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  • The disc appears in the front of each copy, in its ownsealed jacket.

    The disc contains the complete text and illustrations of the book, in fully searchable PDF files. The book and disc are sold only as a package; neither is availableindependently, and no prices are available for the items individually.

    BC Decker Inc is committed to providing high-qualityelectronic publications that complement traditionalinformation and learning methods.

    We trust you will find the book/CD package invaluableand invite your comments and suggestions.

    Every Deckerbook isaccompaniedby a CD-ROM.

    Brian C. DeckerCEO and Publisher

  • PDQ* SERIES

    ACKERMANN

    PDQ PHYSIOLOGY

    BAKER, MURRAY

    PDQ BIOCHEMISTRY

    CORMACK

    PDQ HISTOLOGY

    JOHNSON

    PDQ PHARMACOLOGY, 2/e

    KERN

    PDQ HEMATOLOGY

    McKIBBON

    PDQ EVIDENCE-BASED PRINCIPLES AND PRACTICE

    NORMAN, STREINER

    PDQ STATISTICS, 2/e

    STREINER, NORMAN

    PDQ EPIDEMIOLOGY, 2/e

    SCIUBBA

    PDQ ORAL DISEASE

    *PDQ (Pretty Darned Quick)

  • PDQENDODONTICS

    JOHN I. INGLE, DDS, MSDLecturer, Department of EndodonticsSchool of DentistryLoma Linda UniversityLoma Linda, CA

    Formerly Dean and Professor of Endodontics andPeriodonticsUniversity of Southern CaliforniaLos Angeles, CA

    Formerly Professor of Endodontics and PeriodonticsUniversity of WashingtonSeattle, WA

    Diplomate, American Board of EndodonticsDiplomate, American Board of Periodontology

    2005

    BC Decker Inc

    Hamilton London

  • BC Decker IncP.O. Box 620, L.C.D. 1Hamilton, Ontario L8N 3K7Tel: 905-522-7017; 1-800-568-7281Fax: 905-522-7839; 1-888-311-4987E-mail: [email protected] www.bcdecker.com

    2005 BC Decker IncAll rights reserved. No part of this publication may be reproduced, stored in a retrieval system,or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording,or otherwise, without prior written permission from the publisher.

    05 06 07 08 / WPC / 9 8 7 6 5 4 3 2 1

    ISBN 1-55009-273-1

    Printed in the United States of America

    Sales and Distribution

    United StatesBC Decker IncP.O. Box 785Lewiston, NY 14092-0785Tel: 905-522-7017; 800-568-7281Fax: 905-522-7839; 888-311-4987E-mail: [email protected] www.bcdecker.com

    CanadaBC Decker Inc20 Hughson Street SouthP.O. Box 620, LCD 1Hamilton, Ontario L8N 3K7Tel: 905-522-7017; 800-568-7281Fax: 905-522-7839; 888-311-4987E-mail: [email protected] www.bcdecker.com

    Foreign RightsJohn Scott & CompanyInternational Publishers AgencyP.O. Box 878Kimberton, PA 19442Tel: 610-827-1640Fax: 610-827-1671E-mail: [email protected]

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    Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein,including choice of drugs and drug dosages, is in accordance with the accepted standard and practice at thetime of publication. However, since research and regulation constantly change clinical standards, the readeris urged to check the product information sheet included in the package of each drug, which includes recom-mended doses, warnings, and contraindications. This is particularly important with new or infrequently useddrugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighedon a case-by-case basis against the benefits anticipated. The reader is cautioned that the purpose of this bookis to inform and enlighten; the information contained herein is not intended as, and should not be employedas, a substitute for individual diagnosis and treatment.

  • This volume, PDQ Endodontics,is the offspring of the major text

    Endodontics.

    My children are my offspring.And it is with a great deal of pride and pleasure

    that I dedicate this volume to them:

