How to Make an Endo Fit

An endo in dentistry is endodontic therapy, a procedure that removes a diseased nerve from a tooth, replacing it with a rubber material called "gutta percha," or silver points. It is also known as root canal therapy and is only performed by licensed dentists. The most important part of endodontic therapy is ensuring the materials used to replace the nerve fit properly, extending only to the root-tip or apex of the tooth -- not through it, into the tissue or bone. There are steps taken during the procedure to make sure the materials fits properly.

Things You'll Need

• Syringe
• Anesthetic carpules
• Rubber dam punch
• Rubber dam sheets
• Rubber dam clamp
• Rubber dam clamp pliers
• Dental floss
• Rubber dam frame
• High speed handpiece
• No. 6 round bur
• High-speed evacuation
• Saliva ejector
• Multiple sizes of endodontic files or reamers with rubber stoppers
• Periapical x-ray films
• Endodontic ruler
• Irrigating syringe
• Bleach
• Distilled water
• Absorbent endodontic paper points
• Gutta percha points
• Endodontic cement
• Bunsen burner or lighter
• Flat-edged composite filling instrument
• Temporary filling material

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Instructions

• 1

  Because a rubber dam clamp can hurt, anesthetic is needed.

  Anesthetize the tooth receiving root canal therapy, the nerve itself is probably dead and has no feeling, thus the need for root canal. However, the gum tissue around to tooth will be alive and may feel pain without it.

• 2

  A rubber dam prevents patients from swallowing endo instruments, like files.

  Punch a hole in a sheet of rubber dam; stretching the hole over the tooth receiving endo therapy. Place the clamp around the tooth, securing the dam, and attach the frame to the rubber, preventing collapse of the ruber dam. The rubber dam prevents patients from swallowing the small files used during an endo.

• 3

  A high-speed handpiece and bur is used to access the nerve chamber.

  Drill a hole into the nerve chamber from the top of the tooth if it is a molar or bicuspid; or from the tongue side of the tooth if it is a cuspid, lateral or central incisor.

• 4

  Use a small endodontic reamer or file, sliding it into the nerve chamber until it stops at the end of the tooth; do not force it any further than it obviously goes. Move the red rubber stopper on the file until it touches the tooth and leave the file or reamer in the tooth.

• 5

  Metal in the tooth shows up radiopaque or white.

  Slide an x-ray film under the rubber dam the length of the tooth, having the patient hold it with her finger. Take an x-ray of the file or reamer in place before removing the file and properly repositioning the rubber dam.

• 6

  Develop the x-ray and check it for the length of the file in the canal. The file will show up as radiopaque, or crisp white. The very end of the file should extend only to the root tip. If the file fits only at the end, measure the distance between the rubber stopper and the end of the file, for example, 15 mm -- this is the correct length for everything put into the canal for the rest of the procedure.

• 7

  File and ream the canal with graduated sizes in files, set to the proper length. For example, a size 25 file with the stopper set at 15 mm, a 30 file set to 15 mm. This enlarges the canal and removes debris, preparing for the filling of the empty nerve space.

• 8

  Irrigate the canal with a blunt tipped syringe, most dentists use a combination of bleach and distilled water, or sodium hypochlorite. The canals will need to be dried. This requires absorbent paper points, each measured to the proper length. If blood appears at the end of the point upon removal, it is too long. The canal must be thoroughly dry before continuing treatment.

• 9

  Choose a master gutta percha or silver point. For example, a size 25 gutta percha measured at 15 mm. Place it into the canal all the way to the end. Place an x-ray film against the tooth, and with the patient holding it with his finger, take another x-ray. The gutta percha is also radiopaque. The end of the gutta percha should be at the end of the apex. If it extends too far, the gutta percha will need to be pulled back, followed by a repeat x-ray verifying measurement.

• 10

  Mix endo cement if the gutta percha is the perfect length. Dip the gutta percha in the cement and place it back into the canal, this is the master cone for filling. Continue to add accessory points into the canal; these smaller, thinner points get condensed into the canal using a technique called lateral condensation to fill the canal completely.

• 11

  Place one more x-ray in the patient's mouth against the tooth, while she holds it with a finger, get an x-ray. A properly fit endo will show a filled canal with no gutta percha or cement sticking out through the apex. Once completed, the additional length of gutta percha sticking out the top of the tooth should be burned off with a hot, flat instrument, and a temporary filling placed to seal the tooth.