From mildly relaxed to
"I thought I was asleep"
You can be as relaxed as you wish.
Example of what you see on Roots
www.rxroots.com
Endo Access http://www.bmc.med.utoronto.ca/StudentWeb/Eleanor_Andrew/access.html
It is not a unique situation to have a tooth which has been asymptomatic become symptomatic (acutely pulpitic). There is no way of preventing this or predicting this. The patient's needs required that the restoration be replaced, the quiescent status of the pulp would not give anyone any indication of a problem develping.
The best way of reducing the patient management factor is to "pave your way with words" beforehand. The patient needs to be informed that most of the time the tooth will survive the restorative process just fine, however, at times a tooth will become symptomatic following the placement or replacement of a restoration. If the symptoms are appropriate, a root canal will be recommended.
How to Use properly
CaOH use as a medicament :
Danny,
You can buy Ca(OH)2 USP powder (which is chemically pure) from any dental
supplier. Mix the powder with saline or local anesthetic, and spin it down the canal with lentulo spirals or the PacMac condensers. You can also use the Ultradent product (Ultracal) with the 30g flexible needles. The Ca(OH)2USP will give you the highest possible pH and therefore the best antibacterial properties. Only a few bugs (E. faecalis) can survive in a pH of 12. [[ I need Ultradent to tell me the pH of Ultracal]]. Studies have shown than C&S cannot completely eliminate all the bacteria and tissue from the root canal system in one visit when using 5.25% bleach (Baumgartner, Bystrom, Walton, Senia, etc.). There is always some tissue and bacteria remaining. It has been shown that in many curved canals the files don't touch all the walls of the canals and the bleach may or may not dissolve all remaining tissue. The variables are canal size, needle size, needle penetration---there must be contact between the bleach and tissue for it to work. Therefore, if you want to have the BEST chance of total bug removal, you NEED an intracanal medicament. Ca(OH)2 will do that for you, and it will help necrotize and denature tissue that has remained after C&S and bleach. The second visit you irrigate and agitate the Ca(OH)2 out of the canals (it does not set as it is a paste) and confirm lengths; enlarge one size if needed, then obturate. When using the scope, you may see some remaining Ca(OH)2 in the canals, but an ultrasonic file will remove most (all) remnants.Fred (flame retardant suit on, once again)
Robin,
I'm not completely sure that the
commercial products have a similar and consistent high pH. I do however,
know that when you mix your own, you will obtain a pH of ~12, every time.
I have used the Ultradent product, Ultracal, for quite some time now for
routine cases of AP. For all trauma cases, Cvek partial pulpotomies,
apexification and apexogenesis, I mix the pure stuff.
Fred