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Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
Ch. 54 - Endodontics
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Ch. 54 - Endodontics

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  • General dentists are able to perform endodontic treatment. Endodontists have 3 years of continued training in endodontics. What is another name for endodontics? What is the name for the specialist who deals with the diseases of the pulp?
  • Symptoms: pain on occlusion, pain during mastication, sensitivity to temperature, and facial swelling Who has had a root canal? What was the source of the nerve damage? What were the symptoms?
  • Symptoms differ from patient to patient. Other symptoms include a dull ache in a tooth that lasts over a period of time. How would we put these symptoms in lay terms?
  • The subjective examination includes an evaluation of all symptoms the patient describes. All symptoms should be documented in the patient’s chart. What may be a patient’s chief complaint?
  • The objective examination includes all findings by the dentist in the oral cavity. All findings must be documented in the patient’s chart. Control tooth: What is it? How is it selected? Students: If tooth 14 is hurting, which tooth would be the control tooth?
  • What can we see on this radiograph? Which teeth are involved? What was the probable cause of pulpal damage? What may be the No. 1 symptom this patient is experiencing?
  • All findings should be documented in the patient’s chart. Where are the periapical tissues?
  • Which tooth is the dentist testing? Which tooth would be the control tooth?
  • All findings should be documented in the patient’s chart. The dentist uses the fingertips to palpate the mucosa.
  • Which area is the dentist palpating? What is the dentist looking for?
  • Thermal stimuli are never placed on a metallic restoration or the gingival tissue. Why? A control tooth is used. The heat test is not used very often. Cold relieves pain = irreversible pulpitis Pain in teeth lingers = irreversible pulpitis What is pulpitis? What does necrotic mean?
  • Ice is applied to the cervical area of the tooth only. What would be the control tooth for this photograph? All findings must be documented in the patient’s chart.
  • Electric pulp testing is used to determine whether a tooth is vital or nonvital. The test can produce a false-positive or false-negative response. Would this type of diagnostic testing be used alone or in conjunction with another test?
  • All findings must be documented in the patient’s chart. Explain to patient that he or she may feel a tingling or warm sensation during this test. Toothpaste is used as a conductor. Testing should only be done on the facial surface of the cervical third of the tooth.
  • Initial radiograph should be of diagnostic quality; the dental assistant must see the apex of tooth or teeth in question. The working-length film is taken once the pulp is accessed. Final film: The radiograph shows the files in place in the canal. Completed film: The root canal procedure is complete. Recall films: Taken at prophylaxis appointments or as needed to check the status of a tooth. What type of film should be taken?
  • What type of film would be taken? What if we didn’t get the apex of the tooth? What would we need to do?
  • Top radiograph: Shows at least 4 mm beyond the apex; apex is not distorted; good contrast Bottom radiograph: Does not show at least 4 mm beyond apex; apex is distorted; poor contrast is evident What would we need to do to make the bottom radiograph of diagnostic quality?
  • If a tooth is “normal,” what could be the cause of the pain for the patient?
  • “ itis” = inflammation Reversible pulpitis: When the irritant is removed, the tooth can be saved from root canal treatment. What could be the irritant? Irreversible pulpitis: The pulp is incapable of healing. If root canal therapy does not improve the situation, extraction of the tooth is the next option.
  • What is another term for pus? (Exudate.) Odor/smell/color Chronic periradicular abscess: presence of a draining sinus tract Acute periradicular abscess: pain, tenderness, swelling as a result of the necrosis
  • Odor/smell/color Where is the sulcus located? Does a periodontal abscess always indicate that root canal therapy is needed?
  • Not very common.
  • Mostly seen in older patients Patients with recent trauma to a tooth may be susceptible.
  • What is another term for necrotic ? The tooth is still attached to the alveolus by means of the cementum and periodontal ligaments. If a tooth is necrotic, will it fall out on its own?
  • Capping can be used as an attempt to save the pulp Mostly used when bacteria have come very close to infecting the pulp Goals: to promote pulpal healing and to stimulate production of reparative dentin Most commonly referred to as IPC or DPC The dentist must inform the patient that this procedure may not be a long-term solution.
  • Where is the coronal portion of the tooth? Most commonly done on deciduous teeth. Why wouldn’t root canal therapy be done on a deciduous tooth?
