Endodontics I
Morphology Pulp disease Indication Contraindiction
Instrumentarium
Endodontics
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
Endodoncie I.
Morphology
lustuiimewtaMBimi
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)
Meyerovy zavery
of the outfall is funnel - shap
e
> 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 morphologv
1. X - rav 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)
Dental pulp
Odontoblasty Predentin Dentin 1 \
Defense mechanisms of the pulp
Sclerosis
Pulpodentinální orgán - endodont
Consequences
Necrosis
i
Gangraena
pical periodontitis
Reasons
Mechanical irritants (overinstrumentation, trauma)
Chemické (esp. phenolic based inracanal medicaments, overfilling,irrigants)
Classification of pulp diseases
istopatological
Hyperemia pulpae Pulpitis acuta serosa partialis
Pulpitis acuta purulenta partiali
totalis
Classification of pulp diseases
■ Histopatologica Pulpitis chronica clausa
aperta
ulcerosa
po
Classification of pulp diseases
Clinical
Reversible pulpitis
Pain does not linger after stimulus is removed
iffi
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
Úprava ad integrum ?
mm DŘEN
Chronický
Periodontitida
Gangréna
akutní chronická enoseální, subperiostální, submukózní fáze
Cummulative trauma pf denta
ul -
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
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
Diagnosis
Clinical examination
Pulp sensitivity tests, radiographic
examination, transillumination
Metody zachovávající vitalitu dřeně a podporující tvorbu vlastních tvrdých tkání
Antiflogistický Dentinogenní
Antimikrobiální efekt
Suspenze Cementy Subbase Kořenová výplň
- krátkodobě -střednědobě
- dlouhodobě
Nepřímé překrytí zubní dřeně
Intermitentní exkavace
Podložka s dostatečnou mechanickou odolností, nedráždivá, pokud možno s remineralizačními vlastnostmi
Přímé překrytí zubní dřeně
Nekróza
Reparativní
zánět
Dentinový
můstek
Dentinový můstek
Zbytky preparátu Kalcifikované vazivo Dentin
Přímé překrytí zubní dřeně
Přímé překrytí bodová preforace ve zdravém dentinu, okamžitě po vzniku. Zvážit rizika!
Phases of the endodontic treatment
Diagnosis Consideration Local anaesthesia Removal of old fillings ane caries
cce
urp chamber