DVD 11. Access, cleaning, shaping and filling of a canal in an acrylic block using crown-down technique

DVD 21. Access, cleaning, and shaping of root canal using hand ProTaper instruments2. Access preparation, cleaning and shaping of root canal using rotary ProTaper instruments3. Multiple Choice Questions according to chapters

DVD Contents

Contents

1. Introduction and Scope of Endodontics 1History of Endodontics 1; Modern Endodontics 1; Patient Education 3

2. Pulp and Periradicular Tissue 7Development of Dental Pulp 7; Histology of Dental Pulp 8; Supportive Elements 11; Innervation of Pulp 13; Anatomy of Dental Pulp 15; Pulp Chamber 15; Root Canal 15; Functions of Pulp 17; Age Changes in the Pulp 18; Pulpal Calcifications/Pulp Stones/Denticles 18; Calcific Metamorphosis 19; Periradicular Tissue 19

3. Pathologies of Pulp and Periapex 22Pulp Pathologies 22; Etiology of Pulpal Diseases 23; Progression of Pulpal Pathologies 24; Diagnostic Aids for Pulpal Pathology 25; Classification of Pulpal Pathologies 26; Barodontalgia/Aerodontalgia 27; Reversible Pulpitis/Hyperemia/ Hyperactive Pulpalgia 27; Irreversible Pulpitis 28; Chronic Pulpitis 30; Internal Resorption 32; Pulp Necrosis 32; Pulp Degeneration 34; Periradicular Pathologies 35; Periapex Pathologies 36; Etiology of Periradicular Diseases 36; Diagnosis of Periradicular Pathologies 37; Classification of Periradicular Pathologies 38; Acute Apical Periodontitis 39; Acute Apical Abscess 39; Phoenix Abscess/Recrudescent Abscess 41; Periapical Granuloma 42; Radicular Cyst/Cystic Apical Periodontitis 44; Chronic Alveolar Abscess 46; Persistent Apical Periodontitis 49; External Root Resorption 49; Diseases of Periradicular Tissue of Nonendodontic Origin 49

4. Endodontic Microbiology 51Portals of Entry for Microorganisms 51; Classification of Microorganisms 53; Microbial Virulence and Pathogenicity 54; Factors Influencing the Growth and Colonization of Microorganisms 55; Microbial Ecosystem of the Root Canal 55; Types of Endodontic Infections 56; Identification of the Bacteria 57; How to Combat Microbes in the Endodontic Therapy? 59

5. Biofilm in Endodontics 61Stages of Biofilm Formation 61; Types of Endodontic Biofilm 61; Ultrastructure of Biofilm 62; Microbes in Endodontic Biofilms 62; Methods to Eradicate Biofilms 63

6. Rationale of Endodontic Treatment 65Theories of Spread of Infection 65; Culprit of Endodontic Pathology 65; Portals for Entry of Microorganisms 66; Inflammation 66; Nonspecific Mediators of Periradicular Lesions 68; Antibodies (Specific Mediators of Immune Reactions) 71; Role of Immunity in Endodontics 71; Endodontic Implications (Pathogenesis of Apical Periodontitis as Explained by Fish) 71; Kronfeld’s Mountain Pass Theory 72; Rationale of Endodontic Therapy 73

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7. Diagnostic Procedures 74Case History 74; Pulp Vitality Tests 82; Recent Advances in Pulp Vitality Testing 85; Diagnostic Findings 87; Role of Radiographs in Endodontics 87; Digital Radiography 91; Digital Dental Radiology 91; Phosphor Imaging System 93

8. Differential Diagnosis of Orofacial Pain 95Pain 95; Diagnosis 95; Orofacial Pain 96; Sources of Odontogenic Pain 96; Pulpal Pain 97; Periodontal Pain 98; Sources of Nonodontogenic Pain 99

9. Case Selection and Treatment Planning 103Endodontic Therapy 103; Contraindications of Endodontic Therapy 104; Treatment Planning 105; Medical Conditions Influencing Endodontic Treatment Planning 106; Sequence of Treatment Delivery 107