  • Most root canal instruments are slim in design to fit inside the canals of the teeth and flexible enough to adapt to the curves of the canals. Hand instruments: endodontic explorer, endodontic spoon excavator, spreaders, pluggers, Glick No. 1. Finger files: broaches, K-type files, Hedstrom files. Rotary files: Gates-Glidden burs, Pesso reamers. Ancillary instruments: rubber stops, paper points
  • Universal color-coded system. For example, a white file may have a diameter of 15, 49, or 90. Most manufacturers place the number on the handle of the file.
  • Irrigation solutions help remove debris, bleach and the deodorize canal, and control hemorrhaging. Sodium hypochlorite is the most commonly used solution. A high-volume evacuator must be used at all times during irrigation. Why is this important? Filling materials: Gutta-percha is solid at room temperature, but a heat source is needed during filling. Variety of sizes; the first gutta-percha point in a canal is referred to as the “master cone.” The size should be documented in the patient’s chart. What does “obturation” mean?
  • Local anesthetic is most commonly used. Infiltration for maxillary teeth; nerve blocks for mandibular teeth. Sedatives may also be used to alleviate apprehension. Rubber dams are always used during root canal procedures. Why is the use of a rubber dam important? What is d é bridement? What problems could occur if the working length is incorrect?
  • Root canals have a 10% to 15% chance of failure. Used to save a tooth from extraction.
  • Invasive procedure. A flap is made on the buccal mucosa to gain access to the apex. An endodontist generally performs this procedure.
  • Used in conjunction with apicoectomy, apical curettage, or both. Commonly referred to as “root-end filling.” Amalgam is most commonly used filling material. Why would this procedure be done by an endodontist rather than a general dentist?
  • A root amputation is performed at the furcation. What is furcation? Hemisections are most commonly performed on mandibular molars. Why wouldn’t hemisections be performed on maxillary molars?
  • Transcript

    • 1. Endodontics Chapter 54 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 2. Chapter 54 Lesson 54.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 3. Learning Objectives <ul><li>Pronounce, define, and spell the Key Terms. </li></ul><ul><li>Describe the diagnostic testing performed for endodontic diagnosis. </li></ul><ul><li>List the conclusions of the subjective and objective tests in the endodontic diagnosis. </li></ul><ul><li>Assist in an electric pulp-vitality test. </li></ul><ul><li>Describe diagnostic conclusions for endodontic therapy. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 4. Introduction <ul><li>Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues surrounding the root of the tooth. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 5. Causes of Pulpal Nerve Damage <ul><li>Physical irritation </li></ul><ul><ul><li>Extensive decay moving into the pulp </li></ul></ul><ul><li>Trauma </li></ul><ul><ul><li>Blow to a tooth or the jaw </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 6. Signs and Symptoms of Pulpal Nerve Damage <ul><li>Pain on occlusion </li></ul><ul><li>Pain during mastication </li></ul><ul><li>Sensitivity to hot or cold beverages </li></ul><ul><li>Facial swelling </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 7. Endodontic Diagnosis <ul><li>Subjective examination </li></ul><ul><ul><li>Chief complaint </li></ul></ul><ul><ul><li>Character and duration of pain </li></ul></ul><ul><ul><li>Painful stimuli </li></ul></ul><ul><ul><li>Sensitivity to biting and pressure </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 8. Endodontic Diagnosis <ul><li>(Cont’d) </li></ul><ul><li>Objective examination </li></ul><ul><ul><li>Extent of decay </li></ul></ul><ul><ul><li>Periodontal conditions </li></ul></ul><ul><ul><li>Extensive restoration </li></ul></ul><ul><ul><li>Tooth mobility </li></ul></ul><ul><ul><li>Swelling or discoloration </li></ul></ul><ul><ul><li>Pulp exposure </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 9. Fig. 54-1 Radiograph showing extensive decay into the pulp. (From Johnson W: Color atlas of endodontics , StLouis, 2002, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 10. Fig. 54-2 Radiograph of a necrotic tooth resulting from trauma. (From Johnson W: Color atlas of endodontics , St Louis, 2002, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 11. Diagnostic Testing <ul><li>Percussion tests </li></ul><ul><ul><li>These tests are used to determine whether the inflammatory process has extended into the periapical tissues. </li></ul></ul><ul><ul><li>The dentist taps on the incisal or occlusal surface with the end of the mouth-mirror handle held parallel to the long axis of the tooth. