Podcast
Questions and Answers
What is the step-back technique in endodontics?
What is the step-back technique in endodontics?
Apical preparation is done first with MAF, then stepwise reduction of the WL for larger files, in 0.5-1 mm steps = ↑ Flared shapes
Why do we use irrigants in endodontics?
Why do we use irrigants in endodontics?
Remove debris created during shaping, dissolve organic and inorganic tissues, remove and prevent smear layer, lubricate RC, and serve as an antimicrobial agent.
What is the ideal concentration of sodium hypochlorite (NaOCl) used in endodontics?
What is the ideal concentration of sodium hypochlorite (NaOCl) used in endodontics?
What is the function of chlorhexidine digluconate in endodontics?
What is the function of chlorhexidine digluconate in endodontics?
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What is the purpose of recapitulation for patency?
What is the purpose of recapitulation for patency?
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What is the function of calcium hydroxide in endodontics?
What is the function of calcium hydroxide in endodontics?
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What is the type of antibiotic paste that contains minocycline, ciprofloxacin, and metronidazole?
What is the type of antibiotic paste that contains minocycline, ciprofloxacin, and metronidazole?
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Why are canal sealers used in endodontics?
Why are canal sealers used in endodontics?
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What is the indication of bad odor in RC?
What is the indication of bad odor in RC?
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What are the properties of RC filling material?
What are the properties of RC filling material?
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Silver cone is a successful RC filling material.
Silver cone is a successful RC filling material.
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What is Resilon?
What is Resilon?
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What are the components of Gutta percha?
What are the components of Gutta percha?
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What are the advantages of Gutta percha?
What are the advantages of Gutta percha?
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Gutta percha needs paste for adhesion to dentin.
Gutta percha needs paste for adhesion to dentin.
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What is the RC filling technique that involves heating GP to 160°C?
What is the RC filling technique that involves heating GP to 160°C?
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What is the most common cause of instrument separation?
What is the most common cause of instrument separation?
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What are the steps for retreatment?
What are the steps for retreatment?
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What are the types of peripheral neuron fibers of the Trigeminal system?
What are the types of peripheral neuron fibers of the Trigeminal system?
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What is the classification of oral and facial pain based on?
What is the classification of oral and facial pain based on?
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What is Hyperactive pulpalgia?
What is Hyperactive pulpalgia?
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What is Acute pulpalgia?
What is Acute pulpalgia?
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What is the type of pain that feels like an electric current between the occlusal surface and the pulp?
What is the type of pain that feels like an electric current between the occlusal surface and the pulp?
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What is Reflected pain?
What is Reflected pain?
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What is Internal resorption pain?
What is Internal resorption pain?
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What is Occlusal trauma pain?
What is Occlusal trauma pain?
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What is Incomplete fracture or Tooth crack pain?
What is Incomplete fracture or Tooth crack pain?
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What is the purpose of Local Anesthetics in Endodontic emergencies?
What is the purpose of Local Anesthetics in Endodontic emergencies?
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What is the purpose of maintaining WL in RCT?
What is the purpose of maintaining WL in RCT?
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What is 'Zip' formation at Apex?
What is 'Zip' formation at Apex?
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What is stripping?
What is stripping?
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How can blockage of RCS be avoided?
How can blockage of RCS be avoided?
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What is ledge formation?
What is ledge formation?
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What is perforation?
What is perforation?
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What is the risk of ingestion + aspiration of foreign objects?
What is the risk of ingestion + aspiration of foreign objects?
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What are the causes of pulp disease?
What are the causes of pulp disease?
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What are the types of periapical pain?
What are the types of periapical pain?
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What is pain?
What is pain?
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What are the factors considered in pain control?
What are the factors considered in pain control?
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What is the difference between the pain of Odontogenic origin and pain of Non-odontogenic origin?
What is the difference between the pain of Odontogenic origin and pain of Non-odontogenic origin?
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What is Endodontics?
What is Endodontics?
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What are the indications for performing a RCT?
What are the indications for performing a RCT?
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What are the other indications for RCT?
What are the other indications for RCT?
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What are the factors to consider when deciding not to perform RCT?
What are the factors to consider when deciding not to perform RCT?
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What are the contraindications for RCT?
What are the contraindications for RCT?
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What is a Test cavity?
What is a Test cavity?
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What kinds of Radiographs are used in Endodontics?
What kinds of Radiographs are used in Endodontics?
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What is Diagnosis and How do you approach it?
What is Diagnosis and How do you approach it?
