Page 7 - The Beauty and Sorrow in Endodontics-Chapter 2

rubber dam clamps on gingival tissue for isolation due to the extreme loss of coronal

tooth structure, however, this causes great damages to the surrounding tissues and might
even risk possible sodium hypochlorite accidents. Moreover, this inadequate isolation
will often lead to contamination of the operative field by saliva, adding uncertainties to
the success of the treatment. These large carious teeth also frequently have coronal wall
defects resulting in inadequate volume in the pulp chamber for sodium hypochlorite to be

contained which will reduce the effectiveness of irrigation and disinfection.

Pre-treatment: Removal of Caries and Old Restorations + Assess the

Need for Coronal Buildup, Copper Band, or Temporary Crown

The goal of pre-treatment is to restore the coronal tooth structure before the initiation
of root canal treatment. This includes removing all carious lesions and old restorations as

there may be leakage and recurrent caries around restorative margins. Adequate coronal
seal may not be obtained if these old restorations were left in place as contaminants may
leak into the pulp chamber. Another advantage to completing pre-treatment is the

prevention of complications during treatment. Many times during cleaning and shaping,
some modification to the access cavity is required and old amalgam or composite resin
particles may fall into canals during removal, making it more difficult to maintain
patency. In addition, after removal of old restorations and carious structures, one can then
examine the restorability of said tooth and decide whether root canal treatment can be

initiated at this point or if coronal buildup, copper band, or temporary crowns are
required first.

Cavity Test Cases with Abscess or Draining Fistula/Sinus Tract to

Confirm Diagnosis

It is important to locate the origin of gum boil (abscess) or draining fistula (sinus
tract) prior to endodontic treatment. Gutta percha points and other radiopaque material
can be placed through the abscess opening and trace back to its origin, then radiographs
taken from two different angles can be utilized to confirm the problematic tooth. Once the

patient has decided to proceed with endodontic treatment, explain to the patient that since
the abscess originated from said tooth, its pulp has already necrosed, therefore cavity

5