Transcript Endodontia

DH220 Dental Materials
Lecture #14
Prof. Lamanna RDH, MS
Endodontia
Endodontia
Definition: the specialty in
dentistry concerned with
the etiology, diagnosis,
prevention , and treatment
of diseases and injuries of
the dental pulp and associated
periradicular tissues.
Objectives of Endodontic Therapy
• To provide a clean canal – the aim is to produce a
reduction of bacteria to a non-pathogenic level.
• To provide an “apical seal” – this prevents the
ingress of fluids which will provide nutrients for
canal bacteria and also prevents irritants leaving
the canal and entering the periapical tissues.
• Indications: Necrotic pulp, irreversible pulpitis,
fractured apical third, irreversible
trauma, avulsion
• Contraindications: Reversible pulpitis,
poor perio prognosis,
pt chooses extraction
Endodontic Diagnosis
• Subjective: patient reports –
– location, intensity, duration
• Objective: clinical evaluation –
– dental history, radiographs,
clinical exam
Clinical Examination
• Control teeth – adjacent and contra lateral to observe level
of response.
• Percussion – tapping
• Palpation – pressure
• Thermal sensitivity – applying hot and/or cold
• Mobility
• Transillumination – detection of fractures
• Depth of decay
• Electronic pulp testing with vitalometer
Wilkins p. 273 – 276
Electronic pulp testing with vitalometer
Endodontic instruments
• Endodontic explorer
– locates canal openings
• Endodontic excavator
– removes deep coronal pulp tissue
• Broaches – remove bulk of pulpal tissue
• Files – smooth, shape, and enlarge canal
• Irrigation solution – sodium hypochlorite
• Paper points – absorb irrigating solution and dry canal
• Spreaders & pluggers – obturate
& condense the canal with sealer and
gutta percha
Endodontic Filling Materials:
An “ideal” endodontic filling material should meet the
following requirements:
• it should seal the canal laterally as well as apically
• it should not shrink after insertion
• it should be impervious to moisture
• it should be bacteriostatic
• it should not irritate periradicular tissue
• it should be biocompatible
No one material meets all these requirements;
continual research endeavor to find the ideal
obturating material.
1.
Endodontic Sealer – cement used to obtain an antibacterial seal at
the apical foramen; fills the space between the gutta-percha
(obturating point) and the wall of the canal, producing an
antibacterial seal.
Composition: Three groups –
- zinc oxide-eugenol cement
- resin-based
- calcium hydroxide-based cement
2.
Gutta Percha Points – most frequently used material (rubber) to
obturate the canal after completion of tx.
* Also used: silver points – good bactericidal effect;
but tend to corrode and stain adjacent soft tissues.
Composition:
gutta percha – rubber
zinc oxide – filler
metal salts – radio-opacifier
wax or resin – plasticizer
Overview of Endodontic Therapy
• Administration of local anesthetic
• Isolation of operating field
– mandatory use of dental dam – WHY?
•
•
•
•
Access preparation
Cleaning and shaping the canals
Obturation – sealing and filling the canal(s)
Post –op - permanent restoration placed
ECC paper dental charting
• Draw a line through all roots & views of the
root(s) from the CEJ to the apex of the root.
• Add the final restoration: filling, crown, etc.
Endodontic failures:
what could have happened?
•
•
•
•
Persistent infection
Inadequate instrumentation
Inaccessible canals
Unsealed lateral canals
(accessory canals)
•
•
•
•
•
Severely curved roots
Perforation of the canal
Fractured roots
Extensive root resorption
Pulp stones
Surgical Endodontics
• Apicoectomy – surgical removal of the
apex of the root
• Apical curettage – removal of pathological tissue around
the apex
• Retrograde restoration – placed when apical seal is not
adequate (gutta percha, amalgam, composite)
• Root amputation - removal of one or more roots
without removal of the crown
• Hemisection - root & crown are cut length wise and
removed
Before
After
THE END - Any Questions ????
• Showtime …..
• This is the last teaching class – see you
next week for Test #5 on Ortho & Endo
… you will also hand in Case Study #3.
REVIEW
REVIEW
TEST #5
ORTHO & ENDO
1.HANDOUTS – ALL OBJECTIVES
2.CHPT 13 – GLADWIN TEXT
3.CHPT 16 & 28 – WILKINS TEXT
4.ORTHO HANDOUTS FROM DM LAB (review diagrams)
5. Remember Edpuzzle.com
TEST FORMAT:
T/F – 7
M.C. – 27
MATCHING – 13
SHORT ANS. – 4
DIAGRAM IDENTIFICATION – 6
BONUS QUESTION