Why Most Temporary Restorations Fail — Transcript

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1. 0:00Today, we're going to talk about how to
2. 0:01place a temporary endodontic
3. 0:03restoration. This is another one of
4. 0:05those requests that you guys have asked
5. 0:06for in the comment section. So, you
6. 0:08asked for it, so here it goes.
7. 0:13>> [music]
8. 0:18>> If you're new to the channel, my name is
9. 0:20Siju Jacob. I've been a private
10. 0:21practitioner in Dubai and Bangalore for
11. 0:23the past 25 years. In addition to
12. 0:25private practice, I've also been
13. 0:27teaching dentists how to use a surgical
14. 0:29microscope in everyday clinical practice
15. 0:31for more than a decade. For any
16. 0:33clinician who practices endodontics,
17. 0:35placing temporary restorations is a very
18. 0:38commonly performed procedure in everyday
19. 0:40clinical practice. So, in this video, I
20. 0:42will share with you my own protocol in
21. 0:44everyday clinical practice. By the way,
22. 0:46if you'd like some free articles that
23. 0:47I've written, which can help you in your
24. 0:49everyday clinical practice, do check out
25. 0:51the link in the description below. You
26. 0:53can download it for free. Not all
27. 0:55endodontic cases are performed in a
28. 0:57single visit. Many are performed in
29. 0:59multiple visits. And when a clinician
30. 1:01performs multiple visit endodontics,
31. 1:03they place a temporary restoration. When
32. 1:05a clinician places a temporary
33. 1:07restoration, the expectation is that the
34. 1:10patient is going to come back to the
35. 1:11clinic in a few days' time. But, it can
36. 1:14happen that days can turn into weeks,
37. 1:16weeks to months, and sometimes even
38. 1:18years. So, a patient who is expected to
39. 1:21come back in a week's time or a few
40. 1:22weeks' time can often land up in the
41. 1:24clinic several months or even a year
42. 1:27later. And if the temporary restoration
43. 1:29is not strong enough, then the temporary
44. 1:31restoration can dislodge, and the tooth
45. 1:34and the canals can get recontaminated,
46. 1:36and then it becomes a real challenge to
47. 1:38manage these cases endodontically
48. 1:39because the bacteria and the debris and
49. 1:42all kinds of contaminants go into the
50. 1:44canal, and the environment inside the
51. 1:46canal becomes so altered that it becomes
52. 1:48a big challenge to manage these cases
53. 1:50endodontically. Therefore, a good
54. 1:52temporary restoration is something that
55. 1:54every clinician needs to know how to
56. 1:56perform in everyday clinical practice.
57. 1:58So, let's take a look at what is done
58. 2:00commonly. So, here's what most
59. 2:01clinicians do. They put calcium
60. 2:03hydroxide in the canal, then they take a
61. 2:05cotton pellet, put the cotton pellet
62. 2:08over the calcium hydroxide covering the
63. 2:10orifices and the pulpal floor, and then
64. 2:12they take a temporary restoration like
65. 2:14Cavit, and then place it over the cotton
66. 2:17pellet. And then the patient is sent off
67. 2:20from the clinic until the next
68. 2:21appointment. Now, there are two problems
69. 2:23with this, leakage and dislodgement.
70. 2:25When we place cotton pellet and cover it
71. 2:27with a Cavit, Cavit is not a strong
72. 2:30enough material. It is prone to leakage
73. 2:32the minute you send the patient from the
74. 2:34chair, it starts leaking within a few
75. 2:36minutes. So, leakage is a problem, and
76. 2:38second is dislodgement. The material is
77. 2:40not strong enough, and the more the
78. 2:42patient starts using the tooth, Cavit as
79. 2:44a material can fracture, and then the
80. 2:47underlying cotton pellet gets exposed to
81. 2:49the oral cavity. So, by the time the
82. 2:50patient comes back, there is a very high
83. 2:52chance that the temporary restoration is
84. 2:53completely dislodged and the canals get
85. 2:55recontaminated. So, these are the two
86. 2:57main disadvantages of using cotton
87. 3:00pellet mixed with Cavit. There is
88. 3:01another problem with cotton pellets. On
89. 3:03the surface, it feels like when you
90. 3:05place these cotton pellets, they are
91. 3:07covered completely with Cavit, but often
92. 3:10it can escape the attention of the
93. 3:11clinician that these tiny fibers can
94. 3:14extend past the temporary restoration
95. 3:16onto the external surface of the tooth,
96. 3:18and these tiny fibers can act like
97. 3:21capillaries. They can draw moisture and
98. 3:24contaminants from the oral cavity into
99. 3:26the inner surface of the tooth, thereby
100. 3:29promoting reinfection or
101. 3:30recontamination. So, this is sometimes
102. 3:32overlooked because if you don't have
103. 3:34high magnification, you can overlook the
104. 3:36fact that these cotton fibers are
105. 3:38sticking through the restoration and in
106. 3:40contact with the oral cavity and acting
107. 3:43as capillaries. So, those are some of
108. 3:45the problems with using cotton pellets.
