Endodontics I. Morphology Pulp disease Indication Contraindiction Instrumentarium Endodontics Pulp and periodontal diseases – diagnosis, therapy, prevention 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 Onemocnění zubní dřeně Indikace a kontraindikace endodontického ošetření Instrumentarium Morphology Enamel Dentin Cementum Periodontium Pulp Meyer 1962 3D Meyers conclusions  The root canal is not round but oval (long axis mesiodistal)  The root canal does not go straight but it deflects distal  The outfall is not on the top of the root but below (distal or distooral) Meyer´s conclusions  The walls of the root canal between apical constriction to apical foramen are divergent  The root canal system has usually more outfalls (ramifications)  The ramifications are situated mostly in apical area (first apical mm)  All foramina are situated in cementum Basic forms of the root canal systém (Weine) lenka.roubalikova@tiscali. cz 11 Vertucci Gulabivala Kartal a Yanikoglu…. Apical morphology 1. X – ray apex 2. Foramen apicale 3. Apical constrictionA 4. Periodontal ligament 5. Root cementum 6. 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  Macrocanal system  Microcanal system Endodont: dentin and pulp (morphological and functional unit) Odontoblasty Predentin Dentin Dental pulp Defense mechanisms of the pulp  Sclerosis  Tertiar dentin  Dentin bridge Pulpodentinální orgán - endodont Pulp diseases Inflammation - pulpitis Consequences - Necrosis - Gangraena - Apical periodontitis Reasons  Bacteria  Mechanical irritants (overinstrumentation, trauma)  Chemické (esp. phenolic based inracanal medicaments, overfilling,irrigants) Classification of pulp diseases  Histopatological Hyperemia pulpae Pulpitis acuta serosa partialis totalis Pulpitis acuta purulenta partialis totalis Classification of pulp diseases  Histopatological Pulpitis chronica clausa aperta ulcerosa polyposa Classification of pulp diseases Clinical Reversible pulpitis Pain does not linger after stimulus is removed Pain is difficult to localize 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 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 ? Periodontitida akutní chronická enoseální, subperiostální, submukózní fáze Akutní Chronický GangrénaNekróza Cummulative trauma pf dental pulp Diagnosis  History 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 Ca (OH)2 pH 12,5 Suspenze Cementy Subbase Kořenová výplň - krátkodobě - střednědobě - dlouhodobě Antiflogistický Dentinogenní Antimikrobiální efekt Nepřímé překrytí zubní dřeně Nepřímé překrytí cement suspenze 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  Predentin  Odontoblasty Přímé překrytí zubní dřeně Přímé překrytí – bodová preforace ve zdravém dentinu, okamžitě po vzniku. Zvážit rizika! Vitální amputace Phases of the endodontic treatment  Diagnosis  Consideration  Local anaesthesia  Removal of old fillings ane caries  Access to the pulp chamber