Endodontics I Morphology Pulp disease Indication Contraindiction Instrumentarium Endodontics Endodoncie I. Morphologv lusmjjeuimMUiJi Mevers conclusions e root canal is not round b ) (lon > 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 e form of the outfall is funnel - shaped > The root canal system has usually more outfalls (ramificati > The ramifications are situated mostly in apical area (first apical mm) All outfalls are situated in cementum Basic forms of the root cana systém (Weine Apical morphology 1. X - ray apex 2. Foramen api cale 3. Apical constrictionA 4. Periodontal ligament 5. Root cementum 6. Dentin Acc. to Guldener a Langeland Canal shaping terminates in apic al c onstriction all 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 fillin ■ Macrocanal system ■ Microcanal system Endodont: dentin and pulp (morphological and functional unit) Odontoblasts Predentin Dentin 1 Dental pulp Defense mechanisms of the pulp Sclerosis Pulpodentinální orgán - endodont Consequences Necrosis i Gangraena pical periodontitis Reasons Mechanical irritants (overinstrumentation, trauma) Chemical irritation(esp. phenolic based intracanal medicaments, verfilling,irrigants) Classification of pulp diseases istopatological Hyperemia pulpae Pulpitis acuta serosa partialis Pulpitis acuta purulenta partiali totalis Classification of pulp diseases istopatological Pulpitis chronica clausa ape rta ulcerosa polyposa Classification of pulp diseases Clinical Reversible pulpitis Pain does not linger after stimulus is removed Pain is d Normal periradicular appearance Teeth are not tender to percussion Classification of pulp diseases Clinic Irreversible pulpitis Pain may develop spontaneously or from stimuli In later stages heat is more significant 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 Diagnosis His Presenting complaint Medical history Dental history Pain history Location Type and intensity of pain Duration Stimulus Relief (analgetics, antibiotics, sipping cold drinks) Diagnosis inical examination Extraoral (swelling, redness, extraoral sinuses, lymph nodes, degree of mouth opening) Intraoral examination Swelling, redness,palpation, percussion, sinus tract examination, teeth mobility,pockets Diagnosis Clinical examination Pulp sensitivity tests, radiographic examination, transillumination Antiphlogitic Improves dentinogenesis Antimicrobial effect Suspensions Cements Subbase Temporary root canal filling - Short term - Middle term - Long term Indirect pulp capping Suspension Intermitent excavation Direct pulp capping Necrosis Reparative inflammation Dentin bridge Direct pulp capping Small perforation surrounded with healthy dentin, immediately. ndikace a kontraindokace endodontického ošetření ■ Hledisko I ndikace a kontramdokace endodontického ošetření ■ Hledisko Stav parodontu Anatomické poměry kořenových kanálk i Indications and contraindications of the Point of view Local — morphology of the tooth (number of roots, configuration of the root canals, destruction of the clinical crown). Indications and contraindications of the Point of view > Regional Importance of the tooth ndikace a kontraindokace endodontickeho osetreni Point of view > Systemic Healthy status Ability of cooperation Pre-requisites for succes ❖Right indication ♦♦♦ Elimination of infection^ Canal shaping Canal cleaning i^s ❖Hermetic roo^canaltfilling ❖Adequate reaction of