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Chapter 24 Endodontics

Chapter 24 Endodontics. Endodontic Procedure. Objectives. Understand some of the indications and contraindications for doing a RCT Know the four fracture classifications Know the different diagnostic tests for determining if an RCT is needed

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Chapter 24 Endodontics

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  1. Chapter 24Endodontics

  2. Endodontic Procedure

  3. Objectives • Understand some of the indications and contraindications for doing a RCT • Know the four fracture classifications • Know the different diagnostic tests for determining if an RCT is needed • Understand the difference between reversible pulpitis and irreversible pulpitis • Understand the difference between: pulpectomy, pulpotomy, RCT, open and medicate, incise & drain • Know the steps involved in performing a non-surgical RCT • Understand the difference between a surgical and non-surgical endodontic treatment • Be able to define these surgical tx’s: apicoectomy, root amputation, hemisection

  4. Endodontist • Deals and treats diseases of the pulp and periapical tissues. • 2 additional years of training. • General dentists can do RCT, refer difficult cases to endodontist. • Curved roots • additional canals • re-treats

  5. Indications • Periapical abscess • infection around the end of the root • Advanced decay • caries at or near the pulp chamber • Impact trauma • auto accident • sporting event • fight or battery

  6. Indications • Fractures • near or through the pulp chamber • Invasive restorative procedures • very deep fillings • crown prep close to pulp chamber • Reaction to dental materials • materials used to restore the tooth

  7. Class I Enamel only Class II Dentin involved Possible RCT Class III Pulp involved RCT Class IV Fx @ gumline (no crown) Fracture Classifications

  8. Diagnosis • Pt. Medical/dental history • General dentists diagnosis • Radiographs (x-rays) • Extra-oral exam • redness • facial symmetry • swelling • external fistula • (pathway for pus to drain)

  9. Diagnosis: • Intra-oral exam • discoloration • fractures • visual caries • abscesses • fistulas

  10. Diagnostic Tests • Radiographs • most useful diagnostic tool • correct position • good contrast • must see the apex • must see 2 mm of bone

  11. Diagnostic Tests • Palpation (feeling with fingers) • tissue around apex is palpated for an • abscess • several teeth are palpated for • comparison • control tooth (same tooth, opposite • arch) • May be done by the doctor or an • assistant.

  12. Diagnostic Tests • Percussion (tapping on the tooth) • Lightly tap the occlusal or incisal edge. • Usually done with the handle of the mouth mirror • will tap control tooth • will tap adjacent teeth • will tap suspect tooth • Assistant can do this, too!

  13. Diagnostic Tests • Mobility • (Movement of a tooth within a socket • Determines condition of supporting tissues • Moderate to severe mobility is a contraindication for a RCT • Pt will lose tooth to periodontal disease

  14. Diagnostic Tests • Cold Test • Dry ice • Chemicals • ethyl chloride (Endo Ice) • Ice • frozen water

  15. Diagnostic Tests • Heat Test • Ball of warm gutta percha • on the end of an instrument. • Frictional heat • rubber prophy cup applied to the • tooth • may indicate irreversible pulpitis

  16. HA HA!

  17. Diagnostic Tests • Electronic or Digital Pulp Testing • Transillumination • Fiberoptic light shined • through crown of the • tooth. • May show a shadow • or a Vertical fracture • determines tooth vitality • (if the tooth is dead or • alive) • battery operated device, • sends small “shock” to • tooth . • - Do not place on an amalgam • or a crown • A dead tooth will not feel the • “shock”

  18. Diagnostic Tests • Caries Removal: • Selective anesthetic • can’t determine which tooth. • Numb a tooth / area • if pain subsides, we have located the tooth or quad. • Normally done on Max. • caries removed, tooth • stays the same, gets worse • = Possible RCT • Carries removed, tooth • gets better = No RCT

  19. Irreversible Pulpitis Diseases and Conditions • Reversible pulpitis • inflammation of the pulpal tissues. • When you treat or remove the cause. • Caries, fracture, or attrition. • Inflammation subsides • Pulp is able to heal • Inflammation of the • pulp that does not • subside. • Pulp will not heal • Tx: RCT or EXT

  20. Review Questions from Yesterday • Name some of the diagnostic tests used to determine if a patient is in need of a root canal treatment • What are some indications and contraindications for doing a root canal treatment? • Name the four classifications of fractures and what types of fractures are included in each.

