The Art of Endontic Dental Assisting5.12 Carrier Technique Figure 5.12A– The doctor is back-filling with an Elements™ Obturation Cartridge placed inside of the Elements™ Free If carriers are being used, turn on the Backfill unit. The assistant waits to pass the correspondingoven and pre-heat by running a full cycle. Buchanan Plugger™.This is exactly like pre-heating your oven athome to make sure it is the correctly calibrated Figure 5.12B– The doctor and assistant pass back and forthtemperature before putting anything in to bake. the Elements™ Backfill unit and Buchanan Pluggers™ a few times before completing the backfill. 1. Once pre-heated, place the carriers in by the handle (not the stop) and heat. 2. The doctor will take fresh paper points and coat them in the cement. Each canal will be coated with cement. 3. The doctor will remove the paper point from each canal and coat a second time to ensure the canals have plenty of cement and voids are not be present. 4. When the oven flashes or beeps, the carrier will be fully heated and the doctor may then remove it, break off the handle of the carrier, and place it slowly and firmly into the canal. 5. Once all carriers are placed, the doctor will use a spoon excavator to break the carrier off at the canal orifices. Finally, the doctor may backfill with eitherAutofit™ cones or with the Elements Free™gutta percha cartridges. With the Autofit™ cones,the doctor will go back and forth with the heatand hand pluggers. With the Elements Free™gutta percha backfill, the doctor will go backand forth from the Elements Free™ to the handplugger. (See Figure 5.12A-B)5.13 Final Restoration Figure 5.12C–The doctor uses a Cojet™ Sandblaster in order to clean the pulp chamber floor. This process sprays Once the canals have been filled, the doctor sand throughout a couple inch radius so the assistant is readywill clean the pulp chamber floor by using a mix to evacuate any particular matter in the air as well as rinseof (b) alcohol and chloroform cotton pellets or the cavity well afterwards.(b) sandblaster. The sandblaster is the preferredmethod as it 43 • Takes a few seconds to clean the cavity, and • Etches the area prior to bonding a composite.
Chaprer Five: Assisting During Procedure The doctor will either place a temporary or a Color code systems can be according to (a)permanent restoration with preferred materials. procedure (b) specific doctor or (c) procedure and set-up number. After the final restoration has been placed,the rubber dam may be removed and the Example, if all endodontic procedures in theocclusion can be checked. (See Figure 5.12C and office are “yellow”, and Dr. Bob is “blue” and5.13A-C) Dr. Sue is “pink”, all of Dr. Bob’s endodontic procedures would have a “yellow and blue” band5.14 Post-Operative Care while Dr. Sue’s would be “yellow and pink.” It is a nice touch to present the patient with Alternatively for a single-doctor practicea gift bag of useful items such as lip salve, floss, with multiple set-ups, code the first endodontictoothbrush, or any item that might best reflect the set-up with “yellow and blue” and the secondthoughtfulness of the office. Our office includes with “yellow and pink”. This way, if two, three,locally made artisan chocolates as a reward for or more endodontic procedures are done that daybeing an excellent patient. (See Figure 5.14) and all of the instruments end up in sterilization, it is easy and efficient to separate and sort. Any prescription dispensed by the doctormay be included in the gift bag with aftercareinstructions. Pain relievers such as Aleeve™ arefrequently dispensed with printed labels withspecific directions to take 2 tabs in the morningand 2 in the evening. The doctor may prefer toprescribe narcotic pain medication dependingupon the situation. If this is the case, it is helpful to call-in theprescription ahead of time. Some states, such asCalifornia, have laws that require the patients topresent the hand-written narcotic prescription tothe pharmacist. Patients are directed to eat and drinknormally after numbness subsides. Instruct thepatient to be careful as they may not feel their lipsor tongue, and can accidentally bite into them.5.15 Sterilization After the patient has left the operatory,instruments and trays may be brought to thesterilization room. This is where the beautyof the Zirc™ ZOBE system can be mostappreciated. If working in a multi-doctor practice orsimply have not had time to run the doctor’sinstruments through sterilization, a color-codedsystem can simplified the process.44
The Art of Endontic Dental AssistingFigure 5.13A– The doctor places a final restoration while Figure 5.13C– The doctor and assistant check the patient’sthe assistant remains ready to cure the composite with the oral cavity and final restoration after removing the rubbercuring light. dam.Figure 5.13B– The assistant cures the composite restoration Figure 5.14– Gift Bag to be given to each patient afterwith a curing light for 60 seconds. completion of treatment. Includes: Soft tooth brush (for surgical procedure patients), ice pack (for either surgical procedure patients or patients to place on their jaw joints), lavender scented towel to wrap around the ice pack, lip salve, hand cream or lotion, toothpaste, post-operative medications in separate containers, water, as well as special customized chocolates in a gift package. 45
Terminology and Definitions
