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I NTRODUCTI ON

STERILIZATION OF INSTRUMENTS
DEBRIDEMENT
DRAINAGE
CHEMOPROPHYLAXIS
IMMOBILIZATION
AVOIDANCE OF TRAUMA
TREPHINATION

APPLI CATI ON OF RUBBER DAM
Spectacles and protective bib Operator and seated nurse
Rubber Dam Placement
To maintain a safe and Aseptic operating technique
application of the rubber dam is imperative.

The rubber dam can be applied in less than 2 min and often
within 1 min.
1) Ivory No.9, for upper central incisors and all cuspids;
2) HF No. 211, for upper lateral and all lower incisors
3) HF No. 27, for all premolars;
4) HF No. 26, for all molars


Irrigation and suction procedures
Gutta Percha point transfer
Setting working length of instruments
Instruments transfer
Parallel Transfer
Rubber dam forceps

Rubber dam frames
Ivory clamps, clockwise from top left.
14 Small and medium sized molars,
14a Large molars,
1 Premolars
W8a Broken down molars
Clamp placed onto tooth Clamp in position
Dam fitted over tooth
Dam and clamp being fitted over
tooth together
Dam retained with rubber wedges
Safety chain (parachute)
Radiographic Views
STERI LI ZATI ON OF
I NSTRUMENT
Sponges in a drawer
Ultra sonic bath
Burs for opening into the pulp chamber should be
autoclaved, dry heat sterilized, or sterilized by being dipped in
alcohol and flamed 2 or 3 times,
Instruments should first be cleansed of debris regardless of the
method used to sterilize them. They should be wipped clean by
squeezing the instrument blade with a 2 x 2 Gauze or cotton roll,
moistened with hydrogen peroxide or alcohol, while withdrawing
the instrument, using a counter-clockwise rotary motion before
subjecting them to sterilization
Cold sterilization of instruments, that is sterilization by cold
chemical solutions, is not recommended for two reasons
1. The process is not effective against all varieties of microbial
life.
2. The length of time necessary to destroy microorganisms
against which these solutions are effective namely, a minimum
of 20 min, is too large.

Absorbent points, broaches, files, and other root canal instruments
should be sterilized immediately before use in a hot-salt
sterilizer.
It consists essentially of a metal cup in which table salt is kept at a
temperature of between 425
0
F [218
0
C] and 475
0
F [246
0
C],
Hot air sterilizer
salt sterilizer
Steam Sterilizer
Sterilization bag
The hot salt sterilizer has superseded the molten-metal sterilizer
and the glass bead sterilizer because the metal or the small
glass beads occasionally clung to a wet instrument, escaped
detection, and then clogged the root canal as the instrument was
inserted
Glass beads may be effectively substituted for the salt in a hot-
salt sterilizer, provided the beads are less than 1 mm in diameter.
Larger beads are not so effective in transferring heat to
endodontic instrument
The hottest part of the salt bath in the sterilizer is along its outer
rim. Starting at the bottom layer of salt; the temperature is lowest
in the center of the surface layer of salt.
DEBRI DEMENT
DEBRIDEMENT:
It is a principle of surgery that an infected wound must first be
cleansed mechanically. It is equally true that an infected root
canal must first be cleansed of debris. Devitalized tissue
encourages bacterial growth, whereas healthy tissue resists such
growth. Just as the surgeon rids the wound of debris initially, so
too must the dentist remove all necrotic material in the root canal
as soon as possible. In surgery, cleanliness is next to godliness
The pulp chamber and root canal should preferably be carefully
irrigated with sodium hypochlorite solution before one attempts
instrumentation because this solution has a solvent effect on pulp
tissue and also exerts an antibacterial effect. When the root canal
contains pulp remnants. They may be removed by
instrumentation at the first visit, provided care is taken to confine
all instrumentation to the canal. In all cases, a combination of
biomechanical and chemical means, namely, instrumentation and
irrigation, is necessary for complete debridement and cleansing of
the root canal.
DRAI NAGE
When gross infection and swelling are present, the
surgeon generally makes an incision. To provide drainage. When
an acute alveolar abscess with much edema is present, drainage
should established at once, either through the root canal, or by
incision, or by both. The extent and condition of the swelling
govern the choice in each case. Drainage through the root canal
is preferable because it allows the pent-up pus and gas to escape.
Acute apical abscess producing
a facial swelling
Tooth drainage of an
apical abscess
CHEMOPROPHYLAXI S
If the patient has a history of rheumatic fever or
heart ailment involving the heart valves, an antibiotic such as 2 g
phenoxymethyl penicillin should be given 1 hour before the
operation and then 1 g 6 hours postoperatively. Erythromycin
[Erythrocin] may be substituted if the patient is allergic to
penicillin. The dosage is 1 g 1 hour before treatment and 500mg
6 hours after treatment.
I MMOBI LI ZATI ON
Immobilization is employed by the surgeon to
rest an organ, to allay pain or promote healing. Immobilization
reduces the potential for spreading of microorganisms. The
endodontist may well follow the example of the surgeon and
immobilize the affected tooth by relieving occlusal stress or by
relieving contact with apposing teeth if pain is present.
Polyvinyl splint
Polyvinyl splint in place
Composite splint
AVOI DANCE OF TRAUMA
Soft tissues should be handled gently,
delicately, as by a surgeon when operating. All trauma should be
avoided. Instruments should not be passed beyond the apical
foramen. Ripened Judgment may help to prevent this
complication, but instrument stops are more certain for beginners
and seasoned veterans alike.
TREPHI NATI ON
Trephination as a means of relieving pain has
been used from time to time, By trephination is meant the
creation of surgical passage in the region of the root apex,
usually by a bur or special drill. The purpose of trephination is to
provide a channel for the escape of pus and blood, to relieve the
pressure of accumulated or gas in the jaw bone.
Apical Seal
Trephination has been advocated in the following cases:
Acute abscess where drainage through the root canal is
inadequate and much pain or swelling is present
Teeth with large areas of rarefaction
when the root canal has been overfilled and pain or
discomfort is present
And for postoperative pain following obturation of the canal by
conventional means

The dictum of Hippocrates
WHATEVER YOU DO,
DO NO HARM,