Endodontics Pulpal 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 Morphology Enamel Dentin Cementum Periodontium Pulp Apical morphology 1. X – ray apex 2. Foramen apicale – spical foramen 3. Apical constriction 4. Periodontal ligament 5. Root cementum 6. Dentin Meyer 1962 3D Meyers conclusions ➢The root canal is not round but oval (long axis vestibuloral direction) ➢The root canal does not go straight but it deflects distally ➢The apical foramen is not on the top of the root but below it (distally or distoorally) Meyer´s conclusions ➢The walls of the root canal between apical constriction to apical foramen are divergent ➢The root canal system has usually more apical foramina (side branches - accessory root canals– ramifications) ➢ The ramifications are situated mostly in apical area (first apical mm) ➢ All foramina are situated in cementum Basic forms of the root canal system (Weine) lenka.roubalikova@tiscali.cz 10 Vertucci Gulabivala Kartal a Yanikoglu…. 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 • Macrocanal systém – root canals • Microcanal systém – dentine tubules Endodont: dentin and pulp (morphological and functional unit) Odontoblasts Predentin Dentin Dental pulp Pulpal response to the irritation • Sclerosis • Tertiary dentin • Dentin bridge Endodontic diseases -Pulpitis – reversible, irreversible - Necrosis (Dental pulp lost its vitality) - Gangraena (Necrotic pulp became infected) - Apical periodontitis (inflammation that originates in dental pulp and spreads to the periodontal space) Reasons • Bacteria • Mechanical irritants (overinstrumentation, trauma) • Chemical (esp. phenolic based inracanal medicaments, overfilling,irrigants) Two basic approaches in endodontic treatment • Vital pulp therapy • Root canal treatment Vital pulp therapy VPT Indirect pulp therapy IPT ➢Indirect pulp capping ➢Intermittent excavation - Direct pulp therapy DPT ➢Direct pulp capping ➢Pulpotomy Antiflogistic Dentinogenic Antimicrobial effect Dry soft dentine Calcium hydroxide Indirect pulp capping Indirect pulp capping Tertiary dentin Dental caries next to dental pulp In a small area small amount of carious dentine on the pulpal wall can be left, calcium hydroxide permanent filling follows. Intermittent excavation Dental caries next to dental pulp, Big amount of carious dentine. Calcium hydroxide is placed and temporary filling follows. After six weeks the temporary filling is removed, carious dentine excavated and permanent filling follows Tertiary dentin is being formed during this period. Calcium hydroxide has also antimicrobial effect and can dry up the soft dentine. Tertiary dentin Direct pulp capping Directly on dental pulp, permanent filling. Perforation must - be small (1mm ane less) - surrounded with intact dentine – no carious - treated immedietaly Dentine bridge – new odontoblasts are differenciated Pulpotomy - partial - total - If the perfofration is bigger - Surrounded with carious dentine - Longer time after perforation Dentin bridge Dentin bridge • Dentin bridge : New dentin that is produced by new odontoblasts That differentiate from stem cells in dental pulp Root canal treatment - RCT • Preendo treatment • Access opening • Root canal shaping • Root canal cleaning • Root canal filling • Postendo treatment