Introduction to Dentistry Al-azhar university Gaza collage of dentistry upload by Lama El Banna Dr. Hazem Al agramy

1. Introduction to EndodonticsIntroduction to Endodontics
Prepared by:Prepared by:
Dr. Ashraf Y. ShamiaDr. Ashraf Y. Shamia
Al-Azhar University –GazaAl-Azhar University –Gaza
Faculty of DentistryFaculty of Dentistry

2.  (endodontia, pulp canal therapy, root canal
therapy): the division of dental science that deals
with the causes, diagnosis, prevention, and treatment
of diseases of the dental pulp and their sequel.
 Treatment the pulp is called endodontic treatment,
but it is often referred to as root canal treatment or
root canal therapy (RCT).

4.  R.C.T. is needed for two main reasons:
I. Infection or irreversible damage to the pulp:
An untreated cavity (caries) is a common
cause of pulp infection. The inflammation
caused by the infection restricts the tooth’s blood
supply, so antibiotics in the blood stream can’t
reach the infection very well. The reduced blood
supply also limits the pulp’s ability to heal itself.
so R.C.T is needed.

7. II. Trauma: a fracture or extensive restorative
work, such as several fillings placed over a
period of time. Sometimes a common dental
procedure can cause a pulp inflammation.

11. A. It is to save the tooth by removing the infected or
damaged pulp, treating any infection, and filling
the empty canals with an inert material. If R.C.T.
is not done, the tooth may have to be extracted.
B. If the tooth is then covered with a crown or in
some cases restored with tooth-colored composite
filing material, the tooth can last for long time.

16.  A tooth that hurts significantly when you bite down
on it, touch it.
 Sensitivity to heat or sensitivity to cold that lasts
longer than a couple of seconds.
 Swelling near the affected tooth.
 A discolored tooth, with or without pain.
 A broken tooth.

18. The clinician must complete the database before
beginning the interpretive and decision making
process. The database begins with the patient's
medical history.

19. I. Medical History:
Obtaining a comprehensive written medical
history is mandatory and should precede the
examination and treatment of all patients. The
medical history provides information regarding
the patient's overall health and susceptibility to
disease and indicates the potential for adverse
reactions to treatment procedures. Information
regarding current medications, allergies, and
diseases, can be assessed as it relates to the
clinical problem.

20. II. Dental History:
 The taking of a dental history allows the
clinician to build rapport with the patient
and is often more important than the
examination and testing procedures. The
dental history almost always contributes to
the establishment of a diagnosis.
 The dental history should include the chief
complaint and a history of the present
illness if the patient has signs and/or
symptoms of disease.

21.  Information on previous traumatic injury, a
previous nerve treatment, or a cracked tooth can
be instrumental in a diagnosis. A history of
previous pain from a symptomatic tooth is also an
important finding.

22. III. Clinical Examination:
Visual inspection of the soft tissues should
include an assessment of color, contour, and
consistency. Localized redness, edema, swelling
can indicate inflammatory disease. Examination
of the hard structures may reveal clinical
findings such as caries, abrasion, attrition,
defective restorations, fractured cusps, cracked
teeth, and tooth discoloration.

23. A buccal swelling in the anterior region.A buccal swelling in the anterior region.

25.  Pulp testing:
Pulp tests are an assessment of the patient's
response to stimuli. They are designed to assess
responsiveness and localize symptomatic teeth by
reproducing the patient's symptoms. Pulp testing is
essential in establishing a clinical diagnosis.
Electrical and thermal testing procedures have been
shown to produce reliable results.

26. A. Thermal Testing:
Thermal sensitivity is a common chief
complaint in pulp pathosis. Testing with hot and
cold identifies the tooth and is instrumental in
determining whether the pulp is normal or
inflamed.

27.  Cold testing is usually performed first. Ice sticks is
frequently used to apply cold to teeth. These tests
have been shown to be safe and do not cause
damage to the pulp or enamel. Patients should be
advised of the testing method and expected
sensations. The testing should begin on a normal
“control” tooth (usually of the same tooth group or
type) to educate the patient regarding what to expect
from the test.

29.  Prolonged pain after thermal stimulation is often
the first indication that irreversible pulp damage
has occurred. The spontaneous, radiating pain that
keeps patients awake or awakens them at night
indicates tissue damage and inflammation.

30.  Thermal testing with heat is indicated when a
patient complains of sensitivity to hot food or
liquids. It is performed by applying petroleum jelly
to the tooth surface and heating a stick of gutta-
percha temporary stopping in an open flame. As
the temporary stopping begins to soften, the
clinician applies it to the lubricated tooth surface.
 Heat testing is the least valuable pulp test but is
essential when the patient complains of sensitivity
to heat.

