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Textbook of Endodontics
Nisha Garg, Amit Garg
1:
Introduction and Scope of Endodontics
INTRODUCTION
MODERN ENDODONTICS
SINGLE VISIT ENDODONTICS (SVE)
Advantages of SVE
Disadvantages of SVE
Criteria of Case Selection as given by Oliet Include
Conditions where Single Visit Endodontics cannot be Performed
Indications of Single Visit Endodontics
PATIENT EDUCATION
Who Performs an Endodontic Therapy?
Who is an Endodontist ?
What is Endodontics?
How does Pulp Become Damaged?
Why do I Feel Pain?
How can You Tell if Pulp is Infected?
Why do I Need Root Canal Therapy?
What are Alternatives to Root Canal Therapy?
What is Root Canal Procedure?
What are Risks and Complications?
How many Visits will it Take to Complete this Treatment?
Will I Feel Pain during or after Treatment?
Will I have a Dead Tooth after Root Canal Therapy?
Will the Tooth Need Any Special Care or Additional Treatment after Endodontic Treatment?
Can All Teeth be Treated Endodontically?
2:
Pulp and Periradicular Tissue
INTRODUCTION
DEVELOPMENT OF DENTAL PULP
HISTOLOGY OF DENTAL PULP
CENTRAL PULP ZONE
Structural or Cellular Elements
Ground Substance
ANATOMY OF DENTAL PULP
PULP CHAMBER
ROOT CANAL
SUPPORTIVE ELEMENTS
Pulpal Blood Supply
Lymphatic Vessels
Regulation of Pulpal Blood Flow
Pulpal Response to Inflammation
Effect of Posture on Pulpal Flow
Clinical Correlation
INNERVATION OF PULP
Basic Structure of a Neuron
FUNCTION OF PULP
1. Formation of Dentin
2. Nutrition of Dentin
3. Innervation of Tooth
4. Defense of Tooth
AGE CHANGES IN THE PULP
MORPHOLOGIC CHANGES
PHYSIOLOGIC CHANGES
Pulpal Calcifications/Pulp Stones/Denticles
According to Structure
True Denticle
False Denticles
According to Size
According to Location they can be Classified as
Clinical Significance of Pulp Stones
Calcific Metamorphosis
Helpful Considerations
PERIRADICULAR TISSUE.
Cementum
Types
Acellular Cementum
Cellular Cementum
Periodontal Ligament
Periodontal Fibers
Horizontal Group
Alveolar Crest Group
Oblique Fibers
Transeptal Fibers
Apical Fibers
Interradicular Fibers
Cells
Nerve Fibers
Blood Vessels
Functions
Supportive
Nutritive
Protective
Formative
Resorptive
Alveolar Bone
Cells and Intercellular Matrix
Intercellular Matrix
3:
Pathologies of Pulp and Periapex
INTRODUCTION
ETIOLOGY OF PULPAL DISEASES
RADIATION INJURY TO PULP
PROGRESSION OF PULPAL PATHOLOGIES
DIAGNOSTIC AIDS FOR PULPAL PATHOLOGY
CLASSIFICATION OF PULPAL PATHOLOGIES
REVERSIBLE PULPITIS/HYPEREMIA/ HYPERACTIVE PULPALGIA
Definition
Etiology
Symptoms
Histopathology
Diagnosis
Treatment
IRREVERSIBLE PULPITIS
Definition
Etiology
Symptoms
Diagnosis
Differences between Transudate and Exudate
Treatment
CHRONIC PULPITIS
Etiology
Signs and Symptoms
Histopathology
Diagnosis
Treatment
INTERNAL RESORPTION
Etiology
Mechanism of Resorption
Symptoms
Diagnosis
Treatment
PULP NECROSIS
Etiology
Symptoms
Diagnosis
Treatment
PULP DEGENERATION
Dystrophic Calcifications
Diffuse Calcifications
Denticles / Pulp Stone
Classification
PERIRADICULAR PATHOLOGIES
ETIOLOGY OF PERIRADICULAR DISEASES
Bacterial
Trauma
Factors Related to Root Canal Procedures
DIAGNOSIS OF PERIRADICULAR PATHOLOGIES
OBJECTIVE EXAMINATION
CLINICAL PERIAPICAL TESTS
CLASSIFICATION OF PERIRADICULAR PATHOLOGIES
ACUTE APICAL PERIODONTITIS (AAP)
Etiology
Signs and Symptoms
Histopathology
Treatment
ACUTE APICAL ABSCESS
Etiology
SYMPTOMS
DIAGNOSIS
HISTOPATHOLOGY
MANAGEMENT OF AN ACUTE APICAL ABSCESS
PHOENIX ABSCESS
Etiology
Symptoms
Diagnosis
Treatment
PERIAPICAL GRANULOMA
CLINICAL FEATURES
RADIOGRAPHIC FEATURES
HISTOPATHOLOGIC FEATURES
TREATMENT AND PROGNOSIS
RADICULAR CYST
Etiology
CLINICAL FEATURES
PATHOGENESIS
RADIOGRAPHIC FEATURES
Treatment
CHRONIC ALVEOLAR ABSCESS
Etiology
Symptoms
Diagnosis
Differential Diagnosis
Treatment
EXTERNAL ROOT RESORPTION
Etiology
Symptoms
Radiographs Show
Treatment
DISEASES OF PERIRADICULAR TISSUE OF NON-ENDODONTIC ORIGIN
Benign Lesions
