INTRODUCTION RDS 322

Pre-clinical endodontics

Solaiman Al-HadlaqB.D.S., M.S., Ph.D.

pp, 80 - 96Pathways of the Pulp, Cohen S. and Hargreaves K. M., 9th edition,

2006.

Endodontics

Endodontology is derived from the Greek language and translated as

‘the knowledge of what is inside the tooth’

Definition

• Endodontics: The branch of dentistry concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including the biology of the normal pulp and the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.

AAE glossary of terms

Scope

• Differential diagnosis and treatment of oral pains of pulpal and/or periapical origin.

• Vital pulp therapy such as pulp capping and pulpotomy.

• Nonsurgical treatment of root canal systems.• Selective surgical removal of pathological tissues

resulting from pulpal pathosis • Surgical removal of tooth structure such as in

root-end resection, bicuspidization, hemisection and root resection.

Scope

• Intentional replantation and replantation of avulsed teeth.

• Bleaching of discolored dentin and enamel.• Retreatment of teeth previously treated

endodontically.• Treatment procedures related to coronal

restorations by means of post and/or cores.

AAE glossary of terms

Indications

• Pathologically involved pulp:– Irreversible pulpitis.– Pulp necrosis.

One year follow-up

Failed pulpotomy

Two- years follow-up

One year follow-up

One year follow-up

Six months follow-upComplete lamina dura

Indications

• Intentional endodontics:– When a tooth can not be restored properly

without performing root canal therapy on a vital pulp.

• Hypererupted teeth.

• Drifted teeth.

• Teeth needing post and core restorations.

Indications

• Overdenture abutment:– To preserve the alveolar ridge bone.– Attachments can be added to aid the retention

of the removable prosthesis.

Overdenture

Indications

• Trauma:– Pulp necrosis– Ankylosis– Resorption– Calcification

One month following traumaBeginning of ankylosis and external resorption (6 ms. After)

Contraindications

• From an endodontic point of view there are no absolute contraindications for performing root canal treatment .– Calcifications.– Dilacerations.– Resorptive defects.

• Consider specialist referral.

Calcification

Severe dilaceration of MB root

Curvature is not apparent in Buccolingual aspect

Bayonet- shaped canal

InternalExternal

Contraindications

• Restorative considerations:– Subosseous caries.– Poor crown/root ratio.– Misalignment.– Badly fractured tooth.

Contraindications

• Periodontal considerations:– Extensive periodontal defect that can not be

maintained.

Medical conditions that may influence endodontic treatment

planning

• Pregnancy:– Radiographs.– Local anesthetic.– Avoid treatment during 1st trimester.– 2nd trimester is the safest period.

• Cardiovascular disease:– Myocardial infarction:

• No elective care in the first 6 months.

– Unstable or progressive angina pectoris:• Should not use vasoconstrictor.

– Antihypertensive medications:• Digitalis glycosides (Digoxin) arrhythmias.

– Heart murmur and artificial heart valves :• SBE prophylaxis.

– Coronary artery bypass:• SBE prophylaxis (few months only).

• Minimize vasoconstrictors (first 3 months).

Consult the physician!

• Cancer:– Can metastasize to the jaws and mimic

endodontic pathosis:• Vitality pulp testing.

– Chemo or radio therapy:• Impair healing (consult physician).

• HIV:– Occupational risk is very low– Universal precautions to protect patients.– Opportunistic infections and medications.– CD4 above 400 usually asymptomatic.– Consult physician before surgical treatment.

• Dialysis:– Bleeding tendency due to destruction of

platelets.– Treatment should not be performed on the same

dialysis day due to patient fatigue.– Attention to effect of dialysis on drug

metabolism.– consult physician.

• Diabetes:– Well controlled diabetic should be treated

normally.– Make sure that the patient has taken his

medication and have had his meal on time.– Acute infection may require an increase in

insulin dose, or administration of insulin to non-insulin dependent patients.

• Prosthetic implants:– Antibiotic prophylaxis?– consult physician.

Prognosis

• Success rate is high, around 90%

• Teeth without periradicualr radiolucency have better prognosis than teeth with periradicular radiolucency (up to 20% difference)

Course outline

COURSE ASSESSMENT

I. Practical 50%

a. Daily work (12 projects) 30%b.Practical assessments (2) 5%

c.Practical midterm (1) 5% d.Final practical 10%

II. Written (didactic) 50%

a.Quizzes 5% b.Oral exam 5%

c.Midterm exam 10%d.Final exam 30%

READING TEXTBOOK

• Pathways of the Pulp, 9th edition, S. Cohen, and K. M. Hargreaves, 2006.

