Transcript Chapter 24

Endodontics
Chapter 24
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Endodontics
• Branch of dentistry that deals with
diagnosis and treatment of diseases of
pulp and periapical tissues
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Progress of Pulpal and Periapical
Disease
• Vital pulp
– Healthy pulp
– May be inflamed
– Capable of healing after irritant removed
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Progress of Pulpal and Periapical
Disease
• Nonvital pulp
– Tooth no longer responds to stimuli
– Tooth considered necrotic
– Unable to heal
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Reversible Pulpitis
• Inflamed pulp able to heal when irritant
removed
• Causes:
– Caries
– Enamel fracture
– Occlusal attrition
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Reversible Pulpitis
• Symptoms:
– Thermal sensitivity
• Treatment:
– Remove irritant
– Place sedative dressing
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Pulp Irritants Leading to
Irreversible Pulpitis
•
•
•
•
•
Advanced dental decay
Impact trauma
Fractures
Invasive restorative procedures
Adverse reaction to dental material
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Irreversible Pulpitis
• Results from
prolonged
inflammation
• Pulpal tissue unable
to heal
• Pain symptoms:
– Dull and continual
– Short and sharp
• Treatment:
– Root canal therapy
– Extraction
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Pulpal Necrosis
• Death of pulpal cells
• Exudate (pus) and gas form in pulp
chamber
• Process slowed if pressure released
through:
– Fistula
– Caries
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Periapical Diseases
• Apical periodontitis
• Periapical abscess
Courtesy of Clifton O. Caldwell, Jr., DDS., FICD, FACD.
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Apical Periodontitis
• Pulpal inflammation that has spread to
periapical tissues
• Inflammation creates:
– Granuloma
• Tumor filled with granulation tissue
– Cyst
• Fluid-filled or semisolid-filled
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Periapical Abscess
• Destruction of tissue
• Exudate present
• Pressure must be released
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Endodontic Diagnosis
• Medical and dental history
• Clinical examination
• Referring dentist’s notes
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Medical History
• Review and clarify medical history
– Medical conditions
– Medications
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Dental History
• Review past dental experiences
• Current concerns
– Subjective examination
• Type of pain
• Thermal sensitivity
• Duration of pain
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Clinical Examination
• Current concerns
– Objective examination
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•
•
•
•
Extraoral tissues
Facial asymmetry
Swelling
Redness
Fistulas
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Intraoral Clinical Examination
• Tissues evaluated and palpated
– Caries
– Discoloration
– Fractures
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Clinical Testing Procedures
• Radiographs
– Radiolucent area on xray indicates bone
involvement
• Palpation
• Percussion
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Clinical Testing Procedures
• Mobility
• Cold test
– Dry ice, ethyl chloride,
and ice
• Heat test
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Clinical Testing Procedures
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©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned,
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Clinical Testing Procedures
• Pulp testing
– Indicates if tooth is vital or nonvital
• Transillumination test
• Selective anesthesia
• Caries removal
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Dental Check
• What is an advanced stage of periapical
infection that spreads into the bone?
– Osteomyelitis
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Endodontic Instruments
• Barbed broaches
– Remove soft tissue from canal
– Designed to cut tissue when pulled from canal
– Sized xxx-fine to coarse
– Color-coded handles
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Endodontic Instruments
• Files
– Enlarges and smoothes
canals
– Removes necrotic tissue
– Color-coded system
marks size of file
– K-type or Hedstrom
• Fractured anterior teeth
• Apexogenesis root not
fully developed
– Flex files
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Endodontic Instruments
• Reamers
– Enlarges canal
– Applies with twisting motion
– Color-coded system
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Endodontic Instruments
• Organizers
– Various options to store and organize reamers
and files
– Some can be sterilized
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Endodontic Instruments
• Rubber stops
– Also known as file stops, endo stops, or
markers
– Placed on reamers and files to mark length
of root canal
– Small circular disks have prepunched holes
in center
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Endodontic Instruments
• Gates-Glidden drills
– Used with latch attachments on low-speed
handpieces
– Long-shanked and elliptically-shaped with
blunt, football-shaped ends
– Six sizes marked near notch of shank
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Endodontic Instruments
• Gates-Glidden drills
– Used in upper portion
of canal to prepare
opening access by
removing obstructing
dentin
Courtesy of Sybron Endo
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Endodontic Instruments
• Peeso reamers
– Have parallel cutting sides
– Used with latch attachments on low-speed
handpieces
– Supplied in various sizes
– Used to prepare canal for post and to reduce
curvature of canal orifice for straight-line
access
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Endodontic Instruments
• Lentulo spirals
– Long, twisted, and very flexible wire
instrument used to spin root canal sealer or
cement into canal
– Spirals used with low-speed handpieces and
latch attachments
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Endodontic Instruments
• Endodontic spoon
excavator
– Double-ended
– Long-shanked
– Removes:
• Caries
• Pulp tissue
• Temporary cement
Courtesy of Hu-Friedy Mfg., Co., Inc.
