theone

1. Treatment Plan
Prof. MAGED NEGM

3. Treatment objectives :
 TOTAL CLEANING OF PULP SPACE
 ADEQUATE SHAPING &FLARING
 THREE DIMENTIONAL FILLING
 DO NO HARM

4. Degree of canal enlargement:
Minimum degree  3 sizes wider than
the largest file that initially binds
apically
e.g. if size 15 was the largest to reach the
full working length enlarge to size 35

5.  Cases usually require enlargement more than
3 sizes :
1. Very narrow canals (starting at sizes 6 or 8).
2. Canals with curvature at their entrance
3. Ribbon shaped canals (upper premolars & distal roots
of lower molars).
4. Flaring of preparation

6. Wider Preparation Facilitates :
• Irrigation
• Cleaning
• Obturation

7. Time requirements :
•Long duration appointments are better than short ones.
•Disadvantages of short appointments :
1. Increase the number of appointments.
2. Increase the number of injections.
3. Increase the chances for loss of temporary
filling between appointments.
4. Increase the chances for flare- up and
retreatment.

8. Time requirements :
•Time period between appointments should neither be too close
nor too far apart.
• Too close
appointments 
- insufficient time for
periapical tissue wound
to heal.
• Widely space
appointments :
1. Displacement or loss of
temporary filling.
2. Flare- up or
exacerbation.
3. Ingrowth of chronically
inflamed periapical
tissue occurs.

9. Is it possible to Fill Canals of molars at
different appointments :
 It is possible to fill the root canals of the same molar in
two different appointments .
 If one or more of the canals are complicated and need
more time to prepare, we still can fill the canal which
is ready for obturation.
By doing so we can :
 Seal the canal as soon as possible to avoid the
possibility of flare- up.
 Spend the time of the next appointment exclusively
with the difficult canal.

10. Is it possible to Fill Canals of molars at
different appointments :
 However, all the canals in the same root should be
filled in the same appointment.

11. One- visit (single-visit) endodontic treatment :
- Several studies showed no difference between single-visit
and multiple-visit techniques concerning :
quality , incidence of post treatment complications
and success rate.

12. Contraindications of single visit technique :
- Single- visit technique is contraindicated in case of non
vital (necrotic) pulp.
WHY ??
Necrotic pulp is full of toxins and facultative anaerobes
which may escape to the periapical tissue, multiply
and cause flare up.

13.  Conditions require single-visit technique
:
1. Esthetic restoration of broken front tooth without
pulp exposure.
2. Patients need general anaesthesia such as
mentally retarded & incooperable patients.
3. Patients receive anticoagulants who are not
allowed to stop the medication for a long time.

14.  Criteria for selection (success) of
cases for single-visit treatment :
1. Positive patient’s acceptance.
2. Sufficient time available for treatment.
3. Absence of pulp exposure.
4. Absence of apical periodontitis.
5. Absence of the need for drainage through the canal.
6. Absence of persistent continuous flow of exudate or blood.
7. Absence of anatomical difficulties such as ; calcification, tortuous, or
acutely curved canals.
8. Absence of iatrogenic errors such as ; perforation, instrument
fragmentation, over instrumentation, or use of irritating
medicaments.
9. Absence of periapical radiolucency.
10. Optimal apical & lateral seal.

15. TREATMENT PLAN FOR TEETH WITH
ACUTE PULPITIS

16. Plan of treatment of teeth with pulpitis :
1st visit
• Anaesthesia , rubber dam application, deroofing, pulp
extirpation, irrigation, & length determination.
•Dry with sterile paper points.
•A dry cotton pellet is placed in the pulp chamber .
•Seal the cavity with a temporary filling.

17. Plan of treatment of teeth with pulpitis :
2nd visit :
•Rubber dam application & biomechanical preparation. If
patient complained from pain local anaesthesia may be
given.
•Selection of master cone, examine its fitness & take a
radiograph.
•Insert dry cotton pellet & seal with temporary filling.

18. Plan of treatment of teeth with pulpitis :
3rd visit
•Rubber dam application.
•Evaluation of tooth condition ; absence of pain,
absence of foul odour, absence of discharge, & dry root
canal.
•Obturation and post operative radiograph.
•Permanent coronal restoration.

