Odontologia

Earn

2 CE credits
This course was written for dentists, dental hygienists, and assistants.

Achieving Predictable Success with Root Canal Treatment
A Peer-Reviewed Publication Written by William R. Watson Jr. DDS, MS, FAAOMP

PennWell designates this activity for 2 Continuing Educational Credits

Publication date: May 2008 Review date: March 2011 Expiry date: February 2014

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This course has been made possible through an unrestricted educational grant. The cost of this CE course is $49.00 for 2 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Educational Objectives
Upon completion of this course, the clinician will beable to do the following: 1. Describe the core cause of endodontic disease 2. List and describe the importance of making a proper diagnosis and apply current skills to do so 3. Describe the appropriate size and shape of an access canal to one that may be too small for ideal treatment 4. Describe the benefits of different intracanal irrigants and apply techniques for successfully utilizing sodiumhydrochloride 5. List and describe the benefits of a monoblock obturation method to reduce potential leakage concerns from a posttreatment coronal restoration

Abstract
Root canal treatment is necessitated by endodontic disease, which is, in turn, a product of bacteria. Thus, the detection, management, and elimination of bacteria are of primary importance to the dental clinician. Every RCTprocedure begins with a thorough diagnosis, including a complete clinical and radiographic examination. Following that, treatment of root canal systems consists of two phases: cleaning and shaping the access cavity to the canal, followed by its obturation. There are gener- Figure 1 ally accepted sizes and shapes for the access cavity depending on the location of the tooth in question, but every case hasits own unique requirements. The most common mistake in this stage of the process is to make the access cavity too small. Irrigants are essential when it comes to dissolving tissue, flushing bacteria, and cleaning the canal. Sodium hypochlorite (NaOCl) is the most widely used, often in combination with ultrasonic activation, although other irrigants, such as chlorhexidine and electrolyzed oxidizedwater, have their Figure 2 benefits as well. The second half of RCT, obturation, minimizes empty space inside the canal system and seals the canal. A monoblock of obturating material is recommended for a proper seal. Without this, even the best RCT procedure is undone. This article also includes a case study.

to fail. To that end, everything that we do during RCT should be directed ateliminating bacteria and preventing its recolonization within the root canal system. Evidence for this was found in 1965 by Kakehasi et al. and has since developed as the cornerstone of endodontic therapy. In this landmark study, he had two groups of rats: a germ-free group and a group with normal oral flora. He drilled holes in the teeth of both of these groups of rats. Only the teeth of the rats withnormal oral flora developed pulpal necrosis, severe inflammation, and periapical lesions. Astoundingly, the teeth of the germ-free rats exhibited nothing more than occasional mild inflammation even though some of the teeth were completely perforated through the pulpal floor. Not a single one of these teeth exhibited a pulpal or periapical abscess.1 The successful treatment of endodontic pathosis ismore involved than just placing a packaged series of selected files in the canals, rinsing the canals out with water, and casually sticking a piece or two of gutta-percha in the canal. There are a series of specific steps along the entire root canal procedure that are focally directed toward the central goal of eliminating bacteria and preventing their return. The purpose of this article is to...