Remove tip from irrigating syringe and place in sharps container. Throw syringe in garbage. All used files should be turned in loose on tray. Unused files should remain in sponge and turned in with your tray. ALWAYS try to have your trays turned in to the window early. A half-hour before clinic ends is ideal, but often times not possible. Just be sure to mind your time and turn it in ASAP.
Temporizing Between Appointments
By the time you graduate you will hopefully be able to do all of this in one appointment, but more than likely you will be temporizing the tooth for multiple appointments until then. You should begin temporizing the tooth about 20 minutes before the end of the clinic session. This allows enough time to get the tray back to sterilization on time.
First irrigate the canals really well and dry them using paper points. Place Pulpdent Calcium Hydroxide material into each canal. (Pulpdent is available from the sterilization windows). A lentulo file running clockwise is best at placing Ca(OH)2. A larger hand file can also be used if necessary to pack the Ca(OH)2 into the canals. Turn the hand file counter-clockwise to unload the flutes and Ca(OH)2. Be sure to do this for all canals.
Use a cotton pellet you can use it to wipe off any Ca(OH)2 that got onto the prep walls. Place a correctly sized foam pellet (cut from the sterile sponge that the files came in) into the access cavity. If the cavity is small (1-surface) fill the access cavity using CAVIT. It comes in a small tube about 2 inches long and should be included in the tray when you pick it up. Pull the cap off and use the back of it to puncture the foil seal and squeeze some out. You can use your finger to place some Cavit into the tooth and use the endo plugger as a condenser. Fill the canal and get a good cavosurface seal using any endo instruments or explorers you have on the tray. Remember, this is a temporary restoration and it doesn’t have to be pretty, you just need a good seal. It is also helpful to take a damp cotton roll or pellet and wipe the Cavit and clean the margins. The moisture will help the Cavit start to set.
If the access is larger than 1-surface and receives occlusal load, use glass ionomer cement to make the temporary. The sponge will not bake into the glass ionomer like a cotton pellet will.
Cavit takes approximately 2 hours to set completely. Be sure to warn your patient not to chew on that tooth. Be sure to consider taking the tooth out of occlusion as it may fracture now and you don’t want the patient to break the tooth. Be sure to warn your patient. Also, confirm with the endodontist whether or not they want you to take it out of occlusion. There may be a unique situation where you won’t want to do that adjustment.
Clinic Tip: If the tooth you are working on is missing one or two walls of the access then you might want to place CAVIT only over the pulp floor and use a glass-ionomer restoration to temporize the rest of the tooth.
Using Digital X-rays
Use the mobile x-ray units to take x-rays, check out a sensor for the dispensary and connect to your unit computer. Login into axiUm and click on MiPacs, to confirm you have the right patient look at top of screen. Now hit the button on the toolbar that looks like a radioactive symbol. Look for the timer, you are ready. Place the sensor where you need to and take the picture. If at all possible use a sensor holder, else the patient will have to hold the sensor in place. If you need to re-take the x-ray, set the sensor again and retry. When you have a good picture, set parameters of your picture on left-hand side of the screen: description, modality, location. Click save, name picture and exit program. You will be able to view the x-ray by clicking on the green icon on the patient screen. Remember, the “Standard of Care” requires a copy of both pre-op and post-op films archived in axiUm.
It is a good idea to anticipate at least one appointment for each canal. So if you are doing an endo on a molar with four canals, you should inform your patient that it will take about four appointments to finish the procedure, maybe more. NEVER promise your patient that you will definitely finish in a few appointments. You will be amazed at how often you will think that you are going to finish in the next appointment and something happens to force another appointment.
If you are assigned to assist one of your classmates, be nice enough to do so and not blow them off. Endo is one of those procedures that an assistant can be invaluable. It is nice to have someone just to go to get things for you from the window. Remember, you have to do two endo assists in order to be considered competent. If you assist a resident in the their clinic for two procedures, you will get credit for one root canal.