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🌹اللهم صل ع نبينا محمد🌹 مرحبـــا بكـم بقناتنا شروحات محاضرات طب الاسنان لكل ما يخص طب الاسنان رابط قناة سنة اولى وثانية @dent_first_and_second @Thirdstagedentistrybot بوت القناة
#Endodontic
المحاضرة ال14
● Why file separation!?
#Endodontic
المحاضرة ال13
● Perforation Repair
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#Endodontic
المحاضره العاشرة
The journey to the apex
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#Endodontic
المحاضرة الثامنة
● PAIN CONTROL
#Endodontic
المحاضره السادسة
Pharmacologic prescription medicament in endodontic
#Endodontic
المحاضرةالرابعة
من أرض العراق 🇮🇶 د أحمد حميد في محاضرة عن ال
BIO MATERIAL & PRESERVING PULP VITALITY
المحاضرة الثالتة للآيدك د أحمد الوقاد 🇪🇬
ROTARY FROM A TO Z 🔥🔥🔥🔥
/channel/dentistry_lecture
المحاضرة الأولى للآيدك للدكتور #كريم_سرور 🇪🇬
The fear of broken files in Curved canal
/channel/dentistry_lecture
رمضان كريم و كل عام و انتم بخير 🌙
اللهم أهله علينا بالأمن والإيمان والسلامة والاطمئنان 🌙🕌
6/مارس
يوم #اطباء_الاسنان_العالمي. 🦷
كل عام و نحن بخير ,😃✋🏻.
#Endodontic
#Flare_Up
⛔️INTERAPPOINTMENT EMERGENCIES
✅Treatment of Flare-ups
1⃣Reassurance (the “Big R”) is the most important aspect
of treatment.
The patient is generally frightened 😰
and upset
and may even assume that extraction is necessary. 😱
🤗The explanation is that the
flare-up is neither unusual
nor irrevocable and will be managed.
1⃣Previously Vital Pulps with
Complete Débridement:
✅patient reassurance and the
prescription of a mild to moderate analgesic
often will suffice.
💢 it is important to check that the temporary
restoration is not in traumatic occlusion
2⃣Previously Vital Pulps
with
Incomplete Débridement
✅The working length should
be rechecked,
✅ the canal(s) should be carefully cleaned
with copious irrigation of sodium hypochlorite.
✅A dry cotton pellet is then placed,
followed by a temporary
filling,
✅a mild to moderate analgesic is prescribed
3⃣Previously Necrotic Pulps with No Swelling
✅The tooth is opened
✅ the canal is gently recleaned
and irrigated with sodium hypochlorite.
✅Drainage should
be established if possible
🔰 If there is active
drainage from the tooth after opening,
✅the canal should
be recleaned
(or débridement completed) and irrigated
with sodium hypochlorite.
🔰The rubber dam is left in place
after the tooth is opened;
the patient is allowed to rest
pain-free for at least 30 minutes or until drainage stops.
✅Then, the canals are dried, calcium hydroxide paste is
placed,
and the access is sealed
💢If there is no drainage,
the tooth should also
be
✅lightly instrumented,
✅ gently irrigated,
✅ medicated with
calcium hydroxide paste,
✅and then closed.
😃 The symptoms
usually subside but do so more slowly than if drainage
was present.
Again, patient education and reassurance are
critical.
A long-acting anesthetic and an analgesic regimen
for moderate to severe pain are helpful;
❗️antibiotics are not
indicated
4⃣Previously Necrotic Pulps with Swelling
🔵Previously necrotic pulps with swelling are best managed
with:
✅ incision and drainage.
In addition,
it is most important that the ✅canals have been débrided.
If not,
✅they should be opened and débrided,
✅ medicated
with calcium hydroxide paste, and closed.
✅Then incision
and drainage with placement of a drain are completed.
💢Occasionally but rarely,
a flare-up or a presenting acute
apical abscess may be serious (cellulitis) or
even life- threatening🚨
🚨🚑These situations may require
hospitalization and aggressive therapy with the
cooperation of an oral surgeon.
