Endodontics

By; Dr.Sawda S.
 outlines
• Introduction
• Signs and symptoms of pulpal nerve damage
• Endodontic diagnosis
• Diagnostic testing
• Diseases of the pulp and periapical tissue
 Introduction
• Endodontics is the specialty of dentistry that manage the
prevention , diagnosis , and treatment of the dental pulp and
the periradicular tissue that surround the root of the tooth.
Signs and symptoms of pulpal nerve damage

• Pain when biting

• Pain when chewing
• Sensitivity with hot or cold beverages
• Facial swelling
 Endodontic diagnosis
• Subjective examination
-C/C
-HPI
-character and duration
-painful stimuli
-sensitivity to biting and pressure
• Objective Examination
-extent of decay
-periodontal condition
-presence of an extensive restoration
-swelling
-discoloration
-pulp exposure
 Diagnostic testing
• Percussion
• Palpation
• Thermal sensetivity
• Cold test
• Heat test
PATHWAYS OF BACTERIAL INVASION OF PULP

A) Direct invasion by way of the dentin such as

• Caries
• Fracture of crown or root
• Exposure during cavity preparation
• Attrition, abrasion ,erosion
• Crack in crown

B) Invasion through open blood vessels or lymphatics –

periodontal diseases, an accessory canal in furcation area,
gingival infection.

C) Invasion through blood such as during infectious diseases or

transient bacteremia.
 Diseases of the pulp
• Reversible pulpits
• Irreversible pulpits
• Pulp necrosis
• Pulp degeneration
• Internal root resorpation
 Disease of periapical tissue
1)Acute periradicular disease
• Acute alveolar abscess
• Acute apical periodontitis
• Vital
• Non vital
2)Chronic periradicular diseases with areas of rarefaction
• Chronic alveolar abscess
• Granuloma
• Cyst
3)Condensing osteitis
4)External root resorption
5)Diseases of the periradicular tissues of non odontogenic origin
 REVERSIBLE PULPITIS

• Definition:
Reversible pulpitis is a mild to moderate
inflammatory condition of pulp caused by noxious
stimuli in which the pulp is capable of returning to
un inflamed state following removal of stimulus.

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 • Cause:
-carious
-Trauma
-Disturbed Occlusal relationship
-Overheating during polishing a filling
-Excessive dehydration of a cavity

• Symptoms:
-Sharp pain lasting for a moment which is mainly caused by cold
beverages than hot foods.

• Diagnosis:
-By patients symptoms and by clinical tests.

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• Differential diagnosis:
Irreversible pulpitis.

• Treatment:
Periodic care to prevent development of caries, early
insertion of filling, desensitization of necks of teeth, use of
cavity varnish or base

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 Irreversible pulpitis

• Definition:
Irreversible pulpitis is a persistent inflammatory
condition of pulp, symptomatic or asymptomatic
caused by a noxious stimulus.

• Cause:
-Caries
-Chemical irritation
-thermal irritation
-mechanical irritation

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 Symptoms
• A paroxysm of pain is caused by sudden temperature change,
pressure from packing foods into a cavity .
• Pain comes spontaneously without apparent cause.

Diagnosis:
-By patients symptoms and by clinical tests.
Treatment:
-Complete removal of pulp or pulpectomy and the placement of
an intra canal medicament

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 ACUTE ALVEOLAR ABSCESS

• Definition:
It is a localized collection of pus in the alveolar bone at the
apex of tooth following death of pulp with extension of
infection through the apical foramen into periradicular
tissues.

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 Cause:
-Carious lesion
-Trauma
-Chemical irritation

 Symptoms:
• tenderness of tooth that may be relieved by continued
slight pressure on the extruded tooth to push it back
into alveolus.
• Later severe throbbing pain with swelling seen on
adjacent tissues near the affected tooth.

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DIAGNOSIS
 history given by patient
 clinicial examination
 Radiography

Treatment:
-Establishing drainage.
-Controlling systemic reaction.
-After that endodontic treatment

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 ACUTE APICAL PERIODONTITIS

Definition:
It is a painful inflammation of periodontium as a result of
trauma, irritation or infection through the root canal ,regardless of
whetherthe pulp is vital or non vital.

