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Textbook of Endodontics
Nisha Garg, Amit Garg
CHAPTER 1:
Introduction and Scope of Endodontics
INTRODUCTION
HISTORY OF ENDODONTICS (TABLE 1.1)
MODERN ENDODONTICS
SCOPE OF 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?
Does the Tooth need any Special Care after Endodontic Therapy?
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?
QUESTION
CHAPTER 2:
Pulp and Periradicular Tissue
INTRODUCTION
DEVELOPMENT OF DENTAL PULP
HISTOLOGY OF DENTAL PULP
Structural or Cellular Elements
Extracellular Components
Ground Substance
SUPPORTIVE ELEMENTS
Pulpal Blood Supply
Lymphatic Vessels (Flow Chart 2.3)
Regulation of Pulpal Blood Flow
Pulpal Response to Inflammation
Effect of Posture on Pulpal Flow
Clinical Correlation
INNERVATION OF PULP (Flow Chart 2.4)
Basic Structure of a Neuron
ANATOMY OF DENTAL PULP
PULP CHAMBER
ROOT CANAL
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
a. True Denticle
b. False Denticles
According to Size
According to Location they can be Classified as:
Clinical Significance of Pulp Stones
Calcific Metamorphosis
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 (Fig. 2.33)
Cells
Intercellular Matrix
QUESTION
CHAPTER 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
NORMAL PULP AND PULPITIS
BARODONTALGIA/AERODONTALGIA
REVERSIBLE PULPITIS/HYPEREMIA/ HYPERACTIVE PULPALGIA
Definition
Etiology
Symptoms
Histopathology
Diagnosis
Treatment
IRREVERSIBLE PULPITIS
Definition
Etiology
Symptoms
Diagnosis
Treatment
CHRONIC PULPITIS
Etiology
Signs and Symptoms
Histopathology
Diagnosis
Treatment
INTERNAL RESORPTION
Etiology
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 (FIG. 3.39)
Etiology
Symptoms
Diagnosis
Histopathology
Management of an Acute Apical Abscess
PHOENIX ABSCESS/RECRUDESCENT ABSCESS
Etiology
Symptoms
Diagnosis
Treatment
PERIAPICAL GRANULOMA
Etiology of Periapical Granuloma
Clinical Features
Radiographic Features
Histopathologic Features (Fig. 3.45)
Treatment and Prognosis
RADICULAR CYST
Etiology
Clinical Features
Pathogenesis
Radiographic Features (Fig. 3.48)
Treatment
CHRONIC ALVEOLAR ABSCESS
Etiology
Symptoms
Diagnosis
Differential Diagnosis
Treatment
EXTERNAL ROOT RESORPTION
Etiology
Symptoms
Radiographic Features
Treatment
DISEASES OF PERIRADICULAR TISSUE OF NONENDODONTIC ORIGIN
Benign Lesions
Radiographic Features of Lesions of Nonodontogenic Origin
Diagnosis
Malignant Lesions
Diagnosis
QUESTIONS
CHAPTER 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
CLASSIFICATION OF MICROORGANISMS (FIG. 4.11)
MICROBIAL VIRULENCE AND PATHOGENICITY
Lipopolysaccharides (LPS)
Extracellular Vesicles
Enzymes
Fatty Acids
Polyamines
FACTORS INFLUENCING THE GROWTH AND COLONIZATION OF MICROORGANISMS
Influence of Oxygen
Nutritional Factors
Bacteriocins
Coaggregation
Bacterial Interrelationships
MICROBIAL ECOSYSTEM OF THE ROOT CANAL
PRIMARY ENDODONTIC INFECTIONS
MICROBIOLOGY OF PERIRADICULAR ENDODONTIC INFECTIONS
MICROBIOLOGY OF ROOT CANAL FAILURES
ENDODONTIC ABSCESSES AND CELLULITIS (FIG. 4.16)
ENTEROCOCCUS FAECALIS
IDENTIFICATION OF THE BACTERIA
Principle of Culturing
Types of Culture Medium
Liquid Culture Medium
Solid Media
Bacteriological Media
Culture Technique
Sample from Draining Root Canal
Sample from Dry Canal
Sample from the Abscess
Culture Reversal
Advantages of Culturing Techniques
Disadvantages of Culturing Method
Molecular Diagnostic Methods
DNA-DNA Hybridization Method
Advantages of DNA-DNA Hybridization Method
Disadvantages of DNA-DNA Hybridization Method
Polymerase Chain Reaction Method (PCR Method)
Disadvantages of PCR
Advantages of Molecular Methods
HOW TO COMBAT MICROBES IN THE ENDODONTIC THERAPY
QUESTIONS
CHAPTER 5:
Rationale of Endodontic Treatment
THEORIES OF SPREAD OF INFECTION
Focal Infection
Focus of Infection
Theory Related to Focal Infection
Mechanism of Focal Infection
Oral Foci of Infection
CULPRIT OF ENDODONTIC PATHOLOGY
PORTALS FOR ENTRY OF MICROORGANISMS (FIGS 5.1 AND 5.2)
Entry of Microorganisms into Pulp Through
INFLAMMATION
Signs of Inflammation
Inflammation is of Two Types
TISSUE CHANGES FOLLOWING INFLAMMATION
INFLAMMATORY CELLS (FIG. 5.4)
INFLAMMATORY RESPONSE TO PERIAPICAL LESION (FIG. 5.9)
Nonspecific Mediators of Periradicular Lesions
Cell Derived Mediators (Fig. 5.10)
Lysosomal Enzymes
Platelet Activating Factor
Vasoactive Amines
Prostaglandins
Plasma Derived Mediators (Fig. 5.12)
Effector Molecules
ANTIBODIES (SPECIFIC MEDIATORS OF IMMUNE REACTIONS)
ROLE OF IMMUNITY IN ENDODONTICS
Histopathology of Periapical Tissue Response to Various Irritants
ENDODONTIC IMPLICATIONS (PATHOGENESIS OF APICAL PERIODONTITIS AS EXPLAINED BY FISH) (FIG. 5.14)
Zone of Infection
Zone of Contamination
Zone of Irritation
Zone of Stimulation
KRONFELD'S MOUNTAIN PASS THEORY (FIG. 5.15)
RATIONALE OF ENDODONTIC THERAPY
QUESTION
CHAPTER 6:
Diagnostic Procedures
INTRODUCTION
CASE HISTORY
Chief Complaint
History of Present Illness
Medical History
Extraoral Examination
Intraoral Examination
DIFFERENTIAL DIAGNOSIS
RADIOGRAPH
PULP VITALITY TESTS
Uses of Pulp Vitality Testing
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 Fiberoptic Light
Detection of Interleukin-I Beta in Human Periapical Lesion
Plethysmography
DIAGNOSTIC FINDINGS
ROLE OF RADIOGRAPHS IN ENDODONTICS
Principles of Radiography
Cone Image Shift Technique
Advantages of “SLOB” Rule