Amalgam Restoration Terminology and Definitions A dental restoration made of an alloy of an element or metal with mercury.Apex Pertaining to the end of the root of a tooth.Apex Locator An electronic device used to determine the position of the apical constrictionBaseline and, thus, determine the length of the root canal space.Block Injection Information found at the beginning of a procedure, which is used as a comparison for later data. Used for pain treatment and management where a group of nerves is injected with a nerve-numbing substance.Block Out Blockages occurring from packing pulp, dentinal shavings or other canalCalcium Hydroxide contents.Carrier An inorganic compound used as a disinfectant agent.CBCTCement Obturation technique where sealer is placed in the canal followed by a plastic or metal core carrier coated with gutta-percha; device is heated prior to placement. Acronym for Cone Beam Computer Tomography A radiopaque material used usually in combination with a solid or semi-solid core material to fill voids and to seal root canals.Ceramic Crown A clay material hardened by heat use for dental restoration withoutChelation supporting metal substructure that restores clinical crown of the tooth.Cone The removal of inorganic ions from tooth structure by a chemical agent, usually EDTA. Describes a piece of rolled gutta-percha that is used to fill a root canal.Crescendo Effect Increasing pain/sensitivity followed by a sudden cessation of pain/sensitivity.Crown A type of dental restoration, which completely caps or encircles a tooth or dental implant.48
Diagnostic Testing The Art of Endontic Dental Assisting Consists of a subjective examination, objective examination, percussion test, palpation test, thermal tests, probing depths, 2D radiographs, and 3D imaging.EDTA A white crystalline acid used as an anticoagulant and as a chelator (seeEndodontics chelation). The specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp.Fistula An abnormal passage from the apical periodontal area of a tooth to the surface of the oral mucous membrane, permitting the discharge purulence.Gutta-PerchaIrrigation A purified material taken from the Palaquium tree, similar to natural rubber. The process of washing out with the continuous flow of liquid, solution or chemical.Lubricant The application of an agent to diminish friction.Mucosa The membrane lining the inside of the mouth.NecroticObturation Non-vital, no longer living cells or tissue in a localized area. The three-dimensional filling of the pulp chamber and root canal system with material, usually gutta-percha and sealer.Objective Examination A form of questioning which has a single correct answer.Palpation Testing The process of applying firm pressure with the fingertips to the mucosa above the apex of the root.Paper PointPatent or Patency Cone-shaped paper used to dry a root canal. A canal preparation technique where the apical portion of the canal is maintained free of debris.Percussion Testing The technique of tapping the surface of a tooth to learn the condition of the tooth by the resulting sensation. 49
Permanent Crown Terminology and Definitions A tooth-shaped cap to cover the tooth to restore its shape and size, strength and appearance.Physical Irritation Most often caused by bacteria or decay that has moved into the pulp causing an abscess.Pulp Testing A process to ascertain the vitality of a tooth.Pulpitis Inflammation of dental pulp tissue.Purulence A thick, whitish-yellow fluid resulting from infection. Also known as pus.Reference Point A basis or standard for evaluation, assessment or comparison.Referred Pain Pain felt in a part of the body other than the actual source.Scope of Practice Procedures, action and processes that a practitioner is permitted to take in keeping with the terms of their professional license.Sodium Hypochlorite A chemical compound frequently used as a disinfectant agent.Subjective Examination A form of questioning which may have more than one correct answer, or more then one way of expressing the correct answer.Temporary Crown An interim restoration until a final restoration can be inserted. Also known as a provisional crown or interim crown.Test Zone An area of 3-4 teeth in the problematic area that will be diagnostically tested.Trauma Physical injury.Ultrasonic A process that uses high frequency sound and solution to disinfect.Working Length The distance from a coronal reference point to the point at which canal preparation and obturation should terminate.50
Forms Appendix 51
Forms AppendixNotice of Privacy Practices:52
The Art of Endontic Dental Assisting 53
Forms Appendix54
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Forms Appendix56
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Forms Appendix58
The Art of Endontic Dental AssistingAuthorization Form: 59
Forms AppendixPatient Consent Form:60
The Art of Endontic Dental AssistingTreatment and Financial Policy Form: 61
Forms Appendix62
The Art of Endontic Dental AssistingConsent for Root Canal Treatment Form: 63
Forms AppendixConsent for Composite Fillings Form:64
The Art of Endontic Dental Assisting 65
Forms AppendixConsent for Crown and Bridge Prosethetics Form: 66
The Art of Endontic Dental Assisting 67
Forms AppendixRefusal of Recommended Treatment Form: 68
The Art of Endontic Dental AssistingIn-Take Sheet: 69
Forms AppendixInternal Financial Agreement Sheet:70
The Art of Endontic Dental AssistingFee Form: Simple Approach Advanced Instruments Expert Training 71
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