• Endodontics, 5th Ed. J. I. Ingle and L. K. Backland, 2002.

Laboratory requirements

1st semester:• Access openings on one anterior tooth and one

premolar tooth mounted individually in plaster • Root canal therapy on three anterior teeth.• Root canal therapy on two premolar

(including one with two canals) teeth.• The fourth anterior tooth mounted in

acrylic should be saved for midterm practical exam.

Laboratory requirements

2nd semester:• Access openings on two molars (one maxillary and

one mandibular) mounted individually in plaster.• Root canal therapy on three molar (upper and lower)

teeth.• Retreatment, and Ca(OH)2 application on a previously

obturated single rooted tooth.• Post space preparation on a previously obturated canal.• Three teeth (an anterior, a premolar, and a molar)

should be saved for the second laboratory assessment.• The fourth molar should be saved for final practical

exam (upper or lower).

Laboratory requirements

• All the required teeth (4 anteriors, 2 premolars and 4 molars) must be mounted in acrylic using the rubber mould.

• Additional teeth (3 anteriors, 2 premolars, 3 molars) with inappropriate root morphology (as confirmed by radiographs) should be mounted individually in plaster of paris blocks for the purpose of access opening and other practical exercises.

Laboratory guide lines

• Make sure you write your name, university number and serial number clearly on your assigned station with an adhesive nametag.

• You are responsible for marinating your assigned station in a proper working condition.

• You are responsible for maintaining the tidiness of your workstation.

Laboratory guide lines

• Make sure that you cover the working area with the paper sheets provided in the laboratory.

• At the end of the session make sure you leave your station clean. If your working stations is not clean after you leave the lab you will get a zero for that laboratory session and if repeated you will get a zero for the whole project.

Laboratory guide lines

• The general laboratory area is the responsibility of the whole group, if the lab is not neat at the end of the session, all the students will be marked down. Make sure you do not leave X-ray film wraps or defective films on the floor or benches, you should dispose them appropriately.

Laboratory guide lines

• You will be given a set of instruments that are new or almost new, the course director have inspected each and every set of instruments, you must not abuse the instruments and you should maintain them clean and in proper working condition at all times. The instruments should get you through the whole year if they are used in the manner they are designed to be used for. If an instrument becomes defective or is lost, you should replace it immediately with an instrument of equal quality and the same brand name.

Laboratory guide lines

• Make sure you have all your instruments including, a plastic ruler, an irrigation syringe, an irrigation solution jar, and 2x2 gauze pads available at all times especially before you call your instructor to evaluate your work or help you during a procedure. Also make sure that your instruments, especially the mirror, are always clean.

Laboratory guide lines

• Your laboratory manual should be available with you on every laboratory session. Make sure you read the planned step at home, so when you come to the laboratory session you are ready to proceed and when asked by your instructor you are ready to answer.

Laboratory guide lines

• Failure to demonstrate acceptable level of understanding of the planned step may result in your dismissal from the session.

• You have enough time to finish your assignment during the time allocated for that exercise, therefore, work will not be allowed outside the laboratory time.

Laboratory guide lines

• You should mount your models on the phantom head during all procedures, if I see your model in your hand you will get a zero for that session.

Tooth selection

• Select the teeth that meet the criteria in the memo distributed last year. (straight roots, sound crown, no calcifications, mature apices, and no 3rd molars).

• Expose a radiograph to show the morphology of the pulp space.

• Use size 2 film and expose more than one tooth on the same film, using utility was to stabilize the teeth.

Tooth selection

• Number the teeth and mount them on the wax in a standard fashion, so you can go back and tell which tooth is which on the radiograph.

• Check with your instructor regarding the suitability of the teeth for use.

• Prepare the teeth for mounting by putting a bead of wax on the apex to mimic PA radiolucency.

Tooth Mounting

• Use the provided rubber molds.• Each tooth should be placed into its individual

socket in the rubber mould. Be sure of the orientation of each tooth surface before pouring the mixture.

Tooth Mounting

• In a disposable paper cup add:– 3 x 25 ml scoops polymer (powder)– 3 x 25 ml scoops saw dust– mix until the mixture becomes homogenous.

• Add the mixture to approximately 6.5 x 5.5 ml measuring cylinders (35 ml) monomer (liquid) and mix until a smooth creamy mass is obtained.

• Pour the mixture slowly into the rubber mould covering the apices of the roots.

Tooth Mounting

• During the initial setting of the acrylic, a threaded metal lock component of a screw attachment should be embedded in the middle of the acrylic base. The key component of the attachment that is in the manikin phantom head can be screwed into the lock component. This permits stable mounting of the model in the manikin phantom head.

Thank you