♻️Follow-up Care
With flare-ups,
the patient should be contacted daily 🏃
until the symptoms abate.
📞 Communication may be made
by telephone.
😫Patients with more serious problems or
those that are not resolving (many do not and require
additional measures)
should return to the dentist for
treatment as previously described,
depending on findings.
😨When symptoms recur or cannot be controlled,
these patients should be considered for referral.
Ultimate treatment by a specialist may include extra measures, 🚑🚑
such as apical surgery, or even hospitalization.
⛔️Reference
Endodontic principles and practise 4th edition
Mahmoud Torabinejad, DMD, MSD, PhD
Professor and Program Director Department of Endodontics School of Dentistry Loma Linda University Loma Linda, California
Richard E. Walton, DMD, MS
Professor
Department of Endodontics The University of Iowa College of Dentistry Iowa City, Iowa
/channel/dentistry_lecture
#Endodontic_Case
#Flare_Up
💂A 31-year-old male
presents 24 h after endodontic instrumentation.
🚫 His medical history indicates an allergy to penicillin.
💢He has a large fluctuant swelling in the muccobuccal fold adjacent to #30.
⬆️He reports the swelling has increased significantly in the last 12 h,
as has his pain. 🤕
🙂Treatment notes indicate that he presented with an asymptomatic non-vital tooth without a radiolucent lesion.
👌 Tooth # 30 was instrumented to a 25 K file and 30 rotary instrument.
🚿 It was irrigated with sodium hypochlorite.
🤗Adjacent teeth have no restorations and no caries.
❓❓❓❓
How would you treat this patient?❓❓
🔵Answer
• Inferior alveolar nerve block.
• Take the patient’s temperature (optional, depending on size of swelling, localization, and presence of malaise).
• Confirm measurement control.
• Re-instrument and enlarge the canals and irrigate with sodium hypochlorite.
• Attempt to establish drainage through the canal.
• Place calcium hydroxide dressing.
• Closure.
• Reduce occlusion, if restorative considerations permit.
• Incision and drainage for the fluctuant swelling.
• Analgesics/antibiotic (note penicillin allergy).
Clindamycin is an appropriate substitute.
• Patient should return
in 24–48 h for reassessment and recleaning/shaping and irrigation.
☺️Goal of Treatment:
The suggested approach addresses the microbial cause of the exacerbation.
🌸The goal is to eliminate or significantly reduce the
intracanal microbial flora and decompress the periapical tissues.
💊The use of antibiotics is a supplement to the clinical treatment and is not a “cure” of the basic microbial problem.
In a non-vital case
(no vascular circulation) little or none of the systemic antibiotic reaches the canal space.
/channel/dentistry_lecture
#Endodontic
#Flare_Up
🔵CONCLUSION
The occurrence of mild pain and discomfort is common even if the treatment rendered is of highest standard.
But still
🌟psychological preparation of the patient,
🌟complete cleaning and shaping of root canal system,
🌟 use of long acting anesthetic and analgesics
👇👇👇
decrease the incidence of inter appointment flare- ups in mild to moderate levels.
👌Prompt and effective treatment of flare-ups is an essential part of overall endodontic treatment.
⛔️Reference
🌐IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 9, Issue 4 (Sep.- Oct. 2013), PP 26-31 www.iosrjournals.org
🌐Flare-Ups in Endodontics – A Review
Priyanka.S.R , Dr.Veronica
(Saveetha Dental college, Saveetha University, India)
(Department of Conservative dentistry and Endodontics, Saveetha Dental college, Saveetha University, India)
🌐Article information
J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2): S294–S298.
📘Textbook of Endodontics
SECOND EDITION
Nisha Garg
MDS (Conservative Dentistry and Endodontics)
Ex Resident, PGIMER, Chandigarh
Ex Resident, Government Dental College, Patiala Presently at, Manav Rachna Dental College
Faridabad, Haryana, India
Amit Garg
MDS (Oral and Maxillofacial Surgery)
Ex Resident, Government Dental College
PGIMS, Rohtak
Presently at, Manav Rachna Dental College
Faridabad, Haryana, India
/channel/dentistry_lecture
#Endodontic
#Flare_Up
🔰5⃣Previously Vital Pulps with Complete Debridement.
