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24
Endodontics
Endodontics
• Branch of dentistry that deals with
diagnosis and treatment of diseases of
the pulp and periapical tissues
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Progress of
Pulpal and Periapical Disease
• Vital pulp
– Healthy pulp
– May be inflamed
– Capable of healing after irritant is removed
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Progress of
Pulpal and Periapical Disease
• Nonvital pulp
– Tooth no longer responds to stimuli
– Tooth is considered necrotic
– Unable to heal
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Reversible Pulpitis
• Inflamed pulp is able to heal when
irritant is removed
• Causes
– Caries
– Enamel fracture
– Occlusal attrition
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Reversible Pulpitis
• Symptoms
– Thermal sensitivity
• Treatment
– Remove irritant
– Place sedative dressing
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Pulp Irritants
Leading to Irreversible Pulpitis
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Advanced dental decay
Impact trauma
Fractures
Invasive restorative procedures
Adverse reaction to dental material
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Irreversible Pulpitis
• Results from prolonged inflammation
• Pulpal tissue unable to heal
• Pain symptoms
– Dull and continual
– Short and sharp
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Irreversible Pulpitis
• Treatment
– Root canal therapy
– Extraction
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Pulpal Necrosis
• Death of pulpal cells
• Exudate (pus) and gas form in the pulp
chamber
• Process is slowed if pressure released
through:
– Fistula
– Caries
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Periapical Diseases
• Apical periodontitis
• Periapical abscess
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Apical Periodontitis
• Pulpal inflammation that has spread to
the periapical tissues
• Inflammation creates:
– Granuloma
• Tumor filled with granulation tissue
– Cyst
• Fluid-filled or semisolid-filled
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Periapical Abscess
• Destruction of tissue
• Exudate present
• Pressure must be released
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Endodontic Diagnosis
• Medical and dental history
• Clinical examination
• Referring dentist’s notes
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Medical History
• Review and clarify medical history
– Medical conditions
– Medications
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Dental History
• Review past dental experiences
• Current concerns
– Subjective examination
• Type of pain
• Thermal sensitivity
• Duration of pain
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The Clinical Examination
• Objective examination
– Extraoral tissues
– Facial asymmetry
– Swelling
– Redness
– Fistulas
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Intraoral Clinical Examination
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•
•
•
Tissues evaluated and palpated
Caries
Discoloration
Fractures
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Clinical Testing Procedures
• Radiographs
– Radiolucent area on x-ray indicates bone
involvement
• Palpation
• Percussion
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Clinical Testing Procedures
• Mobility
• Cold Test
– Dry ice, ethyl chloride, ice
• Heat Test
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Clinical Testing Procedures
• Pulp testing
– Indicates if tooth is vital or nonvital
• Transillumination test
• Selective anesthesia
• Caries removal
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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
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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
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Endodontic Instruments
• Reamers
– Enlarges canal
– Applies with a twisting motion
– Color-coded system
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Endodontic Instruments
• Organizers
– Various options to store and organize
reamers and files
– Some can be sterilized
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Endodontic Instruments
• Rubber stops
– Called 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
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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 are marked near notch of shank
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Endodontic Instruments
• Gates-Glidden drills
– Used in upper portion of canal to prepare
opening access by removing obstructing
dentin
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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 a post and to
reduce curvature of canal orifice for
straight-line access
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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
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Endodontic Instruments
• Endodontic spoon excavator
– Double-ended
– Long-shanked
– Removes
• Caries
• Pulp tissue
• Temporary cement
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Endodontic Instruments
• Endodontic explorer
– Locates opening of canals
– Long tapered ends
– Double-ended with sharp-pointed ends
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Endodontic Instruments
• Endodontic spreaders
– Similar to pluggers but
pointed at tip
– Condense gutta percha
into sides of canal
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Endodontic Instruments
• Endodontic pluggers
– Used to condense gutta percha
– Flat-ended
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Endodontic Instruments
• Glick #1 instrument
– Used to remove excess gutta percha from
the coronal portion of canal
– Used to condense remaining gutta percha
in canal opening
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Endodontic Materials
• Paper points
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–
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Dries canals
Place medications
Take cultures
X-fine to coarse
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Endodontic Materials
• Gutta Percha
– Obturates (fills) canals
– Heated and placed in canals
– Condensed with spreader and pluggers
– Removal of apex and infection surrounding
tooth
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Endodontic Materials
• Irrigation solutions
– Root canal is irrigated frequently to remove
debris
• Sterile water
• Sodium hypochlorite
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Endodontic Materials
• Root canal sealers and cements
– Root canal series used with obturating
materials prevent microleakage in canal
– Powders, liquids, pastes, and capsules
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Equipment Assisting
Endodontic Procedures
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Apex finder
Heating unit
Endodontic handpiece
Vitality scanner
Ultrasonic unit
Endodontic bender
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Endodontic Procedures
• Root canal treatment
– Usually completed in two appointments
– Sometimes infection is given time to be
treated before canal is sealed
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General Steps
in Root Canal Therapy
1.
2.
3.
4.
5.
Administer anesthetic
Isolate area
Gain access to pulp
Locate canals
Remove pulpal tissue
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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
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Endodontic Retreatment
• Causes:
– Abscess does not heal
– Narrow or curved canals were not treated
– New decay along filling
– Complicated canal anatomy went
undetected
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Endodontic Retreatment
• Causes:
– Restoration did not occur soon enough
after treatment
– Restoration became loose, cracked, or
broken and exposed tooth to new decay
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Pulpectomy
• Complete removal of pulp
• First stage of a root canal
• Indicated for:
– Permanent teeth with deep caries
– Vertical fracture
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Pulpotomy
• Pulp removed from coronal portion
• Pulp remains in root canal
• Treatment indicated
– Primary teeth with pulpal exposure
– Pulp exposed after accident
– Deep carious lesions
– Root does not develop completely
– Anterior tooth is fractured
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Pulpotomy
Sterile cotton pellet
wetted with
Formocresol solution
Zinc oxideeugenol cement
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Apicoectomy
• Apex of root and
infection is
surgically removed
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Root Amputation
• Surgical procedure to remove one or
more of the roots of a multi-rooted tooth
• Extensive bone loss around the root
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Hemisection
• Surgical removal of one root and
overlying crown
• Diseased portion is removed
• Indications are similar to root
amputation
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Apexification
• Treatment of the apex of the root canal
in a tooth that is necrotic
• Creates a calcified barrier
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Apexogenesis
• Treatment of pulp of a young tooth with
an open apex
• Tooth is vital but has carious or
traumatic exposure
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