Module 11 Presentation

[Audio] CHAPTER 54 ENDODONTICS. CHAPTER 54 ENDODONTICS.

[Audio] CHAPTER 54 LESSON 54.1. CHAPTER 54 LESSON 54.1.

[Audio] LEARNING OBJECTIVES Pronounce, define, and spell the Key Terms. Describe the diagnostic testing performed for endodontic diagnosis. List the conclusions of the subjective and objective tests in the endodontic diagnosis. Assist in electric pulp vitality test. Describe diagnostic conclusions for endodontic therapy..

[Audio] INTRODUCTION Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues surrounding the root of the tooth..

[Audio] CAUSES OF PULPAL NERVE DAMAGE Physical irritation Extensive decay moving into the pulp Trauma Blow to a tooth or the jaw.

[Audio] SIGNS AND SYMPTOMS OF PULPAL NERVE DAMAGE Pain on occlusion Pain during mastication Sensitivity to hot or cold beverages Facial swelling.

[Audio] ENDODONTIC DIAGNOSIS Endodontic Diagnosis Chief complaint Character and duration of pain Painful stimuli Sensitivity to biting and pressure Objective examination Extent of decay Periodontal conditions Extensive restoration Tooth mobility Swelling or discoloration Pulp exposure.

[Audio] FIG. 54-1 Abscess associated with mandibular first molar due to extensive decay into the pulp (From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders.).

[Audio] FIG. 54-2 Radiograph of a necrotic tooth resulting from trauma. (From Johnson W: Color atlas of endodontics, St Louis, 2002, Saunders.).

[Audio] ENDODONTIC DIAGNOSTIC TESTING Percussion tests These tests are used to determine 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 Tests These tests are used to determine whether the inflammatory process has extended into the periapical tissues. The dentist applies firm pressure to the mucosa above the apex of the root..

[Audio] FIG. 54-3 Percussion test (From Johnson W: Color atlas of endodontics, St Louis, 2002, Saunders.).

[Audio] FIG. 54-4 Palpation test (From Johnson W: Color atlas of endodontics, St Louis, 2002, Saunders.).

[Audio] ENDODONTIC DIAGNOSTIC TESTING Thermal sensitivity Necrotic pulp will not respond to cold or heat. Cold test Ice, dry ice, or ethyl chloride is used to determine the response of a tooth to cold. Heat test A piece of gutta-percha or an instrument handle is heated and applied to the facial surface of the tooth..

[Audio] FIG. 54-5 Ice used for testing thermal sensitivity (From Johnson W: Color atlas of endodontics, St Louis, 2002, Saunders.).

[Audio] ENDODONTIC DIAGNOSTIC TESTING Electric pulp testing A small electrical stimulus is delivered to the pulp. Factors that may influence readings: 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 are weak..

[Audio] PROCEDURE 54-1 Placement of a pulp tester..

[Audio] RADIOGRAPHS IN ENDODONTICS Initial radiograph Diagnosis Working-length film To determine the length of the canal Final-instrumentation film Final-size files in all canals Root canal completion film Taken after the tooth has been temporized Recall films Taken at evaluations.

[Audio] REQUIREMENTS OF ENDODONTIC FILMS Must show 4 to 5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition Must present an accurate image of the tooth without elongation or foreshortening Must exhibit good contrast so that all pertinent structures are readily identifiable.

[Audio] FIG. 54-7 Good-quality radiographs are necessary for endodontic evaluation.

[Audio] 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..

[Audio] DIAGNOSTIC CONCLUSIONS Periradicular abscess This inflammatory reaction to pulpal infection may be of chronic or acute onset with pain, tenderness of the tooth in response to pressure, pus formation, and swelling of the tissues. Periodontal abscess This inflammatory reaction is frequently 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. Periradicular cyst This type of cyst develops at or near the root of a necrotic tooth. They develop as an inflammatory response to pulpal infection and necrosis of the pulp..

[Audio] DIAGNOSTIC CONCLUSIONS Pulp fibrosis A decrease in living cells within the pulp causes fibrous tissue to take over the pulpal canal. Necrotic tooth The tooth may also be referred to as nonvital. The term is used to describe a tooth that does not respond to sensory stimulus..

[Audio] CHAPTER 54 LESSON 54.2. CHAPTER 54 LESSON 54.2.

[Audio] LEARNING OBJECTIVES List the types of endodontic procedures. Discuss the medicaments and dental materials used in endodontics. Provide an overview of root canal therapy. Assist in root canal therapy. Describe surgical endodontics and how it affects treatment..

[Audio] ENDODONTIC PROCEDURES Pulp capping Calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin at the site of injury. Indirect pulp capping is indicated when a thin partition of dentin is still intact. Direct pulp capping is indicated when the pulp has been slightly exposed. 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. Pulpectomy Also referred to as root canal therapy, this procedure involves the complete removal of the dental pulp..

[Audio] INSTRUMENTS AND ACCESSORIES FOR ENDODONTIC PROCEDURES Hand instruments Explorer Endodontic spoon excavator Spreaders and pluggers Glick number 1 Hand-operated files K-type file Hedstrom file Reamer file Broaches Rotary-operated files and burs Gates-Glidden burs Peeso files Gates-Glidden burs Peeso files Rubber stops Paper points.

[Audio] TABLE 54-1 Colors and Sizes of Endodontic Files.

[Audio] MEDICAMENTS AND DENTAL MATERIALS IN ENDODONTICS Irrigation solutions Sodium hypochlorite Hydrogen peroxide Parachlorophenol (PCP) Root canal filling materials Gutta-percha points Root canal sealers.

[Audio] OVERVIEW OF ROOT CANAL THERAPY Anesthesia and pain control Isolation and disinfection of the operating field Access preparation Estimated working length Electronic apex locator Débridement and shaping of the canal Obturation.

[Audio] 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.

[Audio] 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: Inadequate sealing of the canal Accessory canals Fractures of the root Pathologic tissue around the root apex.

[Audio] RETROGRADE 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..

[Audio] 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 sectioned lengthwise and removed..