What is endodontology?
It is a study that is concerned with the study of the form, function and health of, injuries to and diseases of the pulp and periradicular region, their prevention and treatment: the principle disease being apical periodontitis, caused by infection
What are the basic outcomes of endodontic treatment?
- Maintain the health of all or part of the dental pulp
- Preserve the normal periradicular tissues
- Restore the periradicular tissues health
What is the most common cause of endodontic problems?
- Caries
- Trauma
- Others
What is tertiary dentine?
Tertiary dentine represents the more or less irregular dentine formed focally in response to noxious stimuli such as tooth wear, dental caries, cavity preparation and restorative procedures.
It is also known as reactionary dentine or reparative dentine - depending on the type of stimulus.
What is reactionary dentine?
Reactionary dentine is defined as a tertiary dntine matrix secreted by surviving postmitotic odontiblast cells in response to an appropriate stimulus, Typically, such a response will be made to milder stimuli and represents up-regulation of the secretoy activity of the existing odontoblat responsible for primary dentine secretion.
What stimulates tertiary dentine formation?
Angiogenic growth factors stimulate tertiary dentine formation.
How can you describe dentine according to Dr. Rossi?
Dentine is like Swiss cheese - it is pour-us - the closer you are to the pulp the bigger the holes.
The permeability properties of dentine regulate the rate of diffusion of irritants that initiate pulpal inflammation.
What are the indication of indirect pulp capping?
- Deep lesions likely to result in pulp exposure
- No history of subjective pretreatment symptoms such as spontaneous pain or provoked pulpal pain
- Pulp should test vital
- Pre-treatment radiographs should exclude apical pathosis
What are some of cumulative damages that can occur during a routine filling procedure that effect the pulp?
- Damage from LA
- Damage from drilling/preparation
- Damage from the filling material
- Damage from an incompetent filling
ANYTHING THAT INCREASES BACTERIA IN THE PULP
What are the three treatments for endodontic problems?
- Extraction
- Root canal treatment
- Vital pulp therapy
What are the requirements for successful vital pulp therapy?
- Pulp is not inflamed
- Haemorrhage is controlled
- Non-toxic caping material is applied
- Good seal provided by capping material and restoration to prevent influx of bacteria - MOST CRITICAL FACTOR
What material is used in vital pulp therapy?
MTA or Calcium Hydroxide but MTA is better
What are the three different types of vital pulp therapy?
- Direct pulp capping - no pulp is removed as pulp is not inflamed during mechanical pulp exposure
- Partial pulpotomy - a little pulp removal to stop the bleeding in inflamed pulps
- Full pulpotomy - removal of the entire pulp in the pulp chamber
How often do you wanna recall your patient after vital pulp therapy?
1, 3, 6 and 12 months
What is apexogenesis?
It is a process of creating an environment for the pulp to allow to continue the formation of the root. Don’t kill the pulp in an immature pulp because it will allow the root to grow to a certain extent. Thus, calcium hydroxite is perfect.
What is endodontics?
Endodontics is the branch of dentistry that deals with the morphology, physiology and pathology of the dental pulp and the periradicular tissues.
How to write a diagnosis for endodontic diagnosis?
- Pulpal and root canal condition - aka irreversible pulpitis, necrotic pulp, reversible pulpitis
- Periapical status - clear periapical radiolucency with a corresponding draining sinus or no periapical radiolucency
What factors should you consider before endodontic treatment?
- Strategic value of the tooth
- Periodontic factors
- Patient factors - MHx, age, compliance
- Restorability options - consider oral hygine - and consider teeth that are not restorable
What system is used for case selection in endodontics?
American Association of Endodontists Endodontic Case Difficulty Assessment Guidlines
The following considerations are used:
- Patient considerations
- Diagnostic & treatment considerations
- Other considerations
Tally the numbers:
1. Easy - less than 20
2. Moderate - 20-40
3. Hard (refer) - above 40
When accessing a tooth - what is a good guide for access cavity location?
A good guide - bitewings!
They will show you that the pulp chamber is situated in the middle thus by drilling in the middle of the tooth - less tooth structure is destroyed comparing to the traditional shape outline method. Remember - long axis of the tooth is an important guide
Remember - traditional shape method does not consider a lot of factors such as the shape of the tooth, caries condition and restorations.
What is the objective of initial access?
Just to reach the roof of the pulp chamber.
If you do not sense the “pin drop” of the bur - stop and re-assess - you don’t want a perforation
What bur should you do after initial access?
A non end-cutting bur in order to extend the pulp chamber access without removing extra tooth structure from the pulpal floor.
How many canal does upper first premolar have?
2 usually
How many canals does upper first and second molar have?
Usually 4 - remember MB2
