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INTRODUCTION
RDS 322
Pre-clinical endodontics
Solaiman Al-Hadlaq
B.D.S., M.S., Ph.D.
pp, 80 - 96
Pathways of the Pulp, Cohen S. and Hargreaves K. M., 9th edition,
2006.
Endodontics
Endodontology is derived from the Greek
language and translated as
‘the knowledge of what is inside the tooth’
Definition
• Endodontics: The branch of dentistry concerned
with the morphology, physiology and pathology of
the human dental pulp and periradicular tissues. Its
study and practice encompass the basic and
clinical sciences including the biology of the
normal pulp and the etiology, diagnosis,
prevention and treatment of diseases and injuries
of the pulp and associated periradicular
conditions.
AAE glossary of terms
Scope
• Differential diagnosis and treatment of oral pains
of pulpal and/or periapical origin.
• Vital pulp therapy such as pulp capping and
pulpotomy.
• Nonsurgical treatment of root canal systems.
• Selective surgical removal of pathological tissues
resulting from pulpal pathosis
• Surgical removal of tooth structure such as in rootend resection, bicuspidization, hemisection and
root resection.
Scope
• Intentional replantation and replantation of
avulsed teeth.
• Bleaching of discolored dentin and enamel.
• Retreatment of teeth previously treated
endodontically.
• Treatment procedures related to coronal
restorations by means of post and/or cores.
AAE glossary of terms
Indications
• Pathologically involved pulp:
– Irreversible pulpitis.
– Pulp necrosis.
One year follow-up
Failed pulpotomy
Two- years follow-up
One year follow-up
One year follow-up
Six months follow-up
Complete lamina dura
Indications
• Intentional endodontics:
– When a tooth can not be restored properly
without performing root canal therapy on a vital
pulp.
• Hypererupted teeth.
• Drifted teeth.
• Teeth needing post and core restorations.
Indications
• Overdenture abutment:
– To preserve the alveolar ridge bone.
– Attachments can be added to aid the retention
of the removable prosthesis.
Overdenture
Indications
• Trauma:
–
–
–
–
Pulp necrosis
Ankylosis
Resorption
Calcification
One month following trauma
Beginning of ankylosis and
external resorption (6 ms. After)
Contraindications
• From an endodontic point of view there are
no absolute contraindications for
performing root canal treatment .
– Calcifications.
– Dilacerations.
– Resorptive defects.
• Consider specialist referral.
Calcification
Severe dilaceration of MB root
Curvature is not apparent
in Buccolingual aspect
Bayonet- shaped canal
External
Internal
Contraindications
• Restorative considerations:
–
–
–
–
Subosseous caries.
Poor crown/root ratio.
Misalignment.
Badly fractured tooth.
Contraindications
• Periodontal considerations:
– Extensive periodontal defect that can not be
maintained.
Medical conditions that may
influence endodontic treatment
planning
• Pregnancy:
–
–
–
–
Radiographs.
Local anesthetic.
Avoid treatment during 1st trimester.
2nd trimester is the safest period.
• Cardiovascular disease:
– Myocardial infarction:
• No elective care in the first 6 months.
– Unstable or progressive angina pectoris:
• Should not use vasoconstrictor.
– Antihypertensive medications:
• Digitalis glycosides (Digoxin)  arrhythmias.
– Heart murmur and artificial heart valves :
• SBE prophylaxis.
– Coronary artery bypass:
• SBE prophylaxis (few months only).
• Minimize vasoconstrictors (first 3 months).
Consult the physician!
• Cancer:
– Can metastasize to the jaws and mimic
endodontic pathosis:
• Vitality pulp testing.
– Chemo or radio therapy:
• Impair healing (consult physician).
• HIV:
–
–
–
–
–
Occupational risk is very low
Universal precautions to protect patients.
Opportunistic infections and medications.
CD4 above 400 usually asymptomatic.
Consult physician before surgical treatment.
• Dialysis:
– Bleeding tendency due to destruction of
platelets.
– Treatment should not be performed on the same
dialysis day due to patient fatigue.
– Attention to effect of dialysis on drug
metabolism.
– consult physician.
• Diabetes:
– Well controlled diabetic should be treated
normally.
– Make sure that the patient has taken his
medication and have had his meal on time.
– Acute infection may require an increase in
insulin dose, or administration of insulin to
non-insulin dependent patients.
• Prosthetic implants:
– Antibiotic prophylaxis?
– consult physician.
Prognosis
• Success rate is high, around 90%
• Teeth without periradicualr radiolucency
have better prognosis than teeth with
periradicular radiolucency (up to 20%
difference)
Course outline
COURSE ASSESSMENT
I. Practical
50%
a. Daily work (12 projects)
b.Practical assessments (2)
c.Practical midterm (1)
d.Final practical
II. Written (didactic)
a.Quizzes
b.Oral exam
c.Midterm exam
d.Final exam
30%
5%
5%
10%
50%
5%
5%
10%
30%
READING TEXTBOOK
• Pathways of the Pulp, 9th edition, S. Cohen,
and K. M. Hargreaves, 2006.
