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Pretreatment
Pretreatment involves preparing a tooth for Endodontic treatment. Many endodontically involved teeth are heavily broken down or carious. Some involve deep fractures, subgingival proximal caries or faulty margins. The need for proper isolation of a tooth during Nonsurgical Endodontic treatment demands the use of rubber dam. Adequate isolation can only be achieved when the portion of the tooth to be clamped is in a reliable condition. Failure to adequately pretreat a tooth can result in gross compromise of the working area through rubber dam leakage, clamp disengagement or loss of reference points.

Pretreatment does require extra effort on the part of the dentist and slight added expense to the patient. However, this is more than made up in the ease and speed of treatment as well as ensuring asepsis of the working area during treatment. It also gives reasonable assurance that the tooth will be protected and sealed until it is restored.

  • Electrosurgery
  • OraSeal Caulking
  • Ultradent (Blue) LC Block-Out Resin


    Strobex Ultron - Electrosurgery Unit



    In some cases, caries, fractures or defective restorations are sub-gingival. Teeth with caries is just below the gingival crest can occasionally be treated by judicious use of electrosurgery or gingivoplasty where hyperplastic or excessive gingival tissue is removed to allow placement of a rubber dam clamp.

    This Whaledent Strobex Ultron unit is 15 years old. It has the advantage of foot switch and/or handpiece activation. Reliability has been good with the exception of cracks in the handpiece that required replacing and wire fatigue in the connection to the grounding pad. If you're going to do endo on broken down teeth, electrosurgery (or laser surgery) is an important tool to have.

    Update Dec. 04

    The unit pictured is no longer being made and parts have been hard to come by. Companies such as Ellman, Parkell, and Macan produce dedicated dental units. However, many of these are being replaced by lasers, which offer better alternatives for gingival sculpting and do not the have injurious effects of electrical energy.

    Update Apr 07

    I was speaking with a Coltene Whaledent representative a the Amer. Acad. or Endodontics meeting in Phila. He informed me that parts, tips, cables and service are still available for this unit! Contact Coltene Whaledent for further details.

     



    OraSeal Caulking

    Adequate isolation of the tooth is imperative for proper endodontic treatment. Occasionally, a tooth not be adequately isolated because the rubber dam cannot seal the area adequately. Gaps in rubber dam can result in contamination of the working field with saliva. OraSeal is a caulking material produced by Ultradent that is used to seal these gaps. It comes in a syringe and has disposable tips. The material is expressed around the edges of the tooth and areas where the dam cannot be made watertight. It is initially quite soft but sets in a few minutes to a rubbery consistency. It is also easily removed after treatment is completed.


    Ultradent(Blue) LC Block-Out Resin


    There are occasions where rubber dam clamps won't stay on a tooth securely. Although we always like to have 4 point contact of the clamp with the tooth, odd shaped teeth, rotations and interference from adjacent crowded teeth all can contribute to a clamp being less stable than desired. Before the advent of light cured materials, we used to use Dental compound which was messy, required a flame and was difficult to deal with. Ultradent's Blue LC Block out material was originally used for blocking out casts when making beaching trays or surgical guides. This syringe applied material can be applied directly to the working area under the clamp in order to stabilize it. Once light cured, it allows the clamp to be stable. Ultradent LC Block-Out Resin is easily removed at the end of the appointment with the flick of an explorer.
    If better retention is required, the tooth surfaces can be etched before the material is applied. With single hole endo dam placement, this is rarely necessary and I use it merely to keep clamps from wobbling and loosening. Good product. easily applied and removed.