💠Treatment:
1-patient reassurance
2-prescription of mild to moderate analgesic .
3- no need of reopening and placing corticosteroids in the canal to reduce the pain and swelling
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#Endodontic
#Flare_Up
🔰 2⃣ Incomplete removal of pulp tissue
🤗Whenever a pulpotomy or partial pulpectomy has been done,
😭the patient may experience pain due to incomplete removal of inflamed pulp tissue
👉 In this condition,
sensitivity to hot🔥 and cold ❄️or pain on percussion 💥🔨is usually seen.
📈Confirmatory test:
1-Apply rubber dam,
2-place a sterile paper point,
of course short of working length.
3- When paper point is removed,
it will display brownish discoloration indicative of inflamed seeping tissue.
💠Treatment:
1-the working length should be rechecked
2-the canals should be carefully cleaned with copious irrigation of sodium hypochlorite.
3-A dry cotton pellet is then placed followed by a temporary filling
4-a mild analgesic is prescribed
5- the tooth relieving from occlusion.
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#Endodontic
المحاضرة ال13
● Endodontic retratment from A to Z
#Endodontic
المحاضرة ال11
● Irrigation from A to Z
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#Endodontic
المحاضره التاسعة
● Requisting CBCT or not ?
#Endodontic
المحاضرة السابعة
● Open discussion on endodontic treatment
#Endodontic
المحاضرة الخامسة
Broken file retreive & Bypass
/channel/dentistry_lecture
اللهم صل وسلم وبارك على سيدنا محمد
قَالَ رسولُ الله ﷺ : إنَّ مِنْ أفْضَلِ أيَّامِكُمْ يَومَ الجُمُعَةِ ، فَأكْثِرُوا عَلَيَّ مِنَ الصَّلاةِ فِيهِ ، فَإنَّ صَلاَتَكُمْ مَعْرُوضَةٌ عَلَيَّ
🌹جْمٌْعتْكِمٌ طِيَبّةِ🌹
المحاضرة الثانية للآيدك #نبراس_الدهاش 🇱🇾🇱🇾
ENDO OR NOT
/channel/dentistry_lecture
اللهم صل وسلم وبارك على سيدنا محمد
قَالَ رسولُ الله ﷺ : إنَّ مِنْ أفْضَلِ أيَّامِكُمْ يَومَ الجُمُعَةِ ، فَأكْثِرُوا عَلَيَّ مِنَ الصَّلاةِ فِيهِ ، فَإنَّ صَلاَتَكُمْ مَعْرُوضَةٌ عَلَيَّ
🌹جْمٌْعتْكِمٌ طِيَبّةِ🌹
اللهم صل وسلم وبارك على سيدنا محمد
قَالَ رسولُ الله ﷺ : إنَّ مِنْ أفْضَلِ أيَّامِكُمْ يَومَ الجُمُعَةِ ، فَأكْثِرُوا عَلَيَّ مِنَ الصَّلاةِ فِيهِ ، فَإنَّ صَلاَتَكُمْ مَعْرُوضَةٌ عَلَيَّ
🌹جْمٌْعتْكِمٌ طِيَبّةِ🌹
اللهم صل وسلم وبارك على سيدنا محمد
قَالَ رسولُ الله ﷺ : إنَّ مِنْ أفْضَلِ أيَّامِكُمْ يَومَ الجُمُعَةِ ، فَأكْثِرُوا عَلَيَّ مِنَ الصَّلاةِ فِيهِ ، فَإنَّ صَلاَتَكُمْ مَعْرُوضَةٌ عَلَيَّ
🌹جْمٌْعتْكِمٌ طِيَبّةِ🌹
#Endodontic_Case
#Flare_Up
👳A 42-year-old male patient with
👉a noncontributory medical history
returns to your office the day after instrumentation,
irrigation,
and closure of tooth # 3.