10. Asepsis in Endodontics 109Rationale for Infection Control 109; Cross-infection 109; Objective of Infection Control 110; Universal Precautions 110; Classification of Instruments 112; Instrument Processing Procedures/Decontamination Cycle 112; Disinfection 118; Antiseptics 119; Infection Control Checklist 120

11. Isolation of Teeth 122Isolation with Rubber Dam 122; Classification of Rubber Dam Clamps 124

12. Pharmacology in Endodontics 131Anxiety Control 131; Pain Control 132; Intrapulpal Injection 139; Infection Control 141; Guidelines for Antibiotic Prophylaxis 143

13. Endodontic Instruments 145Classification of Endodontic Instruments 145; Group I Hand-operated Instruments 146; Group II Nonrotary Endodontic Instruments 152; Group III Rotary Endodontic Instruments used with a Handpiece 155; Various Rotary Nickel Titanium System 157; Profile System 158; Greater Taper File 158; Protaper File 158; Quantec File System 160; Light Speed System 160; K3 Rotary File System 161; HERO 642 161; Race Files (Reamers with Alternating Cutting Edges) 161; Real World Endo Sequence File 162; Wave One System 162; Instrument Deformation and Breakage 163; Instruments used for Filling Root Canals 166

14. Internal Anatomy 169Pulp Cavity 169; Common Canal Configuration 171; Methods of Determining Pulp Anatomy 172; Variations in the Internal Anatomy of Teeth 174; Factors Affecting Internal Anatomy 180; Individual Tooth Anatomy 180; C-Shaped Canals 191; Classification of C–Shaped Root Canals 191

15. Access Cavity Preparation 196Instruments for Access Cavity Preparation 198; Guidelines for Access Cavity Preparation 199; Access Cavity of Anterior Teeth 201; Access Cavity Preparation for Premolars 203; Access Cavity Preparation for Maxillary Molars 204; Access Cavity Preparation for Mandibular Molars 205; Clinical Managing Difficult Cases for Access Opening 206

Contents xvii

16. Irrigation and Intracanal Medicaments 211Ideal Requirements for an Irrigant 211; Functions of Irrigants 212; Factors that Modify Activity of Irrigating Solutions 212; Commonly used Irrigating Solutions 213; Choice of an Irrigant Solution 213; Normal Saline 213; Sodium Hypochlorite 214; Urea 216; Hydrogen Peroxide 216; Urea Peroxide 217; Chlorhexidine 217; Chelating Agents 218; Ultrasonic Irrigation 220; Newer Irrigating Solutions 221; Method of Irrigation 223; Endovac (Apical Negative Pressure Irrigation System) 225; Intracanal Medicaments 227; Characteristics of Intracanal Medicaments 227; Placement of Intracanal Medicament 232

17. Working Length Determination 235Significance of Working Length 236; Different Methods of Working Length Determination 238; Radiographic Method of Working Length Determination 238; Grossman Method/Mathematical Method of Working Length Determination 239; Electronic Apex Locators 240

18. Cleaning and Shaping of Root Canal System 246Objectives of Biomechanical Preparation 247; Different Movements of Instruments 249; Basic Principles of Canal Instrumentation 251; Techniques of Root Canal Preparation 252; Standardized Preparation Technique (Conventional Technique) 253; Step Back Technique/Telescopic Canal Preparation/Serial Root Canal Preparation 253; Modified Step Back Technique 257; Passive Step Back Technique 257; Coronal to Apical Approach Technique 258; Step Down Technique 259; Crown Down Pressureless Technique 259; Hybrid Technique of Canal Preparation (Step Down/Step Back) 262; Double Flare Technique 262; Modified Double Flared Technique 262; Balanced Force Technique 263; Reverse Balanced Force Preparation 264; Types of Crown Down Hand Instrumentation Techniques 264; Modified Manual Step Down Technique 264; Profile GT (Greater Taper) Technique 264; Quantec Instrument Technique 265; Protaper Files 265; Engine Driven Preparation with NiTi Instruments 267; Profile System 267; Greater Taper Files (GT Files) 268; Light Speed System 268; K3 Rotary File System 270;Real World Endo Sequence File 270; HERO 642 270; Wave One File System 271;Canal Preparation using Ultrasonic Instruments 272; Canal Preparation using Sonic Instruments 273; Laser Assisted Root Canal Therapy 274; Evaluation Criteria of Canal Preparation 274; Special Anatomic Problems in Canal Cleaning and Shaping 275