Disadvantages of “SLOB” Rule
Bitewing Radiographs
Two Types
Advantages
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
QUESTION
CHAPTER 7:
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 (WDR) Neurons
2. Nociceptive-specific (NS) Neurons
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
4. PERIODONTAL ABSCESS
Diagnosis
Treatment
5. Pericoronitis
Diagnosis
Treatment
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
QUESTION
CHAPTER 8:
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
Summary
QUESTION
CHAPTER 9:
Asepsis in Endodontics
INTRODUCTION
RATIONALE FOR INFECTION CONTROL
CROSS-INFECTION
For an Infection to be Transmitted, the following Conditions are Required
Different Routes of Spread of Infection
Patient to Dental Health Care Worker
Dental Health Care Worker to the Patient
Patient to Patient
Dental Office to the Community
Community to the Patient
OBJECTIVE OF INFECTION CONTROL
UNIVERSAL PRECAUTIONS
Personal Protection Equipment
Barrier Technique
Hand Hygiene
Types of Hand Scrubs
Indications for Hand Hygiene
Handwash Technique
CLASSIFICATION OF INSTRUMENTS
Definitions
INSTRUMENT PROCESSING PROCEDURES
Steps of Instrument Processing
Presoaking (Holding)
Procedure
Cleaning
Procedure
Procedure
Control of Corrosion by Lubrication
Packaging
Methods of Sterilization
Classification of Sterilizing Agents
Moist/Steam Heat Sterilization
Advantages of Autoclaving
Disadvantages of Autoclaves
Dry Heat Sterilization
Packaging Material Requirements for Dry Heat
Acceptable Materials
Unacceptable Materials
Temperature/Cycle Recommended
Advantages of Dry Heat Sterilization
Disadvantages
Chemical Vapor Sterilization
Advantage
Disadvantages
Precautions to be Taken
Ethylene Oxide Sterilization (ETOX)
Advantages
Disadvantages
Irradiation
Ionizing Radiation
Non-ionizing Radiation
Glass Bead Sterilizer
Advantages
DISINFECTION
Methods of Disinfection
Disinfection by Cleaning
Disinfection by Heat
Low Temperature Steam
Disinfection by Chemical Agents
Levels of Disinfectant
Alcohols Low Level Disinfectant
Phenolic Compounds—Intermediate Level, Broad-spectrum Disinfectant
Aldehyde Compounds—High Level Disinfectant
Antiseptics (Fig. 9.10)
Aqueous Quarternary Ammonium Compounds
Iodophor Compounds
Chloride Compounds
Diguanides
INFECTION CONTROL CHECKLIST
Infection Control During the Pretreatment Period
Chairside Infection Control
Infection Control During the Post-treatment Period
QUESTIONS111
CHAPTER 10:
Isolation
INTRODUCTION
ADVANTAGES OF MOISTURE CONTROL
ISOLATION WITH RUBBER DAM
Recent Modifications in the Designs of Rubber Dam
Insti-dam
Salient Features of Insti-dam
Handi Dam
Dry Dam
Placement of Rubber Dam
Methods of Rubber Dam Placement
MANAGEMENT OF DIFFICULT CASES
Removal of Rubber Dam
QUESTIONS
CHAPTER 11:
Pharmacology in Endodontic
INTRODUCTION
ANXIETY CONTROL
Pharmacosedation
Barbiturates
Contraindications of use of Barbiturates
Benzodiazepines
Diazepam
Doses
Triazolam
Midazolam
Chlordiazepoxide
Iatrosedation
PAIN CONTROL
1. OPIOID DRUGS
Classification
Codeine
Morphine
Side Effects
Dextropropoxyphene
Tramadol
2. NON-OPIOID DRUGS
Aspirin
Side Effects
Contraindications
Precaution
Ibuprofen
Contraindications
Piroxicam
Diclofenac Sodium
Nimesulides
Para-amino Phenol Derivative (Paracetamol or Acetaminophen)
Choice of NSAIDs
3. LOCAL ANESTHESIA
A. Based on Chemical Structure
B. Based on Duration of Action
Composition of a Local Anesthetic Agent
Following Factors should be kept in Mind Prior to Administration of Local Anesthesia
Precautions to be taken before Administration of Local Anesthesia
Various Techniques of Local Anesthesia
Techniques Used for Maxillary Tissues
Techniques for Anesthetizing Maxillary Teeth
Technique
Advantage
Disadvantage
Technique
Technique
Technique
Technique
Technique
Technique
Advantages
Disadvantage
Various Mandibular Anesthesia Techniques
Techniques of Anesthetizing Mandibular Teeth
Technique
Technique
Technique
Technique
Intrapulpal Injection
Indication
Nerves Anesthesized
Technique
Advantages
Disadvantages
Recent Advances in Local Anesthesia
WAND System of Local Anesthesia
Advantages
Disadvantages
Comfort Control Syringe (CCS)
Advantages
Disadvantages
Transcutaneous Electrical Nerve Stimulation (TENS)
Mechanism of Action
Indications
Contraindications
Technique
Electronic Dental Anesthesia (EDA)
Indications
Contraindications
Mechanism of EDA
EDA Advantages
Disadvantages
Needle-less Syringes
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
Classification of Penicillins
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
Conditions Requiring Antibiotics in Endodontics
Conditions which don't Require Adjunctive Antibiotic Therapy in Endodontics
Dental Procedures and Antibiotic Prophylaxis
REASONS FOR FAILURE OF ANTIBIOTIC THERAPY
QUESTION
CHAPTER 12:
Endodontic Instruments
INTRODUCTION
CLASSIFICATION OF ENDODONTIC INSTRUMENTS
Grossman‘s Classification
HAND OPERATED INSTRUMENTS
Alloys Used for Manufacturing Endodontic Instruments
Manufacturing of Hand Instruments
Standardization of Instruments given by Ingle and Levine
Modifications from Ingle's Standardization (Fig. 12.2)
Broaches and Rasps
Broaches
Uses of Broach
Rasps
Reamers (Fig. 12.7)
Files
K-files (Fig. 12.11)
Disadvantage of K-files
K-flex Files (Fig. 12.14)
Flexo Files (Fig. 12.16)
Triple Flex Files
Flex-R-files/Roane Files