Radiographic Features of Lesions of Non-odontogenic Origin
Diagnosis
Malignant Lesions
Diagnosis
HISTOPATHOLOGY OF PERIAPICAL RESPONSE TO VARIOUS IRRITANTS
NONSPECIFIC MEDIATORS OF PERIRADICULAR LESIONS
Cell Derived Mediators
Vasoactive amines
Leukotrienes
Platelet Activating Factor
Lysosomal Enzymes
Cytokines
Prostaglandins
Plasma Derived Mediators
4:
Endodontic Microbiology
INTRODUCTION
PORTALS OF ENTRY FOR MICROORGANISMS
Entry Through Open Cavity
Through Open Dentinal Tubules
Through the Periodontal Ligament or the Gingival Sulcus
Anachoresis
Through Faulty Restorations
MICROBIAL VIRULENCE AND PATHOGENICITY
Lipopolysaccharides (LPS)
Extracellular Vesicles
Enzymes
Fatty Acids
Polyamines
MICROBIAL ECOSYSTEM OF THE ROOT CANAL
PRIMARY ENDODONTIC INFECTIONS
MICROBIOLOGY OF PERIRADICULAR ENDODONTIC INFECTIONS
MICROBIOLOGY OF ROOT CANAL FAILURES
ENDODONTIC ABSCESSES AND CELLULITIS
IDENTIFICATION OF THE BACTERIA
Culture
Technique
Disadvantages of Culturing Method
DNA-DNA Hybridization Method
Polymerase Chain Reaction Method (PCR Method)
Advantages of Molecular Methods
HOW TO COMBAT MICROBES IN THE ENDODONTIC THERAPY
5:
Diagnostic Procedures
INTRODUCTION
CASE HISTORY
Chief Complaint
History of Present Illness
Medical History
Extra Oral Examination
Intra Oral Examination
RADIOGRAPH
PULP VITALITY TESTS
1. Thermal Test
a. Cold Test
b. Heat Test
2. Electric Pulp Testing
Procedure
Disadvantages of Electric Pulp Testing
3. Test Cavity
4. Anesthesia Testing
5. Bite Test
RECENT ADVANCES IN PULP VITALITY TESTING
Laser Doppler Flowmetry (LDF)
Pulp Oximetry
Dual Wavelength Spectrophotometry
Measurement of Surface Temperature of Tooth
Transillumination with Fiber Optic Light
Detection of Interleukin-I Beta in Human Periapical Lesion
Plethysmography
CRACKED TOOTH SYNDROME
Etiology
Diagnosis of Cracked Tooth Syndrome
i. History of the Patient
ii. Visual Examination
iii. Tactile Examination
iv. Periodontal Probing
v. Bite Test
vi. Transillumination
vii. Use of Dyes
viii. Radiographs
xi. Surgical Exposure
Classification of Cracked Teeth
Differential Diagnosis of Cracked Tooth Syndrome
Treatment of Cracked Teeth
DIAGNOSTIC FINDINGS
ROLE OF RADIOGRAPHS IN ENDODONTICS
Principles of Radiography
Cone Image Shift Technique
Advantages of ‘SLOB’ Rule
Disadvantages of ‘SLOB’ Rule
FILM EXPOSURE AND QUALITY
FILM HOLDERS
ADVANTAGES OF RADIOGRAPHS IN ENDODONTICS
1. Diagnosis
2. Treatment
a. Working Length Determination
b. Master Cone Radiographs
c. Obturation
3. Recall
DIGITAL RADIOGRAPHY
Disadvantages
Advantages
DIGITAL DENTAL RADIOLOGY
Digital Dental Radiology is Possible with Two Methods
THE CCD SYSTEM
RVG
Advantages
Disadvantages
PHOSPHOR IMAGING SYSTEM
Advantages
Disadvantages
6:
Differential Diagnosis of Orofacial Pain
INTRODUCTION
PAIN
DIAGNOSIS
HISTORY OF PAIN
Chief Complaint
Location
Onset
Chronology
Quality
Intensity
Aggravating Factors
TRANSMISSION OF PAIN
Second Order Neurons
1. Wide dynamic range neurons (WDR)
2. Nociceptive-specific neurons (NS)
3. Low threshold mechanoreceptive (LTM)
Third Order Neurons
PAIN MODULATION AND PERCEPTION
SOURCES OF ODONTOGENIC PAIN
a. Dental Pain of Pulpal Origin
b. Dental Pain of Periodontal Origin
PULPAL PAIN
1. DENTINAL SENSITIVITY
Diagnosis
Treatment
2. REVERSIBLE PULPITIS
Diagnosis
Treatment
3. IRREVERSIBLE PULPITIS
Diagnosis
Treatment
4. NECROTIC PULP
Diagnosis
Treatment
PERIODONTAL PAIN
1. ACUTE APICAL PERIODONTITIS
Diagnosis
Treatment
2. ACUTE PERIAPICAL ABSCESS
Diagnosis
Treatment
3. CHRONIC APICAL PERIODONTITIS
Diagnosis
SOURCES OF NONODONTOGENIC PAIN
Myofascial Toothache
Neurovascular Toothache
Migraine
Features of Migraine
CLUSTER HEADACHE
CARDIAC TOOTHACHE
NEUROPATHIC PAIN
Neuralgia
Trigeminal Neuralgia
Neuritis
TREATMENT OF NEURITIS
Neuropathy
Clinical Characteristics of Neuropathy (Atypical Odontalgia)
SINUS OR NASAL MUCOSAL TOOTHACHE
PSYCHOGENIC TOOTHACHE
7:
Case Selection and Treatment Planning
INTRODUCTION
WHEN TO DO ENDODONTIC THERAPY?
