Root Canal Treatment for Patients & Dentist

The
Root Canal
TreatmenT
for Dentists & Patients
Everything
About

Created & Presented by
Dr. Amit T. Suryawanshi
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Pune, Sangli & Mumbai (India)
&
founder of
Face Art International Super speciality

For International Calls Dial +91 9405622455
(MH, India)

Root Canal Treatment is one of the most
common treatments in dentistry that manages
the diagnosis, and treatment of the dental pulp
and the periradicular tissues that surround
the root of the tooth.
Introduction

 Physical irritation
• Most generally
brought on by
extensive decay.
 Trauma
• Blow to a tooth
or the jaw.
Causes of Pulpal Nerve Damage

 Pain when biting down.
 Pain when chewing.
 Sensitivity with hot or cold beverages.
 Facial swelling.
Signs and Symptoms of Pulpal Nerve
Damage
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 Subjective examination
• Chief complaint
• Character and duration of pain
• Painful stimuli
• Sensitivity to biting and pressure
Diagnosis
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 Objective examination
• Extent of decay
• Periodontal conditions surrounding the
tooth in question
• Presence of an extensive restoration
• Tooth mobility
• Swelling or discoloration
• Pulp exposure
Diagnosis- cont’d
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 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.
Diagnostic Testing
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 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.
Diagnostic Testing- cont’d
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 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.
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 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.
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Placement of a pulp tester
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 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.
Radiographs in Endodontics
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 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.
Requirements of Endodontic Films

 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.
Diagnostic Conclusions
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 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.
Diagnostic Conclusions- cont’d
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 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.
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 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.
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 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.
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 Pulp fibrosis
• The decrease of living cells within the pulp
causing fibrous tissue to take over the
pulpal canal.
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 Necrotic tooth
• Also referred to as nonvital. Used to
describe a tooth that does not respond to
sensory stimulus.
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 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.
Endodontic Procedures
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Spreaders
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 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.
Endodontic Procedures- cont’d
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Pulpotomy
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 Pulpectomy
• Also referred to as root canal therapy;
procedure involves the complete removal
of the dental pulp.
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Pulpectomy
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 Endodontic explorer
 Endodontic spoon excavator
 Broaches
 Endodontic files
• K-type
• Hedstrom
Instruments and Accessories for
Endodontic Procedures
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Colors and Sizes of Endodontic Files
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 Rubber stops
 Paper points
 Spreaders
 Pluggers
 Glick No. 1
 Millimeter ruler
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 Rotary instruments
• Gates-Glidden bur
• Pesso reamer
• Lentulo spiral
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 Irrigation solution
• Sodium hypochlorite
• Hydrogen peroxide
• Parachlorophenol (PCP)
Medicaments and Dental Materials in
Endodontics
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 Gutta-percha points
 Formocresol
 Root canal sealer
Medicaments and Dental Materials
in Endodontics- cont’d
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 Anesthesia and pain control
 Isolation and disinfection of the site
 Access preparation
 Debridement and shaping the canal
 Obturation
Overview of Root Canal Therapy
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 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.
• Biopsy
Surgical Endodontics
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 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.
Apicoectomy and Apical Curettage
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 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.
Retrograde Restoration
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 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.
Root Amputation and Hemisection

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Root Canal Treatment for Patients & Dentist

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