• Endodontics, 5th Ed. J. I. Ingle and L. K.
Backland, 2002.
Laboratory requirements
1st semester:
•
•
•
•
Access openings on one anterior tooth and one
premolar tooth mounted individually in plaster
Root canal therapy on three anterior teeth.
Root canal therapy on two premolar (including
one with two canals) teeth.
The fourth anterior tooth mounted in acrylic
should be saved for midterm practical exam.
Laboratory requirements
2nd semester:
•
•
•
•
•
•
Access openings on two molars (one maxillary and
one mandibular) mounted individually in plaster.
Root canal therapy on three molar (upper and lower)
teeth.
Retreatment, and Ca(OH)2 application on a previously
obturated single rooted tooth.
Post space preparation on a previously obturated canal.
Three teeth (an anterior, a premolar, and a molar)
should be saved for the second laboratory assessment.
The fourth molar should be saved for final practical
exam (upper or lower).
Laboratory requirements
•
•
All the required teeth (4 anteriors, 2 premolars
and 4 molars) must be mounted in acrylic
using the rubber mould.
Additional teeth (3 anteriors, 2 premolars, 3
molars) with inappropriate root morphology
(as confirmed by radiographs) should be
mounted individually in plaster of paris
blocks for the purpose of access opening and
other practical exercises.
Laboratory guide lines
•
•
•
Make sure you write your name,
university number and serial number
clearly on your assigned station with an
adhesive nametag.
You are responsible for marinating your
assigned station in a proper working
condition.
You are responsible for maintaining the
tidiness of your workstation.
Laboratory guide lines
•
•
Make sure that you cover the working area
with the paper sheets provided in the
laboratory.
At the end of the session make sure you
leave your station clean. If your working
stations is not clean after you leave the lab
you will get a zero for that laboratory
session and if repeated you will get a zero
for the whole project.
Laboratory guide lines
• The general laboratory area is the
responsibility of the whole group, if the lab
is not neat at the end of the session, all the
students will be marked down. Make sure
you do not leave X-ray film wraps or
defective films on the floor or benches, you
should dispose them appropriately.
Laboratory guide lines
• You will be given a set of instruments that are new
or almost new, the course director have inspected
each and every set of instruments, you must not
abuse the instruments and you should maintain
them clean and in proper working condition at all
times. The instruments should get you through the
whole year if they are used in the manner they are
designed to be used for. If an instrument becomes
defective or is lost, you should replace it
immediately with an instrument of equal quality
and the same brand name.
Laboratory guide lines
• Make sure you have all your instruments
including, a plastic ruler, an irrigation
syringe, an irrigation solution jar, and 2x2
gauze pads available at all times especially
before you call your instructor to evaluate
your work or help you during a procedure.
Also make sure that your instruments,
especially the mirror, are always clean.
Laboratory guide lines
• Your laboratory manual should be available
with you on every laboratory session. Make
sure you read the planned step at home, so
when you come to the laboratory session
you are ready to proceed and when asked by
your instructor you are ready to answer.
Laboratory guide lines
• Failure to demonstrate acceptable level of
understanding of the planned step may
result in your dismissal from the session.
• You have enough time to finish your
assignment during the time allocated for
that exercise, therefore, work will not be
allowed outside the laboratory time.
Laboratory guide lines
• You should mount your models on the
phantom head during all procedures, if I see
your model in your hand you will get a zero
for that session.
Tooth selection
• Select the teeth that meet the criteria in the memo
distributed last year. (straight roots, sound crown,
no calcifications, mature apices, and no 3rd
molars).
• Expose a radiograph to show the morphology of
the pulp space.
• Use size 2 film and expose more than one tooth on
the same film, using utility was to stabilize the
teeth.
Tooth selection
• Number the teeth and mount them on the wax in a
standard fashion, so you can go back and tell
which tooth is which on the radiograph.
• Check with your instructor regarding the
suitability of the teeth for use.
• Prepare the teeth for mounting by putting a bead
of wax on the apex to mimic PA radiolucency.
Tooth Mounting
• Use the provided rubber molds.
• Each tooth should be placed into its individual
socket in the rubber mould. Be sure of the
orientation of each tooth surface before pouring
the mixture.
Tooth Mounting
• In a disposable paper cup add:
– 3 x 25 ml scoops polymer (powder)
– 3 x 25 ml scoops saw dust
– mix until the mixture becomes homogenous.
• Add the mixture to approximately 6.5 x 5.5 ml
measuring cylinders (35 ml) monomer (liquid)
and mix until a smooth creamy mass is obtained.
• Pour the mixture slowly into the rubber mould
covering the apices of the roots.
Tooth Mounting
• During the initial setting of the acrylic, a threaded
metal lock component of a screw attachment
should be embedded in the middle of the acrylic
base. The key component of the attachment that is
in the manikin phantom head can be screwed into
the lock component. This permits stable mounting
of the model in the manikin phantom head.
Thank you