Cause:
-Restorations with high points
-pulpal disease.
-Over instrumentation

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Symptoms:
• slightly to extremely painful during
percussion and chewing tests.

Diagnosis:
• history given by the patient
- clinical examination
- Radiographs

Treatment:
• endodontic treatment

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 GRANULOMA
[PERIAPICAL GRANULOMA]
Definition:
It is a growth of granulomatous tissue continuous with
the periodontal ligament resulting from death of pulp and
diffusion of bacteria and bacterial toxins from root canal into
surrounding periradicular tissues through apical and lateral
foramina.
Cause:
• Death of pulp followed by a mild infection or irritation of
periapical tissue that stimulates a productive cellular reaction.
Symptoms:
Asymptomatic

Diagnosis:
1)Routine radiographic examination –shows a well defined area
of rarefaction wit lack of continuity in the lamina dura.
2) Sinus tract may be present .
3)Tooth does not respond to thermal or electric pulp tests.

Differential diagnosis:
Periapical cyst, Cementoma.
Treatment:
Root canal therapy
Resorption of granulomatous tissue and repair with
trabeculated bone.
 RADICULAR CYST
Definition:
A cyst is a closed cavity or sac internally lined
with epithelium the center of which is filled with fluid
or semi solid material.

Symptoms:
• Initially asymptomatic.
• Once it becomes large it produces huge swelling
and causes movement of affected teeth.
• Teeth become mobile.
• If untreated cyst grow at expense of the root.
Cause:
• Physical chemical or bacterial injury.

Diagnosis:
• Tooth does not responds to thermal or electrical pulp tests.
• Radiographs show loss of continuity in the laminadura with an
area of rarefaction which is a well defined radiolucency. This
area may round or oval and is larger in size than granuloma.

Treatment:
Enucleation of the cyst.
CHRONIC PERIRADICULAR DISEASE WITH AREAS
OF CONDENSATION
Condensing osteitis

Definition:
Condensing osteitis is the response to a low grade, chronic
inflammation of periradicular area as a result of a mild
irritation through the root canal.

Cause:
Mild irritation

Symptoms:
Asymptomatic
 EXTERNAL ROOT RESORPTION
• Definition:
It is a lytic process occurring in the cementum or
cementum and dentin of the roots of teeth.

• Cause:
Trauma, excessive forces,
Granuloma, cyst, jaw tumors,
Replantation of teeth,
Bleaching and impaction of teeth,
Systemic diseases.
Idiopathic.
IDIOPATHIC ROOT RESORPTION
 Symptoms:
• Asymptomatic.
• If the root is completely resorbed the tooth may become mobile.
Diagnosis:
• By radiographs
Appears as concave or ragged areas on the root surface or
blunting of the apex is seen.

Differential diagnosis:
• Internal resorption.

Treatment:
• Cause is removed and treated endodontically.
 Endodontic procedures
 pulp capping
• A covering of calcium hydroxide is placed
over an exposed or nearly exposed pulp
to encourage the formation of irritated
dentin at the site of injury.
 Indirect pulp capping
 Direct pulp capping
 Pulpotomy

• Involves the removal of the coronal

portion of an exposed vital pulp.
• Completed to preserve the vitality of
the remaining portion of the pulp
within the root of the tooth.
• This procedure is commonly indicated
for vital primary teeth, teeth with deep
carious lesions, and emergency
situations.
 Root Canal Treatment (RCT)
• Is removal of vital or necrotic pulp tissue from
pulp chamber and root canal by cleaning
and shaping process
• Then the chamber and canal cavities must be
blocked by suitable sealing materials to not
become a shelter of pathogens “hermetic seal”
• Apexogenesis
• Apexification
 Surgical Endodontics
Indications for surgical intervention
• Endodontic failure caused by 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 has not occurred.
• Biopsy
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.
• Pathological tissue around the root apex.
Root Amputation and Hemisection
Root amputation
• A surgery performed to remove one or more
roots of a multirooted tooth without
removing the crown.
Hemisection
• A procedure in which the root and the
crown are cut lengthwise and removed
•Thank you