Dental Specialties Proc & Exp Funct- Ch 54- complete

Endodontics

The specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the perio radicular tissues surrounding the root of the tooth

Causes of Pulpal Nerve Damage

Physical irritation

• Extensive decay moving into the pulp

Trauma

• Blow to a tooth or jaw

Signs and Symptoms of Pulpal Nerve Damage

Pain when occluding

Pain during mastication

Sensitivity to hot or cold beverages

Facial swelling

Fever

Tenderness of surrounding gums

Cracked or discolored teeth

Endodontic Diagnosis: Subjective Examination – Patient Describes

Chief complaint

Painful stimuli

Character and duration of pain

Sensitivity to biting and pressure

Endodontic Diagnosis: Objective Examination – Dentist Findings

Extent of decay

Periodontal conditions

Extensive restoration

Tooth mobility

Swelling or discoloration

Pulp exposure

Percussion Test

Determines whether the inflammatory process has extended into the periapical tissues

The dentist taps on the incisal or occlusal surface with the end of the mouth-mirror handle held parallel to the long axis of the tooth

Palpation Test

Determines whether the inflammatory process has extended into the periapical tissues

The dentist applies firm pressure to the mucosa above the apex of the root

Thermal Sensitivity

Necrotic pulp will not respond to cold or heat

1. Cold test

• Ice, dry ice, or carbon dioxide is used to determine the response of a tooth to cold

2. Heat test

• A piece of gutta-percha or an instrument handle is heated and applied to the facial surface of the tooth

Electric Pulp Testing

A small electrical stimulus is delivered to the pulp-determine if tooth is vital or nonvital.

Factors that may influence readings include:

• The patient has extensive restorations

• The patient has teeth with more than one canal

• Failing pulp produces a variety of responses

• Control teeth don’t respond as anticipated

• There is moisture on the tooth during testing

• The batteries in the tester weaken over time

Five (5) Radiographic Imaging Taken for Endodontic Treatment

Initial radiograph: Diagnosis

Working length image: To determine the length of the canal

Final instrumentation image: Final size files in all canals

Root canal completion image: Taken after the tooth has been temporized

Recall image: Taken at posttreatment evaluations

Requirements of Radiographic Images

Must show apex of the tooth and the surrounding bone or pathologic condition

Must present an accurate image

Must exhibit good contrast so that all pertinent structures are readily identifiable

A. Good contrast around apex

B. Poor Contrast around apex

Diagnostic Conclusions

Normal pulp

• No subjective symptoms or objective signs are noted

• The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp

Pulpitis

• The pulp tissues have become inflamed

Reversible pulpitis

• The pulp is irritated, and the patient is experiencing pain in response to thermal stimuli

Irreversible pulpitis

• The tooth displays symptoms of lingering pain (pulp incapable of healing)

Diagnostic Conclusions: Periradicularor Periapical Abscess

This inflammatory reaction surrounding the tip of the root has pulpal infection which can be chronic or acute onset with pain, tenderness of the tooth due to pressure, pus(exudate), and swelling of the tissues.

Tooth has experienced bone loss and bacteria having access along the root.

• Chronic-presence of a draining sinus tract

• Acute-pain, tenderness, swelling because of the necrosis (dying)

Diagnostic Conclusions: Periodontal Abscess

Inflammatory reaction caused by bacteria trapped in the periodontal sulcus

A patient will experience rapid onset of pain, tenderness of the tooth in response to pressure, pus formation, and swelling

• Chronic

• Acute

Diagnostic Conclusions: Periradicular or Perioapical Cyst

This type of cyst develops at or near the root of a necrotic tooth

The cyst develops as an inflammatory response to pulpal infection and necrosis of the pulp

Diagnostic Conclusions: Pulp Fibrosis

A decrease in living cells within the pulp causes fibrous tissue to take over the pulpal canal

(Mostly seen in older patients.

Patients with recent trauma to a tooth may be susceptible)

Diagnostic Conclusions: Necrosis

The tooth may also be referred to as nonvital

• The term is used to describe a tooth that does not respond to sensory stimulus

Endodontic Procedures: Pulp Capping

Pulp capping is an attempt to save the tooth.

Calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin at the site of injury

2 types of capping:

• Indirect pulp capping (IPC) is indicated when a thin portion of dentin is still intact

• Direct pulp capping (DPC) is indicated when the pulp has been slightly exposed

Endodontic Procedures: Pulpotomy

This procedure involves removal of the coronal portion of an exposed vital pulp

It is used to preserve the vitality of the remaining portion of the pulp within the root of the tooth

The procedure is commonly indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations

Endodontic Procedures: Pulpectomy

This procedure involves the complete removal of the dental pulp

Also referred to as root canal therapy

Instruments and Accessories for Endodontic Procedures

Hand instruments

Explorer

Endodontic spoon excavator

Spreaders and pluggers

Glick Number 1-used to remove excess gutta

percha

ORDER OF INSTRUMENTS USED IN ENDO

TREATMENT

1. Endo Explorer

2. Files

3.Paper Points

4.Gutta Percha

5. Glick Number 1

Hand-operated files

K-type file- cleaning of canal initially

Hedstrom file- spiral edges, cutting occurs only in the pulling stroke

Reamer file- remove dentin, to smooth and increase size of canal

Broaches- remove necrotic pulp tissue from canal

Rotary-operated files and burs

Gates-Glidden burs-first instrument used to enlarge

the cervical portion of the root canal.

Pesso files-to prepare canal for endodontic post

Auxiliary instruments

Rubber stops

Paper points-used to dry canal

Microscopic Endodontics

Medicaments and Dental Materials in Endodontics

Irrigation solutions

• Sodium hypochlorite (Bleach)

• Ethylenediaminetetraacetic acid (EDTA)

• Chlorhexidine (Peridex)

Intracanal medicaments

• Calcium hydroxide

• Chlorhexidine gel

Root canal sealers

Root canal filling materials

• Gutta-percha points

Overview of Root Canal Therapy

Anesthesia and pain control

Isolation and disinfection of the operating field(rubber dam)

Access preparation

Estimated working length (files)

Electronic apex locator

Debridement and shaping of the canal

Obturation (filling and sealing a tooth with root canal material)

Surgical Endodontics

Indications for surgical intervention

Endodontic failure

• 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 did not occur

Biopsy

Apicoectomy and Apical Curettage

To surgically remove the apical portion of the root with the use of a high-speed handpiece and bur

To evaluate the following:

• Inadequate sealing of the canal

• Accessory (extra)canals

• Fractures of the root

• Pathologic tissue around the root apex

Retrograde (root-end filling) Restoration

This procedure is undertaken 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

Root Amputation and Hemisection

Root amputation

• This surgery is performed to remove one or more roots of a multirooted tooth without removing the crown

Hemisection

• The root and the crown are cut lengthwise and removed

abscess

a localized infected area with accumulating pus

acute

sudden or onset illness or pain with a short duration

apical curettage

a surgical procedure that involves the removal of tissue surrounding the apex of a tooth

apicoectomy

a surgical procedure to remove the apex of a tooth's root, usually to treat infection.

chronic

a long-lasting condition or illness that persists over time.

control tooth

A tooth that is used as a reference for comparison in dental studies or treatments.

debridement

The process of removing decayed or infected tissue from a tooth or surrounding area and cleaning out the pulpal canal

direct pulp cap

application of a dental material with an exposed or nearly exposed dental pulp

endodontist

A dental specialist who diagnoses and treats dental pulp and root canal issues, focusing on saving teeth with advanced procedures.

gutta-percha

A biocompatible material used to fill and seal the pulpal canal during root canal treatment.

indirect pulp cap

placement of a sedative material when pulp tissue is close to the surface but not completely exposed

irreversible pulpitis

A painful condition occurring when the dental pulp becomes inflamed and irreversibly damaged, often requiring root canal therapy.

nonvital

dead

obturation

The process of filling a root canal space after endodontic therapy to seal it and prevent reinfection.

palpatation

The act of applying pressure to a specific area of the body to assess for pain, swelling, or other abnormalities.

percussion

The act of tapping on a surface to elicit sounds or vibrations in order to assess underlying structures or conditions.

periodontal abscess

localized infection within the periodontal sulcus

periradicular

refers to the area of nerves, blood vessels, and connective tissue surrounding the apex of a tooth root.

periradicular abscess

inflammatory reaction to pulpal infection

pulpectomy

a dental procedure that involves the removal of the pulp tissue from the tooth to treat infection or decay.

pulpitis

inflammation of the dental pulp

pulpotomy

a dental procedure involving the removal of only the crown portion of the pulp tissue to preserve the tooth.

retrograde restoration

a procedure in which a filling is placed into the root canal after the tooth has been treated, often used to seal the canal and prevent further infection.

reversable pulpitis

a condition where the inflammation of the dental pulp is temporary, typically allowing for recovery if treated promptly.

root canal therapy

a dental procedure used to treat infection or damage to the dental pulp by removing it and sealing the root canals, thereby preserving the tooth.