endodontic emergencies and its management
TRANSCRIPT
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UNDER GUIDANCE OFDepartment of conservative and endodontics
MADE BYSONAL BATRABDS intern
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Endodontic emergencies are usually
associated with pain and or swelling and
require immediate diagnosis and treatment.
These emergencies are caused by pathoses
in the pulp or periradicular tissues.
Grossman defined it as unwanted guest.
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Pulpal DiagnosisPulpal Diagnosis Periradicular Periradicular DiagnosisDiagnosis
Reversible pulppitis
Irreversiblepulpitis
Necrotic pulp
Previously treated
Acute
periradicular
periodontitis
Acute
periradicular
abscess
Traumatic injuries
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•PAIN
•PAIN WITH SWELLING
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• The impulse travel from a delta fibers and c fibers nerve endings through plexus of raschkow to nerve trunk in the central zone of pulp .the a delta fibres are enclosed in myelin sheath while traversing the plexus of raschkow.
• The tissue injury excites c fibres which carry pain
• Mech of action of pain explained on the basis of inflammation ,inflammation accompany tissue injury and release of chemical mediators,this in turn stimulates c fibres and result in pain.
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Determine the Chief Complaint
Medical history
Tests
Radiographic exam
Analyze and results
Treatment plan
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•Acute reversible pulpitis
•Acute irreversible pulpitis
•Acute periapical abcess
•Acute apical periodontitis
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•Localized inflammation of the pulp•Lowering of threshold stimulation for a delta nerve fibres•Exaggerated ,non-lingering response to stimuli
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•Removal of cause
•Recontouring of restoration
•Removal of the restoration
•Relive the occlusion .
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If inflammatory process proggress ,irreversible pulpitis can develop.it is characterized by following:.
History of spontaneous pain and exaggerated response to hot or cold that lingers after the stimulus is removed
Lingering pain occur after thermal stimulation of a delta nerve fibres while spontaneous dull,aching pain occur by stimulation of unmyelinated c fibres in the pulp
Mediators of inflammation directly stimulate the fibres .
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Pulpectomy
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Biphasic treatement :
Pulp debridement
Incision n drainage
In case of systemic
features antibiotics are
prescribed
To control post operative
pain analgesics are
prescribed
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• It is localized collection of pus in the
alveolar bone at the root apex of a
tooth following death of pulp with
extension in the periradicular tissue.
• Large number of bacteria get past the
apex into periradicular tissues.
• Clinically ,swelling to various degree is
present along with pain and a feeling
that tooth is elevated in the socket
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Inflammation of periodontal ligament caused by
tissues damage,extension of pulpal pathosis or
occlusal trauma
Pressure on tooth is transmitted to the fluid which
pushes on nerve ending in periodontal ligament
Tooth may be elevated out its socket because of the
build up in fluid pressure in the periodontal ligament
Discomfort to biting or chewing
Sensitivity to percussion
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Determine the cause and
relive the symptoms
Adjustment of high points
Removal of irritants
Access opening followed
by placement of sedative
dressing followed by closed
dressing
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Mid treatment flare ups
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•Over-instrumentation• Inadequate debridement• Missed canal • Hyper-occlusion*• Debris extrusion • Procedural complications*
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Missed canal
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•PRE-OP PAIN
•PULP VITALITY
•PERCUSSION SENSITIVITY
•ABSENCE OF A PERIRADICULAR RADIOLUCENCY
•COMBINATION OF THESE SYMPTOMS
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Relief of occlusion
Reassure the patient
Analgesics should be
prescribed
Antibiotics if required
are
prescribed
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Perforation
Separated instrument
Zip
Strip
NaOCl accident
Air emphysema
Wrong tooth
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It is pathological or mechanical
communication between root canal
system and external tooth surface
It occur at 3 level:
1. Cervical canal perforation
2. Mid root perforation
3. Apical root perforation
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Isolation of the tooth Free from contamination Control of Bleeding Location of perforation Insertion of the thickest file in the canal
opening up to 5mm below the level of perforation. Calcium hydroxide paste (Dycal) is packed into
the perforation and allowed to set Soft mix of amalgam is gently packed over the
calcium hydroxide paste. After Initial setting of the filling material the file
is gently removed RCT should be perform as conventional method
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Stripping is a lateral perforation caused by over instrumentation through a thin wall in the root canal & is most likely to happen on the inside or concave wall of a curved
canal. Causes : •Over zealous instrumentation in the mid-
root areas •Not use precurved instruments.
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•Both internal and external repair may be required
•A small area may be sealed from inside the tooth.
A large one required surgical repair.
•International re-implantation can be considered.
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Over preparation of the outer wall of the apical curvature of the canal with
inflexible instruments will cause zipping.
Causes : •Failure to used the precurve
the instruments •Rotation of instruments in
curved canals Use of large stiff instrument
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When a zipping is present theremoplasticized GP techniques preferred along with sugical approach
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Reassurence to patients
Complete debridment of root canal
Establishment of drainage
Relief of occlusion
Calcium hydroxidetherapy
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Over instrumentation
Overextended filling beyond root apex
Fracture of crown and tooth
Failure of resolution of inflammation
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Over extended filling Fracture of tooth
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Reassurance
Analgesics
Retreatment
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C E L L Sn eu trop h ils , lym p h ocytes ,
p lasm a ce lls , m ac rop h ag es ,os teoc las ts , ep ith e lia l ce lls , d en d rit ic ce lls
M O L E C U L A R M E D IA TO R Scytok in es (IL , IF N , C S F , TG F )
e icosan o id s (P G , L T)en zym atic e ffec to r m o lecu les
A N TIB O D IE Sim m u n og lob u lin s (Ig G , e tc .)
p rod u ced b y p lasm a ce lls
M ixed M ic ro flo ra
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M IL D6 0 0 -1 0 0 0 ace tam in op h en
M O D E R A TE6 0 0 -1 0 0 0 m g ace tam in op h en
an d op ia te =6 0 m g cod e in e
S E V E R E1 0 0 0 m g ace tam in op h en
an d op ia te =1 0 m g oxycod on e
A sp irin -like D ru g s a re C on tra in d ica ted
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Systemic involvement
Compromised host resistance
Inadequate surgical drainage
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Grossman Text book of endodontics nisha garg
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