😖He complains of severe pain and sensitivity when touching the tooth or masticating.
😶There is no swelling in the muccobuccal fold.
✍Treatment notes indicate that you instrumented three canals to a #20 K file and used rotary instruments.
How would you treat this patient?
🤔
🔵Answer
🔰• Provide local anesthesia.
🔰• Check occlusion.
Reduce occlusion if not already done and restorative consider- ations permit.
🔰• Confirm measurement.
🔰• If the tooth was instrumented only up to a 20 K file or less
⛔️, it is likely that tissue was left in the canals.
🔰• Re-instrument all canals to a 25–30 K file and/or rotary instrument.
🔰• Irrigation.
🔰• Place calcium hydroxide dressing.
🔰• Closure."
🔰• Analgesics.
🌐Goal of Treatment:
🔵The treatment is biologically based.
🔵Confirming the measurement and re-instrumenting should eliminate residual tissue in the canals without further damage to the apical tissues.
🔵Occlusal reduction will put the periodontal ligament at rest.
/channel/dentistry_lecture
#Endodontic
#Flare_up
Flare up
عندما يستشيط السن غضباً 🔥
هيج ترجمتها ، وهالكلمتين ضروري جدا تعرفوها لأن يمثلون جزء مهم مهم مهم بعملك
وعدم معرفتك الهم وعدم معرفتك لأسبابها وعلاجها راح يهز الثقة بينك وبين البيشنت وبالتالي راح تخسر البيشنت صدگني 💔
نگدر نعرف ال flare up على انه نوبات شديدة من الالم والتورم بعد قيامك بحشوة جذر بيرفكت وماشي كلش حسب الخطوات الصحيحة 🤷🏻♂️
تره كارثه 🤦🏻♂️ مهتم ومسوي حشوة جذر بيرفكت وتالي البيشنت يحس بألم أشد من الالم اللي اجه علموده
وهيج راح يگول عليك مو خوش طبيب ويروح لواحد غيرك يگوله هاي شنو شمسوين بيك ويقلعله السن ويخلص من الوجع ويصير الطبيب الثاني هو البطل الاسطوري المنقذ
الفلير اب بيه عدّة كومه اسباب بس اختصرها الكم بـ :
تروما للنسيج السني او بقايا من ال pulp tissue او تروما للنسيج حول السن وخصوصا من تسوي انسترمنتيشن وتعبر الابكس وتضرب الانسجه هناك ..
وهمين تصير اذا انت ال gutta percha تعبر الابكس يعني
Over extended
وهمين همين ، انتبهولي هنا 😒
شايفين الحالات اللي ينشروها اطباء الاسنان وتشوفون مادة السيلر عابرة الابكس او مثلما يسموها
Sealer puff 💭
وهنا الطبيب اولما يشوفها يصور الحالة وينشرها ويستعرض عضلاته 💪
بس يمكن ما تعرفون ان البيشنت وره هالجلسة راح يعيش يومين او ثلاثه من الالم 🙂
لذلك نصيحة ابد لا تخلون اي مادة او اداة تعبر الابكس وخلّو شغلكم داخل ال channel فقط
اي نرجع ونحجي شلون نتجنبها💡
اولن ن
ينصحون انو بأول جلسة من تسوي pulp extirpation تسوون وياها instrumentation وتشيلون العصب بالكامل وتنظفون ال channels كلش زين
ثانياً
تستخدمون irrigation protocol مضبوط
(شارحه قبل بسلسلة الاندو تلگوه بالهايلايت)
ثالثاً
تخلون intracanal medications مثل ال calcium hydroxide
زين رغم كل هذا والبيشنت وره الجلسة الاولى او بعدما كملنه الحشوة صار عنده flare up يعني ألم شديد شنسوي ؟
من الاخير .. تعيد حشوة الجذر من البداية 😁
وتستعمل هالمرة intracanal medicament يتكون من
Corticosteroid + antibiotic
وهذا اسمه ledermix
البيشنت تنطوه مسكنات واللي هي
Ibuprofen + paracetamol
سويه
واذا اكو ويه ال flare up تورم بالمنطقة فأحسن شي تسوي drainage لان هاي abscess ووراها تعيد الانسترمنتيشن والارگيشن
واخير شي بالعلاج انو تخفف من الاطباق
يعني تسوي occlusion reduction
هسه نجي للحچي المرتب واللي يدل على انك طبيب ممتاز
وهي امكانيتك انو تتوقع راح يصير flare up حتى قبل لا تبدي بحشوة الجذر 😁
