Endodontics Lecture: Root Canal Therapy

UNIT 3 ENDODONTIC S ROOT CANAL THERAPY CHAPTER 54  Endodontics That specialty of dentistry that manages prevention, diagnosis, and treatment of the pulp and the periradicular tissues that surround the root of the tooth.  Periradicular Referrin...

UNIT 3 ENDODONTIC S ROOT CANAL THERAPY CHAPTER 54  Endodontics That specialty of dentistry that manages prevention, diagnosis, and treatment of the pulp and the periradicular tissues that surround the root of the tooth.  Periradicular Referring to the area of nerves, blood vessels and tissues that surround the root of a tooth  Objective 1 Describe the symptoms and etiology of pulpal damage. Causes of Pulpal Damage Extensive Decay Physical Irritation – caused by extensive decay that has moved into the pulp carrying bacteria Trauma – blow to the tooth or jaw can over time damage the nerve Trauma tissue and blood vessels of the pulp Most common Signs and Symptoms of Pulpal Nerve Damage Pain when occluding Pain during mastication Sensitivity to hot or cold beverages Noticeable facial swelling  Objective 2 State indications and contraindications for Endo treatment. Indications 1. Necrotic pulp 2. Fractured tooth or tooth knocked out of the socket 3. Possibility of restoring tooth to natural function Necrotic tooth resulting from trauma Fig. 54.2  Contraindications 1. Tooth unable to be restored to its natural function 2. Tooth unable to be maintained periodontally 3. Client’s medical condition 4. Refusal of treatment 5. Root fracture  Objective 3 Describe diagnostic tests to determine tooth vitality  1. Symptoms described by Endodontic client diagnosis is based 2. Dentist’s visual findings on: 3. Tests done by the dentist 1. Subjective examination: Client symptoms Chief complaint Character & duration of pain Painful stimuli Sensitivity to biting & pressure 2. Objective Examination: Dentist’s Visual Findings Includes evaluation of the tooth and surrounding tissues Extent of decay Periodontal conditions Presence of extensive restorations Tooth mobility Swelling & discoloration Pulp exposure 3. Tests conducted by the dentist Percussion and Palpation Thermal Sensitivity Electric Pulp Testing Radiographs  Percussion & Palpation Tests Indicates inflammation in the periodontal ligament with a response if tapped Palpation and applying pressure on mucosa will also indicate inflammation The dentist can often isolate which canal is infected by tapping each cusp separately and waiting for a response Thermal Sensitivity Tests Cold (used on control tooth and tooth in question) dry ice, ice or ethyl chloride a necrotic pulp will not respond to cold  Heat least useful because it can indicate either reversible or non-reversible pulpitis a necrotic pulp will not respond to heat either  Electric pulp testing Electric pulp testers deliver a small electrical stimulus to the pulp-is the pulp vital or non vital A non vital pulp will not react to the stimulus The operator increase the strength of the stimulus to see the response Electronic pulp testing is not always accurate because: A large restoration may prevent the stimulus from reaching the pulp Teeth with more than one canal may have one vital canal and one not Batteries may weaken Moisture can affect reading ideal to use other methods as well  Objective 6 Explain the importance of Radiography in endodontics and criteria for an acceptable endodontic radiograph Radiographs in Endodontics Initial radiograph Diagnosis Working length film Used to determine the length of the canal. Final instrumentation film Taken with the final size file/gutta percha cone in all canals Root canal completion film Taken after the canals have been filled and the tooth has been temporized. Recall films Taken at post treatment evaluations.  Requirements of Endodontic Films 1. Show 4-5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition. 2. Present an accurate image of the tooth without elongation or fore-shortening. 3. Exhibit good contrast so all pertinent structures are readily identifiable.  Objective 7 Describe various endodontic conditions and treatments.  Diagnostic Conclusions Once all subjective and objective tests are complete a diagnosis is presented to the client. Diagnostic Conclusions Normal pulp There are no subjective symptoms or objective signs. The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp. Pulpitis The pulp tissues have become inflamed. 1. Reversible Pulpitis The pulp is irritated, and the patient is experiencing pain to thermal stimuli. Eliminating irritant and placing a sedative material may save the pulp Irreversible pulpitis The tooth will display symptoms of lingering pain. Clinical diagnostic findings indicate the pulp is incapable of healing Treatment options: RCT or Extraction Periradicular Abscess: Irreversible pulpitis Chronic Acute Presence of draining sinus tract Pain No pain because exudate is escaping Tenderness through sinus tract No sinus tract Swelling Chronic Periradicular Abscess Periodontal abscess An inflammatory reaction frequently caused by bacteria entrapped in the periodontal sulcus. A client will experience rapid onset, pain, tenderness of the tooth to pressure, pus formation, and swelling. Periradicular Cyst A cyst that develops at or near the root of a necrotic tooth. These types of cysts develop as an inflammatory response to pulpal infection and necrosis of the pulp. Pulp fibrosis The decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal. Necrotic Tooth Also referred to as nonvital. Used to describe a tooth that does not respond to sensory stimulus. *Remember: the tooth may be dead, but the attachment apparatus is still living Endodontic Procedures Choice of endodontic treatment depends on the diagnosis First line of treatment is to save the pulp- called pulpal therapy Pulp Capping Type of pulpal therapy where Calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin at the site of injury Indirect Pulp Cap is indicated when a thin partition of dentin is still intact. Small amount of decay is left and CaOH is used to stimulate secondary dentin and stop bacteria formation Extensive Decay-slightly into pulp Removal of caries leaving very thin layer of decay Layer of CAOH placed over thin area of dentin remaining (may be soft) Direct Pulp Cap is indicated when the pulp has been slightly exposed. Not as successful-must warn client that endo is probably inevitable  Pulpotomy Removal of the coronal portion of an exposed vital pulp. Goal is to preserve the vitality of the remaining portion of the pulp within the root of the tooth. Commonly indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations. Pulpectomy Also referred to as root canal therapy procedure involves the complete removal of the dental pulp.