i. Actual Reason for Endodontic Therapy
ii. Elective Endodontics
iii. Inadequate Restorations
iv. Devitalization of Tooth
v. Endodontic Emergency
CONTRAINDICATIONS OF ENDODONTIC THERAPY
TREATMENT PLANNING
Factors Influencing the Treatment Planning
Factors Affecting Treatment Planning
MEDICAL CONDITIONS INFLUENCING ENDODONTIC TREATMENT PLANNING
Sequence of Treatment Delivery
ASEPSIS IN ENDODONTICS
Infection Control
Principles of Infection Control
Routes of Disease Transmission
Sterilization
Classification of Instrument Sterilization
Cleaning of Instruments
Sterilization Process
Advantages
Disadvantages
Flash Autoclave Sterilizer
Dry Heat Sterilization
Hot Air Oven
Advantages
Disadvantages
Glass Bead Sterilizer
Advantages
Chemical Vapor Pressure Sterilization
Advantages
Disadvantages
Ethylene Oxide Sterilization
Advantages
Disadvantages
Disinfection
Personal Barrier Protection
Hand Washing and Gloving
Face Masks
Protective Eyewear
Protective Clothing
PAIN CONTROL
Local Anesthesia
Definition
Classification of Local Anesthetic Agents
Techniques for Anesthetizing Maxillary Teeth
1. Supraperiosteal Technique
Technique
Advantages
Disadvantages
2. (a) Anterior Superior Alveolar Nerve Block
Technique
2. (b) Middle Superior Alveolar Nerve Block
Technique
3. Posterior Superior Alveolar Nerve Block
Technique
4. Greater Palatine Nerve Block
Technique
5. Nasopalatine Nerve Block
Technique
6. Maxillary Nerve Block
7. Periodontal Ligament Injection
Techniques
Advantages
Disadvantages
Techniques of Anesthetizing Mandibular Teeth
Technique
Technique
Technique
Technique
Intrapulpal Injection
Indications
Nerves Anesthesized
Technique
Advantages
Disadvantages
ISOLATION OF THE TOOTH
Rubber Dam Sheet (Fig. 7.19)
Metallic
Non-metallic
Rubber Dam Forceps
Rubber Dam Frame
Rubber Dam Punch
Rubber Dam Accessories
Recent Modifications in the Designs of Rubber Dam
Methods of Rubber Dam Placement
Management of Difficult Cases
Extensive Loss of Coronal Tissue
Crowns with Poor Retentive Shapes
Teeth with Pocelain Crowns
Leakage
Summary
8:
Endodontic Instruments
INTRODUCTION
CLASSIFICATION OF ENDODONTIC INSTRUMENTS
HAND OPERATED INSTRUMENTS
Broaches and Rasps
Technique of Pulp Extirpation (Healey, 1984)
Reamers
Files
K-File
K-Flex Files
Flexo File
Flex-R File
Hedstrom Files (H-files)
Safety Hedstrom File
S - File
ENGINE DRIVEN INSTRUMENS
Gates Glidden Burs
Uses of Gates-Glidden Drills
PEESO REAMERS
NICKEL TITANIUM (NITI) ENDODONTIC INSTRUMENTS
Manufacturing of NiTi Files
Instrument Deformation and Breakage
Torsional Fracture
Role of Handpiece
Flexural Fracture
VARIOUS ROTARY NICKEL TITANIUM SYSTEM (RNT)
PROFILE SYSTEM
GREATER TAPER FILES (GT FILES)
PROTAPER FILES
Shaping Files
Sx
S1
S2
Finishing Files
F1
F2
F3
QUANTEC FILE SYSTEM
LIGHT SPEED SYSTEM
K3 ROTARY FILE SYSTEM
HERO 642
Features
RACE FILES (Reamers with Alternating Cutting Edges)
Advantages of RACE Files
REAL WORLD ENDO SEQUENCE FILE
SONICS AND ULTRASONICS IN ENDODONTICS
Ultrasonic Endodontics
Cavitation and Acoustic Streaming
Acoustic Streaming
Uses of Endosonics
Access Enhancement
Orifice Location
Irrigation
Sealer Placement
Gutta Percha Obturation
MTA Placement
Endodontic Retreatment
INSTRUMENTS USED FOR FILLING ROOT CANALS
SURGICAL OPERATING MICROSCOPE (SOM)
USES OF ENDOMICROSCOPE
MINERAL TRIOXIDE AGGREGATE (MTA)
Composition
Properties
Manipulation of MTA
Advantages of MTA
Disadvantages of MTA
Precautions to be taken for MTA
Indications of use of MTA
Clinical Applications of MTA (Fig. 8.45)
9:
Internal Anatomy and Access Cavity Preparation
INTRODUCTION
PULP CAVITY
COMMON CANAL CONFIGURATION
Methods of Determining Pulp Anatomy
VARIATION IN THE INTERNAL ANATOMY OF TEETH
Commonly seen Anomalies of Pulp Cavities are as follows:
Lingual Groove
High Pulp Horns
C-shaped Canals
Presence of Extracanals
Dilacerations
Dens in dente or Dens Invaginatus
Dens Evaginatus
Taurodontism
FACTORS AFFECTING INTERNAL ANATOMY
INDIVIDUAL TOOTH ANATOMY
Maxillary Central Incisor (Fig. 9.21)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Lateral Incisor (Fig. 9.22)
Average Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Canine (Fig. 9.23)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary First Premolar (Fig. 9.24)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Second Premolar (Fig. 9.25)
Pulp Chamber
Root Canals
Clinical Considerations
Maxillary First Molar (Fig. 9.26)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Maxillary Second Molar (Fig. 9.27)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Third Molar
Average Tooth Length
Pulp Chamber and Root Canal
Mandibular Teeth Central Incisor (Fig. 9.28)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Lateral Incisor (Fig. 9.29)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Canine (Fig. 9.30)
Pulp Chamber
Root Canals
Clinical Consideration
Mandibular First Premolar (Fig. 9.31)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Mandibular Second Premolar (Fig. 9.32)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Mandibular First Molar (Fig. 9.33)
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Second Molar (Fig. 9.35)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Third Molar
Pulp Chamber and Root Canals
ACCESS CAVITY PREPARATION
Objectives of Access Cavity Preparation
Guidelines for Access Cavity Preparation (Fig. 9.39)
ACCESS CAVITY OF ANTERIOR TEETH