Hedstrom Files (H-files) (Figs 12.18A and B)
Advantages of H-files
Disadvantages of H-files
Safety Hedstrom File
S-file
C+Files
Golden Medium Files
ENGINE DRIVEN INSTRUMENTS
Gates-Glidden Burs (Fig. 12.23)
Uses of Gates-Glidden Drills
Flexogates (Fig. 12.28)
Advantages of Flexogates
PEESO REAMERS
NICKEL TITANIUM (NITI) ENDODONTIC INSTRUMENTS
Advantages of NiTi Alloys
Disadvantages of NiTi Files
Manufacturing of NiTi Files
INSTRUMENT DEFORMATION AND BREAKAGE
Torsional Fracture
Role of Handpiece
Flexural Fracture
ENGINE DRIVEN INSTRUMENTS
History of Rotary Endodontics
1. Rotary Handpiece
a. Micromotor handpiece (Fig. 12.32)
b. Reduction gear handpiece (Fig. 12.33)
c. Triauto ZX
2. Reciprocating Handpiece
3. Vertical Stroke Handpiece
4. Random Handpiece
Three Different Handing Protocols are followed for Rotary Instruments (Figs 12.38A to C)
VARIOUS ROTARY NICKEL TITANIUM (RNT) SYSTEM
PROFILE SYSTEM
GREATER TAPER FILES (GT FILES)
PROTAPER FILES (FIG. 12.43)
Shaping Files (Fig. 12.47)
Sx (Fig. 12.48)
S1 (Fig. 12.48)
S2 (Fig. 12.48)
Finishing Files
F1
F2
F3
QUANTEC FILE SYSTEM
LIGHT SPEED SYSTEM
K3 ROTARY FILE SYSTEM
HERO 642
Features
RACE (Reamers with Alternating Cutting Edges) FILES
Advantages of RACE Files
REAL WORLD ENDO SEQUENCE FILE
SONICS AND ULTRASONICS IN ENDODONTICS
Sonic Handpiece
Advantages of Sonic Instruments
Disadvantages
Ultrasonic Handpiece
Advantages of Ultrasonics
Type of Ultrasonics
Mechanism of Action
Cavitation and Acoustic Streaming
Acoustic Streaming
Uses of Endosonics
Access Enhancement
Orifice Location
Irrigation
Sealer Placement
Gutta-percha Obturation
MTA Placement
Endodontic Retreatment (Fig. 12.60)
INSTRUMENTS USED FOR FILLING ROOT CANALS
Hand Spreaders
Finger Spreaders (Fig. 12.64)
Hand Pluggers
Finger Pluggers (Fig. 12.68)
Lentulo Spirals (Fig. 12.69)
QUESTIONS
CHAPTER 13:
Internal Anatomy
INTRODUCTION
PULP CAVITY
Pulp Horns
Pulp Chamber
Canal Orifice
Apical Root Anatomy
Isthmus
Identification
Classification
Significance of Isthmus
COMMON CANAL CONFIGURATION
METHODS OF DETERMINING PULP ANATOMY
In vitro Methods
VARIATIONS IN THE INTERNAL ANATOMY OF TEETH
FACTORS AFFECTING INTERNAL ANATOMY
INDIVIDUAL TOOTH ANATOMY
Maxillary Central Incisor (Fig. 13.39)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Lateral Incisor (Fig. 13.40)
Average Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Canine (Fig. 13.41)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary First Premolar (Fig. 13.42)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Maxillary Second Premolar (Fig. 13.43)
Pulp Chamber
Root Canals
Clinical Considerations
Maxillary First Molar (Fig. 13.44)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Maxillary Second Molar (Fig. 13.45)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Maxillary Third Molar
Average Tooth Length
Pulp Chamber and Root Canal
Mandibular Teeth Central Incisor (Fig. 13.46)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Lateral Incisor (Fig. 13.47)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Consideration
Mandibular Canine (Fig. 13.48)
Pulp Chamber
Root Canals
Clinical Consideration
Mandibular First Premolar (Fig. 13.49)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Considerations
Mandibular Second Premolar (Fig. 13.50)
Average Tooth Length
Pulp Chamber
Root Canal
Clinical Consideration
Mandibular First Molar (Fig. 13.51)
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Second Molar (Fig. 13.53)
Average Tooth Length
Pulp Chamber
Root Canals
Clinical Considerations
Mandibular Third Molar
Pulp Chamber and Root Canals
CLASSIFICATION OF C-SHAPED ROOT CANALS
I. Melton's Classification
II. Fan's Classification (anatomic classification)
III. Fan's Classification (radiographic classification)
QUESTIONS
CHAPTER 14:
Access Cavity Preparation
DEFINITION
Objectives of Access Cavity Preparation
INSTRUMENTS FOR ACCESS CAVITY PREPARATION (FIG. 14.8)
Instruments for Access Opening
Access Opening Burs
Access Refining Burs (Fig. 14.10)
Surgical Length Burs
Munce Discovery (MD) Burs
Uses
Muler Burs (Fig. 14.11)
Guidelines for Access Cavity Preparation (Fig. 14.12)
Laws of Access Cavity Preparation for Locating Canal Orifices
Law of Centrality
Law of Cementoenamel Junction
Law of Concentricity
Law of Color Change
Law of Symmetry
Law of Orifice Location
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
CLINICAL MANAGEMENT OF DIFFICULT CASES FOR ACCESS OPENING
Management of Cases with Extensive Restorations
Tilted and Angulated Crowns
Calcified Canals
Sclerosed Canals
Teeth with No or Minimal Crown
QUESTIONS
CHAPTER 15:
Working Length Determination
INTRODUCTION AND HISTORY
DEFINITIONS
SIGNIFICANCE OF WORKING LENGTH
Working Width
Determination of Minimum Initial Working Width
Significance of Working Width
Advantages of Narrow Apex
Disadvantages
Advantages of Wide Apex
Disadvantages
DIFFERENT METHODS OF WORKING LENGTH DETERMINATION
Directional Stop Attachments
RADIOGRAPHIC METHOD OF WORKING LENGTH DETERMINATION
A. Radiographic Methods
Grossman Method/Mathematic Method of Working Length Determination
Disadvantages
Kuttler's Method
Technique
Advantages
Disadvantages
Radiographic Grid
Endometric Probe
Direct Digital Radiography
Xeroradiography
Advantages
Disadvantages
B. Non-radiographic Methods
ELECTRONIC APEX LOCATORS
Components of Electronic Apex Locators
Advantages of Apex Locators
