Presentation on theme: "Introduction to endodontics, pathohistological and clinical classification of pulpal diseases, indication and contraindication of endodontic treatment."— Presentation transcript:
1Introduction to endodontics, pathohistological and clinical classification of pulpal diseases, indication and contraindication of endodontic treatment4.Year - Dental Medicine
2Pulp normality The CLINICALLY NORMAL PULP vital to testing procedures histologic normalityclinical normalityThe CLINICALLY NORMAL PULPvital to testing proceduresresponcive to a variety of excitationsfree of spontaneous symptoms !!!The MICROSCOPICALLY NORMAL PULP demonstrates only those histologic features that are compatible with its age.It is free of inflammatory change of any type!!!
5Dental pulpDP : dental pulp OB : odontoblast D : dentin PD : predentin TF : Tom's fiber
6The response of the pulp The response of the pulp to injury or irritants occcur very soon, when the stimuly are mildPulpodentonal reactions occurs when chemical, mechanical, bacterial irritants attack the odontoblasts, namely Tome´s fibers, transmit a excitation to the pulpThe response of the pulp depends on the character and intensity of stimuly
7Histopathologic classification of pulpal diseases A. Regresive changesB. Inflammatory changesPulpal hyperemyAcute pulpitisChronic pulpitisC. Necrosis of the pulpD. Gangraena of the pulpAcute pulpitisserose partialtotalpurulent partialChronic pulpitisclausaa tergogranulomatosa internaaperta ulcerosaaperta hypertrophica
8A. Regresive changes vacuolar degeneration of odontoblasts hyalinic degeneration of the pulplipidic degeneration of the pulpreticular atrophypathological calcification
9Regresive changes: Vacuolar degeneration of odontoblasts Odontoblasts react very quickly for many stimulies.We can often find parts with vacuolization of odontoblasts.This change can be result of pathologic damage of the pulpIt is the result of intracellular or extracellular break - down of cells metabolism
10A. Regresive changes: Hyalinic degeneration of the pulp In this regresiva change, we can find an albumenic substances in the pulpThis type of degeneratin is typical in teeth:of old peoplewith chronic inflammation
11Regresive changes: Lipidic degeneration of the pulp Reticular atrophy We can find it in pulp with chronic inflammationIt is break - down of metabolism, and the result isthe lipids in cellsRETICULAR ATROPHY:It is regresive change present in pulp of old peopleLost odontoblasts and pulpal cells are compensated by tissue
12A. Regresive changes: Pathological calcification Normal pulp doesn´t contain hard calcified substancesPULPAL DENTICUL - is hard, mineralisated substance located in the pulpal tissueUsually in pulp we can find denticulsSometimes they are small microscopic, sometimes biggist and they can fill pulp chamber or root canal, or obliterate it totally.
13Clinical classification of pulpal diseases 1. HEALTHY PULP:without clinical symptoms2. REVERSIBLE FORM OF PULP INFLAMMATION:pulp with clinical symptoms, in which we can preserve the vitalityof the pulp by treatment3. IRREVERSIBLE FORM OF PULP INFLAMMATION:pulp with clinical symptoms, in which we cannot preserve the vitality4. DEATH OF THE PULP:pulp with lost vitality, necrotic, gangrenous
14Symptoms typical for reversible process pain present only for impulse, never spontaneouspatient can localize the painpain is of short duration,analgetics stop the painVitality test: short sensation, it leaves immediatelypain for percussion is never presentRTG: caries, filling next to the pulptercial dentine is presentperiapical finding is negative
15Symptoms typical for irreversible process spontaneous pain through day, intervals without pain are shorter,intervals with pain start to be longerpain through night is presentpain is neuralgiformicanalgetics do not stop the painVitality test: attack of neuralgiformic painwhich leaves very slowlypulzating painpatient cannot localize the tooth, sometimes even the jawpain for percussion is present, periapex is inflammedRTG: caries, filling close to the pulp, or in pulptercial dentine is not present
16Right diagnosis How do the right diagnosis? anamnesis symptomatology clinical examinationsknowlwdges of pathology of the pulpclinical experiencesFrom all this points we make the clinical dg.:REVERSIBLE OR IRREVERSIBLE PULPAL DISEASE
17Reversible or irreversible pulpal disease? Reversible form of pulp inflammation turns into irreversible form of pulp inflammation- to pulpitis.In clinical practice this moment play the key role in decision of the TREATMENT CHOICE -to treat hyperemia without pulpotomy or extirpation and preserve the pulp vitality orto treat pulpitis as irreversible inflammation with endodontic treatment.
18Reversible or irreversible pulpal disease? The appropriate decision is not easy because the histologic changes are frequently not in correlation withthe clinical symptoms.for appropriate diagnosis we have clinical symptoms
19Reversible or irreversible pulpal disease? B. INFLAMMATORY CHANGES:HyperemyAcute pulpitis acute serous partial pulpitis––––––––––––––––––––––––––––––––––––––––––––––- acute serous total pulpitis- acute purulent partial pulpitis- acute purulent total pulpitisChronic pulpitisC. NECROSISD. GANGRAENAreversibleirreversibleEndodontic
20Endodontic treatment What is endodontics? Endodontics is the area of dentistry concerned with the prevention, diagnosis and treatment of disorders of the dental pulpYears ago, such teeth with diseased or injured pulps were extracted. Today endodontic treatment offers a way for a safe and effective means of saving the teeth.
21Considerations for endodontic therapy 1. Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis?2. Is the tooth salvageable, or is it so badly destroyed that it cannot be restored?3. Is the entire dentition so completely broken down that it would be virtually impossible to restore?4. Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement?5. Is the tooth so severely involved periodontally that it would be lost soon for this reason?6. Is the practitioner capable of performing the needed endodontic procedures?
22Indications for endodontic therapy Presence of irreversible pulpal diseaseProphylactic pulpal therapy which may be needed prior to other treatment procedures (restorative dentistry, prosthodontics & periodontics)
23Contraindications for endodontic therapy The objections are listed according to:status of the patientdental reasonslocal reasonsStatus of the patient:Age - past middle lifeHealth of the patient - DM, leukemia, terminal cancer, radiationnecrosis, tuberculosis, syphilis ...Too many treated pulpless teeth
24Contraindications for endodontic therapy Dental reasons:Pulpless teeth are not salvageable if there are associated periapical and periodontal lesionsLocal reasons:the periapical lesion is an apical cystthe tooth is badly broken down by cariesthe involved tooth is badly fracturedthe involved tooth has a mechanical root perforationthe involved tooth has perforating internal or external root resorptionthe involved tooth is wholly or partially luxated
25Contraindications for endodontic therapy Severe, untreatable periodontal diseaseCondition of remaining teethNon-restorable teethExtensive resorptionVertical root fracturesMalpositioning of teethLimited accessibilityNon-strategic toothAberrant root morphologyUnfavorable crown:root ratioPredicatable failuresProximity to vital structures