Endodontics - An Introduction

A short presentation that talks about what endodontics is and what endodontists do and what their future is.

1. An introduction ENDODONTICS Dr. Aaron Sarwal

2. DEFINITION Branch of dentistry concerned with the: Morphology Physiology Pathology of the human dental pulp and peri-radicular tissues. Abscess

3. SCOPE OF ENDODONTICS Its study and practice encompass: Biology of the normal pulp Etiology Diagnoses Prevention Treatment of diseases and injuries of the pulp and associated peri-radicular tissues.

4. PRINCIPLES OF ENDODONTIC THERAPY Diagnosis Patient education Local anaesthesia Isolation Rubber dam isolation Access cavity Working length Instrumentation Obturation Final restoration

5. DIAGNOSIS According to Ingle, diagnosis is the procedure of Accepting a patient Recognizing that he has a problem Determining the cause of the problem and Developing a treatment plan that will solve or alleviate the problem

6. DIAGNOSIS

7. PATIENT EDUCATION Patient should be informed about the condition of his teeth and the treatment options available. Instructions to the patient about improvement of the oral hygiene.

8. LOCAL ANAESTHESIA Similar to the local anesthesia given for various other dental procedures. Supplemental anesthesia may be required for certain cases – "Hot Tooth"

9. ISOLATION Rubber Dam isolation - usually a single tooth isolation. Isolation is very important not only for maintaining a sterile field but also to prevent aspiration of irrigation materials and instruments

10. ACCESS CAVITY

11. WORKING LENGTH The distance from a coronal reference point to the point at which canal preparation and obturation should terminate.

12. INSTRUMENTATION May be done using hand instruments or rotary instruments. Simultaneous irrigation and lubrication are essential.

13. OBTURATION Many techniques: Hot/ Cold Lateral/ Vertical Single Cone/ Multiple Cone

14. FINAL RESTORATION Many options. Ideally should provide strength to the remaining tooth structure. Should promote physiological function of the tooth and the surrounding tissues.

15. INDICATIONS Carious teeth [caries involving pulp] Teeth with irreversible pulpitis Necrotic pulps Treatable periodontal conditions [endo-perio lesions] Salvageable resorptive defects Supra-erupted teeth with good bone support Fractured teeth involving pulp Intentional endodontics for FPD's or over-dentures

16. Insufficient periodontal support. CONTRAINDICATIONS

17. Canal instrumentation not practical: Calcification of the canal Sharp dilacerations/curvature of the roots CONTRAINDICATIONS

18. Non restorable teeth CONTRAINDICATIONS

19. CONTRAINDICATIONS Inadequate crown root ratio Vertical tooth/root fracture

20. Patient's general medical condition: Patients general medical condition is never an absolute contraindication to endodontic therapy However, management of other medical conditions may take precedence over endodontic therapy for eg : pregnancy, diabetes, hypertension. CONTRAINDICATIONS

21. BEFORE UNDERTAKING ENDODONTICS Relating to the tooth in question: Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis? Is the tooth salvageable, or is it so badly destroyed that it cannot be restored?

22. BEFORE UNDERTAKING ENDODONTICS Relating to the patient’s general dentition: Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement? Is the tooth so severely involved periodontally that it would be lost soon for this reason?

23. The future of endodontics is very bright, indeed! Techniques and material advancements make the future of endodontics exciting and profitable for all dentists.  Instrumentation also will evolve dramatically. We will see more sophisticated design features on rotary files to increase efficiency, yet maintain safety, as with the new K3 file by SybronEndo . FUTURE OF ENDODONTICS

24. FUTURE OF ENDODONTICS Enhanced magnification, using either a microscope or loupes, is a must when performing challenging endodontic procedures. In the future, as these tools become more affordable, we will observe more general practitioners performing dental procedures under a microscope or with a good set of loupes and an external light source.

25. Obturation has benefitted from major changes in the past 10 years. Expect the introduction of new materials, and also a change in sealer characteristics. Most likely, more "resin dentistry" will be introduced into endodontics. The art of filling a root canal will progress scientifically. However, future obturation improvements will continue to be contingent upon good cleaning and shaping. FUTURE OF ENDODONTICS