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What are the stages of diagnosis?
What are the stages of diagnosis?
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What is the importance of Medical history in Diagnosis?
What is the importance of Medical history in Diagnosis?
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What are some common side effects of medications that affect the Oral cavity?
What are some common side effects of medications that affect the Oral cavity?
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What are the diseases that cause the enlargement of Cervical and Submandibular L.ns?
What are the diseases that cause the enlargement of Cervical and Submandibular L.ns?
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What are the diseases that cause paresthesia of Oral ST?
What are the diseases that cause paresthesia of Oral ST?
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What are the diseases that mimic dental pain?
What are the diseases that mimic dental pain?
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What disease results in loss of Trabecular bone pattern on radiographs?
What disease results in loss of Trabecular bone pattern on radiographs?
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What disease causes unexplained tooth mobility?
What disease causes unexplained tooth mobility?
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What are the complications of Radiation therapy?
What are the complications of Radiation therapy?
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What helps in determining whether there’s a crack in the surface of a tooth?
What helps in determining whether there’s a crack in the surface of a tooth?
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What is pulp testing used for?
What is pulp testing used for?
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What is the normal response to thermal pulp testing?
What is the normal response to thermal pulp testing?
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What is the purpose of electric pulp testing?
What is the purpose of electric pulp testing?
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What is laser doppler flowmetry used for?
What is laser doppler flowmetry used for?
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What is a potential false-positive response in electric pulp testing?
What is a potential false-positive response in electric pulp testing?
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What is the purpose of the examination kit in endodontics?
What is the purpose of the examination kit in endodontics?
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What is the purpose of the shaping and cleaning kit?
What is the purpose of the shaping and cleaning kit?
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What is the purpose of the incision for drainage kit?
What is the purpose of the incision for drainage kit?
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What is the purpose of obturation?
What is the purpose of obturation?
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What is the purpose of the instruments used in endodontics?
What is the purpose of the instruments used in endodontics?
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What is the purpose of the K-type files and reamers?
What is the purpose of the K-type files and reamers?
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What is the purpose of the H-type files?
What is the purpose of the H-type files?
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What is the purpose of the Barbed Broaches?
What is the purpose of the Barbed Broaches?
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What is the purpose of the Lentulo spiral drills?
What is the purpose of the Lentulo spiral drills?
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What is the purpose of the Ultrasonic and Sonic instruments?
What is the purpose of the Ultrasonic and Sonic instruments?
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What is the purpose of the Nickel Titanium instruments?
What is the purpose of the Nickel Titanium instruments?
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What is the purpose of determining the working length?
What is the purpose of determining the working length?
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What is the purpose of the Radiographic method?
What is the purpose of the Radiographic method?
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What is the purpose of the Electronic Apex locators?
What is the purpose of the Electronic Apex locators?
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What are the phases of an endodontic treatment?
What are the phases of an endodontic treatment?
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What type of pain is associated with cold?
What type of pain is associated with cold?
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What is the structure of L.A?
What is the structure of L.A?
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What is the type of Procaine?
What is the type of Procaine?
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What is the advantage of Lidocaine?
What is the advantage of Lidocaine?
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What is the risk associated with Prilocaine?
What is the risk associated with Prilocaine?
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Why do we use vasoconstrictors in Dentistry?
Why do we use vasoconstrictors in Dentistry?
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What type of local anesthetic is preferred in patients with Heart diseases?
What type of local anesthetic is preferred in patients with Heart diseases?
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What is the treatment for Pulpal necrosis + Symptomatic Apical Periodontitis?
What is the treatment for Pulpal necrosis + Symptomatic Apical Periodontitis?
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What is the possible complication in Indirect pulp capping?
What is the possible complication in Indirect pulp capping?
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What is the recommended capping material for Primary molar pulpotomy?
What is the recommended capping material for Primary molar pulpotomy?
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What is the primary goal of revascularization in regenerative endodontics for immature permanent teeth with necrotic pulp? ______
What is the primary goal of revascularization in regenerative endodontics for immature permanent teeth with necrotic pulp? ______
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What are the factors that affect the outcome of Vital pulp therapy in immature teeth?
What are the factors that affect the outcome of Vital pulp therapy in immature teeth?
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What can Acute Periapical abscess occur as?
What can Acute Periapical abscess occur as?
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Acute lesions show on radiographs immediately.
Acute lesions show on radiographs immediately.
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What should be done if there is localized swelling?
What should be done if there is localized swelling?
