7 Endodontic Disease

Endodontics

this is the study of the basics and clinical sciences of normal *dental pulp*

Enamel

This is the hardest substance in the body

Hydroxyapatite

What is enamel mainly composed of?

true

TRUE OR FALSE: enamel is avascular

Thickest: crown

Thinnest: cementoenamel junction

Where is enamel the thickest? Thinnest?

CATS: 0.1-0.3 mm

DOGS: 0.1-0.6 mm

How thick is enamel in cats? Dogs?

Dentin

What does the enamel directly cover?

This just means that exposed dentin is VERY SENSITIVE

There are 29,000-52,000 dentinal tubules per mm^2 of cut dentin in the maxillary canine tooth in the dog. Who cares?

Primary: forms PRIOR TO eruption

Secondary: forms AFTER eruption (because remember the young dog has a wide pulp chamber and the older dog has a thin pulp chamber in health)

Tertiary: formed in response to trauma, discolored

How many types of dentin are there and what is the difference?

Pulp --> should be thought of together with dentin (as the dentin pulp complex)

This is the part of the tooth where tissue within the root canal consists of blood vessels, nerves, fibroblasts, collagen fibers, odontoblasts, and other connective tissue cells

Pulp narrows due to the continuous production of dentin

Why is the pulp wide in young dogs and narrow in old dogs?

Odontoblasts

What are the cells responsible for new production of dentin?

Cementum

This is the off-white colored substance that covers the root surface, which may cause tooth sensitivity

Cementoenamel junction

Where does cementum formation begin in the tooth?

Hypercementosis

This condition is common in cats, where the cellular cementum of the root apex increases in thickness overtime due to occlusal stresses of the tooth. May potentially cause bulbous thickening of the apex

1. Traumatic dentoalveolar injuries

2. developmental diseases

3. intrinsically stained teeth

What are the 3 broad categories of endodontic disease?

Traumatic dentoalveolar injuries

Alveolar fractures, enamel infraction, concussion, tooth fracture, tooth avulsion, tooth subluxation, and luxation are all examples of what type of endodontic disease?

Developmental disease

Enamel defects (hypoplasia, hypomineralization, dentinogenesis and amelogenesis imperfecta), pulp stones, and regional odontodysplasia are examples of what type of endodontic disease?

1. Uncomplicated crown fracture: only dentin exposed, only crown affected

2. Complicated crown fracture: pulp exposed, only crown affected

3. Complicated crown-root fracture: pulp exposued, crown and root affected

4. Root fracture: rare, root affected

Name the types of tooth fractures and the differences between each.

enamel infraction

What is this?

Extrusive luxation

What is this?

Intrusive luxation (pushed in)

What is this?

Uncomplicated crown fracture

What is this?

Crown-root fracture WITHOUT pulp involvement (uncomplicated)

What is this?

root fracture

What is this?

Complicated crown fracture

What is this?

Complicated crown root fracture

What is this?

Alveolar fracture

What is this?

Avulsion (tell the client to put the tooth and milk, will still be viable 6-8 hours later)

What is this?

Enamel fracture

What is this?

Traumatic dentoalveolar injuries

What is the second most common oral disease (second to periodontal disease)?

MOST COMMON OVERALL: canine then premolars

MOST COMMON LUXATION: canine and incisors

MOST COMMON FRACTURE: premolar (PM4) then canine

What teeth are commonly affected by traumatic dentoalveolar injuries? Which are the most commonly luxated? How about fractured?

enamel infraction

What is this?

Uncomplicated crown root fracture

What is this?

Complicated crown root fracture

What is this?

root fracture

What is this?

Enamel fracture

What is this?

enamel infraction

this is defined as an incomplete fracture or crack of the enamel, no tooth structure is lost and you do not need to treat

enamel fracture

this is a fracture with loss of crown substance confined to the enamel. it is rare and treated with odontoplasty (basically just smooth the edges, same as uncomplicated crown fracture)

Enamel Defects: Hypomineralization

What is this?

Enamel hypoplasia

This occurs when there is inadequate deposition of enamel matrix, resulting in normal density but thin enamel layer

Enamel hypomineralization

This occurs when there is inadequate mineralization of the enamel matrix resulting in white/yellow/brown spots in the enamel = crowns are softer and wear faster

Dentinogenesis imperfecta

This hereditary abnormality in the formation of the dentin causes the enamel to separate from the dentin easily

Amelogenesis imperfecta

This is a general term that includes any genetic/developmental enamel formation and maturation abnormality

Pink intrinsic staining but we don't know what causes it: trauma, thermal damage, etc.