Disadvantages
Uses of Apex Locators
Contraindications to the Use of Apex Locator
Classification of EALs
First Generation Apex Locators (Resistance Apex Locators)
Technique for Using Resistance Based EAL
Advantages
Disadvantages
Second Generation Apex Locators (Impedance Based Apex Locators)
Advantages
Disadvantages
Third Generation Apex Locators (Fig. 15.12)
Advantages
Disadvantages
Fourth Generation Apex Locators
Combination Apex Locators and Endodontic Handpiece
Basic Conditions for Accuracy of EALs
SUMMARY
QUESTIONS
CHAPTER 16:
Irrigation and Intracanal Medicaments
INTRODUCTION
Ideal Requirements for an Irrigant
FUNCTIONS OF IRRIGANTS
FACTORS THAT MODIFY ACTIVITY OF INTRACANAL IRRIGATING SOLUTIONS
CHOICE OF MAIN IRRIGANT SOLUTION
Normal Saline (Fig. 16.5)
Advantage
Disadvantages
Sodium Hypochlorite
Historical Review
Mechanism of Action of Sodium Hypochlorite
Precautions to be Taken While Using Sodium Hypochlorite Solution
Advantages of Sodium Hypochlorite
Disadvantages
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
Combination of 0.2 percent Chlorhexidine and 2 percent Sodium Hypochlorite
Mechanisms of Action
Advantages and Uses
Disadvantages
CHELATING AGENTS
Functions of EDTA
Mechanism of Action
Uses of EDTA
Different Forms of EDTA
Citric Acid
Polyacrylic Acid
Hydroxyethylidene Bisphosphonate (HEBP)
Salvizol
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
Different Needle Designs
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
Effects of Calcium Hydroxide
Physical
Chemical
Indications of Calcium Hydroxide
Disadvantages of Calcium Hydroxide as Intracanal Medicament
Functions of Ca(OH)2
Use of Calcium Hydroxide in Weeping Canal Cases
Halogens
Chlorine
Chlorhexidine Gluconate
PBSC Paste
Sulfonamides
N2 by Sargent
Grossman Paste
Chloramines-T
Quaternary Ammonium Compounds
Corticosteroid-antibiotic Combinations
PLACEMENT OF INTRACANAL MEDICAMENT
Limitations of Intracanal Medicaments
QUESTIONS
CHAPTER 17:
Cleaning and Shaping of Root Canal System
INTRODUCTION
Cleaning
Shaping
Objectives of Biomechanical Preparation
Biologic Objectives of Root Canal Preparation
Clinical Objectives of Biomechanical Preparation
DIFFERENT MOVEMENTS OF INSTRUMENTS
Reaming
Filing
Combination of Reaming and Filing (Fig. 17.13)
Balanced Force Technique
Watch Winding
Watch Winding and Pull Motion
Motions of Instruments for Cleaning and Shaping
BASIC PRINCIPLES OF CANAL INSTRUMENTATION
TECHNIQUES OF ROOT CANAL PREPARATION
STANDARDIZED TECHNIQUE OF CANAL PREPARATION
Technique
Disadvantages of Standardized Technique
STEP BACK TECHNIQUE
Advantage of Step Back Technique
Disadvantages of Step Back Technique
MODIFIED STEP BACK TECHNIQUE
Advantages
Disadvantages
PASSIVE STEP BACK TECHNIQUE
Technique
Advantages of Passive Step Back Technique
HYBRID TECHNIQUE OF CANAL PREPARATION
Technique
Advantages
BALANCED FORCE TECHNIQUE
Technique
Advantages of Balanced Force Technique
REVERSE BALANCED FORCE PREPARATION
Technique
ANTICURVATURE FILING
Technique (Fig. 17.41)
DOUBLE FLARE 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 (Figs 17.63 and 17.64)
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
2. Management of Calcified Canals
Steps
Guidelines for Negotiating Calcified Canals (Figs 17.94A to C)
3. Management of C-shaped Canals
4. Management of S-shaped/Bayonet shaped Canals
QUESTIONS
CHAPTER 18:
Obturation of Root Canal System
INTRODUCTION
PURPOSE OF OBTURATION
TIMING OF OBTURATION
Patient Symptoms
Pulp and Periradicular Status
Negative Culture
EXTENT OF OBTURATION
MATERIALS USED FOR OBTURATION
Gutta-percha
Sources
Chemistry
Chemical Structure
Phases of Gutta-percha
Current Available Forms of Gutta-percha
Advantages of gutta-percha
Disadvantages
Medicated Gutta-percha
Advantages of Ca(OH)2 points
Disadvantages
Ca(OH)2 plus points
Silver Points
ROOT CANAL SEALERS
Requirements of an Ideal Root Canal Sealer
Functions of Root Canal Sealers
Classification
Zinc Oxide Eugenol Sealers (Fig. 18.15) Kerr Root Canal Sealer or Rickert's Formula
Advantages
Disadvantage
Manipulation
Procosol Radiopaque-silver Cement (Grossman, 1936)
Procosol Non Staining Cement (Grossman 1958)
Grossman's Sealer
Properties
Disadvantage
Setting Time
Wach's Sealer
Properties
Advantages
Disadvantage
Tubliseal (1961)
Setting Time
Advantages
Disadvantages
Indications
Endoflas
Setting Reaction of Zinc Oxide-Eugenol Cement
Advantages of Zinc Oxide-Eugenol Cement
Disadvantages
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
Advantages
Disadvantages
AH-26
Properties
Thermaseal
AH Plus (Fig. 18.16)
Dosage and Mixing
Fiberfill
Manipulation
Calcium Hydroxide Sealer
Disadvantages
Seal Apex
Advantage
Disadvantages
Calcibiotic Root Canal Sealer (CRCS)
CRCS
Advantages
Disadvantages
Apexit
Advantages
Medicated Sealers
N2
Toxicity
Endomethasone
Silicone-based Root Canal Sealers
Endofill
Advantages
Disadvantages
Rocko Seal
Glass Ionomer Sealer (Ketac-Endo)
Advantages
Disadvantages
Resilon (Fig. 18.19)
The Monoblock Concept
Method of Use
Advantages of Epiphany
Disadvantage
METHODS OF SEALER PLACEMENT
OBTURATION TECHNIQUES
ARMAMENTARIUM FOR OBTURATION (FIG. 18.24)
LATERAL COMPACTION TECHNIQUE
Technique
Advantages of Lateral Compaction Technique
Disadvantages
VARIATION OF LATERAL COMPACTION TECHNIQUE
For Tubular Canals (Figs 18.40A and B)
For Curved Canals (Fig. 18.41)