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Endodontic Instruments
• Endodontic explorer
– Locates opening of
canals
– Long, tapered ends
– Double-ended with
sharp-pointed ends
Courtesy of Hu-Friedy Mfg., Co.,
Inc.
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Endodontic Instruments
• Endodontic spreaders
– Similar to pluggers
• But pointed at tip
– Condense gutta
percha into sides of
canal
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Endodontic Instruments
• Endodontic pluggers
– Used to condense gutta percha
– Flat-ended
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Endodontic Instruments
• Glick #1 instrument
– Used to remove excess gutta percha from
coronal portion of canal
– Used to condense remaining gutta percha in
canal opening
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Dental Check
• Which intracanal instrument comes in
diameters ranging from xxx-fine to coarse?
– Barbed broach
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Endodontic Materials
• Paper points
– Extra-fine to coarse
– Uses:
• Dries canals
• Places medications
• Takes cultures
© Cengage Learning 2013
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Endodontic Materials
• Gutta percha
– Obturates (fills) canals
– Heated and placed in canals
– Condensed with spreader and pluggers
– Removal of apex and infection surrounding
tooth
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Endodontic Materials
• Irrigation solutions
– Root canal irrigated frequently to remove
debris
• Sterile water
• Sodium hypochlorite
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Endodontic Materials
• Root canal sealers and cements
– Root canal series used with obturating
materials prevent microleakage in canal
– Powders, liquids, pastes, and capsules
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Equipment Assisting Endodontic
Procedures
• Apex finder
• Heating unit
• Endodontic
handpiece
• Vitality scanner
•
•
•
•
Ultrasonic unit
Endodontic bender
Dental microscope
Endodontic obturation
system
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Endodontic Procedures
• Root canal treatment
– Usually completed in two appointments
– Sometimes infection given time to be treated
before canal sealed
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General Steps in Root Canal
Therapy
1.
2.
3.
4.
5.
Administer anesthetic
Isolate area
Gain access to pulp
Locate canals
Remove pulpal tissue
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General Steps in Root Canal
Therapy
6. Enlarge and smooth root canal
7. Irrigate root canal
8. Place temporary filling
9. Obturate (seal) root canal
10.Refer patient to general dentist for final
restoration
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Endodontic Retreatment
• Causes:
– Abscess did not heal
– Narrow or curved canals were not treated
– New decay grew along filling
– Complicated canal anatomy went undetected
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Endodontic Retreatment
• Causes:
– Restoration did not occur soon enough after
treatment
– Restoration became loose, cracked, or broken
and exposed tooth to new decay
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Pulpectomy
• Complete removal of pulp
• First stage of root canal
• Indicated for:
– Permanent teeth with deep caries
– Vertical fracture
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Pulpotomy
• Pulp removed from coronal portion
• Pulp remains in root canal
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Pulpotomy
• Treatment indicated:
– Primary teeth with pulpal exposure
– Pulp exposed after accident
– Deep carious lesions
– Root does not develop completely
– Anterior tooth is fractured
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Pulpotomy
Sterile cotton pellet
wetted with
Formocresol solution
Zinc oxideeugenol cement
© Cengage Learning 2013
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Surgical Endodontics
• Sometimes required to save tooth
• Involves facial surface incision to expose
bone
• Root exposed and treatment performed
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Apicoectomy
• Apex of root and
infection surgically
removed
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Root Amputation
• Surgical procedure to
remove one or more
of the roots of multirooted tooth
• Extensive bone loss
around root
Courtesy of Dr. Gary Shellerud
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Hemisection
• Surgical removal of
one root and
overlying crown
• Diseased portion
removed
• Indications similar to
root amputation
Courtesy of Dr. Gary Shellerud
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Apexification
• Treatment of apex of root canal in necrotic
tooth
• Creates calcified barrier
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Apexogenesis
• Treatment of pulp of young tooth with open
apex
• Tooth vital, but has carious or traumatic
exposure
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Dental Check
• What are some reasons for a root canal
treatment (RCT) to fail?
– Abscess did not heal
– Narrow or curved canals were not treated
– New decay grew along filling
– Complicated canal anatomy went undetected
– Too long in between treatment appointments
– New infection due to trauma
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