What is happening here?

Pink, yellow, and grey

What are the three main shades that manifest the changes in the pulp of traumatized teeth?

Enamel discoloration is related to tetracycline antibiotics: tetracyclines bind Calcium --> byproducts incorporated into enamel and dentin = yellow/orange/brown staining

What is the deal with tetracycline staining in teeth?

Image A is NORMAL. Image B is ABnormal = tooth turns purple/pink with transillumination telling you there is pulp necrosis

Which one of these images is normal? Abnormal? What is this telling you?

*root canal therapy* preferred

How do you treat intrinsically stained teeth?

Image 1 contains nonvital teeth = wide pulp means dead tooth in 404.

Image 2 shows a normal 304 pulp cavity

Which of these images contains nonvital teeth?

Vital pulp therapy (direct pulp capping)

What endodontic treatment can you do for complicated crown fractures UNDER 48 hours old in young dogs?

When did the trauma occur?

What is one of if not the most CRITICAL question to ask about traumatic dentoalveolar injuries?

With acute avulsion where the owner recovers the tooth = have owner PLACE IT IN MILK. If you replace the tooth in the alveolus WITHIN 24 HOURS there is a chance to save the tooth

What is the treatment option with tooth avulsion? What can you tell the owner when it happens and how long do you have to fix it?

Luxation injury, 2 fracture areas present in right image. Incisor missing and areas of active hemorrhage. 304 canine is asymmetric.

Splint tooth with wire to stabilize

Describe what you are seeing here. How do you fix it?

Enamel Fracture

What is this?

Uncomplicated crown fracture: bacteria can easily penetrate dentin via tubules because tooth structure is lost = odontoplasty to treat (same as enamel fracture)

What is this? What is the problem? How do you treat?

Premolar

Where is the most common location for uncomplicated crown fractures?

Complicated crown fracture = exposed pulp is black and dead meaning it is no longer functional

PROBLEM: VERY PAINFUL and may lead to pulp necrosis if left untreated

=treat with root canal or extraction

What is this? What are you seeing? What is the problem? How do you treat?

Uncomplicated crown root fracture = slab fracture when it occurs on buccal aspect of PM4 *MOST COMMON HERE*

What is this? What is another name for this?

Same as complicated crown fracture AND complicated crown root fractures, with a root canal or extraction

How can you treat uncomplicated crown root fractures?

Complicated crown root fracture = commonly in canine of working dogs

Treat with root canal (very challenging) or extraction

What is this? Where do you most commonly see it? How do you treat?

root fracture = involves cementum, dentin, and pulp

What is this? Name some structures involved

1. hard tissue union between fracture segments

2. connective tissue attachment only

3. localized resorption of alveolar bone and tooth

Name how root fractures heal

Splint (unless it is in apical third where you can do endodontic therapy)

How do you treat root fractures?

Class 1: endo (tooth) is primary problem with a fracture. periodontal tissue is secondarily infected

• Tx: Root canal

Class 2: starts with periodontic disease and made its way to the pulp (BOTH endo + perio)

• Tx: Extraction

Class 3: the disease is chronic so you don't know if the endo or perio portion came first (BOTH endo + perio)

• Tx: Extraction

Name the endo-perio lesions. What are their treatments?

Fluoride FREE prophy paste (grey powder)

In preparation for an odontoplasty and dentin bonding, you must do radiographs and clean/polish the teeth with WHAT

REFERRAL

Standard root canal therapy and vital pulp therapy are both *referral or general practice* procedures.

Standard root canal therapy

This is a procedure that involves removal of the pulp to repair a decaying or infected tooth

Vital pulp therapy

This is the removal of infected pulp while allowing continued growth and tooth maturation in order to keep the tooth alive and allow for continued root closure and dentinal wall thickening

Odontoplasty and dentin bonding

What is all of this equipment for?

FALSE: if pulp becomes exposed, you must either refer for root canal therapy or extraction, CANNOT do odontoplasty and dentin bonding

TRUE OR FALSE: Odontoplasty and dentin bonding is recommended for exposed pulp teeth.

Cage-chewers, high anxiety dogs, working dogs, strong chewers because fracture will progress

Who is odontoplasty and dentin bonding are not recommended for (for fractures)?

Abscess formation, Endo-Perio Lesions, Pain, Infection

What are consequences of untreated TDIs?