Maxillary Central Incisor
Maxillary Lateral Incisor
Maxillary Canine
Mandibular Incisors
Mandibular Canine
ACCESS CAVITY PREPARATION FOR PREMOLARS
Maxillary First Premolar
Maxillary Second Premolar
Mandibular First Premolar
Mandibular Second Premolar
ACCESS CAVITY PREPARATION FOR MAXILLARY MOLARS
Maxillary First Molar
Maxillary Second Molar
ACCESS CAVITY PREPARATION FOR MANDIBULAR MOLARS
Mandibular First Molar
Mandibular Second Molar
MANAGING DIFFICULT CASES FOR ACCESS OPENING
Extensive Restorations
Tilted and Angulated Crowns
Calcified Canals
Sclerosed Canals
Teeth with No or Minimal Crown
10:
Working Length Determination
INTRODUCTION AND HISTORY
DEFINITIONS
SIGNIFICANCE OF WORKING LENGTH
DIFFERENT METHODS OF WORKING LENGTH DETERMINATION
RADIOGRAPHIC METHOD OF WORKING LENGTH DETERMINATION
MATHEMATIC METHOD OF WORKING LENGTH DETERMINATION
ELECTRONIC APEX LOCATORS
Classification of EALs
First Generation Apex Locators: (Resistance Apex Locators)
Technique for Using Resistance Based EAL
Advantage
Disadvantages
Second Generation Apex Locators (Impedence Apex Locators)
Third Generation Apex Locator
Fourth Generation Apex Locators
Combination Apex Locators and EndodonticHandpiece
Basic Conditions for Accuracy of EALs
Uses of Apex Locators
Contraindications to the Use of Apex
SUMMARY
11:
Irrigation and Intracanal Medicaments
INTRODUCTION
FUNCTIONS OF IRRIGANTS
FACTORS THAT MODIFY ACTIVITY OF INTRACANAL IRRIGATING SOLUTIONS
CHOICE OF MAIN IRRIGANT SOLUTION
Sodium Hypochlorite
Historical Review
Mechanism of Action of Sodium Hypochlorite
Precautions to be Taken While Using Sodium Hypochlorite Solution
Use of Sodium Hypochlorite in Combination with other Medicaments
UREA
Mechanism of Action
Uses
HYDROGEN PEROXIDE
Mechanism of Action
Use
UREA PEROXIDE
Mechanism of Action
Use
Disadvantages
CHLORHEXIDINE
Mechanisms of Action
Advantages and Uses
Disadvantages
CHELATING AGENTS
Citric Acid
ULTRASONIC IRRIGATION
Mechanism of Action
Advantages
Disadvantages
NEWER IRRIGATING SOLUTIONS
Electrochemically Activated Solution
Ozonated Water Irrigation
Ruddle's Solution
Composition
Mechanism of Action
Photo Activated Disinfection (PAD)
Mechanism of PAD
Advantages of PAD
MTAD (A Mixture of a Tetracycline Isomer, an Acid and a Detergent)
Purpose of MTAD
Composition
Advantages
METHOD OF IRRIGATION
Facts
PRECAUTIONS TO BE TAKEN WHILE IRRIGATION
INTRACANAL MEDICAMENTS
Functions
CHARACTERISTICS OF INTRACANAL MEDICAMENTS
ESSENTIAL OILS
Eugenol
Uses of Eugenol
Phenolic Compounds
Phenol
Uses
Parachlorophenol
Composition
Concentration
Uses
Camphorated Monoparachlorophenol (CMCP)
Composition
Uses
Cresatin
Composition
Aldehydes
Formocresol
Uses
Paraformaldehyde
Calcium Hydroxide
Use of Calcium Hydroxide in Weeping Canal Cases
Halogens
Chlorine
Chlorhexidine Gluconate
PBSC Paste
Sulfonamides
Corticosteroid-antibiotic Combinations
PLACEMENT OF INTRACANAL MEDICAMENT
12:
Cleaning and Shaping of Root Canal System
INTRODUCTION
Cleaning
Shaping
Objectives of Biomechanical Preparation
VARIOUS MOVEMENTS OF INSTRUMENTS
Reaming
Filing
Combination of Reaming and Filing (Fig. 12.12)
Balanced Force Technique
Watch Winding
Watch Winding and Pull Motion
BASIC PRINCIPLES OF CANAL INSTRUMENTATION
TECHNIQUES OF ROOT CANAL PREPARATION
STEP BACK TECHNIQUE
MODIFIED STEP BACK TECHNIQUE
PASSIVE STEP BACK TECHNIQUE
Technique
Advantages of Passive Step Back Technique
BALANCED FORCE TECHNIQUE
Technique
Advantages of Balanced Force Technique
CROWN DOWN TECHNIQUE
Technique of Crown Down Preparation
Apical Gauging
Biological Benefits of Crown Down Technique
Clinical Advantages of the Crown Down Technique
ENGINE DRIVEN PREPARATION WITH NITI INSTRUMENTS
PROFILE SYSTEM
CLINICAL TECHNIQUE FOR USE OF PROFILES
Advantages
GREATER TAPER FILES (GT FILES)
CLINICAL TECHNIQUE
PROTAPER FILES
CLINICAL TECHNIQUE
Advantages of ProTaper Files
QUANTEC FILE SYSTEM
CLINICAL TECHNIQUE
LIGHT SPEED SYSTEM
CLINICAL TECHNIQUE
ADVANTAGES OF LIGHT SPEED SYSTEM
K3 ROTARY FILE SYSTEM
CLINICAL TECHNIQUE
REAL WORLD ENDO SEQUENCE FILE
CLINICAL TECHNIQUE
Advantages of Real World Endo Sequence File System
HERO 642
Technique
CANAL PREPARATION USING ULTRASONIC INSTRUMENTS
Technique
Advantages of Ultrasonic Canal Preparation
Disadvantages
CANAL PREPARATION USING SONIC INSTRUMENTS
Technique
LASER ASSISTED ROOT CANAL THERAPY
EVALUATION CRITERIA OF CANAL PREPARATION
SPECIAL ANATOMIC PROBLEMS IN CANAL CLEANING AND SHAPING
1. Management of Curved Canals
Decrease in the force can be done by :
2. Management of Calcified Canals
Location of the Orifice and Penetration
Penetration and Negotiation of the Calcified Canal
Guidelines for Negotiating Calcified Canals
3. Management of C-shaped Canals
4. Management of S-shaped Canals
13:
Obturation of Root Canal System
INTRODUCTION
TIMING OF OBTURATION
Patient Symptoms
Pulp and Periradicular Status
Negative Culture
MATERIALS USED FOR OBTURATION
Gutta-Percha
History
Sources
Chemistry
Chemical Structure
Phases of Gutta-percha
Current Available Forms of Gutta-percha
Silver Points
ROOT CANAL SEALERS
Requirements of an Ideal Root Canal Sealer
Functions of Root Canal Sealers
Classification
Zinc Oxide Eugenol Sealers
Kerr Root Canal Sealer or Rickert's Formula
Advantages
Disadvantages
Manipulation
Procosol Radiopaque-silver Cement (Grossman, 1936)
Procosol Non Staining Cement (Grossman's 1958)
Grossman's Sealer
Properties
Disadvantage
Setting Time
