24 Endodontics. 2 Branch of dentistry that deals with diagnosis and treatment of diseases of the...

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Endodontics

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Endodontics

• Branch of dentistry that deals with diagnosis and treatment of diseases of the 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 is removed

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Progress of Pulpal and Periapical Disease

• Nonvital pulp– Tooth no longer responds to stimuli– Tooth is considered necrotic– Unable to heal

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Reversible Pulpitis• Inflamed pulp is able to heal when

irritant is 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

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Irreversible Pulpitis• Treatment

– Root canal therapy– Extraction

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Pulpal Necrosis

• Death of pulpal cells

• Exudate (pus) and gas form in the pulp chamber

• Process is slowed if pressure released through:– Fistula– Caries

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Periapical Diseases

• Apical periodontitis

• Periapical abscess

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Apical Periodontitis

• Pulpal inflammation that has spread to the 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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The Clinical Examination

• Objective examination– 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 x-ray indicates bone

involvement

• Palpation

• Percussion

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Clinical Testing Procedures

• Mobility

• Cold Test– Dry ice, ethyl chloride, ice

• Heat Test

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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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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

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Endodontic Instruments • Reamers

– Enlarges canal– Applies with a 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 – Called 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 are 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

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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 a 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

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Endodontic Instruments

• Endodontic explorer– Locates opening of canals– Long tapered ends– Double-ended with sharp-pointed ends

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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

the coronal portion of canal – Used to condense remaining gutta percha

in canal opening

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Endodontic Materials

• Paper points – Dries canals– Place medications– Take cultures– X-fine to coarse

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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 is 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

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Endodontic Procedures

• Root canal treatment– Usually completed in two appointments– Sometimes infection is given time to be

treated before canal is sealed

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General Steps in Root Canal Therapy

1. Administer anesthetic

2. Isolate area

3. Gain access to pulp

4. Locate canals

5. 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 does not heal– Narrow or curved canals were not treated– New decay 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 a 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

• 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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PulpotomySterile cotton pellet wetted with Formocresol solution

Zinc oxide-eugenol cement

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Apicoectomy

• Apex of root and infection is surgically removed

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Root Amputation

• Surgical procedure to remove one or more of the roots of a multi-rooted tooth

• Extensive bone loss around the root

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Hemisection

• Surgical removal of one root and overlying crown

• Diseased portion is removed

• Indications are similar to root amputation

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Apexification

• Treatment of the apex of the root canal in a tooth that is necrotic

• Creates a calcified barrier

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Apexogenesis

• Treatment of pulp of a young tooth with an open apex

• Tooth is vital but has carious or traumatic exposure