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 [USEMAP] zubprůřez Morphology Enamel Dentin Cementum Periodontium Pulp [USEMAP] FOLIE2 Apical morphology 1.X – ray apex 2.Foramen apicale – spical foramen 3.Apical constriction 4.Periodontal ligament 5.Root cementum 6.Dentin 7. Acc. to Guldener a Langeland [USEMAP] kkmeyer1 kkmeyer2 Meyer 1962 zubprůřez 3D 3D Meyers conclusions ØThe root canal is not round but oval (long axis vestibuloral direction) • ØThe root canal does not go straight but it deflects distally Ø ØThe apical foramen is not on the top of the root but below it (distally or distoorally) Meyer´s conclusions ØThe walls of the root canal between apical constriction to apical foramen are divergent ØThe root canal system has usually more apical foramina (side branches - accessory root canals– ramifications) Ø The ramifications are situated mostly in apical area (first apical mm) Ø All foramina are situated in cementum Ø Basic forms of the root canal system (Weine) lenka.roubalikova@tiscali.cz 10 morfologie01 morfologie02 morfologie04 morfologie03 morfologie05 morfologie06 morfologie08 morfologie07 Vertucci Gulabivala Kartal a Yanikoglu…. morfologiedetail01 morfdetail02 morfdetail03 morfdetail04 morfologiedetail05 morfologiedetail06 morfologiedetail07 morfologiedetail08 morfologiedetail09 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 dentin5 2_AUX1 zubprůřez Endodont: dentin and pulp (morphological and functional unit) dren histol Odontoblasts Predentin Dentin zubprůřez 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 ØIndirect pulp capping ØIntermittent excavation -Direct pulp therapy DPT ØDirect pulp capping ØPulpotomy hydroxidlahev hydroxidstrikacka Antiflogistic Dentinogenic Antimicrobial effect Dry soft dentine Calcium hydroxide kavitaspodlozkou podlozka 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 perforacefurk2 Root canal treatment - RCT •Preendo treatment •Access opening •Root canal shaping •Root canal cleaning •Root canal filling •Postendo treatment