Wach's Sealer
Properties
Advantages
Disadvantages
Tubliseal (1961)
Setting Time
Advantages
Disadvantages
Indications
Setting Reaction of Zinc Oxide Eugenol Cement
Root Canal Sealers Without Eugenol
Kloroperka N - Ø Sealers
Chloropercha
Modified Chloropercha Methods
Hydron
Advantages
Disadvantages
Nogenol
Appetite Root Canal Sealer
Resin Based Sealers
Diaket
AH-26
Properties
Thermaseal
AH Plus
Dosage and Mixing
Fiberfill
Manipulation
Calcium Hydroxide Sealers
Disadvantages
Seal apex
Calcibiotic root canal sealer (CRCS)
Apexit
Advantages
Medicated Sealers
N2
Toxicity
Endomethasone
Silicone-based Root Canal Sealers
Endo Fill
Advantages
Disadvantages
Glass Ionomer Sealer (Ketac-Endo)
Advantages
Disadvantages
Newer Sealers
The Monoblock Concept
Method of Use
Sealer Placement
OBTURATION TECHNIQUES
LATERAL COMPACTION TECHNIQUE
Technique
Advantages of Lateral Compaction Technique
Disadvantages
CHEMICAL ALTERATION OF GUTTA-PERCHA
VERTICAL COMPACTION TECHNIQUE
Technique
Advantages of Vertical Compaction Technique
Disadvantages of this Technique
SYSTEM B: CONTINUOUS WAVE OF CONDENSATION TECHNIQUE
Technique
LATERAL/VERTICAL COMPACTION OF WARM GUTTA-PERCHA
Technique
SECTIONAL METHOD OF OBTURATION
Technique
MCSPADDEN COMPACTION/ THERMOMECHANICAL COMPACTION OF THE GUTTA-PERCHA
THERMO PLASTICIZED INJECTABLE GUTTA-PERCHA OBTURATION
Obtura II Heated Gutta-Percha System/High Heat System
Technique
Variations in Thermoplasticizing Technique of Gutta-Percha
1. Ultrasonic Plasticizing of Gutta-Percha
2. Ultrafil System
Technique
SOLID CORE CARRIER TECHNIQUE
Thermafil Endodontic Obturators
Technique
OBTURATION WITH SILVER CONE
Steps
Apical Third Filling
Dentin Chip Filling
Calcium hydroxide
Mineral trioxide aggregate (MTA)
POST OBTURATION INSTRUCTIONS
Patient Recall
14:
Mid Treatment Flare-Ups in Endodontics
INTRODUCTION
ETIOLOGY
CLINICAL CONDITIONS OF FLARE-UP
SCONTRIBUTING FACTORS FOR FLARE-UPS
MICROBIOLOGY AND IMMUNOLOGY OF FLARE-UPS
DIAGNOSIS AND MANAGEMENT OF FLARE-UPS
Previously Vital Pulps with Complete Debridement
Previously Vital Pulps with Incomplete Debridement
Previously Necrotic Pulps without Swelling
Previously Necrotic Pulp with Swelling
GENERAL MANAGEMENT OF FLARE-UPS
CONCLUSION
15:
Endodontic Emergencies
INTRODUCTION
DIAGNOSIS AND TREATMENT PLANNING
History of the Patient
Subjective Examination
Objective Examination
Radiographic Examination
TREATMENT PLANNING
PRETREATMENT ENDODONTIC EMERGENCIES
CONDITIONS REQUIRING EMERGENCY ENDODONTIC TREATMENT
Management
Management
Management
Management (Fig. 15.10)
INTERATREATMENT EMERGENCIES
Etiology of Mid-treatment Flare-ups
Risk Factors Contributing Inter Appointment Flare Ups
Prevention
Treatment
POSTOBTURATION EMERGENCIES
Treatment
16:
Procedural Accidents
INTRODUCTION
INADEQUATELY CLEANED AND SHAPED ROOT CANAL SYSTEM
LOSS OF WORKING LENGTH
CANAL BLOCKAGE
Treatment
Prevention
LEDGING
Treatment
MISSED CANAL
INSTRUMENT SEPARATION
PREVENTION OF INSTRUMENT SEPARATION
ZIPPING
STRIPPING OR LATERAL WALL PERFORATION
Management
Prevention
CANAL TRANSPORTATION
INADEQUATE CANAL PREPARATION
Over Instrumentation
Treatment
Prevention
Overpreparation
Underpreparation
PERFORATIONS
MATERIAL USED FOR PERFORATION REPAIR
Management of the Coronal Third Perforations
Management of Perforations in Mid Root Level
Technique of Placement of Matrix
Indications
Contraindications
Disadvantages of Matrix Placement Technique
Management of Perforations in Apical Third of the Root Canal
Technique
POST SPACE PERFORATIONS
Prevention of Post-related Perforation
UNDER FILLING/INCOMPLETELY FILLED ROOT CANALS
OVERFILLING OF THE ROOT CANALS
VERTICAL ROOT FRACTURE
Clinical Features
Prevention of Root Fracture
INSTRUMENTS ASPIRATION
17:
Endodontic Failures and Retreatment
INTRODUCTION
EVALUATION OF SUCCESS OF ENDODONTIC TREATMENT
Clinical Evaluation
Radiographic Evaluation
Histological Evaluation
CAUSES OF THE ENDODONTIC FAILURES
Local Factors Causing Endodontic Failures
Infection
Incomplete Debridement of the Root Canal System
Excessive Hemorrhage
Over Instrumentation
Chemical Irritants
Iatrogenic Errors
Systemic Factors
Factors Responsible for Endodontic Failures
CASE SELECTION FOR ENDODONTIC RETREATMENT
Factors Affecting Prognosis of Endodontic Treatment
Contraindications of Endodontic Retreatment
Problems Commonly Encountered during Retreatment
STEPS OF RETREATMENT
Coronal Disassembly
Establish Access to Root Canal System
Removing Canal Obstructions and Establishing Patency
Silver Point Removal
Gutta-Percha Removal
Pastes and Cements
Separated Instruments and Foreign Objects
Completion of the Retreatment
18:
Surgical Endodontics
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
CLASSIFICATION
PRESURGICAL CONSIDERATIONS
INCISION AND DRAINAGE
Surgical Drainage
Protocol of Treatment
PERIRADICULAR SURGERY
ARMAMENTARIUM FOR PERIRADICULAR SURGERY
LOCAL ANESTHESIA AND HEMOSTASIS
Amount of Local Anesthesia
RECEPTORS AND MECHANISM OF HEMOSTASIS
Reactive Hyperemia: The Rebound Phenomenon
FLAP DESIGNS AND INCISIONS
PRINCIPLES AND GUIDELINES FOR FLAP DESIGNS
Functions of a Flap
FULL MUCOPERIOSTEAL FLAPS
Types of Incision
Triangular Flap
Advantages
Disadvantages
Indications
Rectangular Flap (Fig. 18.12)
Advantages
Disadvantages
Indications
Trapezoidal Flap
Disadvantages
Envelope Flap
Indications
Advantages
Disadvantages
Potential Disadvantages of Full Mucoperiosteal Flaps
