Seven Steps Of Endo

Diagnosis 

• Vital pulp testing
• Cold test, heat test, signs of swelling, radiograph

The first step is to diagnose a need for treatment. The patient will usually come to the dentist complaining of pain. Indications such as swelling and sensitivity allow the dentist to isolate the infected area. Sometimes the pain will feel like it is coming from a tooth that is not infected. The dentist will then use several methods to determine the exact tooth causing the problems. X-rays can show lesions that might be otherwise invisible. Percussion testing is the tapping on teeth with a mirror handle. Thermal testing with ice and heated objects can help further pinpoint the problem tooth.

Access

Access to the pulp is gained through the crown of the tooth. A series of burs, including the Transmetal™ and Endo-Z™ bur are used to open up the tooth. This is the first area where Maillefer can help your clients.. And their patients.  Proper access will help each of the remaining steps go much easier.

Extirpation

The next step is removing the diseased pulp tissue. This is called extirpation. Many dentists use what is known as a barbed broach.

Debridement

Cleaning and shaping the canal is next. In the debridement step, the dentist will use a variety of instruments, irrigants like Sodium Hypochlorite... (aka bleach) and lubricants like Glyde File Prep® to remove the rest of the infected tooth structure. They will also shape the canal to facilitate filling (obturation). Another key part of the debridement process is the determination of the location of the end of the root. This process is known as determining " working length" or "working distance". Finding the " working length" is important because the dentist does not want to go too short, thereby leaving bacteria in the tooth, or go too long. Going out the apex can push bacteria into the surrounding jaw structure and cause more irritation for the patient. To find working length, the dentist will put a hand file in the canal, set the stopper at the cusp of the tooth, and take a radiograph. The comparison of the radiograph with the known length of the file will allow the dentist to determine the working length. At the apex, or bottom of the tooth, the canal narrows. This narrowing is the CementoDentinal Junction or CDJ. This narrow spot, as shown here, is generally one-half millimeter in length and provides a natural stop for debris, irrigation and filling materials from being forced into the periapical tissue. Most dentists will work to clean the canal down to this point in their root canal procedures. There are two primary methods for shaping the root canal structure. They are "Crown Down" and "Step Back". These utilize files such as the SureFlex® and FlexoFiles® and traditional K-Files.  With both techniques, the goal is the same... A funnel shape for the canal to make filling the canal easier.

Drying

During and after cleaning and shaping the canal in the debridement step, the funnel shaped canal space is flooded with an irrigant to ease removal of the contents. As we mentioned, this is usually sodium hypochlorite. The sodium hypochlorite must then be removed from the canal space before filling. This is done with paper points. The dentist places one or more paper point in the canal and uses them to absorb all the moisture. This continues until the last paper point comes back dry. Once the canal is dry, the dentist can temporarily seal the tooth and finish the procedure on another appointment, or as most practioners are doing today, they can opt to fill (or obturate) the canal.

Obturation

The obturation or filling the canal is primarily done with gutta-percha. Gutta-percha is a very bio-compatible material. It is pink, firm, waxy and somewhat rubbery. We offer several instruments including finger pluggers/spreaders, Schilder instruments, and our M-Series pluggers/spreaders to assist the doctor in packing the gutta percha in the canal. There are several methods of obturation available including our quick and effective Densfil® thermal endodontic obturation system.

Restoration

With the canal properly filled, we are ready for the 7th step, known as Restoration. Here we will restore the tooth back to it’s original form. When a core buildup is necessary, dentists will often times install a post. Post systems are used to secure the material to the remaining tooth structure. Remember though, no post will add strength to a tooth.