Dental Specialties Proc & Exp Funct- Ch 54

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