LIMITED MUCOPERIOSTEAL FLAPS
Semilunar Flap
Disadvantages
Ochsenbein-Luebke Flap
Advantages
Indication
Disadvantages
FLAP DESIGN CONSIDERATION IN PALATAL SURGERY
FLAP REFLECTION AND RETRACTION
For Full Mucoperiosteal Flap
For Submarginal Flaps
Flap Reflection
Flap Retraction
Time of Retraction
HARD TISSUE MANAGEMENT
Osseous Tissue Response to Heat
Tissue Response to Bone Removal
Speed of Cutting
Use of Coolant
Bur Types
Pressure and Time during Cutting Procedure
PRINCIPLES OF SURGICAL ACCESS TO ROOT STRUCTURE
PERIRADICULAR CURETTAGE
Indications
Surgical Techniques
ROOT-END RESECTION (APICOECTOMY, APICECTOMY)
Guidlines for Bone Removal
Angle of Root-End Resection
ROOT-END PREPARATION
Traditional Root-End Cavity Preparation
RETROGRADE FILLING
ROOT-END FILLING MATERIALS
Amalgam
Advantages
Disadvantages
Zinc Oxide Eugenol Cements
Effects of free Eugenol
Intermediate Restorative Material (IRM)
Super EBA
Advantages
Disadvantages
Mineral Trioxide Aggregate (MTA)
MTA Placement Technique
Advantages of MTA
Disadvantage
Composite Resins
REAPPROXIMATION OF THE SOFT TISSUE
Repositioning of the Flap
POSTSURGICAL CARE
Instructions
SUTURING MATERIALS AND TECHNIQUES
Ideal Suture Characteristics
FEW FACTS ABOUT SUTURES
Suture Needle
Parts of Surgical Needle (Fig. 18.29)
The Body
Point
The Swage
Principles of Suturing
SUTURING TECHNIQUES
Interrupted Suture (Fig. 18.31)
Advantages
Continuous Locking Suture (Fig. 18.32)
Vertical Mattress Suture (Fig. 18.33)
Horizontal Mattress Suture (Fig. 18.34)
COMPLICATIONS OF SUTURING
Suture Removal
POSTSURGICAL COMPLICATIONS
Management
Management
Extraoral Ecchymosis (Extraoral discoloration)
Management
Pain
Management
Infection
Management
Miscellaneous
19:
Endodontic Periodontal Relationship
INTRODUCTION
PHYSIOLOGIC PATHWAYS
Dentinal Tubules
Lateral or Accessory Canals
Apical Foramen
Palato Gingival Grooves
NON-PHYSIOLOGICAL PATHWAYS
Perforation of the Root
Vertical Root Fracture
IMPACT OF PULPAL DISEASES ON THE PERIODONTIUM
EFFECT OF PULPAL DISEASES ON PERIODONTIUM
IMPACT OF PERIODONTAL DISEASE ON PULPAL TISSUE
ETIOLOGY OF ENDODONTIC-PERIODONTAL PROBLEMS
CLASSIFICATION OF ENDODONTIC PERIODONTAL LESIONS
DIAGNOSIS OF ENDODONTIC-PERIODONTAL LESIONS
Treatment and Prognosis
Clinical Considerations
Primary Endodontic Lesions (Fig. 19.13)
Primary Endodontic Lesion with Secondary Periodontal Involvement (Fig. 19.14)
Primary Periodontal Lesions (Fig. 19.15)
Primary Periodontal Lesions with Secondary Endodontic Involvement (Fig. 19.16)
Independent Endodontic and Periodontal Lesions which do not Communicate
True Combined Endo-Perio Lesions (Fig. 19.17)
20:
Restoration of Endodontically Treated Teeth
INTRODUCTION
EFFECTS OF ENDODONTIC TREATMENT ON THE TOOTH
Structural Changes
Changes in the Dentin Physical Characteristics
Aesthetic Consideration
PLANNING POSTENDODONTIC RESTORATION PROCEDURE
For Anterior Teeth
For Posterior Teeth
CONDITIONS WHERE POST SHOULD NOT BE GIVEN
Post
Core
Purpose of Use of Post and Core
CLASSIFICATION OF POSTS
I. Prefabricated Post
II. Custom Made Posts
CUSTOM CAST METAL POST
Advantages
Disadvantages
ALL CERAMIC POST AND CORES
Advantages
Disadvantages
PREFABRICATED POSTS
Indications of Prefabricated Posts
PREFABRICATED METAL POSTS
Advantages
Disadvantages
CARBON FIBER POSTS
Advantages
Disadvantages
GLASS FIBER POST
Advantages
Disadvantages
ZIRCONIA POST
Advantages
Disadvantages
FACTORS TO BE CONSIDERED WHILE PLANNING POST AND CORE
A. Retention and the Resistance Form
POST LENGTH
Accepted Guidelines for Determining Post Length Include
POST DIAMETER
The Conservationist
The Preservationist
The Proportionist
POST DESIGN
LUTING AGENTS
LUTING METHOD
CANAL SHAPE
POSITION OF TOOTH IN THE DENTAL ARCH
B. Preservation of the Tooth Structure
Ferrule Effect
Mode of Failure
Retrievability
Posts can be Removed by
Preparation of the Canal Space and the Tooth
CORE
BIOMECHANICAL CRITERIA FOR EVALUATION OF CORE MATERIALS
Bonding
Strength
Ease of Use
Setting Time
Dimensional Stability
21:
Management of Traumatic Injuries
INTRODUCTION
CLASSIFICATION OF DENTOFACIAL INJURIES
EXAMINATION OF TRAUMATIC INJURIES
CHIEF COMPLAINT
HISTORY OF PRESENT ILLNESS
MEDICAL HISTORY
CLINICAL EXAMINATION
CLINICAL PHOTOGRAPHS
MANAGEMENT OF THE TRAUMATIC INJURIES
Crown Infarction
Biological Consequence
Diagnosis
Treatment
Prognosis
CROWN FRACTURE
Uncomplicated Crown Fracture
Incidence
Biological Consequences
Diagnosis
Treatment
Prognosis
Complicated Crown Fractures
Incidence
Biological Consequences
Diagnosis
Treatment
Factors Affecting Pulpal Survival
Pulp Capping and Pulpotomy
Pulp Capping
Indications
Technique
Follow-up
Prognosis
Pulpotomy
Partial Pulpotomy
Indications
Technique
Follow-up
Prognosis
Cervical Pulpotomy/Deep Pulpotomy
Indications
Technique
Follow-up
Prognosis
Prerequisites for Success
Apexification
CROWN ROOT FRACTURES
Incidence
Biological Consequences
Diagnosis
Treatment
Prognosis
ROOT FRACTURE
Biological Consequences
Diagnosis
Treatment of Root Fractures
PROGNOSIS DEPENDS ON
Follow-up Procedure
LUXATION INJURIES
Incidence
CONCUSSION
SUBLUXATION
Treatment of Concussion and Subluxation
LATERAL LUXATION
EXTRUSIVE LUXATION
Treatment of Lateral and Extrusive Luxation
Prognosis
INTRUSIVE LUXATION
Treatment
Follow-up
AVULSION (EXARTICULATION)
Definition
Incidence
Primary Teeth
Permanent Teeth
Biologic Consequences
What to Do When a Patient Comes with Avulsed Tooth?