اول شي ال females توقع نسبة جبيرة منهم يصير عدهم هاي الـ flare up 🤷🏻♂️
(دوم مشاكلهم هوايه 🤦🏻♂️😂)
ثاني شي بالاشعة اذا شفت
Large periapical radiolucency
همين توقع تصير عندك
ثالث شي اذا البيشنت عنده حساسيات تجاه علاجات او اكلات معينه همين تصير عدهم
رابعاً اذا البيشنت الالم مالته من يعض ع السن يعني
Acute periapical periodontitis
فمعرفتك ليگدام انو راح يصير flare up راح يخليك تتجنبها وهيج انت تفوز ♥️
وشكرا 😁
/channel/dentistry_lecture
#Endodontic
#Flare_Up
🔰6⃣Previously Necrotic Pulps without Swelling
Teeth with necrotic pulp often develop as acute apical abscess after the initial appointment.
😭As the lesion is confined to bone, there occurs the severe pain.
🔵management:
1- establish accurate working length
2- complete instrumentation of root canal.
( In these cases, the tooth is opened and the canal is gently recleaned and irrigated with copious amount of sodium hypochlorite. )
3-Drainage must be established if possible.
If there is drainage from tooth after opening, then tooth is again cleaned and debrided completely and irrigated with sodium hypochlorite.
4- After drying the canal,
calcium hydroxide dressing is placed
5-access is sealed.
⛔️If there is no drainage from the canal,
still gently open the tooth,
lightly instrument and completely debride the canal.
After debridement, copiously irrigate the canal with sodium hypochlorite and place calcium hydroxide paste and close the access. Prescribe analgesics and antibiotics.
🔰7⃣ Previously Necrotic Pulp with Swelling
💠management
1- incision and drainage.
2- canals should be opened
3-debrided and gently irrigated with sodium hypochlorite solution.
4-calcium hydroxide paste should be placed and closed
/channel/dentistry_lecture
#Endodontic
#Flare_Up
🔰3⃣ Recrudescence of chronic apical periodontitis
(Phoenix Abscess):
🕴 It is a condition that occurs in teeth with necrotic pulps and apical lesions that are asymptomatic.
⚔There is no exacerbation of previously symptomless periradicular lesion.
☠The reason for this phenomenon is thought,
to be due to the alteration of the internal environment of root canal space during instrumentation which activates the bacterial flora.
💢Mobility, tenderness and swelling are usually the sign and symptoms found in phoenix abscess.
🔰4⃣ Recurrent periapical abscess
▶️It is a condition where a tooth with an acute periapical abscess is relieved by emergency treatment after which the acute symptoms return ♻️
In some cases, the abscess may recur more than once,😰
due to microorganism of high virulence😈
or poor host resistance.🤒🤕
/channel/dentistry_lecture
#Endodontic
#Flare_Up
⚡️The cause of this pain may be:
• Overinstrumentation
• Over medication
• Forcing debris into periapical tissues
📈Confirmatory test:
1-Apply the rubber clamp and use a sterile paper point.
2- Access and mark the working length.
3- place the paper point in the canal.
📝 If over instrumentation has happened by fault,
then the paper point will go beyond the working length without obstruction.
On withdrawal, tip of the point will show a reddish or brownish color indicating inflamed tissue in the periapical region and absence of stop in apical preparation
/channel/dentistry_lecture