterilization of reusable instruments is mandatory. Endodontic instruments which are reusable have to be autoclaved.

This should take the form of a clearly defined process of decontamination.

DECONTAMINATION CYLCE

It is a combination of processes including cleaning, disinfection and sterilization, used to make reusable surgical instruments safe for further use.

The effective decontamination of reusable medical devices is essential in reducing the risk of transmission of infectious agents.

Elements

Cleaning Disinfection Inspection Packaging Sterilization Storage Use

CLEANING Can be achieved either by manual/mechanical

means. Mechanical method is more effective than

manual method. It provides high standards of cleanliness,

reduces infection to the staff involved. Washer disinfectors are more efficient at pre

sterilization cleaning than ultrasonic cleaners. Hand cleaning must not be a substitute for

sterilization procedures.

DISINFECTION

Disinfection is a process which uses chemical substances or heat to reduce the number of microorganisms present

It may not inactivate some viruses and bacterial spores.

Disinfection should not be used as a substitute for sterilization.

INSPECTION

Inspection should be performed before sterilization in order to ensure that appropriate safety levels are maintained.

Instruments should be examined to ensure that they are clean with no sign of debris remaining and there is no evidence of damage.

Substandard instruments should be removed from the cycle immediately.

PACKAGING

It is required for items which are to be stored for later use.

Packed items should be processed in the vacuum autoclave.

STERILIZATION Sterilization is a process to render

an object free from viable microorganisms, including bacterial spores and viruses.

Sterilization of objects can be achieved in many ways including hot air, gas, irradiation and

Steam sterilization which is the most commonly practiced method for sterilizing reusable medical devices in health care premises because it has high lethality, its rapid and is non toxic.

STORAGE

In all cases storage should be clean and dust free.

USE Whether an instrument needs to be sterile at the point

of use depends on the procedure to be carried out and the associated risk to the patient.

Processing of storage is also affected by levels of risk : LOW RISK PROCEDURES – where items come in contact

only with the skin, thermometers and blood pressure cuffs. They should be cleaned as per manufacturers instructions.

MEDIUM RISK PROCEDURES: are those where instruments come in contact with intact mucous membrane/body fluids such as gingiva and teeth. These instruments must be cleaned and sterilized after use. Eg mouth mirrors, probes.

HIGH RISK PROCEDURES: are those where instruments come into contact with breaches in the skin or when they enter a sterile body cavity such as endodontic microsurgical procedures. The instruments must be sterile at the point of use immediately after autoclaving.

STERILIZATION RECOMMENDATIONS It is preferable to protect the points of instruments with

cotton in order to prevent bag perforation.

Sterilize instruments with hinges in an open position.

Allow drying cycle to finish completely.

Never overfill a sterilizer.

Instruments should be bagged before storage after sterilization.

Instruments that have been bagged are considered sterilized for 4 months if the bag is intact.

Store it in a dry and low traffic area

COLD STERILIZATION It is a method for chairside disinfection of noncritical instruments and

chair side accessories and cannot replace the role of steam sterilization.

Cold sterilization is not recommended because:

Process is not effective against all varities of microbial life.

The length of time which is 20 mins is too long to destroy the

microorganisms.

The cold sterilizing solution consists of phenol , sodium tetraborate , glutaraldehyde and sodium phenate ,

Disinfects cleaned instruments in 10 minutes at room temperature , kills aerobic spore formers including Bacillus subtilis in 3 hours and achieves sterilization in 6.75 hours

GLASS BEAD STERILIZERS

These sterilizers used to consists of either hot salt or glass beads as a medium for dry heat sterilization . The temperature range employed was between 425-475 degree F

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