Hank's Balanced Solution (Save-A-Tooth)
Milk
Saline
Saliva
Management Options for an Avulsed Tooth
Precautions to be Taken While Handling the Avulsed Tooth
POST EMERGENCY TREATMENT
ASSESSMENT OF TRAUMATIC INJURIES
Patient's History
Check if Present and Describe
Extraoral Examination
TMJ Assessment
Intraoral Examination (Check any injury present)
Occlusion
Teeth
Radiograph
Photographs
Treatment
PREVENTION OF TRAUMATIC INJURIES
Functions of Mouthguard
22:
Pulpal Response to Caries and Dental Procedure
INTRODUCTION
PULPAL REACTION TO DENTAL CARIES
INFLAMMATION UNDER CARIES
RESPONSE OF PULP TO TOOTH PREPARATION
Irritating Agents of Tooth Preparation
REMAINING DENTIN THICKNESS
THERMAL AND MECHANICAL INJURY
Speed of Rotation
Nature of Cutting Instrument
Use of Coolants
RESPONSE OF PULP TO LOCAL ANESTHETICS
EFFECT OF CHEMICAL IRRITANTS ON PULP
DENTIN STERILIZING AGENTS
CAVITY LINER AND VARNISHES
RESPONSE OF PULP TO RESTORATIVE MATERIALS
Calcium Hydroxide
Zinc Oxide Eugenol
Zinc Phosphate
Zinc Polycarboxylate Cements
Glass Ionomer Cement
Amalgam
Precautions to be taken while using Amalgam as a Restorative Material
RESTORATIVE RESINS
Acid Etchants
EFFECTS OF PIN INSERTION
IMPRESSION MATERIAL
EFFECTS OF RADIATIONS ON PULP
EFFECT OF HEAT FROM ELECTROSURGERY
EFFECT OF LASERS ON PULP
DEFENSE MECHANISM OF PULP
Tubular Sclerosis
Smear Layer
Reparative Dentin Formation
HOW THE PULP RECOVERS?
23:
Pharmacology in Endodontics
INTRODUCTION
ANXIETY CONTROL
Pharmacosedation
Barbiturates
Contraindications of use of Barbiturates
Benzodiazepines
Diazepam
Doses
Triazolam
Midazolam
Chlordiazepoxide
Iatrosedation
PAIN CONTROL
Opioid Drugs
Classification
Codeine
Morphine
Side Effects
Dextropropoxyphene
Tramadol
Non-opioid Drug
Aspirin
Side Effects
Contraindications
Precaution
Ibuprofen
Contraindications
Piroxicam
Diclofenac Sodium
Nimesulides
PARA AMINO PHENOL DERIVATIVE (PARACETAMOL OR ACETAMINOPHEN)
Choice of NSAIDs
INFECTION CONTROL
ANTIBIOTICS
Definition
Classification of Antibiotics
FACTORS AFFECTING SELECTION OF ANTIBIOTICS
Drug Resistance and Toxicity
Drug Allergic Reactions
Cost Therapy
COMMONLY USED ANTIBIOTICS
Beta-lactam Antibiotics
Mechanism of Action
Benzyl Penicillin (Penicillin G)
Penicillin V (Phenoxymethyl penicillin)
Penicillinase Resistant Penicillins
Broad-spectrum Penicillins (Ampicillin, Amoxycillin)
Cephalosporins
Erythromycin
Tetracycline
Mechanism of Action
Metronidazole
Ciprofloxacin
GUIDELINES FOR ANTIBIOTIC PROPHYLAXIS
Dental Procedures and Antibiotic Prophylaxis
REASONS FOR FAILURE OF ANTIBIOTIC THERAPY
24:
Bleaching of Discolored Teeth
INTRODUCTION
CLASSIFICATION OF DISCOLORATION
Stains During Odontogenesis (Pre-eruptive)
Amelogenesis Imperfecta (AI)
Fluorosis
Dentinogenesis Imperfecta (DI)
Tetracycline
Stains After Odontogenesis (Post eruptive)
Extrinsic Stains
Chemicals
BLEACHING
History of Tooth Bleaching
CONTRAINDICATIONS FOR BLEACHING
VARIOUS MEDICAMENTS USED AS BLEACHING AGENTS
Constitution of Bleaching Gels
MECHANISM OF BLEACHING
EFFECTS OF BLEACHING AGENTS ON TOOTH
HOME BLEACHING TECHNIQUE/ NIGHT GUARD VITAL BLEACHING
Indications for Use
Contraindications
Thickness of Tray
Steps of Tray Fabrication
Treatment Regimen
Maintenance after Tooth Bleaching
IN OFFICE BLEACHING
BLEACHING OF NONVITAL TEETH
INTRACORONAL BLEACHING/WALKING BLEACH OF NONVITAL TEETH
INSIDE/OUTSIDE BLEACHING TECHNIQUE
Synonyms: Internal/External Bleaching, Modified Walking Bleach Technique
Procedure
CLOSED CHAMBER BLEACHING/EXTRA CORONAL BLEACHING
MICROABRASION
PROTOCOL
CONCLUSION
25:
Tooth Resorption
INTRODUCTION
DEFINITION
CLASSIFICATION OF RESORPTION
CELLS INVOLED IN TOOTH RESORPTION
Clast Cells
MECHANISM OF TOOTH RESORPTION
Degradation of the Inorganic Crystal Structures
Degradation of the Organic Matrix
Inhibitory Mechanisms of Resorption
Cementum
Dentin
FACTORS REGULATING TOOTH RESORPTION
Systemic Factors
Local Factors
INTERNAL RESORPTION
Etiology
Clinical Features
TYPES OF INTERNAL RESORPTION
Root Canal Replacement Resorption (Metaplastic Resorption)
Internal Inflammatory Resorption
Pathophysiology
