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Endo Tribune Asia Pacific Edition

ENDOTRIBUNE Asia Pacific Edition No. 3/2015 Trends & Applications 19 important, as it will give the clini- cian some indication of the prog- nosis and any difficulties that mightoccurduringtreatment.All ofthesefactorsmustbediscussed with the patient prior to treat- ment, so that he or she can de- cide whether to proceed with the endodontic therapy. While the use of a periapical radiograph alone may be suffi- cient in most cases, supplemen- taryradiographsmaybeneededif the clinician finds that the tooth mayhaveadditionalrootsortoas- certaintherootcurvature.Taking another periapical radiograph at a different horizontal angulation (10–30 degrees) may therefore be necessary. Again, care must be taken to minimise the extent of superimposition on adjacent teeth. The SLOB rule (same lin- gual,oppositebuccal)canbeused to determine the location of an additional root or root canal. The size of the root canal can also be assessed from the radi- ograph. This information will provide some indication of the complexity of the treatment and the choice of the obturation ma- terial and technique. A tooth with an open apex may require place- ment of a calcific barrier, such as mineral trioxide aggregate, api- cally prior to obturation. The status and quality of the existing coronal restoration must be assessed radiographically and clinically. All defective restora- tions must be removed and re- placed with either permanent or temporary restorations. Any cari- ous lesion must be noted, and the depth of the lesion must be de- termined clinically. This is im- portant in order to ensure that the tooth is deemed restorable prior to treatment. The clinician must decide on how to restore the tooth after completion of endodontic therapy prior to ini- tiation of treatment. Posts, separated instruments or root filling material within the root canal may complicate the endodontic treatment (Fig. 3). The size and type of post will determine the feasibility of re- moving such a post. A separated instrument in the apical third of the root and below the curved root may be more difficult to remove than a more coronally located fragment. Operative assessment (treatment phase) Working length is confirmed and quality of obturation is assessed during treatment to ensure the treatment is carried out satisfactorily. A periapical radiograph may also be taken to ascertain the correct angulation of the bur or endodontic file when negotiating a blocked or calcified canal, during post space prepa- ration and even during access preparation through a calcified pulp chamber (Fig. 4). This is es- sential for preventing procedural errors, such as perforation of the pulpal floor or canal wall. During obturation, it is im- portant that the root canal be obturated to the predetermined working length and have no voids. This can be confirmed by taking a periapical radiograph during treatment. Obturation that is shorter or longer than the working length may affect the treatment outcome. Post-operative assessment After therapy has been com- pleted, a periapical radiograph should be taken to ensure that the treatment was carried out adequately. This will function as a baseline when reviewing the patient six to 12 months later. From this immediate post-opera- tive radiograph, the quality of the final coronal restoration can be ascertained and the size of the periapical lesion, if present, can be assessed. At the recall ap- pointment, a new periapical radiograph of the endodontically treated tooth is taken to monitor the healing of the periapical le- sion and to confirm the success of treatment. The presence of a new periapical lesion or the enlarge- ment of an existing one should be noted, and necessary measures should be taken to identify the cause of treatment failure. Conclusion Using intra-oral radiographs is the only method in endodontic therapy that allows the clinician to make an assessment of the root and its supporting tissue. In order to gain the full benefit of this radi- ograph, clinicians have to ensure that it is appropriately exposed, shows no processing errors and has no or minimal image distor- tion. It also has to be correctly mounted, labelled and dated. Clinicians must be able to select which radiograph is necessary to aid in their endodontic diagnosis based on the patient’s history and clinical examination. DT DrSafuraBaharin isHeadofClinical Services at the Faculty of Den- tistry of the Na- tional University of Malaysia near Kuala Lumpur in Malaysia. She can be contacted at Contact Info Desinfection THE POWER OF EFFICIENCY CONCEPT PATENTED Tip oscillation to allow perfect desinfection. Here is the absolute desinfection in Endodonties ! Irrigation YOUR ROOT CANAL CLEANING EVEN MORE EFFECTIVE IRRIGATYS : the new two-in-one handpiece with dual fonctions A removable tank allows the irrigationoftherootcanal with Hypochlorite and EDTA. The irrigation line leads the solu- tion through the Irriga-Tip® . These patented technology, developed after 6 years of research, optimize the result of the complex procedure of root canal irrigation. Class IIa medical device. CE0120. For dental healthcare professional use only. Certifying body SGS United Kingdom Two-in-one system that can provide the solution and strongly activate the liquid for a perfect cleaning. AD

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