Endodontics Laboratory - UNINASSAU - 5th Period

• "Welcome!!!! Laboratory Endodontics - UNINASSAU - 5th Period - 2025.1"
• Ruth Ricardo is a dental surgeon who specializes in Endodontics

Endodontics Laboratory Course Plan Overview

• The information is based on the 2023 dentistry course plan for UNINASSAU
• The course code is GRA-PLE-0237-F
• The plan was updated on April 11, 2023

Course Details

• The course is on the 5th Period
• It includes both theoretical and practical activities
• In-person theoretical activities account for 20 hours
• In-person practical activities total 40 hours

Course Description

• Focuses on the study of pulp cavity anatomy and clinical complications
• Covers the basics of accessing root canals
• Includes recognition and identification of endodontic instruments
• Teaches the chemical-mechanical preparation of root canals
• Properties and indications of chemical substances in Endodontics
• Principles and foundations of endodontic obturation
• Materials and techniques for root canal obturation

Specific Competencies

• Recognize general anatomical characteristics of the pulp cavity of each dental element
• Can identify location and nomenclature of root canals
• Can recognize instruments for access and locate root canals
• Perform access to pulp chamber of single and multi-rooted teeth safely
• Recognizes kinematics used in root canal preparation
• Understands the principles and phases of chemical-mechanical preparation of root canals
• Understands the principles of radiographic Odontometry
• Identifies physical, chemical, and biological properties of solutions and obturation material

Course Content

Unit I

• Preliminary measures and pre-operative procedures
• Radiology in Endodontics
• Endodontic instruments
• Asepsis, antisepsis, and sterilization in Endodontics

Unit II

• Anatomy of the pulp cavity
• Surgery to access the pulp chamber

Unit III

• Auxiliary chemical substances and root canal preparation techniques
• Fundamentals of chemical-mechanical preparation

Unit IV

• Intracanal medication
• Obturation Materials and Cements
• Root Canal Obturation

Teaching Methodology

• Uses synchronized and mediated strategies
• Employs different tools for theory and practice
• Applies active methodologies
• Uses various tools and strategies like flipped classrooms, guided readings, case studies, debates, lectures, content assimilation tasks, and lab practices
• Integrates virtual practices mediated by Information and Communication Technology (ICT)

Resources

• The available resources include: Internet, didactic support material, learning objects, Virtual Learning Environment (VLE), digital whiteboards, Information Technology Resources (ITR), computer lab, multimedia projector or Smart TV, databases/libraries and practice laboratories

Evaluation

• Evaluation includes monitoring attendance, performance, assessment of the teaching-learning process per discipline, and a minimum attendance rate of 75% of the planned hours

Class Schedule for Endodontics

Term B, 5th Period

• The course features theory and practice that covers topics from endodontic introduction to final evaluation
• Classes include radiology review, instrumentation, canal opening, preparation, irrigation, and obturation
• The total course involves 60 hours across 17 meetings

Term A, 5th Period

• The course includes an introduction to endodontics, pulp anatomy, microbiology, diagnostic reviews, and practical sessions
• Covers topics like canal opening, irrigation, chemical preparation, intra-canal medication, and filling techniques
• The course involves 60 hours across 15 meetings

Desires

• The lecturer wishes students an excellent semester and wants to get started

Definition of Endodontics

• Endodontics involves the study, prevention, diagnosis, and treatment of dental pulp pathologies and their impact on the periapical region

Endodontics Recognition

• Recognized as a dental specialty by the American Dental Association in 1963
• Regulated in Brazil by the Federal Council of Dentistry since 1975

Skills Required

• Manual dexterity, tactile sensitivity, delicate handling of instruments, concentration, patience, technical expertise, and biological principles

Microneurosurgery

• Endodontic treatment is considered a "microsurgery" and cannot apply the principle of "see first"
• The endodontist cannot open the root canal, but can know its morphology through touch, radiographic examination, knowledge of internal anatomy, and the use of loupes/microscopes

Endodonto Components

• Dentin
• Predentin
• Odontoblastic layer
• Subodontoblastic layer
• Pulp, Pulp Cavity

Dentin

• Mineralized tissue with a tubular structure
• The dental tubules extend from the pulp periphery to the amelo-dentin junction
• Tubule number and diameter vary with proximity to the pulp tissue

Predentin

• Unmineralized dentin matrix that is elaborated by odontoblasts
• Forms between mineralized dentin and the odontoblastic layer
• Precipitation of calcium and phosphorus salts in the protein-carbohydrate complex leads to mineralization

Pulp Chamber

• The dentin is physiologically developed throughout life by forming so-called secondary dentin, reducing the volume of the pulp cavity

Odontoblastic Layer

• Consists of odontoblasts or dentinoblasts
• These are highly specialized cells

Subodontoblastic Layer

• Characterized by undifferentiated mesenchymal cells
• Located between the odontoblastic layer and the interior of the pulp

Pulp Functions

• Induction
• Formation
• Defense
• Nutrition
• Sensitivity

Polpo Induction

• Dentin and enamel formation are linked, with interactions between epithelium and mesenchyme
• Epithelium induces odontoblast differentiation
• Odontoblasts create dentin, which drives enamel formation

Pulp Formation

• Odontoblasts form dentin
• Specialized cells help to form dentin in 3 ways: synthesize and control a matrix's mineralization; they also transport inorganic components for newly matrix and make an environment for mineralization
• Dentinogenesis during initial tooth development is rapid and symmetrical
• Secondary dentinogenesis occurs at a slower rate with less symmetry post-maturation