  21. Pulpal Necrosis • Apical Periodontitis • when infection reaches • the surrounding tissues • death of the pulp cells • result of irreversible\ • pulpitis • creates exudate • Ligament • Bone • Gingiva • pus and gas that forms in • the pulp chamber • Cold relieves the pain. • Can form a granuloma or a cyst Diseases and Conditions

  22. Diseases and Conditions • Periapical (PA) abscess • localized area of infection. • mod - severe discomfort; can cause swelling • Tx • RCT • EXT

  23. Related Terms • Cellulitis: swelling and discomfort caused by the abscess spreading into the facial tissue. • Osteomyelitis: Advanced PA infection that has spread into the bone.

  24. Treatment • Prescription therapy: No Tx given. • RX for analgesic • RX for antibiotic • I & D (incise and drain) • Tx done to relieve pressure from • the abscess or cellulitis • O & M (open and medicate) • Tooth is opened to relieve the pressure. Medication is • placed. Pt comes back for RCT

  25. Treatment • Pulpectomy • removal of pulpal tissue to about 1-3 mm short of the apex • 1st step or appointment of RCT • RCT is done next • clean • enlarge • obturate (fill) the canals • Pulpotomy • removal of pulpal tissue from the pulp chamber only • Tissue is left in the canals • Done on baby teeth w/pulp exposure • Root end(s) not fully developed (apexogenesis)

  26. RCT • Root Canal Treatment / Therapy • Done after a pulpectomy • Can be a “1-step”. Pulpectomy and RCT done at the • same appointment. • Clean, shape, smooth, and enlarge the canals. • Rinse / irrigate (sodium hypochlorite solution) • Fill & Seal w/ Gutta percha = OBTURATION • Master cones and accessory cones or • Warm gutta percha.

  27. Obturation, Obturation…

  28. My Office’s Endo Cart Special Endo. Rotary Handpiece Sodium Hypochlorite

  29. On The ____ Day of Endo. My Dentist Gave To Me A Lidocaine in a main nerve Two Rubber dams Three Long burs Four Hiding holes Five Endo. Rings Six Gates a-gliding Seven Barbs a-broaching Eight Files a’flexing Nine Diluted Bleaches Ten Papers Pointing Eleven Guttas perching Twelve Composites curing

  30. Endo. Activity p. #15:Post-Op Instructions • You will be numb for 1-3 hours, depending upon the type of • anesthetic given • 2. Try not to bite your lip or tongue during the time you are numb • 3. Your tooth may be sore to bite on for 2-3 days. • Your tooth has a temporary filling in it, stay away from sticky • foods on that side of your mouth. • If the filling comes out, please call the office to schedule a • time to replace it. Food can get trapped in the opening • 6. Take your medications as directed or prescribed • If you notice any swelling on your gum above the tooth, or • have any bad taste, or drainage, contact the office • immediately. • 8. Please call the office if you have any questions or concerns.

  31. Surgical Endodontics • Apicoectomy • - Complete removal of the apex of the tooth. • Single rooted tooth or multiple rooted tooth • Must do a retrograde restoration, • (filling at the bottom of the tooth) • Amalgam • Composite • Gutta percha

  32. Apicoectomy / Retro-grade Restoration

  33. Apicoectomy / Retro-grade Restoration

  34. Apicoectomy /Retro-Grade Restoration

  35. Root Amputation • Complete removal of one root. • Only done on a multi-rooted tooth • Must do a retro-grade restoration.

  36. Hemisection • Surgical removal of part of a multi-rooted tooth, including the overlying crown. • Only done on • Multi-rooted teeth.

  37. Hemisection • Post-op x-ray • Pre-op photo • Post-op photo

  38. Closing • Understanding Indications, contra-indications, and Treatment is a very important part of your job. • You should be able to confidently explain RCT to your patient. • If in doubt…ask questions. • (( Activities to Follow this Page))

  39. Group Questions • What is the difference between a open and medicate and a pulpotomy? • What is the difference between a pulpectomy and a pulpotomy? • What is an incise and drain? • Which instrument would you use to locate the canals during an endodontic treatment? • What is the difference between a root amputation and a hemisection? • What is a retrograde restoration? When would you see one placed?

  40. Activity: Endo Instruments • Work on p. #14 in your lab book • On p #14 in your lab book, write the steps in performing an endodontic tx. • If you get stuck, use your endo. instrument packet & p. #517 in your textbook

  41. Steps in A Root Canal Tx • Administer Anesthetic • Isolate the area (a.k.a. Using a Rubber Dam) • Gain access to the pulp w/burs • Locate the canals (with an endo. exploer, of course! ) • Use the gates glidden to open and widen the canal • Use the barbed broaches to remove the majority of the nerve & soft tissue • Enlarge and smooth the root canal with k-files and/or hedstrom files • Irrigate the root canal (with an irrigating syringe full of NaOCl & H20 • Dry the canals with paper points • Obturate (seal) the root canal with sealer & gutta percha • Place temporary filling or build up over tooth

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