19. TREATMENT PLAN FOR TEETH WITH
PULP NECROSIS

20. Plan of treatment of tooth with pulp necrosis :
- Pulp chamber and root canals are full of toxic
material and microorganisms.  Therefore,
removal of necrotic material is preferably done
on 2 successive visits.
- However , some schools prefer to debride
the canal completely in one visit followed
by injecting intracanal Ca(oH)2
medication .

21. Plan of treatment of tooth with pulp necrosis :
1st visit :
•Rubber dam application, deroofing, debridement,
of pulp chamber by means of a spoon excavator.
•Debridement of the coronal 2/3 of root canals by
means of barbed broach & reamers, irrigation.
•Dryness, injection of Ca(oH)2 , dry cotton pellet
and temporary filling.
N.B : Some patients may complain of pain in the first visit which may
be due to partial necrosis local anaesthesia is indicated.

22. Plan of treatment of tooth with pulp necrosis :
2nd visit
•Rubber dam application, removal of temporary
filling and cotton pellet.
•Cautiously remove the necrotic remnants from
the apical 1/3 , irrigation and dryness.
•Injection of Ca(oH)2 medicament, cotton
pellet and temporary filling.

23. Plan of treatment of tooth with pulp necrosis :
3rd visit
•Rubber dam application, removal of temporary filling
& cotton pellet.
•Irrigation to remove Ca(oH)2.
•Tooth length determination and mechanical
preparation.
•Selection of master cone fitness and radiograph.
•Dry cotton pellet and temporary filling.

24. Plan of treatment of tooth with pulp necrosis :
4th visit
•Rubber dam application and obturation.
•Permanent coronal restoration.

26. Time table for treating single
rooted teeth

27. Treatment First appt. vital
or non vital
Second appt.
non vital
Third appt. non
vital
Second appt. vital
Diagnosis & treatment plan 1
Initial access 2
Rubber dam 3 1 1
Complete access 4
Irrigate canal 5 3 3
Broach canal 6
Length determination 7
Enlargement
Minimal (size 35)
Moderate (size 40)
Maximal (size 60)
8
Curved canal
8
Straight canal
4
Curved canal
4
Straight canal
4
Curved canal
4
Straight canal
Dry canal 9 5 6
Medicate 10 6

28. Temporary dressing 11 7
Remove temporary
dressing
2 2
Fit & verify master cone 5
Obturation 7
Final radiograph 8
Seal with cement 9
Time required for appt.
(hours)
½ to 1 ½ ½ to 1
Time until next appt. Vital 1 to 2 weeks;
Non vital: 2 days to
2 weeks
2days to
2weeks
Wait a week or more
before final
restoration

29. Time table for treating
molar teeth

30. Treatment First appt.
vital or non
vital
Second appt.
vital or non
vital
Third appt.
vital or
nonvital
second appt.
vital
Fourth appt.
vital or non
vital
Diagnosis &
treatment plan
1
Initial access 2
Rubber dam 3 1 1 1
Complete access 4
Irrigate canal 5 3 3 3
Broach canal 6
Length
7 4
determination
Enlargement
Minimal (size35)
8
Max. palatal
Mand. distal
5
Max. buccal
Mand. mesial
4
Complete
enlargement
4
Small curved
canals
Moderate (size 35 to
40)
8
Max. palatal
Mand. distal
4
Complete
enlargement
4
Small curved
canals

31. Maximal (size 60) 5
Max. palatal
Mand. distal
4
Complete
enlargement
Dry canal 9 6 5 6
Medicate 10 7 6
Temporary dressing 11 8 7
Remove temp.
dressing
2 2 2
Fit and verify master
cone
5
7
Obturation 8
Final radiograph 9
Seal with cement 1 to 1 ½ 1 to 2 ½ to 1 1 to 2
Time required for
appt. (hours). Time
until next appt.
Vital 1 to 2
weeks: non
vital: 2 days to
2 weeks
1 to 2 weeks 2 days to 2
weeks
Wait a week or
more before
final restoration

32. Thank You