©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontics Chapter 24

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontics Branch of dentistry that deals with diagnosis and treatment of diseases of pulp and periapical tissues

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Progress of Pulpal and Periapical Disease Vital pulp –Healthy pulp –May be inflamed –Capable of healing after irritant removed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Progress of Pulpal and Periapical Disease Nonvital pulp –Tooth no longer responds to stimuli –Tooth considered necrotic –Unable to heal

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Reversible Pulpitis Inflamed pulp able to heal when irritant removed Causes: –Caries –Enamel fracture –Occlusal attrition

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Reversible Pulpitis Symptoms: –Thermal sensitivity Treatment: –Remove irritant –Place sedative dressing

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulp Irritants Leading to Irreversible Pulpitis Advanced dental decay Impact trauma Fractures Invasive restorative procedures Adverse reaction to dental material

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Irreversible Pulpitis Results from prolonged inflammation Pulpal tissue unable to heal Pain symptoms: –Dull and continual –Short and sharp Treatment: –Root canal therapy –Extraction

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulpal Necrosis Death of pulpal cells Exudate (pus) and gas form in pulp chamber Process slowed if pressure released through: –Fistula –Caries

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periapical Diseases Apical periodontitis Periapical abscess Courtesy of Clifton O. Caldwell, Jr., DDS., FICD, FACD.

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Apical Periodontitis Pulpal inflammation that has spread to periapical tissues Inflammation creates: –Granuloma Tumor filled with granulation tissue –Cyst Fluid-filled or semisolid-filled

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periapical Abscess Destruction of tissue Exudate present Pressure must be released

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Diagnosis Medical and dental history Clinical examination Referring dentist’s notes

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Medical History Review and clarify medical history –Medical conditions –Medications

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental History Review past dental experiences Current concerns –Subjective examination Type of pain Thermal sensitivity Duration of pain

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Examination Current concerns –Objective examination Extraoral tissues Facial asymmetry Swelling Redness Fistulas

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intraoral Clinical Examination Tissues evaluated and palpated –Caries –Discoloration –Fractures

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Testing Procedures Radiographs –Radiolucent area on x- ray indicates bone involvement Palpation Percussion © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Testing Procedures Mobility Cold test –Dry ice, ethyl chloride, and ice Heat test © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Testing Procedures © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Testing Procedures Pulp testing –Indicates if tooth is vital or nonvital Transillumination test Selective anesthesia Caries removal

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What is an advanced stage of periapical infection that spreads into the bone? –Osteomyelitis

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 –Flex files © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Reamers –Enlarges canal –Applies with twisting motion –Color-coded system © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Organizers –Various options to store and organize reamers and files –Some can be sterilized

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Rubber stops –Also known as 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

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 marked near notch of shank

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Gates-Glidden drills –Used in upper portion of canal to prepare opening access by removing obstructing dentin Courtesy of Sybron Endo

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 post and to reduce curvature of canal orifice for straight-line access

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Endodontic spoon excavator –Double-ended –Long-shanked –Removes: Caries Pulp tissue Temporary cement Courtesy of Hu-Friedy Mfg., Co., Inc.

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Endodontic explorer –Locates opening of canals –Long, tapered ends –Double-ended with sharp-pointed ends Courtesy of Hu-Friedy Mfg., Co., Inc.

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Endodontic spreaders –Similar to pluggers But pointed at tip –Condense gutta percha into sides of canal © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Endodontic pluggers –Used to condense gutta percha –Flat-ended

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Instruments Glick #1 instrument –Used to remove excess gutta percha from coronal portion of canal –Used to condense remaining gutta percha in canal opening

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Which intracanal instrument comes in diameters ranging from xxx-fine to coarse? –Barbed broach

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Materials Paper points –Extra-fine to coarse –Uses: Dries canals Places medications Takes cultures © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Materials Gutta percha –Obturates (fills) canals –Heated and placed in canals –Condensed with spreader and pluggers –Removal of apex and infection surrounding tooth

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Materials Irrigation solutions –Root canal irrigated frequently to remove debris Sterile water Sodium hypochlorite

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Materials Root canal sealers and cements –Root canal series used with obturating materials prevent microleakage in canal –Powders, liquids, pastes, and capsules

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Equipment Assisting Endodontic Procedures Apex finder Heating unit Endodontic handpiece Vitality scanner Ultrasonic unit Endodontic bender Dental microscope Endodontic obturation system

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Procedures Root canal treatment –Usually completed in two appointments –Sometimes infection given time to be treated before canal sealed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. General Steps in Root Canal Therapy 1.Administer anesthetic 2.Isolate area 3.Gain access to pulp 4.Locate canals 5.Remove pulpal tissue

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Retreatment Causes: –Abscess did not heal –Narrow or curved canals were not treated –New decay grew along filling –Complicated canal anatomy went undetected

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Endodontic Retreatment Causes: –Restoration did not occur soon enough after treatment –Restoration became loose, cracked, or broken and exposed tooth to new decay

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulpectomy Complete removal of pulp First stage of root canal Indicated for: –Permanent teeth with deep caries –Vertical fracture

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulpotomy Pulp removed from coronal portion Pulp remains in root canal

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulpotomy Treatment indicated: –Primary teeth with pulpal exposure –Pulp exposed after accident –Deep carious lesions –Root does not develop completely –Anterior tooth is fractured

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulpotomy Sterile cotton pellet wetted with Formocresol solution Zinc oxide- eugenol cement © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Endodontics Sometimes required to save tooth Involves facial surface incision to expose bone Root exposed and treatment performed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Apicoectomy Apex of root and infection surgically removed © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Root Amputation Surgical procedure to remove one or more of the roots of multi- rooted tooth Extensive bone loss around root Courtesy of Dr. Gary Shellerud

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hemisection Surgical removal of one root and overlying crown Diseased portion removed Indications similar to root amputation Courtesy of Dr. Gary Shellerud

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Apexification Treatment of apex of root canal in necrotic tooth Creates calcified barrier

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Apexogenesis Treatment of pulp of young tooth with open apex Tooth vital, but has carious or traumatic exposure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What are some reasons for a root canal treatment (RCT) to fail? –Abscess did not heal –Narrow or curved canals were not treated –New decay grew along filling –Complicated canal anatomy went undetected –Too long in between treatment appointments –New infection due to trauma