Blunderbuss/Immature Canals (Figs 18.43A and B)
CHEMICAL ALTERATION OF GUTTA-PERCHA
VERTICAL COMPACTION TECHNIQUE
Technique
Advantage of Vertical Compaction Technique
Disadvantages of this Technique
System B: Continuous Wave of Condensation Technique
Technique
Advantages of System B
LATERAL/VERTICAL COMPACTION OF WARM GUTTA-PERCHA
Techniques
Advantages
SECTIONAL METHOD OF OBTURATION
Techniques
Advantages
Disadvantages
McSPADDEN COMPACTION/THERMOMECHANICAL COMPACTION OF THE GUTTA-PERCHA
Advantages
Disadvantages
THERMOPLASTICIZED INJECTABLE GUTTA-PERCHA OBTURATION
Obtura II Heated Gutta-Percha System/High Heat System
Indications
Techniques
Variations in Thermoplasticizing Technique of Gutta-percha
1. Ultrasonic Plasticizing of Gutta-Percha
2. Ultrafil System
Techniques
SOLID CORE CARRIER TECHNIQUE
Thermafil Endodontic Obturators
Technique
Advantages
Cold Gutta-percha Compaction Technique
Gutta Flow
Composition
Advantages
OBTURATION WITH SILVER CONE
Indications
Contraindications
Advantages
Disadvantages
Steps
Stainless Steel
Apical Third Filling
Simplifill Obturator
Steps
Fiberfill Obturator
Dentin Chip Filling
Technique
Advantages
Disadvantage
Calcium Hydroxide
Mineral Trioxide Aggregate (MTA)
POSTOBTURATION INSTRUCTIONS
Patient Recall
QUESTIONS
CHAPTER 19:
Single Visit Endodontics (SVE)
INTRODUCTION
Advantages of Single Visit Endodontics
Disadvantages of Single Visit Endodontics
Criteria of Case Selection
Conditions where Single Visit Endodontics cannot be Performed
Indications of Single Visit Endodontics
QUESTION
CHAPTER 20:
Mid Treatment Flare-ups in Endodontics
INTRODUCTION
ETIOLOGY
CLINICAL CONDITIONS OF FLARE-UP
CONTRIBUTING 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
General Management of Flare-ups
Precautions to be Taken to Prevent Flare-ups
CONCLUSION
QUESTIONS
CHAPTER 21:
Endodontic Emergencies
INTRODUCTION
DIAGNOSIS AND TREATMENT PLANNING
History of the Patient
Subjective Examination
Objective Examination
Radiographic Examination
Classification of Endodontic Emergencies (According to P Carrotte)
PRETREATMENT ENDODONTIC EMERGENCIES
CONDITIONS REQUIRING EMERGENCY ENDODONTIC TREATMENT
Treatment
Definitive Treatment
Management
Management
Management
Management (Fig. 21.12)
Definitive Treatment
INTRATREATMENT EMERGENCIES
Patients under Treatment
Clinical Features
Management
Prevention
Etiology
Clinical Features
Differential Diagnosis
Treatment
Prevention
To Summarize, Etiology of Mid Treatment Flare-ups
Risk Factors Contributing Inter Appointment Flare-ups
Prevention
Treatment
POSTOBTURATION EMERGENCIES
Vertical Root Fracture (VRF)
Treatment
Various Analgesics Used in Endodontic Emergencies
QUESTIONS
CHAPTER 22:
Procedural Accidents
INTRODUCTION
VARIOUS PROCEDURAL ACCIDENTS
INADEQUATELY CLEANED AND SHAPED ROOT CANAL SYSTEM
LOSS OF WORKING LENGTH
CANAL BLOCKAGE
Treatment
Prevention
LEDGING
Treatment
Prevention of Ledge Formation
MISSED CANAL
Common Sites for Missed Canals
Missed Canals can be Located by
Prevention of Missed Canal
Significance of Missed Canal
INSTRUMENT SEPARATION
Management
Instrument Retrieval
Masserann Kit
Use of Endoextractor
Instrument Removal System (Fig. 22.19)
Technique of Using IRS (Fig. 22.20)
File Bypass Technique
Prognosis
Prevention
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
Precautions to Prevent Perforations
POST SPACE PERFORATIONS
Prevention of Post-related Perforation
UNDERFILLING/INCOMPLETELY FILLED ROOT CANALS
Prevention of Underfilling
OVERFILLING OF THE ROOT CANALS
VERTICAL ROOT FRACTURE
Clinical Features
Prevention of Root Fracture
INSTRUMENTS ASPIRATION
QUESTIONS
CHAPTER 23:
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 (Fig. 23.5)
Excessive Hemorrhage
Overinstrumentation
Chemical Irritants
Iatrogenic Errors
Systemic Factors
Factors Responsible for Endodontic Failures
Before going for endodontic retreatment, following factors should be considered:
Before performing endodontic retreatment following points should be considered:
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
Removal of Gutta-percha
Removal of Resilon
Carrier Based Gutta-percha Removal
Removal of Paste
Separated Instruments and Foreign Objects
Completion of the Retreatment
Radiographic Criteria for Success of Endodontic Treatment
Factors Affecting Success or Failure of a Particular Case
Occurrence of Endodontic Failures does not Depend on
QUESTIONS
CHAPTER 24:
Endodontic Periodontal Relationship
INTRODUCTION
Definition
Pathways of Communication between Pulp and Periodontium
Physiologic Pathways
Pathological
Iatrogenic
PHYSIOLOGIC PATHWAYS
Dentinal Tubules
Lateral or Accessory Canals
Lateral and Accessory Canals
Apical Foramen
Palato Gingival Groove
PATHOLOGIC PATHWAYS
Perforation of the Root (Fig. 24.5)
Vertical Root Fracture (Fig. 24.6)
Loss of Cementum
IATROGENIC
Perforation During Endodontic Therapy
Root Fracture During Root Canal Therapy
Exposure of Dentinal Tubules During Root Planning
IMPACT OF PULPAL DISEASES ON THE PERIODONTIUM
IMPACT OF PERIODONTAL DISEASE ON PULPAL TISSUE
ETIOLOGY OF ENDODONTIC PERIODONTAL PROBLEMS
CLASSIFICATION OF ENDODONTIC PERIODONTAL LESIONS
Classification
DIAGNOSIS OF ENDODONTIC PERIODONTAL LESIONS
Treatment and Prognosis
PRIMARY ENDODONTIC LESIONS (FIG. 24.16)
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
PRIMARY ENDODONTIC LESION WITH SECONDARY PERIODONTAL INVOLVEMENT (FIG. 24.17)
