Endodontics Chapter 54
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  • 1. 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 0-7216-9770-4Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 2. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 3. Causes of Pulpal Nerve Damage  Physical irritation • Most generally brought on by extensive decay.  Trauma • Blow to a tooth or the jaw.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 4. Signs and Symptoms of Pulpal Nerve Damage  Pain when biting down.  Pain when chewing.  Sensitivity with hot or cold beverages.  Facial swelling.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 5. Endodontic Diagnosis  Subjective examination • Chief complaint • Character and duration of pain • Painful stimuli • Sensitivity to biting and pressureCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 6. 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 exposureCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 7. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 8. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 9. Diagnostic Testing− cont’d  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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 10. Diagnostic Testing− cont’d  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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 11. Fig. 54-4 Placement of a pulp tester.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 12. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 13. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 14. Fig. 54-5 Quality radiograph in endodontics.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 15. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 16. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 17. Diagnostic Conclusions− cont’d  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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 18. Diagnostic Conclusions− cont’d  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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 19. Diagnostic Conclusions− cont’d  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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 20. Diagnostic Conclusions− cont’d  Pulp fibrosis • The decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 21. Diagnostic Conclusions− cont’d  Necrotic tooth • Also referred to as nonvital. Used to describe a tooth that does not respond to sensory stimulus.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 22. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 23. Fig. 54-11 Spreader and plunger.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 24. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 25. Fig. 54-13 Example of a pulpotomy.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 26. Endodontic Procedures− cont’d  Pulpectomy • Also referred to as root canal therapy; procedure involves the complete removal of the dental pulp.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 27. Fig. 54-14 A diagram of a pulpectomy.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 28. Instruments and Accessories for Endodontic Procedures  Endodontic explorer  Endodontic spoon excavator  Broaches  Endodontic files • K-type • HedstromCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 29. Table 54‑ 1 Colors and Sizes of Endodontic FilesCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 30. Instruments and Accessories for Endodontic Procedures− cont’d  Rubber stops  Paper points  Spreaders  Pluggers  Glick No. 1  Millimeter rulerCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 31. Instruments and Accessories for Endodontic Procedures− cont’d  Rotary instruments • Gates-Glidden bur • Pesso reamer • Lentulo spiralCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 32. Medicaments and Dental Materials in Endodontics  Irrigation solution • Sodium hypochlorite • Hydrogen peroxide • Parachlorophenol (PCP)Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 33. Medicaments and Dental Materials in Endodontics− cont’d  Gutta-percha points  Formocresol  Root canal sealerCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 34. Overview of Root Canal Therapy  Anesthesia and pain control  Isolation and disinfection of the site  Access preparation  Debridement and shaping the canal  ObturationCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 35. 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. • BiopsyCopyright 2003, Elsevier Science (USA). All rights reserved.
  • 36. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 37. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.
  • 38. 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.Copyright 2003, Elsevier Science (USA). All rights reserved.