19. Obturation of Root Canal System 282Timing of Obturation 284; Extent of Root Canal Filling 285; Materials used for Obturation 286; Methods of Sealer Placement 301; Obturation Techniques 301; Armamentarium for Obturation 302; Lateral Compaction Technique 302; Variation of Lateral Compaction Technique 305; Chemical Alteration of Gutta-percha 306; Vertical Compaction Technique 309; System B: Continuous Wave of Condensation Technique 311; Lateral/Vertical Compaction of Warm Gutta-percha 312; Sectional Method of Obturation/Chicago Technique 313; McSpadden Compaction/Thermomechanical Compaction of the Gutta-percha 313; Thermoplasticized Injectable Gutta-percha Obturation 313; Solid Core Carrier Technique 315; Obturation with Silver Cone 318; Apical Third Filling 318; Postobturation Instructions 321; Repair following Endodontic Treatment 322

20. Single Visit Endodontics 323Advantages of Single Visit Endodontics 323; Disadvantages of Single Visit Endodontics 323; Criteria of Case Selection 323; Contraindications of Single Visit Endodontics 325

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21. Mid Treatment Flare-ups in Endodontics 326Etiology 326; Mechanisms for Flare-ups 328; Clinical Conditions Related to Flare-up 330; Management of Flare-ups 331

22. Endodontic Emergencies 335Diagnosis and Treatment Planning 335; Pretreatment Endodontic Emergencies 336; Conditions Requiring Emergency Endodontic Treatment 337; Intratreatment Emergencies 341; Postobturation Emergencies 343

23. Endodontic Failures and Retreatment 345Evaluation of Success of Endodontic Treatment 345; Causes of the Endodontic Failures 346; Case Selection for Endodontic Retreatment 351; Steps of Retreatment 352

24. Procedural Accidents 364Inadequately Cleaned and Shaped Root Canal System 364; Instrument Separation 368; Deviation from Normal Canal Anatomy 373; Inadequate Canal Preparation 375; Perforation 377; Obturation Related 383; Vertical Root Fracture 384; Instrument Aspiration 385

25. Surgical Endodontics 386Contraindications 387; Presurgical Considerations 388; Incision and Drainage 388; Periradicular Surgery 389; Flap Designs and Incisions 391; Principles and Guidelines for Flap Designs 391; Full Mucoperiosteal Flaps 391; Limited Mucoperiosteal Flaps 392; Flap Design Consideration in Palatal Surgery 393; Flap Reflection and Retraction 394; Hard Tissue Management 395; Principles of Surgical Access to Root Structure 395; Periradicular Curettage 396; Root-end Resection (Apicoectomy, Apicectomy) 397; Root-end Preparation 400; Retrograde Filling 402; Reapproximation of the Soft Tissue 404; Replantation 404; Transplantation 405; Root Resection/Amputation 405; Bicuspidization/Bisection 405; Endodontic Implants 409; Postsurgical Care 409; Suturing 411; Postsurgical Complications 411

26. Endodontic Periodontal Relationship 413Pathways of Communication between Pulp and Periodontium 414; Impact of Pulpal Diseases on the Periodontium 416; Impact of Periodontal Disease on Pulpal Tissue 417; Etiology of Endodontic-periodontal Problems 417; Classification of Endodontic-periodontal Lesions 417; Diagnosis of Endodontic-periodontal Lesions 419; Primary Endodontic Lesions 420; Primary Endodontic Lesion with Secondary Periodontal Involvement 421; Primary Periodontal Lesions 422; Primary Periodontal Lesions with Secondary Endodontic Involvement 422; Independent Endodontic and Periodontal Lesions which do not Communicate 426; True Combined Endo-Perio Lesions 426