Clinical Features
Diagnosis
Treatment
Prognosis
PRIMARY PERIODONTAL LESIONS (FIG. 24.18)
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
PRIMARY PERIODONTAL LESIONS WITH SECONDARY ENDODONTIC INVOLVEMENT (FIG. 24.19)
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
INDEPENDENT ENDODONTIC AND PERIODONTAL LESIONS WHICH DO NOT COMMUNICATE
Clinical Feature
Treatment
Prognosis
TRUE COMBINED ENDO-PERIO LESIONS (FIG. 24.20)
Clinical Features
Treatment
Prognosis
QUESTIONS
CHAPTER 25:
Surgical Endodontics
INTRODUCTION
OBJECTIVES OF ENDODONTIC SURGERY
RATIONALE FOR ENDODONTIC SURGERY
INDICATIONS
CONTRAINDICATIONS
CLASSIFICATION
PRESURGICAL CONSIDERATIONS
INCISION AND DRAINAGE
Surgical Drainage
Protocol of Treatment
PERIRADICULAR SURGERY
Armamentarium for Periradicular Surgery
Local Anesthesia and Hemostasis (Fig. 25.5)
Amount of Local Anesthesia
Receptors and Mechanism of Hemostasis
Reactive Hyperemia: The Rebound Phenomenon
FLAP DESIGNS AND INCISIONS
Classification
PRINCIPLES AND GUIDELINES FOR FLAP DESIGNS
Functions of a Flap
FULL MUCOPERIOSTEAL FLAPS
Types of Incision
Triangular Flap
Advantages
Disadvantage
Indications
Rectangular Flap (Fig. 25.14)
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
Indications
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)
Guidelines for Bone Removal
Angle of Root-end Resection
ROOT-END PREPARATION
Traditional Root-end Cavity Preparation
Advantages
Steps of Root-end Preparation by Ultrasonic Instruments
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
Disadvantages
Composite Resins
REAPPROXIMATION OF THE SOFT TISSUE
Repositioning of the Flap
REPLANTATION
Classification
Indications
Contraindications
Techniques
TRANSPLANTATION
ROOT RESECTION/AMPUTATION
Indications for Root Resections
Contraindications for Root Resections
Technique
Presurgical Crown Contouring (Fig. 25.39)
BICUSPIDIZATION/BISECTION
Indications
Contraindications
ENDODONTIC IMPLANTS
Case Selection for Endodontic Implants
Indications
Contraindications
Material Used for Implants
Technique
Reasons for Failure of Endodontic Implants
POSTSURGICAL CARE
Instructions
SUTURING MATERIALS AND TECHNIQUES
Definition
History
Classification of Sutures
Ideal Suture Characteristics
Few Facts About Sutures
Suture Needle
Parts of Surgical Needle (Fig. 25.42)
The Body
Point
The Swage
Principles of Suturing
Suturing Techniques
Interrupted Suture (Fig. 25.44)
Advantages
Continuous Locking Suture (Fig. 25.45)
Vertical Mattress Suture (Fig. 25.46)
Horizontal Mattress Suture (Fig. 25.47)
COMPLICATIONS OF SUTURING
Suture Removal
POSTSURGICAL COMPLICATIONS
Management
Management
Extraoral Ecchymosis (Extraoral discoloration)
Management
Pain
Management
Infection
Management
Miscellaneous
QUESTIONS
CHAPTER 26:
Restoration of Endodontically Treated Teeth
INTRODUCTION
IMPORTANCE OF CORONAL RESTORATION
EFFECTS OF ENDODONTIC TREATMENT ON THE TOOTH
Structural Changes
Changes in the Dentin Physical Characteristics
Esthetic Consideration
PLANNING POSTENDODONTIC RESTORATION PROCEDURE
For Anterior Teeth
Not all endodontically treated teeth require posts
For Posterior Teeth
Features Evaluated before Going for Post and Core
Requirements of a Tooth to Accept a Post and Core
Post
Core
Purpose of Use of Post and Core
Post Mainly Serves Two Functions
Ideal Requirements of a Post
A Post Should:
CLASSIFICATION OF POSTS
CUSTOM CAST METAL POST
Advantages
Disadvantages
ALL CERAMIC POST AND CORES
Advantages
Disadvantages
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
Retention and the Resistance Form
Post Length
Accepted Guidelines for Determining Post Length
Post Diameter
Post Design
Luting Agents
Luting Method
Canal Shape
Position of Tooth in the Dental Arch
Preservation of the Tooth Structure
Ferrule Effect (Fig. 26.32)
Functions of Ferrule
Secondary Ferrule/core Ferrule
Mode of Failure
Factors Affecting Clinical Longevity of Post and Core
Retrievability
PREPARATION OF THE CANAL SPACE AND THE TOOTH
CORE
Ideal Requirements for a Core Material
Amalgam Core
Glass Ionomer Cements
Composite Resins
Advantages
Disadvantages
Cast Core
Biomechanical Criteria for Evaluation of Core Materials
Bonding (Maximum to Least)
Strength
Ease of Use
Setting Time
Dimensional Stability
QUESTIONS
CHAPTER 27:
Management of Traumatic Injuries
INTRODUCTION
Etiology of Traumatic Injuries
Extent of Trauma can be Assessed by Four Factors (Hallet;1954)
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 Infraction
Biological Consequence
Diagnosis
Treatment
Prognosis
CROWN FRACTURE
Uncomplicated Crown Fracture
Incidence
Biological Consequences
Diagnosis
Treatment
Prognosis
Complicated Crown Fracture (Fig. 27.14)
Incidence
Biological Consequences
Diagnosis
Treatment
Factors Affecting Pulpal Survival
Pulp Capping and Pulpotomy
Pulp Capping
Indications
Technique
Follow-up
Prognosis
Pulpotomy
Two Types
Partial Pulpotomy
Indications
Technique
Follow-up
Prognosis
Cervical Pulpotomy/Deep Pulpotomy
Indications
Technique
Follow-up
Prognosis
Prerequisites for Success
Apexification
CROWN ROOT FRACTURE
Incidence
Biological Consequences
Diagnosis
Treatment
Prognosis
ROOT FRACTURE
Incidence
Biological Consequences
Diagnosis
Treatment of Root Fractures
PROGNOSIS
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
Biologic Consequences
What to Do When a Patient Comes with Avulsed Tooth?
