Endodontics and Its Indications

Scope of Endodontics

• Endodontics is the branch of dentistry concerned with the human dental pulp and periapical tissues.
• Endodontics encompasses the basic clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp as well as associated periapical conditions.
• The term endodontics comes from the Greek words “en” meaning in or within, and “odous” meaning tooth; it involves working within the tooth.

Indications for Endodontic Therapy

• Endodontic therapy gives the dentist and the patient the opportunity to save pulp and periapically involved teeth.
• Any tooth from the central incisor to the third molar can be considered for treatment.
• Modern dentistry sees endodontics as an integral part of restorative and prosthetic treatment.
• Severely broken-down teeth and potential and actual abutment teeth are potential candidates for endodontic treatment.

Endodontic therapy is generally indicated in:

• Teeth suffering pulp or apical pathology:
  • Pulp Pathology: Irreversible pulpitis, and necrosis of the pulp.
  • Pulp Calcification, internal resorption and external resorption.
  • Apical pathology: Acute and chronic apical lesions.
  • Asymptomatic and symptomatic apical periodontitis.

Intentional endodontic treatment can be performed in teeth with healthy pulp in cases of:

• The need for post and core construction to rebuild the missing coronal part of the tooth.
• Overerupted or mesially drifted teeth when crown reduction may cause pulp exposure.
• Teeth retained in the mouth to retain overdentures.
• Esthetic requirements.
• Crown fracture with pulp exposures and traumatic pulp exposure during dental procedures and traumatic injuries.

Contraindications for Endodontic Therapy

• Absolute contraindications for endodontic treatment include:
  • Non-strategic teeth, those having no opponent, and would not serve one day as an abutment for prosthesis.
  • Non-restorable teeth which can't properly function after endodontic treatment.
  • Teeth with extensive internal or external root resorptions.
  • Teeth having insufficient periodontal support with severe mobility.
  • Single root teeth with vertical root fracture passing through the root canal.

The Scope of Endodontics

• The scope of endodontic treatment options and clinically related topics includes:
  • Differential diagnosis and treatment of oral pain of pulpal and/or periapical origin, or referred pain.
  • Vital pulp therapy (pulp capping, pulpotomy, treatment of immature teeth: apexogenesis and apexification).
  • Non-surgical treatment of root canal systems with or without periapical pathosis of pulpal origin, including obturation of these systems.
  • Selective surgical removal of periapical pathosis resulting from extension of pulpal pathosis including tooth structures: apical curettage, root-end resection, hemisection, bicuspidization, root resection, and root end filling.
  • Intentional replantation and replantation of avulsed teeth and management of other traumatic tooth injuries.
  • Interrelationship between pulpal and periodontal disease.
  • Endodontic endoesseous implants.
  • Bleaching of discolored dentin and enamel.
  • Retreatment of previously treated root canal systems, both non-surgical and surgical.

Phases of Endodontic Treatment

• Diagnostic phase: Aims to determine the disease condition and set a treatment plan.