Endodontics I Morphology Pulp disease Indication Contraindiction Instrumentarium Endodontics ~ ' ' periodontal diseases - revention Aim of endodontic treatment Healing of pulp diseases or removal bacteria from the root canal system and regeneration of damaged periodontal tissues. (Canal shaping, cleaning and filling) „ Endodontist helps nature only " W.D.Miller Endodonci Morphology DľJBľ/JuD/já/jj -zubní dľsjTJ ^ Judikíjce í j liD/JíľŕJJ/jdjkíJc ^ Bndüdün'uzkBhü oB^íf^ní JľJäíriJj/jB/JÍ:sjľjy;/j Morphology / Pulp Enamel Dentin Cementům Periodontium y***^ i 1 1 ^K. ^Rtl i M ^. 1 ^Vl L^B^Híi m ^^^H The root canal is not round but oval (long axis mesiodistal) The root canal does not go straight but i deflects distal The outfall is not on the top of the root but below (distal or distooral) Meyer s conclusions The form of the outfall is funnel - shaped The root canal system has usually more outfalls pi mnirasiiraffl« The ramifications are situated mostly in apical area (first apical mm) All outfalls are situated in cementům Basic forms of the root cana systém (Weine' Apical morphology © = ■ X - ray apex Foramen apicale Apical constriction Periodontal ligament Root cementům Dentin Canal shaping terminates in apical constriction Small communication Less risk of periodontal damage Prevention of overfilling Prevention of apical transport of infectious material Possibility of good bacterial decontamination Possibility of good condensation of the root filling Configuration of apical constriction X-ray apex Real situation W-- \& Macrocanal system Microcanal system Endodont: dentin and pulp (morphological and functional unit) Dental pulp Odontoblasty Predentin \ Dentin \ \ Defense mechanisms of the pulp Sclerosis Dentin bridge J \ 0 i\^L<^JLs> J i í * t t É 4 1 1 * t t Endodont - dentin and pulp H I I I I}- Pulp diseases Consequences - Necrosis - Gangraena - Apical periodontitis Reasons Bacteria Mechanical irritants (overinstrumentation, trauma) Chemical ieeitants (esp. phenolic based inracanal medicaments, overfilling,irrigants) Classification of pulp diseases Histopatoloqical Hyperemia pulpae Pulpitis acuta serosa partialis Pulpitis acuta purulenta partialis totalis Classification of pulp diseases ■ Histopatological Pulpitis chronica clausa ulcerosa lyposa Classification of pulp diseases Clinical Reversible pulpitis Pain does not linger after stimulus is removed Pain is difficult to localiz Normal periradicular appearance Teeth are not tender to percussion Classification of pulp diseases Clinical Irreversible pulpitis Pain may develop spontaneously or from stimuli In later stages heat is more signißcant Response lasts from minutes to hours When the periodontal ligament is involved, the pain is localized A widened periodontal ligament may be seen in later stages Akutní Úprava ad integrum ? i n w Í Chronický kroza Periodontitida akutní ^ "^ chronická enoseální, subperiostální, submukózní fáze ■ History Presenting complaint Medical histoi Dental history Pain history vocation Type and intensity of pain Duration Stimulus Relief (analgetics, antibiotics, sipping cold drinks) Clinical examination Extraoral (swelling, redness, extraoral sinuses, lymph nodes, degree of mouth opening) Intraoral examination Swelling, redness,palpation, percussion, sinus tract examination, teeth mobility,pockets Clinical examination examination, transillumination Protection of dentin wound Against: Thermal Chemical Irritation Electrical Disociace - silná alkalita Malá rozpustnost - vápenná voda Suspenze (vápenné mléko, vápenná kaše) Antif logistický Dentinogenní Antimikrobiální efekt Suspenze Cementy Subbase Kořenová výplň - krátkodobě - střednědobě - dlouhodobě Indirect pulp capping Filling Base Subbase Intermitent excavation Direct pulp capping Necrosis Inflammation Dentin Bridge