Pulp Nutrition

• Supplies elements that are key for producing dentin and to sustain the pulp

Pulp Defense

• Odontoblasts create tertiary dentin that occurs in response to injuries
• Tertiary dentin occurs in 2 forms: reactionary and reparative
• Reactionary tertiary dentin is tubular and created by original odontoblasts
• Reparative tertiary dentin is atubular and created by differentiated stem cells after the original odontoblasts are dead
• There is an ability to detect/create an immune response to harmful materials like bacteria or toxins

Polpo Sensitivity

• Nerves can detect an action done directly to the pulp tissues
• The pulp is stimulated from actions done on the dentin and enamel is expressed by pain

Pulp Cells

• Contains odontoblasts, stem cells, fibroblasts, and immune cells

Odontoblasts

• This is a distinctive feature of the pulp
• It creates one layer on the exterior part of the pulp
• The cells can be columnar or cubic, which shows their state of actions
• There is a cell body with an elongation

Stem cells

• Specific to many tissues
• There is a response to trauma where precursor cells will move to the wounded spot and change into odontoblasts
• The major action molecules include the proteins in BMP, and the growth modifier- B

Fibroblasts

• They make up the prominent area of the pulp
• They make and sustain collagen/supporting matrix of the pulp

Immune Cells

• An important protective property of dental pulp that is dendritic cells
• When exposed to foreign body, there are many responses from immune
• In the odontoblastic layer, the blood vessel walls are a main point
• Immune cells are like macrophages and neutrophils, which have properties, but dendritic cells number and placement in the are more important
• Macrophages are inactive and in lymphocytes in normal state

Extracellular Components in the Pulp

• Fibers
• Non-collagenous Matrix
• Calcifications

Fibers

• Collagen types I and III located in the pulp occur at a estimated ratio of 55:45
• The connection point has more collagen, aiding in pulpectomy when extracting nerves for root canals

Calcifications

• Calcifications can exist with diffused or in linear deposits
• Can be present in one or multiple teeth
• Most are seen in older pulps, ongoing inflammation and after trauma has occurred
• Large calcifications are extremely relevant clinically due to can prevent access to the canals during root canal

Endodontic Treatment in Elderly Patients

• Calcifications that occur due to age, number of restorations, and caries can make endodontic treatment difficult
• In multi-rooted teeth, pulp space calcification is common and access surgery becomes critical
• Care must be taken to differentiate dentin colors during surgery
• Odontometry may be difficult because of cementum deposition in the apical area
• Older patients’ pulps exhibit constricted root canals, so chelating agents could be used to remove calcified obstructions

Blood Vessels

• Afferent
• Efferent
• Lymphatic

Afferent Blood Vessels

• The large vessels enter at the apical foramen and are arterioles
• They extend towards the direction of the crown where they narrow and branch off to form capillaries
• A large number of capillaries form a tight plexus in subodontoblastic area
• A number of the vessels stretch from odontoblast, where nutrition occurs and waste products are removed

Afferent BloodvVessel Branches

• Inferior alveolar artery
• Superior alveolar artery (posterior)
• Infraorbital artery

Efferent Blood Vessels

• Venules are the efferent aspect of blood vessel flow in the pulp
• They are formed where capillaries connect
• Venules are larger than arterioles
• Vessels drain through the apical foramen posteriorly to the maxillary vein through the pterygoid plexus, and anteriorly to the facial vein

Lymph Vessels

• Vessels start at the outer surface and form like small, un-sealed pockets, then move throughout
• Openings in exterior permits interstitial fluid passage
• They assist with removing debris in the cells and removing fluid during inflammation
• Where vessels exit location is at regional lymph nodes where under the jaw prior emptying into the clavicle veins

Sensory Innervation

• Sensorial Innervation main: tooth's top to bottom: V2 and V3 respectively
• The 3rd is inferior molars which accepts sensitive perception from nerve C2, and C3
• Lack of anesthesia can be prevalent in these types

Sensory Nerves

• The nerves contain amyelinated and myelin fibre, axon
• Aδ axons have slow conduction
• Axons Aβ conduct in rapidly
• Proprioceptors is known, inflammation and nerves are in action to create pain

Raschkow's Subodontoblastic Plexus

• Axons that have lost myelin coat and ends like minor projections are under osteoblast, but above odontoblast
• Under layer of these cells, these create Raschkow's Plexus
• The plexi form one a tooth erupts
• There are notable amounts of differences for vital testing

Motor Innervation

• Help in maintaining a good tone for vasometer found in sphincters that are responsible to distribute flow
• Nerve from T2 passes near Cervical Gang
• Nerves enters interior and branch off across the vessels

Pulp Nerve Paths

• Impulse from actions are created, like a stimulus
• Fibers travel across trig. or max. parts of the branch, and moves to a trig. ganglion
• From the ganglion, it goes through nerve cells and the cells create a synapse in the spinal area

Pulp Cavity

• It is an isolated container
• In the outer areas a dental pulp can extend within and has limits around dentin
• Approximate shape matches the tooth's exterior

Pulp Chamber Division

• Chambers are coronal
• Root is radicular

Pulp

• It a protector that is used to prevent harsh reactions
• The pulps can provide the resistance
• Tooth can be damaged if extreme external effects reach protection area
• Tooth can become inflamed or experience spreading

Chamber

• A hollow within a structure
• The walls surrounding it can be made of mesial or distal structures depending on the location

Root Channels

• Split 3rds: in location to top, middle, and bottom
• Structurally exist in : dentinal structure area in pulpal space
• Field of Endodontist, CDC for short, there is mucus
• Cement-like - has strands inside space