Download Lecture #2

Root Structure
and Supporting Tissue
Permanent teeth-root numbers
• Incisors and cuspids have 1 root
• Premolars have 1 root except Max 1st
which has two roots
• Molars-Max molars have 3 roots,
mandibular molars have 2 roots
Primary teeth-root numbers
• Primary incisors and cuspids have 1 root
• Primary molars=Maxillary have three
roots, mandibular have two roots.
Root numbers
Root position
• Maxillary 1st premolars-One root facial,
one lingual
• Maxillary molars-Two roots facial (MF, DF)
one root lingual
• Mandibular molars-One root mesial, one
root distal
Root canals
• Not all roots contain a single canal
– MF roots of max molars usually contain 2 root
canals (MB1, MB2)
– Mesial roots of mandibular molars have two
root canals (MF, ML)
Root canals are not totally
predicable
• There are exceptions to all the rules.
Views and sections
Pulpal anatomy
Subjective symptoms (symptoms
reported by the patient)
Spontaneous pain
Swelling
“My bite feels high”
“It hurts to bite on”
Swelling
Objective symptoms
• Pain with percussion (tapping)
• No response to cold or slow recovery from
cold, no response to electricity
• Apical radiolucency
• Drainage, fistula
• Looseness of the tooth
Apical radiolucency
Fistula
Root canal therapy
• 1. Diagnose
• 2. Access the pulpal chamber
• 3. Determine length of roots
– Electronic apex locators
– Radiographic determination
• 4. Clean chemically and mechanically
• 5. Obturate with gutta percha and sealer
• 6. Restore the tooth (Crowns or fills)
Decay accessing the pulpal
chamber
Mechanical and chemical cleaning
Obturation with Gutta Percha and
sealer
Early abscess
Endo files
Gates Gliddens
Endo files in tooth
Bleach irrigant
Electronic apex locator
Drying the canals
Paste sealer
Gutta percha in place
Finished Root canal treatment
Supporting bone
Alveolus and the PDL
Osteoclasts and osteoblasts
Orthodontic movement and the
PDL
Terms related to the oral muccosa
• Gingiva
– Free gingiva
– Attached gingiva
•
•
•
•
Muccogingival junction
Muccosa
Sulcus
Stippling
Gingivitus
Advanced periodontal disease
PSR
(Periodontal screening and
recording)
What predisposes for Periodontal
disease?
•
•
•
•
•
Home care (brushing and flossing)
Genetics
Diseases like diabetes
Habits like smoking or other drug use
Number of roots
– Incidence of periodontal disease is directly
proportional to the number of roots
• Dominant bacteria in the mouth-Mothers
gum health
How is periodontal disease
treated?
•
•
•
•
Changing home care habits
Controlling habits like smoking
Controlling disease like diabetes
Monitoring and deep debridement of
infected sites
• Chemical controls such as antibiotics
• Surgery
Periodontal disease and it’s
relationship to other factors
Partial in place