32. The heated gutta-percha is placed on the toothThe heated gutta-percha is placed on the tooth

33. B. Electric Pulp Testing:
It is often used to confirm the results of previous
tests. The EPT requires an isolated dry field.
Traditionally the electrode is coated with a
conducting medium, usually toothpaste, and
placed on the dry enamel labial or buccal surface
of the tooth to be tested. Evidence indicates that
the incisal edge is the optimal placement site for
the electric pulp tester electrode to determine the
lowest response threshold.

34. An Electric Pulp TesterAn Electric Pulp Tester

35. The tip of the Electric Pulp Tester is coatedThe tip of the Electric Pulp Tester is coated
in toothpaste to improve conductivity.in toothpaste to improve conductivity.

36. Radiographic examination of the hard tissues can
often provide valuable information regarding
caries and existing restorations, calcifications,
resorptions, tooth and pulpal morphology, root
fractures, and the relationship of anatomic
structures. However, they do have many
limitations and are of little value in assessing
pulpal status. Vital and necrotic pulps cast the
same image. Moreover, radiographs are only two-
dimensional images of three dimensional
structures.

37.  Because radiography and some other imaging
methods require ionizing radiation, during the
clinical examination the clinician must prescribe
the projection that will provide the most
information at the lowest dose regarding the
patient's problem. In most cases this is a peri-
apical film.

40.  R.C.T can be done in one or more visits,
depending on the situation. An infected tooth will
need several appointments to make sure that the
infection is eliminated.
 Some teeth may be more difficult to treat because
of the position of the tooth, because they have
many and curved root canals
 An uncomplicated R.C.T often can be completed
in one visit.

41.  Goals of Endodontic Access:
Access preparation is the most important phase
of the technical aspects of RCT. The bulk of
procedural errors and treatment difficulties are
related to errors and problems in obtaining
adequate access.

43.  The ideals of endodontics access as follows:
1. Complete removal of the chamber roof.
2. Removal of coronal pulp.
3. Straight-line access to facilitate placement
of endodontic instruments.

52.  These ideals are balanced with the following
constraints:
1. Conservation of tooth structure.
2. Retention and esthetics of the final
restoration.

53. Methods for determining working length include
using average root lengths from anatomic studies,
preoperative radiographs, using working length
radiographs made with a variety of different film
types or digital sensors, or any combination of the
above. Ideally, the clinician should measure working
length after attaining straight line access to the
apical third of the root canal system.

54. The depth of the pulp chamber can beThe depth of the pulp chamber can be
estimated from pretreatment radiograph.estimated from pretreatment radiograph.

56. 1. Cleaning and Shaping.
2. Develop a continuously tapering funnel from
the apex to the coronal orifice.
3. Maintain the original shape of the canal.
4. Maintain the apical foramen in its original
position.
5. Keep the apical opening as small as possible.

59. The file is placed to working length and rotatedThe file is placed to working length and rotated
clockwise with light pressure. The file is then rotatedclockwise with light pressure. The file is then rotated
counterclockwise while apical pressure is maintainedcounterclockwise while apical pressure is maintained
to cut and enlarge the canal.to cut and enlarge the canal.

60. The end result should be a tapered canal in itsThe end result should be a tapered canal in its
original position with a small apical opening.original position with a small apical opening.

65. All of the instrumentation techniques rely on the use
of irrigates to help flush debris from the canal.

67.  Canal size:
Small canals are more difficult to prepare and
may not exhibit any natural taper.
 Canal curvature:
Difficulty increases as curves progress from
gentle to sharp dilacerations.

69. A. Anesthesia.
B. Measuring.
C. Cleaning.
D. Filling.

70.  Administration of local anesthesia most of time is
mandatory before endodontic treatment, as
sometime the tooth is not vital so administration
is not required.

72.  Dentist needs to know how long the canals to
make sure all the diseased tissue is removed and
the entire canal is cleaned.
 Dentists use X-Ray to determine the length of the
canals.

75.  Dentists use a set of instruments in order to
accomplish this step, starting from broches to
remove the pulp tissue, files to enlarge the root
canal in order to be suitable for filling beside
irrigation solution.
 For R.C.T to be effective, all the canals within
the tooth must be cleaned. Generally, the anterior
teeth have one canal, the premolars 1 or 2, and
the molars 3 or 4 canals. However, the location
and shape of these canals can vary significantly.

76.  Several materials used to fill the canal but the most
common one is called gutta percha with the use of
endodontic sealer for the canal filling, for the coronal
part a tempory filling or a permanent restoration can
be placed.
 A crown will help to restore the tooth’s strength and
protect it from cracking. A crown should be placed
as soon as possible and it is important to get the tooth
permanently restored to prevent damage to the tooth
later.

79.  The tissues and nerves surrounding your tooth
remain, so your tooth will still respond to
pressure and touch.

80. Routine clinical and radiographic examinations at 6
months, 1 year, and 2 or more years after
endodontic treatment are essential. These
evaluation methods determine and attempt to
predict the success and stability of endodontic
treatment. Reevaluation should occur before any
new restorative procedure.