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PDQ* SERIES
ACKERMANN
PDQ PHYSIOLOGY
BAKER, MURRAY
PDQ BIOCHEMISTRY
CORMACK
PDQ HISTOLOGY
JOHNSON
PDQ PHARMACOLOGY, 2/e
KERN
PDQ HEMATOLOGY
McKIBBON
PDQ EVIDENCE-BASED PRINCIPLES AND PRACTICE
NORMAN, STREINER
PDQ STATISTICS, 2/e
STREINER, NORMAN
PDQ EPIDEMIOLOGY, 2/e
SCIUBBA
PDQ ORAL DISEASE
*PDQ (Pretty Darned Quick)
PDQENDODONTICS
JOHN I. INGLE, DDS, MSDLecturer, Department of EndodonticsSchool of DentistryLoma Linda UniversityLoma Linda, CA
Formerly Dean and Professor of Endodontics andPeriodonticsUniversity of Southern CaliforniaLos Angeles, CA
Formerly Professor of Endodontics and PeriodonticsUniversity of WashingtonSeattle, WA
Diplomate, American Board of EndodonticsDiplomate, American Board of Periodontology
2005
BC Decker Inc
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Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein,including choice of drugs and drug dosages, is in accordance with the accepted standard and practice at thetime of publication. However, since research and regulation constantly change clinical standards, the readeris urged to check the product information sheet included in the package of each drug, which includes recom-mended doses, warnings, and contraindications. This is particularly important with new or infrequently useddrugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighedon a case-by-case basis against the benefits anticipated. The reader is cautioned that the purpose of this bookis to inform and enlighten; the information contained herein is not intended as, and should not be employedas, a substitute for individual diagnosis and treatment.
This volume, PDQ Endodontics,is the offspring of the major text
Endodontics.
My children are my offspring.And it is with a great deal of pride and pleasure
that I dedicate this volume to them:
JOHN GEOFFREY INGLE
SCHUYLER NEAL INGLE
LESLIE JOYCE INGLE MOXLEY
Contents vii
ContentsPREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . XIII
1. EXAMINATION, DIAGNOSIS, . . . . . . . . . . . . . . . . . . . . . 1AND TREATMENT
2. ENDODONTIC TREATMENT PROCEDURES . . . . . . . . . 41
3. ACCESS TO THE ROOT CANAL SYSTEM: . . . . . . . . . . 58PREPARATION FOR TREATMENT
4. ACCESS TO THE ROOT CANAL SYSTEM: . . . . . . . . . . 71CORONAL CAVITY PREPARATION
5. ROOT CANAL PREPARATION . . . . . . . . . . . . . . . . . . . . 111
6. OBTURATION OF THE RADICULAR SPACE . . . . . . . . 142
7. ENDODONTIC SURGERY . . . . . . . . . . . . . . . . . . . . . . . . 167
8. ENDODONTIC MISHAPS. . . . . . . . . . . . . . . . . . . . . . . . 215
9. MANAGEMENT OF ENDODONTIC . . . . . . . . . . . . . . . 235EMERGENCIES
10. RESTORATION OF ENDODONTICALLY . . . . . . . . . . . 261TREATED TEETH
11. DISCOLORATION AND BLEACHING . . . . . . . . . . . . . . 279
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
viii PDQ ENDODONTICS
PrefaceEndodontics is that branch of dentistry centered on the dental pulpand periradicular tissues. The scope of endodontics deals with thediagnosis and treatment of pulp and periradicular pathology and theprevention of pulp disease; of oral pains of pulpal and/or periradic-ular origin as well as extraoral referred pain; vital pulp capping orpulpotomy; pulp extirpation and cleaning and shaping of the rootcanal, its disinfection, and its obturation; surgical removal and biopsyof pathologic periapical tissue; root end resection and reverse obtu-ration of the canals, as well as hemisection and full root resection ofpathologic roots; endodontic and osseointegrated implants; man-agement of traumatic injuries to the teeth and implantation of avulsedteeth; internal and external bleaching of discolored teeth; retreat-ment of previously treated teeth; and post and core placement involv-ing the root canal space.