Hank's Balanced Solution (Save-A-Tooth)
Milk
Saline
Saliva
Visapan
Coconut Water
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
Treatment Options for Teeth with Root Fractures with Necrotic Pulp
Mainly Five Types of Luxation Injuries are seen:
Biologic Consequences
Contraindications of Replantation
Legal Consequences
QUESTIONS1
CHAPTER 28:
Pulpal Response to Caries and Dental Procedure
INTRODUCTION
PULPAL IRRITANTS
EFFECT OF DENTAL CARIES ON PULP
INFLAMMATION UNDER CARIES
RESPONSE OF PULP TO TOOTH PREPARATION
Irritating Agents of Tooth Preparation
Factors Affecting the Response of Pulp to Irritants
REMAINING DENTIN THICKNESS
THERMAL AND MECHANICAL INJURY
Speed of Rotation
Nature of Cutting Instrument
Basic Rules for Use of Diamond Instruments
Use of Coolants
RESPONSE OF PULP TO LOCAL ANESTHETICS
Effects of Local Anesthetics on the Pulp
EFFECT OF CHEMICAL IRRITANTS ON PULP
Factors Influencing the Effect of Restorative Materials on Pulp
DENTIN STERILIZING AGENTS
CAVITY LINER AND VARNISHES
RESPONSE OF PULP TO RESTORATIVE MATERIALS
Calcium Hydroxide
Zinc Oxide Eugenol
Zinc Phosphate
Routes of Microleakage
Zinc Polycarboxylate Cements (Fig. 28.14)
Glass Ionomer Cement
Amalgam
Effects of Amalgam on Pulp
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
Effects of Radiations
EFFECT OF HEAT FROM ELECTROSURGERY
EFFECT OF LASERS ON PULP
DEFENSE MECHANISM OF PULP
Tubular Sclerosis
Smear Layer
Reparative Dentin Formation (Fig. 28.19)
Prevention of Pulpal Damage due to Operative Procedure
HOW DOES PULP RECOVER?
QUESTIONS
CHAPTER 29:
Management of Discolored Teeth
INTRODUCTION
CLASSIFICATION OF DISCOLORATION
Intrinsic Stains
Pre-eruptive Causes
Posteruptive Causes
Extrinsic Stains
Daily Acquired Stains
Chemicals
BLEACHING
History of Tooth Bleaching
CONTRAINDICATIONS FOR BLEACHING
MEDICAMENTS USED AS BLEACHING AGENTS
HOME BLEACHING TECHNIQUE/ NIGHTGUARD BLEACHING
Indications for Use
Contraindications
Advantages of Home Bleaching Technique
Disadvantages of Home Bleaching Technique
Factors that Guard the Prognosis for Home Bleaching
Steps of Tray Fabrication
Thickness of Tray
Treatment Regimen
Maintenance After Tooth Bleaching
Side Effects of Home Bleaching
IN-OFFICE BLEACHING THERMOCATALYTIC VITAL TOOTH BLEACHING
Light Sources Used for In-office Bleach
Conventional Bleaching Light
Tungsten-Halogen Curing Light
Xenon Plasma Arc Light
Argon and CO2 Laser
Diode Laser Light
Indications of In-office Bleaching
Contraindications of In-office Bleaching
Advantages of In-office Bleaching
Disadvantages of In-office Bleaching
Procedures (Fig. 29.15)
NON-THERMOCATALYTIC BLEACHING
Steps
MICROABRASION
Indications
Contraindications
Advantages
Disadvantages
Protocol
BLEACHING OF NONVITAL TEETH THERMOCATALYTIC TECHNIQUE OF BLEACHING FOR NONVITAL TEETH
INTRACORONAL BLEACHING/WALKING BLEACH OF NONVITAL TEETH
Indications of Intracoronal Bleaching
Contraindications of Intracoronal Bleaching
Steps
Complications of Intracoronal Bleaching
Precautions to be Taken for Safer Nonvital Bleaching
INSIDE/OUTSIDE BLEACHING TECHNIQUE
Synonyms
Internal/External Bleaching, Modified Walking Bleach Technique
Procedures
Advantages
Disadvantages
CLOSED CHAMBER BLEACHING/EXTRACORONAL BLEACHING
LASER ASSISTED BLEACHING TECHNIQUE
Argon Laser
CO2 Laser
GaAlAs Diode Laser (Gallium Aluminium–Arsenic)
EFFECTS OF BLEACHING AGENTS ON TOOTH AND ITS SUPPORTING STRUCTURES
Tooth Hypersensitivity
Effects on Enamel
Effects on Dentin
Effects on Pulp
Effects on Cementum
Cervical Resorption
Effects on Restorative Materials
Mucosal Irritation
Genotoxicity and Carcinogenicity
Toxicity
QUESTIONS
CHAPTER 30:
Tooth Resorption
INTRODUCTION
DEFINITION
CLASSIFICATION OF RESORPTION
Classification
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
Enzymes Involved in Degradation of Organic Matrix
Inhibitory Mechanisms of Resorption
Cementum
Dentin
FACTORS REGULATING TOOTH RESORPTION
Systemic Factors
Local Factors
Factors Regulating Tooth Resorption
INTERNAL RESORPTION
Etiology
Clinical Features
Types of Internal Resorption
Root Canal Replacement Resorption (Metaplastic Resorption)
Internal Inflammatory Resorption
Pathophysiology
Management of Internal Root Resorption
Treatment Options in Teeth with Internal Resorption
Root Canal Treatment
Pulp Removal and Canal Preparation
Canal Obturation
Management of Perforating Internal Resorption
Non-surgical Repair
Surgical Repair
EXTERNAL ROOT RESORPTION
Classification
External Resorption may be Found in Following Conditions
Surface Resorption
External Inflammatory Root Resorption
Etiopathology
Clinical Features
Radiographic Feature
Treatment
Replacement Resorption/Dentoalveolar Ankylosis
Etiopathogenesis
Histological Examination
Clinical Features
Radiographic Appearance
Diagnosis
Treatment
Prevention
Recently Introduced Enamel Product “Emdogain”
CERVICAL ROOT RESORPTION (EXTRACANAL INVASIVE RESORPTION)
Etiology
Etiopathogenesis
Clinical Features of Cervical Root Resorption
Theories of Cervical Root Resorption
Clinical Features
Heithersay's Classification
Franks's Classification of Cervical Root Resorption
Radiographic Feature
Treatment
TRANSIENT APICAL BREAKDOWN
CONCLUSION
QUESTIONS
CHAPTER 31:
Tooth Infractions
TOOTH INFRACTIONS
Etiology
Classification of Cracked Teeth
Diagnosis
Clinical Examinations
Chief Complaint
History of Patient
Visual Examination
Tactile Examination
Periodontal Probing
Bite Test
Transillumination
Use of Dyes
Radiographs
Surgical Exposure
Differential Diagnosis of Cracked Tooth Syndrome
Treatment of Cracked Teeth
VERTICAL ROOT FRACTURE (VRF)
Etiology
Signs and Symptoms
Radiographic Examination
Diagnosis
Treatment of Vertical Root Fracture
Prevention of Root Fracture
QUESTIONS
CHAPTER 32:
Tooth Hypersensitivity
INTRODUCTION
DEFINITION
NEUROPHYSIOLOGY OF TEETH
MECHANISM OF DENTIN SENSITIVITY
Theories of Dentin Sensitivity
Neural Theory
Odontoblastic Transduction Theory
Hydrodynamic Theory
INCIDENCE AND DISTRIBUTION OF DENTIN HYPERSENSITIVITY
Intraoral Distribution
ETIOLOGY AND PREDISPOSING FACTORS
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
TREATMENT STRATEGIES
Management of Tooth Hypersensitivity
Natural Process Contributing to Desensitization
Home Care with Dentifrices (Fig. 32.8)
Strontium Chloride Dentifrices
Potassium Nitrate Dentifrices
Fluoride Dentifrices
In-office Treatment Procedure
Rationale of Therapy
Varnishes
Corticosteroids
Partial Obliteration of Dentinal Tubules
Dental Resins and Adhesives
Lasers
Patient Education
Dietary Counseling
Toothbrushing Technique
Plaque Control
QUESTIONS
CHAPTER 33:
Pediatric Endodontics
INTRODUCTION
Importance of Pulp Therapy
Why Endodontic Treatment of Primary Teeth is Challenging?
