But the maximum should be only after 45
For as long as, they’ve advised
degree angulation, you cannot go beyond 55,
but you can go lower than 45. So what’s the
reason for that, you have the dentinal tubules
that are present here
(look at pic).
If you cut at an
angulation more than 45
degrees, you will be
cutting or exposing the
dentinal tubules in these
area. That can lead to
failure of your treatment
because it can lead to
seepage of fluid into this
area (look at pic).
45 degree angulation, there is less dentinal
tubules present, exposed. The only reason why
you have to cut it in a slanted manner is for you
to have easy access and visibility.
The best cut is 0 degree, but how can you
prepare you Class 1 preparation in the apex of
the tooth if you cannot see it. So, it has to be in
a slanted manner.
So, again, for the opening of the cavity, for the
enlargement of the cavity, you have to use your
ROUND SURGICAL BUR, but for the making of
the trough (?) and also cutting the apex of the
tooth, you have to use your FISSURED BUR or
STRAIGHT SURGICAL BUR.
So, when you cut, it should be cleanly made that
there should be no catch when you try to pass
your explorer on the cut tooth surface. It should
be smooth all the way, there should be no
catch. And then you make your cavity
preparation in the apex. It was mentioned that
it has to be a special tip for an ultrasonic scaler
because it can cut less tooth structure and there
is a lesser chance to perforate any areas, but
since those instruments are quite expensive, we
only make do with the handpieces that we use.
But actually, the handpiece that we use is not
advisable because it produce air. There is
actually air in its opening and that can actually
lead to AIR EMPHYSEMA. So, they have
recommended the ultrasonic flips, electronic
handpieces that will not produce air, basically
minimizes the risk of having air emphysema. So
far, by God’s grace, wala pa naka encounter si
doc and the students here in school og air
emphysema.
their students nga sa air and water syringes,
THEY CAN NEVER USE THAT WITH AIR because
dako kaaayo and chance nga maka cause og air
emphysema.
AIR EMPHYSEMA, there will be an enlargement
or swelling of the area immediately. It happens
immediately after the procedure was done. You
have to treat this with antibiotic coverage
because there is an area that can house
microorganisms that is prone to infection and
we don’t want that to happen.
So, for your root filling material/ retrograde
filling material there is a lot that you could
choose from:
 Amalgam
 Composite
- it has to be with a bonding agent
dentine (bonding agent); you can have
your IRM, supereproxyzoic acid (?),
GICs, but the one that is commonly used
is the MTA (mineral trioxide aggregate).
- MTA is new in the market, its long
term effects is not yet been establish,
but since it is a material that can be
placed in an area with slight bleeding, it
set is not affected by the presence of
blood. And of course, having a cavity in
the apical portion having a flap
reflected, means that it will be
contaminated with blood. So, lisod ang
pag-use og amalgam og composite –
because the field has to be completely
dry; otherwise, the seal will not be good
it will just come off.
- So, for amalgam, you have to use
ZINC-FREE AMALGAM TO PREVENT
RUSTING IN THE APICAL AREA. You
have to be very specific of your cavity
preparation. When you do cavity prep in
the apex, it is just a ROUNDED
STRUCTURE that basically follows the
contour of the external structure of the
root. So, when you make an amalgam
prep, it needs to have 3mm depth. AND
OF COURSE, YOU HAVE TO MAKE
SOME UNDERCUTS. It has to be placed
in the proximal side only, not on the
buccal surface. You can also place
undercuts on the palatal side of the
root, again not on the labial.
- Why not on the labial? Remember,
you have already made a cut. It has to
be in a slanted manner for easy access.
When you make a cut in this area (look
at pic- kanang nay circle),

you will be
severely

compromising the stability of this area.

Because it is already thin and you will
be making an undercut in this area. Dili
siya acceptable, so undercut can only be
placed in the PALATAL AREA.
- Nobody uses amalgam anymore
because of the difficulty of the
preparation. It is a deep cavity prep and
you have to make sure that the area is
not contaminated with moisture. So,
MTA is what is now commonly used
nowadays.
- MTA can give you at least a working
time of 10 minutes, but the complete
set can happen in 2-3 hours. So,
meaning after you placed your cement
in your cavity prep for retrograde filling,
it can be easily washed off by your
irrigating solution. So, you have to
make sure that all irrigating solutions,
by the way when you irrigate: it
removes hard and soft tissue debris, it
removes hemorrhage, it removes blood
clot, and creates a cleaner surface for
reattachment of the periosteum cleanly
into the bone surface. So that is why we
have to irrigate.