Endodontics Chapter 54

Endodontics
Chapter 54

1. Copyright 2003, Elsevier Science (USA). All rights reserved.
Endodontics
Chapter 54
Copyright 2003, Elsevier Science (USA).
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ISBN 0-7216-9770-4

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Endodontics is the specialty of dentistry that
manages the prevention, diagnosis, and
treatment of the dental pulp and the
periradicular tissues that surround the root of
the tooth.
Introduction

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

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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
Endodontic 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
Endodontic 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.
Diagnostic Testing- cont’d

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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.
Diagnostic Testing- cont’d

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Fig. 54-4 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

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Fig. 54-5 Quality radiograph in endodontics.

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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.
Diagnostic Conclusions- cont’d

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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.
Diagnostic Conclusions- cont’d

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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.
Diagnostic Conclusions- cont’d

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Pulp fibrosis
•The decrease of living cells within the pulp
causing fibrous tissue to take over the
pulpal canal.
Diagnostic Conclusions- cont’d

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Necrotic tooth
•Also referred to as nonvital. Used to
describe a tooth that does not respond to
sensory stimulus.
Diagnostic Conclusions- cont’d

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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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Fig. 54-11 Spreader and plunger.

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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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Fig. 54-13 Example of a pulpotomy.

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Pulpectomy
•Also referred to as root canal therapy;
procedure involves the complete removal
of the dental pulp.
Endodontic Procedures- cont’d

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Fig. 54-14 A diagram of a 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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Table 54 1 Colors and Sizes of Endodontic Files
‑

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Rubber stops
Paper points
Spreaders
Pluggers
Glick No. 1
Millimeter ruler
Instruments and Accessories for
Endodontic Procedures- cont’d

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Rotary instruments
•Gates-Glidden bur
•Pesso reamer
•Lentulo spiral
Instruments and Accessories for
Endodontic Procedures- cont’d

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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 highspeed 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