An endodontist is a dentist with 2 or more years of advanced train-ing in endodontics who has received a certificate or advanced degreefrom an accredited program. Those who meet these qualificationshave the privilege of appearing before the American Board ofEndodontics; if they pass, they become diplomates of the ABE.
Note to the reader: If you are seeking additional information overand above the contents of this book, please refer to the full textEndodontics by J.I. Ingle and L.K. Bakland, published by BC Decker,Hamilton, ON, 2003; 974 pages. To contact BC Decker, phone1-800/568-7281, fax 1-905/522-7839, or e-mail [email protected],or visit their Web site at www.bcdecker.com.
Preface ix
The fifth edition of Endodontics.
Endodontology deals withdiseases of the pulp andperiradicular tissues aswell as the study of theiranatomy, physiology, andpathology.
x PDQ ENDODONTICS
Root canal treatment is well illustrated by this treatment of two pulpless teeththat serve well as bridge abutments. Courtesy of N. Hertl.
Preface xi
A, previous page, Two centralincisors were fractured throughthe pulp and the lateral incisorwas totally luxated as a result ofa bicycle accident. B, above, Thelateral incisor was treated “inhand” and replanted, and theinjuries began to heal. C, left,Radiograph illustrates the rootcanal treatment to the centralincisors and the replanted root ofthe lateral incisor. D, below, Finalrestoration with three porcelainjacket crowns.
xii PDQ ENDODONTICS
A, Left Advanced cellulites related to an infected maxillary lateral incisor. B,Right Eight days following incision, drainage, and antibiotic therapy. Courtesyof B. Wolfson.
Left, Discolored central incisor, years after trauma. Right, Incisor 1 week later,following internal bleaching with 30% hydrogen peroxide.
Acknowledgments xiii
AcknowledgmentsMy cup runneth over.
—Psalm XXIII
I have been so blessed! Blessed first of all with loving parents whoprovided me a fine education. And then with a loving and extraor-dinary family. I have also been blessed with wonderful teachers, bril-liant students, and marvelous associates and fellow faculty members,who have led me on a pathway I never dreamed of. And through itall, I have been backed up by talented and dedicated nurses, assis-tants, secretaries, technicians, and publishers. How fortunate I havebeen!
In my course through life, I have been associated with a numberof unusual universities, each one depositing special skills and knowl-edge. I am deeply indebted to them all: Washington State University,Northwestern University, University of Michigan, University ofWashington, University of Southern California, Howard andGeorgetown Universities, UCLA, and finally, Loma Linda University.My stint at the Institute of Medicine, National Academy of Sciences,was a humbling experience. I suddenly learned what I didn’t know.
And now to this text. The backup at Loma Linda University hasbeen outstanding. Drs. Leif Bakland and Mahmoud Torabinejad wereeager to help. The very versatile, talented, and enormously patient,Richard Tinker, director of Loma Linda’s Educational SupportServices, was untiring in his efforts to make perfect every illustrationand photo. How fortunate I am, at my age, to be a member of sucha distinguished faculty. Thanks to my computer guru and maven,Scott Arnett, I was able to suffer through many failures, “viruses,”“worms,” and my own inadequacies.
And I must thank my wife, Joyce, for her exceptional computertyping skills, far outclassing my “hunt and peck” abilities.
xiv PDQ ENDODONTICS
I’d be remiss if I failed to thank those countless associates who,as contributing authors, were so generous with their time and knowl-edge to make the text Endodontics the success it has been. I haveborrowed unsparingly from their writings and research in produc-ing this condensed version.
Finally, I must acknowledge those at BC Decker, Publisher, whoworked so diligently on editing, indexing, publishing, and market-ing this text. They include Brian Decker, Paula Mucci, Susan Ball,and Petrice Custance.
John I. Ingle, DDS, MSDSan Diego, CA, 2005
The Loma Linda “Three Musketeers”: Left to right, Leif Bakland,John Ingle, Mahmoud Torabinejad at the 2004 meeting of theAmerican Association of Endodontists. Dr. Torabinejad was presi-dent of the AAE in 2003–2004, Dr. Ingle was president of the AAEin 1966–1967, and Dr. Bakland was president of the AmericanBoard of Endodontics in 1992–1993.