Differential Features of Internal and External Resorption (Fig. 25.6)
Management of Internal Root Resorption
Root Canal Treatment
Pulp Removal and Canal Preparation
Canal Obturation
Management of Perforating Internal Resorption
a. Non-surgical Repair
b. Surgical Repair
EXTERNAL ROOT RESORPTION
Classification
Surface Resorption
External Inflammatory Root Resorption
Etiopathology
Clinical Features
Radiographic Features
Treatment
Replacement Resorption
Etiopathogenesis
Histological Examination
Clinically
Diagnosis
Treatment
Recently Introduced Enamel Product “Emdogain”
Dentoalveolar Ankylosis
Etiopathology
Clinical Features
Radiographic Features
Histological Examination
Treatment of Ankylosis
Prevention
CERVICAL ROOT RESORPTION (EXTRA CANAL INVASIVE RESORPTION)
Etiology
Etiopathogenesis
Theories of Cervical Root Resorption
Clinical Features
Franks's Classification of Cervical Root Resorption
Radiographic Features
Treatment
TRANSIENT APICAL BREAKDOWN
CONCLUSION
26:
Tooth Hypersensitivity
INTRODUCTION
HISTORIC REVIEW
THE NEUROPHYSIOLOGY OF TEETH
MECHANISM OF DENTIN SENSITIVITY
Theories of Dentine Sensitivity
A. Neural Theory
B. Odontoblastic Transduction Theory
C. The Hydrodynamic Theory
D. Modulation Theory
Incidence and Distribution of Dentine Hypersensitivity
Intra-oral Distribution
Etiology and Predisposing Factors
TREATMENT STRATEGIES
Management of Dentine Hypersensitivity
Management of Tooth Hypersensitivity
A. Home care with dentifrices
Strontium Chloride Dentifrices
Potassium Nitrate Dentifrices
Fluoride Dentifrices
B. In Office Treatment Procedure
Cavity Varnishes
Corticosteroids
Partial Obliteration of Dentinal Tubules
Burnishing of Dentin
Formation of Insoluble Precipitates to Block Tubules
Dental Resins and Adhesives
Patient Education
Dietary Counseling
Tooth Brushing Technique
Plaque Control
Recent Developments
Treatment of Dentine Hypersensitivity by Lasers
SUMMARY
27:
Lasers in Endodontics
INTRODUCTION
HISTORY AND DEVELOPMENT
CLASSIFICATION OF LASER
LASER PHYSICS
Light Absorption and Emission
Light Amplification by Stimulated Emission of Radiation
Beam Profile and Spot Geometry
Power Density
TYPES OF LASERS
Carbon Dioxide Lasers
Uses
NEODYMIUM: YTTRIUM ALUMINIUM-GARNET LASERS
Uses
Argon Lasers
Uses
LASER INTRACTION WITH BIOLOGICAL TISSUES
Tissue Effects of Laser Irradiation
Photochemical Effects
Biostimulation
Photothermal Interaction
Photomechanical and Photoelectrical Interaction
Laser Effects on Dental Hard Tissues
Thermal Effects
Mechanical Effects
Chemical Effects
Laser Effects on the Dental Pulp
LASER SAFETY IN DENTAL PRACTICE
Fire and Electrical Control Measures
Personal Protective Equipment
Eye Protection
Control of Air Borne Contamination
Procedural Controls
SOFT AND HARD TISSUE APPLICATIONS OF LASERS IN DENTISTRY
Use of Lasers in Endodontics
Bleaching
CONCLUSION
28:
Pediatric Endodontics
INTRODUCTION
Why Endodontic Treatment of Primary Teeth is Challenging?
ANATOMY OF PRIMARY TEETH
PULP TREATMENT PROCEDURES
Indirect Pulp Capping
Indications
Contraindications
Clinical Technique
DIRECT PULP CAPPING
PULPOTOMY
Calcium Hydroxide Pulpotomy
Indications
Partial Pulpotomy
Technique
Complete Pulpotomy
Technique
Formocresol Pulpotomy
Indications
Contraindications
Clinical Technique
Other Materials used for Pulpotomy
PULPECTOMY FOR PRIMARY TEETH
Follow-up after Pulpectomy
APEXIFICATION
29:
Ethics in Endodontics
INTRODUCTION
Nature of Ethics
PRINCIPLES OF ETHICS
Related to Patient
Related to Community
Related to Profession
ROOT CANAL ETHICS
Treatment Records
INFORMED CONSENT
DENTAL NEGLIGENCE
Related to Local Anesthesia
Fracture of the Needle In Situ
Thermal or Chemical Burns
Thermal Burns
Chemical Burns
Poor Quality of Radiographs
Failure to Provide Adequate Care
Negligence Related to Patient
MALPRACTICE AND THE STANDARD OF CARE
Standard of Care Set by Endodontics
ABANDONMENT
MALPRACTICE CASES
Injury from Slips of the Drill
Inhalation or Ingestion of Endodontic Instruments
Broken File
Perforations
Overextensions
Further Reading
INDEX
TOC
Index
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