Root Canal Treatment
Root Canal Treatment
What is root canal treatment?
Root canal treatment is the dental procedure when the dentist or the endodontist removes the infected pulp and the nerves of the tooth, they clean and disinfect every canal (the canals are where the nerves live), and they place a medication, fill them and place a temporary or permanent filling on the top (depends on the case).
In most of the cases after the root canal treatment the tooth is going to need a crown for extra protection as the structure of the tooth after the root canal treatment becomes very weak.
Set up:
On the dentist/endodontist’s tray:
A mouth mirror (front surface)
✅
Perio probe
Endo explorer
Locking tweezers (If your practice doesn't have it's ok, you can use college tweezers)
Excavator
Endo condenser
Condenser
Ball burnisher
Flat plastic
Endo ruler
Endo ring with a sponge (Some dentists/orthodontists they will ask you to hold it for them)
I place a sheet from the mixing pad with EDTA (creamy form) next to the dentist's tray
The irrigation with the sodium hypochlorite
And the irrigation with EDTA solution (liquid)
*Write on the irrigation syringes what is inside so they will no mix them up and make sure that you’re keep filling them up before they finish so they’ll be ready for the next use.
- Endodontic Rotary machine/ Endo Motor
-Fast hand piece & the burs
-Slow hand piece & the burs
-Scaler, scaler tip, endo scaler tips (there many kinds of endo scaler tips, they will tell you which one they want depends on the case)
Few examples of how I prepare the endodontist/dentist's tray- Keep in mind that every endodontist or dentist has their own way, the third one is the most common that I use every time I work with a endodontist or dentist that I haven't worked before.
Example A (This endodontist uses the endo bloc as a ruler - It's the only endodontist I have worked with that they uses this tool )
Endo bloc👇
Example B ( This endodontist wants the plastic cup to throw away the used paper points so it will be easier for the dental nurse to clean)
Next to you: Topical anaesthetic, cotton roll, local anaesthetic, local anaesthetic needle, cartridges, slow and fast suction tips , hygosurge (Check below👇)
College tweezers (you might need them to pass the paper points or the gp points to the dentist and you must no touch them because you can bend them), surgical scissors (in case you need them).
PA x-ray holder, endodontic x-ray holder
Rubber Dam kit:
Rubber Dam Frame
Anisworth Rubber Dam Punch Pliers
Rubber dam Clamp Holder
Rubber dam sheet (There are many types eg. latex ,no latex, heavy, medium etc, many colours eg. purple, blue, green etc.)
Clamps
Floss ( we use floss to secure the clamp)– check the photo below.
Root canal sealer, oraseal and the tips, filling materials ( the dentist will tell you what they’ll need depends on the case).
K-Files 06 – 80 (21mm,25mm,31mm), Rotary’s files, gutta percha(gp points- there are many sizes and different types) , paper points (there are many sizes and different types), paper mixing pad, transparent mixing pad.
(Check the photos below)
K-files (or we also call them Endo files)
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Paper Points
Paper Mixing pad
Procedure :
Always make sure that you’ve checked the medical history before the patient comes into the room and if you can check the notes of the patient would be great!👍
(When the patient comes into the room the dentist might take an x-ray (PA holder)).
After that they’re going to use the topical anaesthetic. As a dental nurse you’ll place the topical anaesthetic on a mixing pad with a cotton roll next to that and you’ll hand it to the dentist.
The dentist will take it and they’ll place it on the area that they’ll inject. They’ll leave the cotton roll with the topical anaesthetic for few seconds to work.
And then you’ll pass the local anaesthetic with the right cartridge and the right needle to the dentist.
When the anaesthetic is done, you have to wait few minutes for the anaesthetic to work.
Rubber dam placement
It’d be very helpful and you’ll save a lot of time if you have checked the notes of the patient from before and you know which tooth you’ll treat, so you can prepare the rubber dam sheet and the clamp that the dentist will need.(Some dentists like to do it by themselves – you can always ask!)
Punch the right hole on the rubber dam sheet (there are rubber dam positioning templates) place the clamp and give it to the dentist with the clamp holder. When the dentist will place it on the tooth, you can give them the frame and help them to place it. Then, you pass them the flat plastic so they can adjust the rubber dam sheet around the tooth.
Oraseal time! The oraseal helps to fully isolate the tooth and to avoid any leakage. You pass them the oraseal and then a cotton pellet (wet) so they can adjust it.
Ready to ‘’open’’ the tooth!
First, they will use the fast handpiece and the slow handpiece (with the right burs) to create a hole on the tooth so they can access the canals, then they will use the endo explorer to find the canals and then they will start with the K-files. Always have all the sizes and lengths next to you (06-80 21mm/25mm/31mm) and as I mentioned before, EDTA (creamy form) in a mixing pad next to their tray it will help them with the preparation.
* Few of the fast handpiece and slow handpiece's burs :
👇Endo Z bur - Access bur
Rotary’s file time!
They will use the rotary files to open and clean the canal. Every dentist/endodontist using a different technic depends on the case, so it’s good to have everything next to you just in case. (If you work with the same dentist after a while you will know exactly what they are going to use for every case).
Rotary Machine or Endo Motor (An example)
Rotary machine/Endo Motor 's files :
Protaper system's file
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Paper points to dry the canal and then the Apex locator to measure the canals. (Keep a piece of paper and a pen next to you as they might ask you to write down the measurements). ✍
They will adjust the gutta percha (gp points) and they will place them in every canal and they will take an x-ray. (Endodontic x-ray holder ). Some dentists/endodontists use the endo gauge to adjust the gp points or Endo ruler and surgical scissors
Endodontic x-ray holder
Endo Gauge
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A bit of more cleaning, paper points to dry the canals and then they will ask you to mix the root canal sealer.
* if they will finish the root canal treatment, if not, they will ask you for calcium hydroxide, cotton pellet, temporary filing and a flat plastic instrument. And then, they will ask the patient to come back in few weeks for the 2nd stage )
Paper mixing pad and mixing spatula please!
You will mix the root canal sealer and you’ll give it to them with the gp points and they will place them together in every canal.
Then some dentists/endodontists use the scaler or the spoon excavator with the dental burner or the obturation system with the tips (they are many sizes depends on the thickness of the canals, ask them which one they want for this treatment) and the tips with the heated gp points while there are using the regular gp points. In the end they will use the endo condenser to push the gp points inside the canals to make sure that they've filled the canals till the tip of the root.
Obturation system
(on the left is the heated gp points and on the right is the tip that it will cut the gp points - be careful they will be extra hot when you re using them!)
(Some dentists they will take an x-ray (Endodontic x-ray holder) after they fill the canals before they put the filling on the top)
Depends on the case ; the dentist will tell you what to use as a permanent filling or temporary filling.
And then the last x-ray! (PA x-ray holder)
They will use a lot of sodium hypochlorite during the treatment so make sure you keep the sodium hypochlorite next to you.
All the photos that I used I found them on google search , no copyrights intended.
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