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Small doses of local anesthesia can lead to ___ due to methemoglobinemia.
Small doses of local anesthesia can lead to ___ due to methemoglobinemia.
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Match the following complementary anesthesia methods:
Match the following complementary anesthesia methods:
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When is antibiotic administration indicated in endodontic treatment?
When is antibiotic administration indicated in endodontic treatment?
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What does MTA stimulate to produce in reparative dentinogenesis?
What does MTA stimulate to produce in reparative dentinogenesis?
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What is the primary goal of endodontic treatment?
What is the primary goal of endodontic treatment?
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What is the result of apexification?
What is the result of apexification?
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RCT is always performed in immature teeth with open apex.
RCT is always performed in immature teeth with open apex.
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What is the success criteria for apexification?
What is the success criteria for apexification?
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What is the diagnosis of the upper incisors restored with composite?
What is the diagnosis of the upper incisors restored with composite?
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Post-traumatic necrosis develops immediately after trauma.
Post-traumatic necrosis develops immediately after trauma.
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Study Notes
Introduction to Endodontics
- Endodontics is a branch of dentistry that deals with the diagnosis, treatment, and prevention of diseases affecting the pulp and surrounding tissues.
- The goal of endodontics is to preserve the natural tooth and prevent extraction.
Indications for Root Canal Treatment (RCT)
- Acute and chronic pulpitis
- Necrotic or gangrenous pulp
- Post-core is needed
- Prosthetic treatments (e.g., abnormal root shape or tilt)
- Repetitive treatments
- Periradicular inflammation
- Internal resorptions with no large lesion opening to periodontium
- Pulp exposure due to caries, attrition, erosion, abrasion, or trauma
- Failure of direct capping or amputation
Contraindications for RCT
- Inadequate periodontal support
- RC expansion cannot be done
- Tooth fracture or vertical fracture
- Wide resorptions
- Unrepairable tooth
- Old age (decreased tissue repair ability)
- Certain diseases (e.g., cancer, leukemia, syphilis, inflammatory rheumatic disease, diabetes, tuberculosis)
Diagnosis in Endodontics
- Diagnosis is the detection and differentiation of the problem and its cause
- A systematic approach involves:
- Patient's chief complaint
- Medical and dental history
- Localization (identifying the concerned tooth)
- Intraoral and extraoral examination
- Radiographic examination
- Pulp testing (e.g., thermal, electric, and palpation tests)
- Correlation of objective and subjective findings
Pulp Testing Methods
- Thermal methods (e.g., frozen CO2, heated GP)
- Electric methods (e.g., pulp tester)
- Other non-invasive tests (e.g., laser doppler flowmetry, pulse oximetry)
Potential False-Negative or False-Positive Response Interpretations
- False-positive: ↑ anxiety, failed tooth isolation, contact with metal restoration, partially necrotic pulp
- False-negative: calcifications in RC, immature apex, recently traumatized teeth, drugs that ↑ pain threshold, poor contact of pulp tester
Instruments Used in Endodontics
- Examination kit (e.g., mouth mirror, periodontal probe, double-ended No. 5 explorer)
- Emergency kit (e.g., anesthetic armamentarium, suction tip)
- Shaping and cleaning kit (e.g., GG drills, Lentulo spiral drill, broaches, files)
- Incision for drainage kit (e.g., scalpel handle, periosteal elevator, suction tip)
- Instruments used for obturation (e.g., spreaders, pluggers, Glock No. 1)
Intracanal Usage of Files and Reamers
- K-type files and reamers: reaming and filing motions
- H-type files: filing motion only
- Barbed broaches: for pulp removal
Dimensions of K-Files
- D0: diameter at the tip of the point
- D16: diameter at the end of the cutting edge
- File diameter increases 0.02 mm per running mm of length
- Helix: angle between the cutting edge and the long axis of the file
- Flute: the groove on the working surface that removes ST and debris from the RC
- Radial area: reduces the tendency of the file to screw into the canal
Determining Working Length
-
Working length is the distance between the coronal region and the minor foramen
-
Ideal endpoint for RC filling is the cemento-dentinal junction
-
Methods used to determine WL:
- Radiographic method
- Digital radiograph
