Intro to Endodontics
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Intro to Endodontics

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Questions and Answers

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?

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?

  • 5.2% (correct)
  • 10.2%
  • 1.2%
  • What is the function of chlorhexidine digluconate in endodontics?

    <p>Broad-spectrum antibacterial against most common endo pathogens</p> Signup and view all the answers

    What is the purpose of recapitulation for patency?

    <p>To prevent dentin packing and ensure patency by keeping the apical foramen free of debris</p> Signup and view all the answers

    What is the function of calcium hydroxide in endodontics?

    <p>Stimulates secondary odontoblasts to repair with dentinal bridge formation, causterizes tissues, and kills bacteria</p> Signup and view all the answers

    What is the type of antibiotic paste that contains minocycline, ciprofloxacin, and metronidazole?

    <p>TAP</p> Signup and view all the answers

    Why are canal sealers used in endodontics?

    <p>To remove all entrances between the periodontium and root canal</p> Signup and view all the answers

    What is the indication of bad odor in RC?

    <p>Infection</p> Signup and view all the answers

    What are the properties of RC filling material?

    <p>Dimensionally stable, biocompatible, radiopaque, easily manipulated, and easily removed when needed.</p> Signup and view all the answers

    Silver cone is a successful RC filling material.

    <p>False</p> Signup and view all the answers

    What is Resilon?

    <p>High-performance polyurethane, alternative to Gutta percha.</p> Signup and view all the answers

    What are the components of Gutta percha?

    <p>All of the above</p> Signup and view all the answers

    What are the advantages of Gutta percha?

    <p>Easily manipulated, low toxicity, easily removed, dimensionally stable, and easily disinfected.</p> Signup and view all the answers

    Gutta percha needs paste for adhesion to dentin.

    <p>True</p> Signup and view all the answers

    What is the RC filling technique that involves heating GP to 160°C?

    <p>Thermoplasticized Gutta percha injection.</p> Signup and view all the answers

    What is the most common cause of instrument separation?

    <p>Overuse of instruments</p> Signup and view all the answers

    What are the steps for retreatment?

    <p>Solvent to dissolve coronal third of GP, stiff hand instrument to create a glide path, rotary or retreatment file to remove GP, frequent irrigation, and sequential radiographs.</p> Signup and view all the answers

    What are the types of peripheral neuron fibers of the Trigeminal system?

    <p>Aα, Aβ, Aγ, Aδ, and C fibers</p> Signup and view all the answers

    What is the classification of oral and facial pain based on?

    <p>All of the above</p> Signup and view all the answers

    What is Hyperactive pulpalgia?

    <p>A type of pulpalgia caused by restoration of dentin, PD operation, bruxism, incomplete fracture, or sinusitis</p> Signup and view all the answers

    What is Acute pulpalgia?

    <p>A type of pulpalgia caused by intrapulpal pressure increase due to inflammation</p> Signup and view all the answers

    What is the type of pain that feels like an electric current between the occlusal surface and the pulp?

    <p>Hypersensitivity</p> Signup and view all the answers

    What is Reflected pain?

    <p>Pain felt in an area away from the tissues causing it</p> Signup and view all the answers

    What is Internal resorption pain?

    <p>A type of pain that is mild and accompanied by pink coloration in the coronal area</p> Signup and view all the answers

    What is Occlusal trauma pain?

    <p>A type of pain caused by bruxism or high restorations</p> Signup and view all the answers

    What is Incomplete fracture or Tooth crack pain?

    <p>A type of pain that is accompanied by tenderness while chewing</p> Signup and view all the answers

    What is the purpose of Local Anesthetics in Endodontic emergencies?

    <p>To reduce permeability of neural canals and interrupt the transmission of impulses</p> Signup and view all the answers

    What is the purpose of maintaining WL in RCT?

    <p>To maintain WL: Intact + reusable reference, Fixed safe rubber stopper should be used, Use fixed radiograph angles</p> Signup and view all the answers

    What is 'Zip' formation at Apex?