27. Restoration of Endodontically Treated Teeth 428Importance of Coronal Restoration 428; Factors Making Endodontically Treated Teeth Different from Vital Teeth 429; Restorative Treatment Planning for Endodontically Treated Teeth 430; Components of the Restored Tooth 432; Factors to be Considered while Planning Post and Core 439; Preparation of the Canal Space and the Tooth 447; Core 450; Custom-made Post 451; Core Fabrication 452; Investing and Casting 452; Evaluation 452; Cementation 452

Contents xix

28. Management of Traumatic Injuries 454Classification of Dentofacial Injuries 454; Examination of Traumatic Injuries 455; Crown Infraction 457; Crown Fracture 458; Complicated Crown Fracture 459; Crown Root Fracture 463; Root Fracture 467; Luxation Injuries 471; Assessment of Traumatic Injuries 477; Prevention of Traumatic Injuries 478

29. Pulpal Response to Caries and Dental Procedure 480Response of Pulp to Dental Caries 481; Response of Pulp to Tooth Preparation 482; Response of Pulp to Local Anesthetics 485; Effect of Chemical Irritants on Pulp 486; Dentin Sterilizing Agents 486; Cavity Liner and Varnishes 486; Response of Pulp to Restorative Materials 486; Restorative Resins 488; Effects of Pin Insertion 488; Impression Material 489; Effects of Radiations on Pulp 489; Effect of Heat from Electrosurgery 490; Effect of Lasers on Pulp 490; Defense Mechanism of Pulp 490; Prevention of Pulpal Damage due to Operative Procedure 491; How does Pulp Recover? 491

30. Management of Discolored Teeth 492Classification of Discoloration 492; Bleaching 496; Contraindications for Bleaching 496; Bleaching Agents 497; Home Bleaching Technique/Night Guard Bleaching 497; In-Office Bleaching 499; Bleaching of Nonvital Teeth 502; Effects of Bleaching Agents on Tooth and its Supporting Structures 505

31. Tooth Resorption 507Classification of Resorption 507; Cells Involved in Tooth Resorption 508; Mechanism of Tooth Resorption 509; Factors Regulating Tooth Resorption 509; Internal Resorption 510; External Root Resorption 516; Cervical Root Resorption (Extracanal Invasive Resorption) 522

32. Tooth Infractions 524Tooth Infractions 524; Vertical Root Fracture 529

33. Tooth Hypersensitivity 531Mechanism of Dentin Sensitivity 531; Incidence and Distribution of Dentin Hypersensitivity 532; Etiology and Predisposing Factors 532; Differential Diagnosis 534; Diagnosis 534; Treatment Strategies 534

34. Pediatric Endodontics 538Anatomy of Primary Teeth 538; Pulp Treatment Procedures 540; Pulpotomy 542; Pulpectomy for Primary Teeth 545; Apexification 548; Mineral Trioxide Aggregate 551

35. Geriatric Endodontics 554Age Changes in the Teeth 554; Endodontics in Geriatric Patients 555; Diagnosis and Treatment Plan 558

36. Lasers in Endodontics 561History 561; Classification of Laser 562; Laser Physics 562; Type of Lasers 564; Laser Interaction with Biological Tissues 564; Laser Safety in Dental Practice 565; Soft and Hard Tissue Applications of Lasers in Dentistry 566

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37. Magnification 569Loupes 569; Surgical Operating Microscope 570; Endoscope 572; Orascope 572

38. Ethics in Endodontics 574Principles of Ethics 574; Root Canal Ethics 574; Informed Consent 575; Dental Negligence 575; Malpractice and the Standard of Care 576; Abandonment 577; Malpractice Cases 577

39. Tissue Engineering 579Strategies of Stem Cell Technology 579; Triad of Tissue Engineering 579; Dental Pulp Stem Cells 582; Stem Cells from Human Exfoliated Deciduous Teeth 582; Periodontal Ligament Stem Cells 582; Stem Cell Markers 582; Morphogens/Signaling Molecules 582; Scaffold/Matrix 583; Approaches to Stem Cell Technology 583; Revascularization to Induce Apexification/Apexogenesis in Infected Non-vital Immature Tooth 586; Apexification 586; Pulp Revascularization 586; Pulp Revascularization in Immature Teeth 587; Mechanism of Revascularization 587; Advantages of Revascularization Procedure 588; Limitations of Revascularization Procedure 588

Index 591