109. 3:47Now, one way to overcome this problem
110. 3:49with cotton pellets of the fibers
111. 3:50sticking out is by Teflon, which a lot
112. 3:53of practitioners do. So, Teflon is
113. 3:56probably a better alternative to cotton
114. 3:58pellet, but we will show you what we do
115. 3:59in everyday clinical practice, which we
116. 4:01think is a far better method than using
117. 4:04Teflon, too. So, here's what we do in
118. 4:06everyday clinical practice. We put
119. 4:08calcium hydroxide in the canal, and then
120. 4:11we don't use cotton pellets or Teflon.
121. 4:13We directly put Cavit G on top of the
122. 4:16calcium hydroxide. So, we take Cavit G,
123. 4:19condense it into the canal, use a moist
124. 4:22cotton pellet or moist microbrush to
125. 4:25condense the Cavit G into the canals,
126. 4:27and then once that's done, we cover the
127. 4:30Cavit and the topmost part of the tooth
128. 4:33surface with glass ionomer cement. So,
129. 4:35there are two different layers,
130. 4:37or at the base you have a thick layer of
131. 4:39Cavit, and on top you have a glass
132. 4:41ionomer cement, which is much more
133. 4:43harder than Cavit. So, the glass ionomer
134. 4:45will resist occlusal forces better than
135. 4:48Cavit, and in case there is dislodgement
136. 4:51of the glass ionomer, then you have
137. 4:52another layer of Cavit underneath that.
138. 4:55There is no cotton pellet, so your
139. 4:56chances of contamination are far less
140. 4:59than what it would be if you used cotton
141. 5:02pellet and covered that with Cavit. So,
142. 5:04this is what we prefer. Now, one of the
143. 5:05questions people ask when we share this
144. 5:07technique with them is
145. 5:09doesn't the Cavit go into the canal and
146. 5:11block the canals? No, it really doesn't
147. 5:13happen because unless the canal is like
148. 5:15really wide, like an open apex or
149. 5:17something like that, in 99% cases, what
150. 5:20usually happens is the pressure that you
151. 5:22exert or the flowability of Cavit is not
152. 5:25such that it will go deep into the canal
153. 5:27and block the canals. And the second
154. 5:30thing is the Cavit in the inner portion,
155. 5:32because there isn't much moisture, it
156. 5:33doesn't harden. Even if it does harden,
157. 5:36it is easily removed with ultrasonics.
158. 5:38So, here's what we do when we go back
159. 5:40into these teeth, when we see these
160. 5:42patients for the appointment to complete
161. 5:44the the
162. 5:45So, when the patient comes back, you can
163. 5:47look at the glass ionomer. The glass
164. 5:49ionomer is hard, so it doesn't respond
165. 5:52to ultrasonic, so we need need to use a
166. 5:54bur to remove the harder glass ionomer
167. 5:57on top. So, you can see me using a bur,
168. 6:00and we remove the glass ionomer. And
169. 6:02once the hard glass ionomer is removed
170. 6:04with a bur, and we reach the cavit
171. 6:07inside, the cavit can be easily removed
172. 6:09by using ultrasonics. You can even use
173. 6:12routine ultrasonics what you use for
174. 6:14scaling. You don't even need a
175. 6:15specialized endodontic ultrasonic tip.
176. 6:18Here, you can see me using the regular
177. 6:21ultrasonic tip which we use for scaling.
178. 6:23You can use that, and it easily removes
179. 6:25the cavit underneath.
180. 6:27Yes, if you want to go deeper into the
181. 6:28canal, you can use an endodontic
182. 6:30ultrasonic tip as well, which removes
183. 6:33all the debris or the cavit which is
184. 6:35sticking onto the pulpal floor. You can
185. 6:37use an endodontic ultrasonic tip, and it
186. 6:39easily removes all the cavit there. And
187. 6:41then, of course, the calcium hydroxide
188. 6:43in the canal coronally is removed a
189. 6:45little bit with ultrasonic. The calcium
190. 6:47hydroxide in the canal is easily rinsed
191. 6:49out with water from an irrigation
192. 6:51syringe, and this can be followed up
193. 6:54with EDTA and K files to remove whatever
194. 6:57residual calcium hydroxide is there in
195. 6:59the canal. So, this is what we do in
196. 7:01everyday clinical practice, and we find
197. 7:03it's very effective. I've been doing the
198. 7:05same technique for the last 25 years,
199. 7:06and it's always worked. I haven't had a
200. 7:08single case where the cavit has gone in
201. 7:09and blocked the canals.
202. 7:11Let me know what you think. If you have
203. 7:13any questions, do let me know in the
204. 7:14comments, and I look forward to seeing
205. 7:16your response. Like I mentioned earlier,
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207. 7:20clinical articles and guides which can
208. 7:21help you in everyday clinical practice,
209. 7:23do check out the link in the description
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221. 7:43Thanks [music] for watching.