Endodontics

DB 305C Module 1 Year 3. Wan Noorina WA

 Explain the scope of endodontic treatment Explain why root canal treament needs to be

carried out Describe the stages of root canal treatment Describe the standards of treatment List the factors that determine the success of treatment

Characterize aetiological factors causing pulpal inammation Explain the mechanism of spread of inammation in the pulp and periradicular tissues and its consequences Explain why the pulp has diculty in recovering from severe injury Classify the pulpal and periradicular lesions Describe the step involve in healing(resolution) of periradicular lesions following successful root canal treatment Identify in general, non-endodontic lesions that may simulate endodontic periradicular lesions

The study of form, function and health of:-

Injuries to and diseases of dental pulp and periradicular region The prevention The treatment management

The clinical management that consists of procedures that are design to maintain the health of all or part of dental pulp When pulp is diseased or injured, treatment aimed at preserving the normal periradicular tissues When infection pursues, treatment is aimed at restoring the periradicular tissues to health This is done with root canal treatment, + surgical endodontics

Healthy pulp

Inamed Maintain health

Infected

Pulpectomy Root canal treatment

(Preserving The Normal Periradicular Tissues)

Pulp capping Pulpotomy

Root canal treatment Root canal re-treatment Apical surgery

(Restoring The Periradicular Tissues To Health)

WHY?

 Living organisms
Micro-organisms Bacteria Viruses ? Others

Non-living irritants
Mechanical Thermal Chemical

Kakehashi et al. The eects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 20:340; 1965

Moller et al. Inuence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scant J Dent Res 89:475, 1981

 Microorganisms Toxins By products

Pulp is inltrated at the base of the carious tubules by

Chronic inammatory cells Macrophages, lymphocytes Plasma cells

Pulp tissue will

Remain inamed for a long

Depending on

time or Undergo necrosis slowly or rapidly

Bacteria virulence Ability to release

Once pulp is exposed, pulp is inltrated by PMN to form liquefaction area at the site of exposure Bacteria colonize and persist at the site

inammatory uids Host The amount of circulation Lymph drainage

By this time pulp harbors bacteria and by-products. Pulp can only defend temporarily to impede the spread of infection and tissue destruction More irritantmore damage and will spread throughout pulp Subsequently bac, toxins & by-products will diuse periapicallyapical inammatory lesions Where is the bacteria?

 Cavity prep (physical) Cavity prep without water (physical with thermal) Physical pressure on the prepared tooth (physical) Deep periodontal curettage (physical) Occlusal trauma (physical) Orthodontic movement (physical) Dentine expose Dental materials Restorative materials Cements

Chemical irritants? Leakage?

IEJ 42, 422-444, 2009

Mixed pulpal response to Dycal after 3 months. CP (restorative material along with Dycal) C: Distinct but incomplete hard tissue bridge (BR), revealing gaps on either side of BR with inltrate of chronic inammatory cells

 Who can survive after an injury?

Type of injury The condition of the

pulp Tissue involve

Pulp tissue

 Initial response
Hard tissue formation Examples? How?

Moderate to severe response

Inammatory process Non specic inammatory mediators and specic

immune reactions

Direct irritation
Hyper-occlusion Occlusal trauma Endodontic procedural

accidents Overinstrumentation Overextention of GP

Bacteria?

Physical Chemical

31 Jan 2005

16 Apr 2005

25 June 2005

Healing

How can you tell? The aim of RCT is to remove the irritant within the canal Healing by repair will take place once the irritant is removed and inammation process for healing will take its course Immune system will take its course

Regeneration Repair

Osteoclastic resorption stops resorbing bone. In healing process, osteoblast cells will start depositing new bone and deposit new matrix.

REGENERATION OR REPAIR?

Normal pulp, Healthy pulp Reversible pulpitis

Symptoms Treatment

Irreversible pulpitis

Symptoms? Asymptomatic? Signs- PA? Treatment Hyperplastic pulpitis

Chronically inamed young pulp

Pulp calcication Internal resorption

Lectures in Year 4

Pulpal necrosis
Symptoms Test & treatment Not responsive PA radiographs= normal

Normal Periapical tissues Apical periodontitis

Acute
Moderate to severe pain Tender to palpation Excruciatingly painful to percussion May or may not respond to EPT PA- Slight widening of lamina dura May not be in severe pain Tender to palpation Tender to percussion Not responsive to EPT PA- apical radiolucency

Apical abscess

Acute apical abscess Rapid onset, painful No swelling if conned to

Chronic apical periodontitis

bone, otherwise swelling is positive as collection of pus seeps through path of least resistance: soft tissue Tender to palpation and percussion PA- no lesion, + ve widening, and obvious
Chronic abscess
Presented with sinus tract + PA radiolucency

ACUTE APICAL PERIODONTITIS

46

CHRONIC APICAL PERIODONTITIS

Acute apical abscess

Chronic Apical Abscess

Very similar to odontogenic lesions Must be vigilant Use tests to guide

Clinical ndings Sensibility testing PA radiographs

Normal structures Non odontogenic diseases

Early stage of

Usually response to EPTs

monostotic bro dysplasia Ossifying broma Dentigerous cysts Central giant cell granuloma

Ameloblastoma

Periapical cemento-osseous dysplasia

Hartys, Endodontics in Clinical Practice, BS Chong 2010 Endodontics Principles and Practice T and Walton

Questions?