牙体解剖学精品课件（中山大学）17.根管治疗并发症及根管再治疗.pptVIP

* * * * * Staining method Methylthionine chloride: the root canal orifice is often dyed blue.Iodophor: the missed root canal orifice is in darker color. Foaming test Sodium hypochlorite：root canal orifice with small bubbles (3) Regaining Access to the Apical Area Once the coronal-radicular access is made and all posts and obstructing restorations have been removed, the clinician must regain access to the apical area by removing the previous root-filling materials, such as gutta-percha and sealing agent. 1) Gutta-percha Removal A combination of heat, solvents, and mechanical instrumentation can be used to remove well-condensed gutta-percha Several solvents to dissolve gutta-percha The solvent is introduced into the coronal portions of the canals using an irrigating syringe Small hand files (sizes #15 and #20) are used to penetrate the gutta-percha to enhance its dissolution Remove the gutta-percha carefully to avoid overextending beyond the confines of the canal to minimize the risk of severe postoperative pain Heat to soften gutta percha Heat sources—such as the Touch ’n Heat or DownPack to provide constant, consistent heat application to soften the gutta-percha in the coronal portion of the canal Avoid overheating the root, which can cause damage to the periodontal ligament Rotary instrumentation ProFile Canal Finder GPX Mtwo R ProTaper Universal retreatment files The dedicated retreatment files have end-cutting tips to enhance penetration and removal of the root filling mass to increase their efficiency. Overextended gutta-percha removal Insert a new Hedstrom file into the extruded apical fragment of root filling. Use a gentle clockwise rotation to a depth of 0.5 to 1?mm beyond the apical constriction. The file is then slowly and firmly withdrawn with no rotation, removing the overextended material. B 2011／3／23 10：58 2011／4／6 14：34 2011／4／9 11：42 2011／9／17 11：54 2011／12／31 11：23 2) Sealing agent removal Root canal sealer can be remo