d. Filling and Sealing the Root Canal. A small mosquito hemostat, 5 1/2
inches, is usually used for placing a silver point in the canal. A silver point pliers is the
instrument used to seat the point in the canal. When gutta-percha points are used, cotton
forceps are used to place the point. Depending on the technique, a plugger, a spreader,
or both, are used to condense the gutta-percha in the canal. In other techniques, both
gutta-percha and silver points are used at the same time. A trial radiograph of the root
canal filling is taken and, if it is satisfactory, a thick mix of zinc oxide and eugenol or zinc
phosphate cement is made and plugged into the access area to completely seal the
canal. A number three Ladmore plugger is the instrument of choice for plugging the
access opening with the cement.
e. The Multiappointment Method. The sequence of treatment for the
multiappointment method of endodontic therapy differs from the single appointment
method in that the sequence is interrupted at various stages to allow for drainage of
infected material, for changing of medications in the root canal, or to alleviate a lengthy
appointment. Medications commonly used in endodontic techniques include cresatin and
camphorated paramono-chloro-phenol, which are placed in dappen dishes and then
placed into the root canal by using paper points or into the pulp chamber by using cotton
pellets. The tooth is then sealed and kept sealed until the next appointment.
Occasionally, bacterial cultures are done each time the root canal dressing is changed.
Root canal therapy is completed after a negative culture is obtained.
f. Follow-up Appointments. Upon completion of the treatment by either
method, arrangements should be made to recall the patient 6 months later for a follow-up
radiograph to determine the success of the treatment.
g. Sterilization. Successful endodontics depends greatly upon sterility. Anything
placed into the tooth must be sterilized. Hot salt, glass bead, and molten metal sterilizers
are used for sterilization of and working endodontic instruments. Broaches, files and
reamers, paper points and cotton pellets are submerged in the sterilizer for not less than
4-10. APICOECTOMY SURGICAL ENDODONTIC THERAPY
a. General. Apicoectomy is defined as the excision of the apical portion of the
tooth root through an opening made in the overlying labial or buccal alveolar bone and
oral mucosa. There are indications and contraindications for using this procedure. The
dental officer will evaluate each case. Surgical techniques, instruments, and materials
vary with the operator.
b. Preparation. The dental specialist should make certain that all instruments to
be used have been sterilized and are ready. If the patient has received preoperative
medication, he must be watched closely. The dental specialist should be alert to any
unfavorable reactions during the surgery and report them to the dental officer.