    <p>The transport of the apical portion of RC (hourglass shape)</p> Signup and view all the answers

    What is stripping?

    <p>The thinning + perforation of Lateral root wall</p> Signup and view all the answers

    How can blockage of RCS be avoided?

    <p>Remove all carious, weak, unsupported structures before opening access cavity, Walls of access cavity toward the occlusal, Straight-line access, Effective irrigation, Clean materials used during treatments before each use, Don't skip file sizes, Recapitulation should be performed in all procedures</p> Signup and view all the answers

    What is ledge formation?

    <p>Artificially created irregularity the RC wall that prevents the instrument from being inserted up to the apex</p> Signup and view all the answers

    What is perforation?

    <p>Creating an artificial opening that causes a connection between Pulp cavity + Periodontium</p> Signup and view all the answers

    What is the risk of ingestion + aspiration of foreign objects?

    <p>Risk of perforation, Partial/total airway obstruction, Brain damage, Pulmonary infection, or Death</p> Signup and view all the answers

    What are the causes of pulp disease?

    <p>Physical, Chemical, Bacterial microleakage</p> Signup and view all the answers

    What are the types of periapical pain?

    <p>Acute periapical pain, Chronic periapical pain, Acute apical periodontitis, Acute apical abscess, Chronic apical periodontitis, Chronic apical abscess, Apical cyst</p> Signup and view all the answers

    What is pain?

    <p>Highly unpleasant physical sensation caused by illness or injury</p> Signup and view all the answers

    What are the factors considered in pain control?

    <p>Understanding the pain system, Good endodontic procedure, Use of appropriate analgesics</p> Signup and view all the answers

    What is the difference between the pain of Odontogenic origin and pain of Non-odontogenic origin?

    <p>Pain description, Effect of LA, Area of pain, Radiographic + Clinical exams</p> Signup and view all the answers

    What is Endodontics?

    <p>Endodontics is a RCT where we mechanically expand RCs after removing pulp tissue from crown + root, purifying them from microorganisms by irrigation, and filling them completely.</p> Signup and view all the answers

    What are the indications for performing a RCT?

    <p>Acute/Chronic Pulpitis and Necrotic or Gangrenous pulp, where pulp is necrotic due to obstruction or inflammation.</p> Signup and view all the answers

    What are the other indications for RCT?

    <p>All of the above</p> Signup and view all the answers

    What are the factors to consider when deciding not to perform RCT?

    <p>If there's inadequate periodontal support, if RC expansion can’t be done, or if there are contraindications.</p> Signup and view all the answers

    What are the contraindications for RCT?

    <p>If patient is old, if patient has a disease that ↓ Repair ability of tissues, Cancer, Leukemia, Syphilis, Inflammatory rheumatic disease, Diabetes, Tuberculosis.</p> Signup and view all the answers

    What is a Test cavity?

    <p>Invasive irreversible pulp vitality test used when all other methods are deemed imp or Inconclusive results.</p> Signup and view all the answers

    What kinds of Radiographs are used in Endodontics?

    <p>All of the above</p> Signup and view all the answers

    What is Diagnosis and How do you approach it?

    <p>Diagnosis is detecting and distinguishing WHAT the problem is patient is having and WHY he’s having it.</p> Signup and view all the answers

    What are the stages of diagnosis?

    <p>Patient tells clinician the reason he is seeking advice, Clinician questions patient about the symptoms + history, Clinician performs Objective clinical tests, Clinician correlates Objective findings w/ Subjective details.</p> Signup and view all the answers

    What is the importance of Medical history in Diagnosis?

    <p>Oral ST changes are usually due to the meds used to treat the medical condition, not the condition itself.</p> Signup and view all the answers

    What are some common side effects of medications that affect the Oral cavity?

    <p>Stomatitis, Xerostomia, Petechiae, Ecchymosis, Lichenoid mucosal lesions, Bleeding of oral ST.</p> Signup and view all the answers

    What are the diseases that cause the enlargement of Cervical and Submandibular L.ns?