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 12. Fig. 54-3 Percussion test. (From Johnson W: Color atlas of endodontics , St Louis, 2002, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 13. Diagnostic Testing <ul><li>(Cont’d) </li></ul><ul><li>Palpation Tests </li></ul><ul><ul><li>These tests are used to determine whether the inflammatory process has extended into the periapical tissues. </li></ul></ul><ul><ul><li>The dentist applies firm pressure to the mucosa above the apex of the root. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 14. Fig. 54-4 Palpation test. (From Johnson W: Color atlas of endodontics , St Louis, 2002, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 15. Diagnostic Testing <ul><li>(Cont’d) </li></ul><ul><li>Thermal sensitivity </li></ul><ul><ul><li>Necrotic pulp will not respond to cold or heat. </li></ul></ul><ul><li>Cold test </li></ul><ul><ul><li>Ice, dry ice, or ethyl chloride is used to determine the response of a tooth to cold. </li></ul></ul><ul><li>Heat test </li></ul><ul><ul><li>A piece of gutta-percha or an instrument handle is heated and applied to the facial surface of the tooth. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 16. Fig. 54-5 Ice used for testing thermal sensitivity. (From Johnson W: Color atlas of endodontics , St Louis, 2002, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 17. Diagnostic Testing <ul><li>(Cont’d) </li></ul><ul><li>Electric pulp testing </li></ul><ul><ul><li>A small electrical stimulus is delivered to the pulp. </li></ul></ul><ul><li>Factors that may influence readings: </li></ul><ul><ul><li>The patient has extensive restorations. </li></ul></ul><ul><ul><li>The patient has teeth with more than one canal. </li></ul></ul><ul><ul><li>Failing pulp produces a variety of responses. </li></ul></ul><ul><ul><li>Control teeth don’t respond as anticipated. </li></ul></ul><ul><ul><li>There is moisture on the tooth during testing. </li></ul></ul><ul><ul><li>The batteries in the tester are weak. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 18. Procedure 54-1 Placement of a pulp tester. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 19. Radiographs in Endodontics <ul><li>Initial radiograph </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><li>Working-length film </li></ul><ul><ul><li>To determine the length of the canal </li></ul></ul><ul><li>Final-instrumentation film </li></ul><ul><ul><li>Final-size files in all canals </li></ul></ul><ul><li>Root canal completion film </li></ul><ul><ul><li>Taken after the tooth has been temporized </li></ul></ul><ul><li>Recall films </li></ul><ul><ul><li>Taken at evaluations </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 20. Requirements of Endodontic Films <ul><li>Must show 4 to 5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition </li></ul><ul><li>Must present an accurate image of the tooth without elongation or foreshortening </li></ul><ul><li>Must exhibit good contrast so that all pertinent structures are readily identifiable </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 21. Fig. 54-6 Good-quality radiograph in endodontics. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 22. Diagnostic Conclusions <ul><li>Normal pulp </li></ul><ul><ul><li>No subjective symptoms or objective signs are noted. The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 23. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Pulpitis </li></ul><ul><ul><li>The pulp tissues have become inflamed. </li></ul></ul><ul><li>Reversible pulpitis </li></ul><ul><ul><li>The pulp is irritated, and the patient is experiencing pain in response to thermal stimuli. </li></ul></ul><ul><li>Irreversible pulpitis </li></ul><ul><ul><li>The tooth displays symptoms of lingering pain. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 24. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Periradicular abscess </li></ul><ul><ul><li>This inflammatory reaction to pulpal infection may be of chronic or acute onset with pain, tenderness of the tooth in response to pressure, pus formation, and swelling of the tissues. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 25. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Periodontal abscess </li></ul><ul><ul><li>This inflammatory reaction is frequently caused by bacteria trapped in the periodontal sulcus. A patient will experience rapid onset of pain, tenderness of the tooth in response to pressure, pus formation, and swelling. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 26. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Periradicular cyst </li></ul><ul><ul><li>This type of cyst develops at or near the root of a necrotic tooth. They develop as an inflammatory response to pulpal infection and necrosis of the pulp. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 27. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Pulp fibrosis </li></ul><ul><ul><li>A decrease in living cells within the pulp causes fibrous tissue to take over the pulpal canal. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 28. Diagnostic Conclusions <ul><li>(Cont’d) </li></ul><ul><li>Necrotic tooth </li></ul><ul><ul><li>The tooth may also be referred to as nonvital. The term is used to describe a tooth that does not respond to sensory stimulus. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 29. Chapter 54 Lesson 54.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 30. Learning Objectives <ul><li>List the types of endodontic procedures. </li></ul><ul><li>Discuss the medicaments and dental materials used in endodontics. </li></ul><ul><li>Provide an overview of root canal therapy. </li></ul><ul><li>Assist in root canal therapy. </li></ul><ul><li>Describe surgical endodontics and how it affects treatment. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 31. Endodontic Procedures <ul><li>Pulp capping </li></ul><ul><ul><li>Calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin at the site of injury. </li></ul></ul><ul><li>Indirect pulp capping is indicated when a thin partition of dentin is still intact. </li></ul><ul><li>Direct pulp capping is indicated when the pulp has been slightly exposed. </li></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 32. Endodontic Procedures <ul><li>(Cont’d) </li></ul><ul><li>Pulpotomy </li></ul><ul><ul><li>This procedure involves removal of the coronal portion of an exposed vital pulp. </li></ul></ul><ul><ul><li>It is used to preserve the vitality of the remaining portion of the pulp within the root of the tooth. </li></ul></ul><ul><ul><li>The procedure is commonly indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations. </li></ul></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 33. Endodontic Procedures <ul><li>(Cont’d) </li></ul><ul><li>Pulpectomy </li></ul><ul><ul><li>Also referred to as root canal therapy, this procedure involves the complete removal of the dental pulp. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 34. Instruments and Accessories for Endodontic Procedures <ul><li>Hand instruments </li></ul><ul><li>Instruments for pulp preparation </li></ul><ul><ul><li>Hand- and finger-operated files </li></ul></ul><ul><ul><li>Instruments attached to a low-speed handpiece </li></ul></ul><ul><ul><li>Rotary files </li></ul></ul><ul><li>Ancillary instruments </li></ul><ul><ul><li>Rubber stops </li></ul></ul><ul><ul><li>Paper points </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 35. Table 54-1 Colors and Sizes of Endodontic Files Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 36. Medicaments and Dental Materials in Endodontics <ul><li>Irrigation solution </li></ul><ul><ul><li>Sodium hypochlorite </li></ul></ul><ul><ul><li>Hydrogen peroxide </li></ul></ul><ul><ul><li>Parachlorophenol, or PCP </li></ul></ul><ul><li>Root canal–filling materials </li></ul><ul><ul><li>Gutta-percha points </li></ul></ul><ul><li>Root canal sealers </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 37. Overview of Root Canal Therapy <ul><li>Anesthesia and pain control </li></ul><ul><li>Isolation and disinfection of the site </li></ul><ul><li>Access preparation </li></ul><ul><li>Débridement and shaping of the canal </li></ul><ul><li>Obturation </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 38. Surgical Endodontics <ul><li>Indications for surgical intervention </li></ul><ul><ul><li>Endodontic failure </li></ul></ul><ul><ul><ul><li>Persistent infection, severely curved roots, perforation of the canal, fractured roots, extensive root resorption, pulp stones, or accessory canals that cannot be treated </li></ul></ul></ul><ul><ul><li>Exploratory surgery </li></ul></ul><ul><ul><ul><li>To determine why healing did not occur </li></ul></ul></ul><ul><ul><li>Biopsy </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 39. Apicoectomy and Apical Curettage <ul><li>To surgically remove the apical portion of the root with the use of a high-speed handpiece and bur </li></ul><ul><li>To evaluate: </li></ul><ul><ul><li>Inadequate sealing of the canal </li></ul></ul><ul><ul><li>Accessory canals </li></ul></ul><ul><ul><li>Fractures of the root </li></ul></ul><ul><ul><li>Pathologic tissue around the root apex </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 40. Retrograde Restoration <ul><li>This procedure is undertaken when an apical seal is not adequate. </li></ul><ul><ul><li>A small class I preparation is made at the apex and sealed with filling materials such as gutta-percha, amalgam, or composite. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    • 41. Root Amputation and Hemisection <ul><li>Root amputation </li></ul><ul><ul><li>This surgery is performed to remove one or more roots of a multirooted tooth without removing the crown. </li></ul></ul><ul><li>Hemisection </li></ul><ul><ul><li>The root and the crown are sectioned lengthwise and removed. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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