- Electronic apex locators### Endodontic Treatment
-
The treatment has three phases: shaping and cleaning, hermetic obturation, and restoration of the tooth
-
Objectives of endodontic treatment:
-
Remove all vital and necrotic pulp tissue
-
Eliminate microorganisms
-
Create space for obturation
-
Preserve the natural tooth structure
-
Avoid further irritation of periradicular tissues
-
Avoid iatrogenic damage
Shaping and Cleaning
- Techniques used:
- Standardized technique: starting with small instruments to bigger ones, all inserted to working length
- Step-back technique: apical preparation is done first, then stepwise reduction of working length for larger files
- Step-down technique: instrumenting coronal third of root canal before apical shaping
- Guidelines for shaping and cleaning:
- Anatomical considerations: most critical area for disinfection is apical 3-4 mm, enlarge it enough to allow flow of irrigants
- Restrict instruments and irrigants within root canal space to avoid damaging periradicular tissues
- Precurving: precurve a stainless steel instrument before inserting it into canals to facilitate its insertion to working length and prevent ledging into walls
- Recapitulation for patency: regularly go back to a smaller instrument to prevent dentin packing and ensure patency
- Removal of dentinal debris from used instruments: remove debris by squeezing the blade between a wet gauze while turning counterclockwise
Irrigation in Endodontics
- Why we use irrigants:
- Remove debris created during shaping
- Dissolve organic and inorganic tissues
- Remove and prevent smear layer
- Lubricate the canal
- Ideal requirements of an irrigant:
- Mechanically flushed out debris from canal
- Dissolved vital and necrotic tissues
- Removed smear layer
- Served as a lubricant
- Antimicrobial
- Non-toxic and non-irritating to periradicular tissues
- Types of irrigants:
- Sodium hypochlorite (most effective at 5.2%)
- Chlorhexidine digluconate (2%, broad-spectrum antibacterial)
- Note: NaOCl and CHX should not be mixed, as they interact and lose their effectiveness
Intracanal Medicaments
- Types of intracanal medicaments:
- Calcium hydroxide (stimulates secondary odontoblasts repair with dentinal bridge formation)
- Chlorhexidine digluconate (broad-spectrum antibacterial)
- Antibiotics (e.g., triple antibiotic paste, with limited role due to inability to completely eradicate complex polymicrobial flora in infected root canal)
- Steroids (provide rapid pain relief and anti-inflammatory effects)
Canal Sealers
- Properties of root canal filling material:
- Must be dimensionally stable and not resorbable
- Biocompatible and radiopaque
- Easily manipulated and removed when needed
- Should not discolor teeth
- Types of canal sealers:
- Zinc oxide eugenol sealer
- Formaldehyde-containing pastes
- Silicone-based sealers (e.g., RoekoSeal, GuttaFlow)
- Calcium hydroxide sealer
- GI pastes
- Resin-based sealers
- Calcium silicate pastes
Filling the Root Canals
- Why we fill the root canals:
- Remove all entrances between periodontium and root canal
- Properties of root canal filling material:
- Must be dimensionally stable and not resorbable
- Biocompatible and radiopaque
- Easily manipulated and removed when needed
- Should not discolor teeth
- Techniques for filling the root canals:
- Cold lateral compaction
- Warm lateral compaction
- Vertical compaction
- Chemically softened techniques
- Thermomechanical compaction
- Thermoplasticized Gutta percha injection
- Thermoplasticized core techniques
RCT Failures
- Causes of RCT failures:
- Operator-related causes (e.g., inadequate cleaning, missed root canals, improper isolation)
- Non-operator causes (e.g., persistent periradicular infection, extraradicular cysts, vertical root fractures)
- Clinical management of RCT failures:
- Non-surgical endodontic treatment
- Surgical endodontic treatment (preferably with operating dental microscope)
Non-Surgical Endodontic Treatment
- When surgical and non-surgical treatments are not possible and cannot be restored prosthodontically, extraction is the last treatment option.
- Non-surgical endodontic retreatment aims to remove the RC filling from the tooth, reshape, and obturate.
- Steps for retreatment:
- Use solvent to dissolve the coronal third of GP.
- Create a glide path using a stiff and smaller hand instrument.
- Use rotary or retreatment files to remove remaining GP.
- Perform frequent irrigation to avoid blockage.
- Use sequential radiographs to monitor progress.
Instrument Separation
- Causes of instrument separation:
- Inadequate access opening.
- No glide path.
- Excessive apical pressure during shaping.
- Overuse of instruments.
- Operator inexperience.
- Improper speed of instruments.
- Tips to prevent instrument separation:
- Examine files regularly.
- Regularly irrigate the canal with NaClO.
- Avoid keeping the file in one spot, especially in curved canals.