    <p>Tuberculosis and Lymphomas.</p> Signup and view all the answers

    What are the diseases that cause paresthesia of Oral ST?

    <p>Iron deficiency anemia, Pernicious anemia, Leukemia, Sickle cell anemia.</p> Signup and view all the answers

    What are the diseases that mimic dental pain?

    <p>Bone pain that mimics dental pain, Trigeminal neuralgia, Multiple sclerosis, Referred pain from cardiac angina, Acute maxillary sinusitis.</p> Signup and view all the answers

    What disease results in loss of Trabecular bone pattern on radiographs?

    <p>Sickle cell anemia.</p> Signup and view all the answers

    What disease causes unexplained tooth mobility?

    <p>Multiple myeloma.</p> Signup and view all the answers

    What are the complications of Radiation therapy?

    <p>↑ Sensitivity of Teeth, Osteoradionecrosis.</p> Signup and view all the answers

    What helps in determining whether there’s a crack in the surface of a tooth?

    <p>Transillumination and staining, Percussion and Bite test.</p> Signup and view all the answers

    What is pulp testing used for?

    <p>To check the responsiveness of sensory neurons found in pulp, also known as vitality.</p> Signup and view all the answers

    What is the normal response to thermal pulp testing?

    <p>Sensation is felt and immediately disappears after stimulus' removal.</p> Signup and view all the answers

    What is the purpose of electric pulp testing?

    <p>To determine the vitality of the pulp by assessing the intactness and health status of the vascular supply.</p> Signup and view all the answers

    What is laser doppler flowmetry used for?

    <p>To assess the blood flow in the pulp chamber.</p> Signup and view all the answers

    What is a potential false-positive response in electric pulp testing?

    <p>All of the above.</p> Signup and view all the answers

    What is the purpose of the examination kit in endodontics?

    <p>To examine the tooth and surrounding tissues.</p> Signup and view all the answers

    What is the purpose of the shaping and cleaning kit?

    <p>To shape and clean the root canal.</p> Signup and view all the answers

    What is the purpose of the incision for drainage kit?

    <p>To drain the abscess or swelling in the surrounding tissues.</p> Signup and view all the answers

    What is the purpose of obturation?

    <p>To seal the root canal with a hermetic seal.</p> Signup and view all the answers

    What is the purpose of the instruments used in endodontics?

    <p>To shape, clean, and obturate the root canal, as well as to examine and treat the surrounding tissues.</p> Signup and view all the answers

    What is the purpose of the K-type files and reamers?

    <p>To shape and clean the root canal.</p> Signup and view all the answers

    What is the purpose of the H-type files?

    <p>To file the root canal.</p> Signup and view all the answers

    What is the purpose of the Barbed Broaches?

    <p>To remove pulp tissue.</p> Signup and view all the answers

    What is the purpose of the Lentulo spiral drills?

    <p>To spin pastes, sealers, or cements into the canal.</p> Signup and view all the answers

    What is the purpose of the Ultrasonic and Sonic instruments?

    <p>To energize the instruments and facilitate cleaning and shaping of the root canal.</p> Signup and view all the answers

    What is the purpose of the Nickel Titanium instruments?

    <p>To shape and clean the root canal, and to facilitate obturation.</p> Signup and view all the answers

    What is the purpose of determining the working length?

    <p>To determine the ideal length for root canal filling.</p> Signup and view all the answers

    What is the purpose of the Radiographic method?

    <p>To determine the radiological apex and terminate 0.5-1 mm behind it.</p> Signup and view all the answers

    What is the purpose of the Electronic Apex locators?

    <p>To determine the ideal length for root canal filling using an electronic device.</p> Signup and view all the answers

    What are the phases of an endodontic treatment?

    <p>Access preparation, shaping and cleaning, and hermetic obturation.</p> Signup and view all the answers

    What type of pain is associated with cold?

    <p>Intermittent or Spontaneous pain</p> Signup and view all the answers

    What is the structure of L.A?

