Endodontics Chapter 54

Chapter 54
Endodontics

Copyright 2003, Elsevier Science (USA).
All rights reserved. No part of this product may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including input into or storage in any
information system, without permission in writing from the publisher.
PowerPoint® presentation slides may be displayed and may be reproduced in print
form for instructional purposes only, provided a proper copyright notice appears on
the last page of each print-out.
Produced in the United States of America
ISBN 0-7216-9770-4

Copyright 2003, Elsevier Science (USA). All rights reserved.

Introduction
Endodontics is the specialty of dentistry that
manages the prevention, diagnosis, and
treatment of the dental pulp and the
periradicular tissues that surround the root of
the tooth.


Causes of Pulpal Nerve Damage
 Physical irritation
• Most generally brought on by extensive
decay.
 Trauma
• Blow to a tooth or the jaw.


Signs and Symptoms of Pulpal Nerve
Damage
 Pain when biting down.
 Pain when chewing.
 Sensitivity with hot or cold beverages.
 Facial swelling.


Endodontic Diagnosis
 Subjective examination
• Chief complaint
• Character and duration of pain
• Painful stimuli
• Sensitivity to biting and pressure


Endodontic Diagnosis− cont’d
 Objective examination
• Extent of decay
• Periodontal conditions surrounding the
tooth in question
• Presence of an extensive restoration
• Tooth mobility
• Swelling or discoloration
• Pulp exposure


Diagnostic Testing
 Percussion tests
• Used to determine whether the inflammatory
process has extended into the periapical
tissues.
• Completed by the dentist tapping on the
incisal or occlusal surface of the tooth in
question with the end of the mouth mirror
handle held parallel to the long axis of the
tooth.


Diagnostic Testing− cont’d
 Palpation tests
• Used to determine whether the
inflammatory process has extended into
the periapical tissues.
• The dentist applies firm pressure to the
mucosa above the apex of the root.


 Thermal sensitivity
Necrotic pulp will not respond to cold or
•
hot.
 Cold test
• Ice, dry ice, or ethyl chloride used to
determine the response of a tooth to cold.
 Heat test
• Piece of gutta-percha or instrument handle
heated and applied to the facial surface of
the tooth.


 Electric pulp testing
Delivers a small electrical stimulus to the pulp.
•
 Factors that may influence readings:
• Teeth with extensive restorations.
• Teeth with more than one canal.
• Failing pulp can produce a variety of
responses.
• Control teeth may not respond as anticipated.
• Moisture on the tooth during testing.
• Batteries in the tester may be weak.


Fig. 54-4 Placement of a pulp tester.


Radiographs in Endodontics
 Initial radiograph
• Diagnosis.
 Working length film
• Used to determine the length of the canal.
 Final instrumentation film
• Taken with the final size files in all canals.
 Root canal completion film
• Taken after the tooth as been temporized.
 Recall films
• Taken at evaluations.


Requirements of Endodontic Films
 Show 4-5 mm beyond the apex of the tooth
and the surrounding bone or pathologic
condition.
 Present an accurate image of the tooth without
elongation or fore-shortening.
 Exhibit good contrast so all pertinent structures
are readily identifiable.


Fig. 54-5 Quality radiograph in endodontics.


Diagnostic Conclusions
 Normal pulp
• There are no subjective symptoms or
objective signs. The tooth responds
normally to sensory stimuli, and a healthy
layer of dentin surrounds the pulp.


Diagnostic Conclusions− cont’d
 Pulpitis
• The pulp tissues have become inflamed.
 Reversible pulpitis
• The pulp is irritated, and the patient is
experiencing pain to thermal stimuli.
 Irreversible pulpitis
• The tooth will display symptoms of lingering
pain.


 Periradicular abscess
• An inflammatory reaction to pulpal
infection that can be chronic or have rapid
onset with pain, tenderness of the tooth to
pressure, pus formation, and swelling of
the tissues.


 Periodontal abscess
• An inflammatory reaction frequently caused
by bacteria entrapped in the periodontal
sulcus. A patient will experience rapid
onset, pain, tenderness of the tooth to
pressure, pus formation, and swelling.


 Periradicular cyst
• A cyst that develops at or near the root of
a necrotic tooth. These types of cysts
develop as an inflammatory response to
pulpal infection and necrosis of the pulp.


 Pulp fibrosis
• The decrease of living cells within the pulp
causing fibrous tissue to take over the
pulpal canal.


 Necrotic tooth
• Also referred to as nonvital. Used to
describe a tooth that does not respond to
sensory stimulus.


Endodontic Procedures
 Pulp capping
• A covering of calcium hydroxide is placed
over an exposed or nearly exposed pulp
to encourage the formation of irritated
dentin at the site of injury.
 Indirect pulp cap is indicated when a thin
partition of dentin is still intact.
 Direct pulp cap is indicated when the pulp
has been slightly exposed.


Fig. 54-11 Spreader and plunger.


Endodontic Procedures− cont’d
 Pulpotomy
• Involves the removal of the coronal portion
of an exposed vital pulp.
• Completed to preserve the vitality of the
remaining portion of the pulp within the
root of the tooth.
• This procedure is commonly indicated for
vital primary teeth, teeth with deep carious
lesions, and emergency situations.


Fig. 54-13 Example of a pulpotomy.


 Pulpectomy
• Also referred to as root canal therapy;
procedure involves the complete removal
of the dental pulp.


Fig. 54-14 A diagram of a pulpectomy.


Instruments and Accessories for
Endodontic Procedures
 Endodontic explorer
 Endodontic spoon excavator
 Broaches
 Endodontic files
• K-type
• Hedstrom


Table 54‑ 1 Colors and Sizes of Endodontic Files


 Rubber stops
 Paper points
 Spreaders
 Pluggers
 Glick No. 1
 Millimeter ruler


 Rotary instruments
• Gates-Glidden bur
• Pesso reamer
• Lentulo spiral


Medicaments and Dental Materials in
Endodontics
 Irrigation solution
• Sodium hypochlorite
• Hydrogen peroxide
• Parachlorophenol (PCP)


Medicaments and Dental Materials
in Endodontics− cont’d
 Gutta-percha points
 Formocresol
 Root canal sealer


Overview of Root Canal Therapy
 Anesthesia and pain control
 Isolation and disinfection of the site
 Access preparation
 Debridement and shaping the canal
 Obturation


Surgical Endodontics
 Indications for surgical intervention
• Endodontic failure caused by persistent
infection, severely curved roots, perforation
of the canal, fractured roots, extensive root
resorption, pulp stones, or accessory
canals that cannot be treated.
• Exploratory surgery to determine why
healing has not occurred.
• Biopsy


Apicoectomy and Apical Curettage
 To surgically remove the apical portion of the
root with the use of a high‑speed handpiece
and bur.
 To evaluate:
• Inadequate sealing of the canal.
• Accessory canals.
• Fractures of the root.
• Pathological tissue around the root apex.


Retrograde Restoration
 Completed when an apical seal is not
adequate. A small class I preparation is made
at the apex and sealed with filling materials
such as gutta-percha, amalgam, or
composite.


Root Amputation and Hemisection
 Root amputation
• A surgery performed to remove one or more
roots of a multirooted tooth without
removing the crown.
 Hemisection
• A procedure in which the root and the
crown are cut lengthwise and removed.


Endodontics Chapter 54

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (15)

Similar to Endodontics Chapter 54

Similar to Endodontics Chapter 54 (20)

More from Türk Endodonti Derneği

More from Türk Endodonti Derneği (20)

Recently uploaded

Recently uploaded (20)

Endodontics Chapter 54