Endodontics I
Morpholo Pulp diseas 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
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Morphology
Meyer's conclusions
> The root canal is not round but oval (Ion axis mesiodista
> 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 form of the outfall is funnel - shaped
ape
> The root canal system has usually more outfalls (ramifications)
> The ramifications are situated mostly in aoic area (first apical mm
> All outfalls are situated in cementům
Basic forms of the root canal
systém (Weine)
Apical morphology
X - ray apex Foramen apicale Apical constriction Periodontal ligament Root cementum Dentin
Canal shaping terminates in apical constrictio
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Less risk of periodontal damage Prevention of overfillin
Prevention of apical transport of infectiou material
Possibility of good bacterial decontamination Possibility of good condensation of the root filling
■ Macrocanal system
Endodont: dentin and pulp
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■ Tertiär dentin
■ Dentin bridge
Endodont - dentin and pulp
Pulp diseases
Inflammation - pulpitis
Necrosis
Gangraena
Apical periodontitis
Reasons
Bacteria
Mechanical irritants (overinstrumentation, trauma)
Chemical ieeitants (esp. phenolic based inracanal medicaments, overfilling,irrigants)
Classification of pulp diseases
Histopatological
ere mi a
HE
Pulpitis acu
partialis totalis
Pulpitis acuta purulenta partialis
totalis
Classification of pulp diseases
Clinical
Reversible pulpitis Pa
imulus is removed
Normal periradicular appearance Teeth are not tender to percussio
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
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
Protection of dentin wound
Disociace - silná alkalita
Malá rozpustnost - vápenná voda I-
Suspenze (vápenné mléko, vápenná kaše)
Suspenze Cementy Subbase Kořenová výplň
- krátkodobě
- střednědobě
- dlouhodobě
Intermitent excavation
Direct pulp capping
Necrosis Inflammation Dentin Bridge