    <p>Lipophilia (allows drug to reach the area) and Hydraulic part (allows drug to disperse in the tissue)</p> Signup and view all the answers

    What is the type of Procaine?

    <p>Ester</p> Signup and view all the answers

    What is the advantage of Lidocaine?

    <p>It is more efficacious than Procaine and suitable for topical use.</p> Signup and view all the answers

    What is the risk associated with Prilocaine?

    <p>Methemoglobinemia</p> Signup and view all the answers

    Why do we use vasoconstrictors in Dentistry?

    <p>To increase duration, depth of effect, and to control bleeding during the procedure.</p> Signup and view all the answers

    What type of local anesthetic is preferred in patients with Heart diseases?

    <p>Non-vasoconstrictor L.A or Low dosage I.A</p> Signup and view all the answers

    What is the treatment for Pulpal necrosis + Symptomatic Apical Periodontitis?

    <p>Articaine (Ultracain DS) must be used, and the treatment involves removing pulp remnants from RC space, irrigating with NaOCl, drying canals, and sealing with CaOH (intracanal medicament) and restoring.</p> Signup and view all the answers

    What is the possible complication in Indirect pulp capping?

    <p>Determining the exact point where Caries excavation should be terminated</p> Signup and view all the answers

    What is the recommended capping material for Primary molar pulpotomy?

    <p>MTA</p> Signup and view all the answers

    What is the primary goal of revascularization in regenerative endodontics for immature permanent teeth with necrotic pulp? ______

    <p>Elimination of symptoms + Evidence of bone healing</p> Signup and view all the answers

    What are the factors that affect the outcome of Vital pulp therapy in immature teeth?

    <p>Age of patient, Microleakage of capping material, Tooth development, Severity of pulp damage + Regenerative potential of Pulp</p> Signup and view all the answers

    What can Acute Periapical abscess occur as?

    <p>Sequel to Chronic apical periodontitis</p> Signup and view all the answers

    Acute lesions show on radiographs immediately.

    <p>False</p> Signup and view all the answers

    What should be done if there is localized swelling?

    <p>Apply gentle finger pressure to mucosa overlying the swelling.</p> Signup and view all the answers

    Small doses of local anesthesia can lead to ___ due to methemoglobinemia.

    <p>swelling</p> Signup and view all the answers

    Match the following complementary anesthesia methods:

    <p>Intraseptal = Very thin needle applied to interdental septum Intraosseous = Move apical application into spongy bone cavity Intraligamentary = Anesthetic administered directly into PDL membrane at pressure Intrapulpal = Injected directly to pulp chamber</p> Signup and view all the answers

    When is antibiotic administration indicated in endodontic treatment?

    <p>Fever over 37</p> Signup and view all the answers

    What does MTA stimulate to produce in reparative dentinogenesis?

    <p>cementoblasts to produce Hard tissue</p> Signup and view all the answers

    What is the primary goal of endodontic treatment?

    <p>To achieve no pain, no swelling, and no sinus tract obstruction</p> Signup and view all the answers

    What is the result of apexification?

    <p>Creates a calcific bridge barrier or continues the continuity of a Necrotic immature tooth</p> Signup and view all the answers

    RCT is always performed in immature teeth with open apex.

    <p>False</p> Signup and view all the answers

    What is the success criteria for apexification?

    <p>Both A and B</p> Signup and view all the answers

    What is the diagnosis of the upper incisors restored with composite?

    <p>Crown fracture</p> Signup and view all the answers

    Post-traumatic necrosis develops immediately after trauma.

    <p>False</p> Signup and view all the answers

    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:
      1. Patient's chief complaint
      2. Medical and dental history
      3. Localization (identifying the concerned tooth)
      4. Intraoral and extraoral examination
      5. Radiographic examination
      6. Pulp testing (e.g., thermal, electric, and palpation tests)
      7. 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.

    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.

    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.

    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.
    • 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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    Introduction to Endodontics, understanding the basics of Root Canal Treatment (RCT) and its indications, including correct diagnosis and procedure.

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