Complications of RCT
- Loss of working length:
- To maintain WL, use an intact and reusable reference point, a fixed safe rubber stopper, and fixed radiograph angles.
- "Zip" formation at the apex:
- Caused by the transport of the apical portion of the RC, resulting in an hourglass shape.
- More common in highly curved RCs.
- Stripping:
- Thinning and perforation of the lateral root wall due to over-preparation.
- Blockage of RCs:
- To avoid, remove all carious, weak, and unsupported structures before opening the access cavity.
- Use straight-line access, effective irrigation, and clean materials.
- Ledge formation:
- Artificially created irregularity in the RC wall that prevents instruments from reaching the apex.
- Causes include failure to establish a straight-line access, using straight tools in curved canals, and excessive apical pressure.
- Suspected when unable to reach the WL.
Perforation
- Creating an artificial opening between the pulp cavity and periodontium.
- Causes:
- Insufficient determination of WL.
- Inadequate opening of the access cavity.
- Using a straight file in a curved canal.
- Using larger files in smaller canals.
- Management:
- Create a new apical stop within the RC, called a "back-up apex."
Pulp Disease
- Causes:
- Physical:
- Mechanical (trauma, attrition, etc.).
- Thermal (exothermic heat, conduction of heat, etc.).
- Electrical (galvanic current).
- Chemical:
- Least common.
- Pulpal reaction to restorative materials.
- Bacterial microleakage:
- Most common cause of pulp injury.
- Physical:
Periapical Pain
- Types:
- Acute periapical pain:
- Acute apical periodontitis.
- Acute apical abscess.
- Chronic periapical pain:
- Chronic apical periodontitis.
- Chronic apical abscess.
- Features:
- Severe, continuous, and pulsating pain.
- Sensitivity to vertical percussion and palpation.
- Tooth mobility.
- Heat aggravates pain, while cold relieves it.
- Acute periapical pain:
Endodontic Pain
- Factors considered in pain control:
- Understanding the pain system.
- Good endodontic procedure.
- Use of appropriate analgesics.
- Types of pain:
- Odontogenic pain:
- Throbbing, pulsating, pressure, and sharp pain.
- Relieved by LA.
- Non-odontogenic pain:
- Tingling, burning, electrical, and combustion pain.
- Not relieved by LA.
- Odontogenic pain:
Classification of Oral and Facial Pain
- Regional pain:
- Periodontal pain.
- Pulpal pain.
- Periapical pain.
- Neural pain:
- Trigeminus neuralgia.
- Trigeminus neuritis.
- Herpes zoster neuritis and post-herpetic neuralgia.
- Reflected pain:
- Pain reflected from the pulp.
- Pain reflected from nasal and paranasal tissues.
- Pain reflected from MI, coronary thrombosis, and angina pectoris.
- Atypical facial pain:
- Mental facial pain.
- Facial pain due to vasodilation.
Periodontal Pain
- Pain of periodontal origin.
- Features:
- Pulsating and throbbing pain.
- Mild to severe mobility.
- Redness and swelling of the gums.
- Pulp is vital.
- In the acute phase, pain becomes severe and fever develops.
Types of Pulpal Pain
- Hyperactive pulpalgia:
- Reasons:
- Restoration of dentin.
- PD operation that exposes the root.
- Bruxism.
- Incomplete fracture.
- Sinusitis in the upper jaw.
- Types:
- Hypersensitivity.
- Hyperemia.
- Reasons:
- Acute pulpalgia:
- Intrapulpal pressure increase due to inflammation.
- Painful pulpitis develops spontaneously.
- Types:
- Incipient.
- Moderate.
- Advanced.
- Chronic pulpalgia:
- Diffuse pain.
- Pain on pressure or when lying down.
- Sensitivity to heat.
- Pulp polyp pain:
- If no direct pressure, painless.
- Necrosis pulp pain:
- Total: painless.
- Partial: chronic pulpalgia pain-like.
- Internal resorption pain:
- Mild pain.
- Pink coloration in the coronal area.
- Resorption zone seen on radiograph.
- Occlusal trauma pain:
- Due to bruxism or high restorations.
- Sensitivity to cold and chewing.
- Incomplete fracture or tooth crack pain:
- Tenderness while chewing.
- Risks:
- If the crack extends to the pulp.
- Leakage of microorganisms to the pulp.
- Pulpitis.
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Description
Introduction to Endodontics, understanding the basics of Root Canal Treatment (RCT) and its indications, including correct diagnosis and procedure.