ANATOMY OF PRIMARY TEETH
Anatomic Differences between Primary and Permanent Teeth
PULP TREATMENT PROCEDURES
Indirect Pulp Capping
Indications
Contraindications
Clinical Techniques
Direct Pulp Capping
Indications
Contraindications
Clinical Procedure
PULPOTOMY
Objectives of Pulpotomy
Rationale of Pulpotomy
Criteria for Successful Pulpotomy
Calcium Hydroxide Pulpotomy
Indication
Partial Pulpotomy
Techniques
Cervical or Complete Pulpotomy
Technique
Formocresol Pulpotomy
Indications
Contraindications
Clinical Techniques
Other Materials Used for Pulpotomy
PULPECTOMY FOR PRIMARY TEETH
Indications
Contraindications
Clinical Sequence
Follow-up after Pulpectomy
APEXIFICATION
Objectives of Apexification
Rationale of Apexification
Indications
Materials Used for Apexification
Techniques
Types of Closure which can Occur during Apexification
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
QUESTIONS
CHAPTER 34:
Geriatric Endodontics
ORAL ASPECTS OF AGING
Age Changes in Bone Tissue
AGE CHANGES IN THE TEETH
Macroscopic Changes
Age Changes in Enamel
Age Changes in Cementum
Age Changes in Dentin
Clinical Implications of Age Changes in Dentin
Age Changes in Pulp (Fig. 34.4)
Age Changes in Oral Mucosa
Clinical Changes in Epithelium
Histological Changes in Oral Mucosa
Epithelial Changes
Connective Tissue Change
Age Changes in Periodontal Connective Tissue
Structural Changes
Age Changes in Salivary Glands
ENDODONTICS IN GERIATRIC PATIENTS
Medical History
Chief Complaint of Geriatric Patients
Past Dental History
Subjective Symptoms
Objective Symptoms
Pulp Vitality Tests in Geriatric Patients
Radiographs
Problems Encountered
Common Radiographic Observations in Geriatric Patients
DIAGNOSIS AND TREATMENT PLAN
Isolation
Access to Canal Orifice
Biomechanical Preparation
Obturation
Prognosis of Endodontic Treatment
Endodontic Surgery
Indications
Other Factors to be Considered in Older Patients
QUESTIONS
CHAPTER 35:
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 (Nd: YAG)
Uses
Argon Lasers
Uses
LASER INTRACTION WITH BIOLOGICAL TISSUES
Tissue Effects of Laser Irradiation
Photochemical Effects
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 Airborne Contamination
Procedural Controls
SOFT AND HARD TISSUE APPLICATIONS OF LASERS IN DENTISTRY
Soft Tissue Applications
Hard Tissue Applications
APPLICATION OF LASERS IN ENDODONTICS
CONCLUSION
QUESTIONS
CHAPTER 36:
Magnification
INTRODUCTION
LOUPES
Multi-lens Loupes
Advantages
Disadvantage
SURGICAL OPERATING MICROSCOPE (SOM)
How does Surgical Operating Microscope Work?
Uses of SOM
ENDOSCOPE
Advantage
Disadvantage of Endoscope
ORASCOPE
Advantage
Disadvantages
QUESTION
CHAPTER 37:
Tissue Engineering
CURRENT STRATEGIES FOR TREATMENT OF LOST TISSUE
Tissue Engineering
STRATEGIES OF STEM CELL TECHNOLOGY
Conductive
Inductive
Cell Transplantation (Fig. 37.2)
TRIAD OF TISSUE ENGINEERING (FIG. 37.3)
Stem Cells/Progenitor Cells
Unique Characteristics of Stem Cells
Stem Cells are Often Categorized by Their Source
Progenitor Cells (Fig. 37.5)
Types of Stem Cells
DENTAL PULP STEM CELLS (DPSCS)
STEM CELLS FROM HUMAN EXFOLIATED DECIDUOUS TEETH (SHED)
PERIODONTAL LIGAMENT STEM CELLS (PDLSCS)
STEM CELL MARKERS, ISOLATION
Isolation of Stem Cells
MORPHOGENS/SIGNALING MOLECULES
Functions
SCAFFOLD/MATRIX
Requirements of a Scaffold
APPROACHES TO STEM CELL TECHNOLOGY
Cell Therapy
Gene Therapy and Protein Delivery (Fig. 37.9)
Gene Delivery
Protein Delivery
Stem Cell Engineering of Biomimetic Material
Harvesting Teeth Created by Tissue Engineering
Bioengineered Teeth From Tooth Bud Cells (Fig. 37.11)
Bioactive Molecules in Restorative Dentistry
Calcium Hydroxide
New Bioactive Molecules
Different Strategies Used for Regenerative Endodontics
Definition
REVASCULARIZATION TO INDUCE APEXIFICATION/APEXOGENESIS IN INFECTED, NONVITAL, IMMATURE TOOTH
Apexification
Calcium Hydroxide
Disadvantages
Mineral Trioxide Aggregate
Pulp Revascularization
Definition
Advantages
Pulp Revascularization in Replanted Teeth
Pulp Revascularization in Immature Teeth
Indications
Techniques
Mechanism of Revascularization
Advantages of Revascularization Procedure
Limitations of Revascularization Procedure
QUESTIONS
CHAPTER 38:
Ethics in Endodontics
INTRODUCTION
Nature of Ethics
PRINCIPLES OF ETHICS
Related to Patient
Related to Community
Related to Profession
ROOT CANAL ETHICS
Treatment Records
Common Elements of Negligence and Malpractice
Common Malpractice Errors Against Endodontics
INFORMED CONSENT
DENTAL NEGLIGENCE
Related to Local Anesthesia
Syncope (fainting)
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
Standard of Care as Set by Endodontist
ABANDONMENT
MALPRACTICE CASES
Injury from Slips of the Drill
Inhalation or Ingestion of Endodontic Instruments
Broken File
Perforations
Overextensions
QUESTIONS
INDEX
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