    JOHN GEOFFREY INGLE

    SCHUYLER NEAL INGLE

    LESLIE JOYCE INGLE MOXLEY

  • Contents vii

    ContentsPREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII

    ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . XIII

    1. EXAMINATION, DIAGNOSIS, . . . . . . . . . . . . . . . . . . . . . 1AND TREATMENT

    2. ENDODONTIC TREATMENT PROCEDURES . . . . . . . . . 41

    3. ACCESS TO THE ROOT CANAL SYSTEM: . . . . . . . . . . 58PREPARATION FOR TREATMENT

    4. ACCESS TO THE ROOT CANAL SYSTEM: . . . . . . . . . . 71CORONAL CAVITY PREPARATION

    5. ROOT CANAL PREPARATION . . . . . . . . . . . . . . . . . . . . 111

    6. OBTURATION OF THE RADICULAR SPACE . . . . . . . . 142

    7. ENDODONTIC SURGERY . . . . . . . . . . . . . . . . . . . . . . . . 167

    8. ENDODONTIC MISHAPS. . . . . . . . . . . . . . . . . . . . . . . . 215

    9. MANAGEMENT OF ENDODONTIC . . . . . . . . . . . . . . . 235EMERGENCIES

    10. RESTORATION OF ENDODONTICALLY . . . . . . . . . . . 261TREATED TEETH

    11. DISCOLORATION AND BLEACHING . . . . . . . . . . . . . . 279

    INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

  • viii PDQ ENDODONTICS

    PrefaceEndodontics is that branch of dentistry centered on the dental pulpand periradicular tissues. The scope of endodontics deals with thediagnosis and treatment of pulp and periradicular pathology and theprevention of pulp disease; of oral pains of pulpal and/or periradic-ular origin as well as extraoral referred pain; vital pulp capping orpulpotomy; pulp extirpation and cleaning and shaping of the rootcanal, its disinfection, and its obturation; surgical removal and biopsyof pathologic periapical tissue; root end resection and reverse obtu-ration of the canals, as well as hemisection and full root resection ofpathologic roots; endodontic and osseointegrated implants; man-agement of traumatic injuries to the teeth and implantation of avulsedteeth; internal and external bleaching of discolored teeth; retreat-ment of previously treated teeth; and post and core placement involv-ing the root canal space.

    An endodontist is a dentist with 2 or more years of advanced train-ing in endodontics who has received a certificate or advanced degreefrom an accredited program. Those who meet these qualificationshave the privilege of appearing before the American Board ofEndodontics; if they pass, they become diplomates of the ABE.

    Note to the reader: If you are seeking additional information overand above the contents of this book, please refer to the full textEndodontics by J.I. Ingle and L.K. Bakland, published by BC Decker,Hamilton, ON, 2003; 974 pages. To contact BC Decker, phone1-800/568-7281, fax 1-905/522-7839, or e-mail [email protected],or visit their Web site at www.bcdecker.com.

  • Preface ix

    The fifth edition of Endodontics.

    Endodontology deals withdiseases of the pulp andperiradicular tissues aswell as the study of theiranatomy, physiology, andpathology.

  • x PDQ ENDODONTICS

    Root canal treatment is well illustrated by this treatment of two pulpless teeththat serve well as bridge abutments. Courtesy of N. Hertl.

  • Preface xi

    A, previous page, Two centralincisors were fractured throughthe pulp and the lateral incisorwas totally luxated as a result ofa bicycle accident. B, above, Thelateral incisor was treated inhand and replanted, and theinjuries began to heal. C, left,Radiograph illustrates the rootcanal treatment to the centralincisors and the replanted root ofthe lateral incisor. D, below, Finalrestoration with three porcelainjacket crowns.

  • xii PDQ ENDODONTICS

    A, Left Advanced cellulites related to an infected maxillary lateral incisor. B,Right Eight days following incision, drainage, and antibiotic therapy. Courtesyof B. Wolfson.

    Left, Discolored central incisor, years after trauma. Right, Incisor 1 week later,following internal bleaching with 30% hydrogen peroxide.

  • Acknowledgments xiii

    AcknowledgmentsMy cup runneth over.

    Psalm XXIII

    I have been so blessed! Blessed first of all with loving parents whoprovided me a fine education. And then with a loving and extraor-dinary family. I have also been blessed with wonderful teachers, bril-liant students, and marvelous associates and fellow faculty members,who have led me on a pathway I never dreamed of. And through itall, I have been backed up by talented and dedicated nurses, assis-tants, secretaries, technicians, and publishers. How fortunate I havebeen!

    In my course through life, I have been associated with a numberof unusual universities, each one depositing special skills and knowl-edge. I am deeply indebted to them all: Washington State University,Northwestern University, University of Michigan, University ofWashington, University of Southern California, Howard andGeorgetown Universities, UCLA, and finally, Loma Linda University.My stint at the Institute of Medicine, National Academy of Sciences,was a humbling experience. I suddenly learned what I didnt know.

    And now to this text. The backup at Loma Linda University hasbeen outstanding. Drs. Leif Bakland and Mahmoud Torabinejad wereeager to help. The very versatile, talented, and enormously patient,Richard Tinker, director of Loma Lindas Educational SupportServices, was untiring in his efforts to make perfect every illustrationand photo. How fortunate I am, at my age, to be a member of sucha distinguished faculty. Thanks to my computer guru and maven,Scott Arnett, I was able to suffer through many failures, viruses,worms, and my own inadequacies.

    And I must thank my wife, Joyce, for her exceptional computertyping skills, far outclassing my hunt and peck abilities.

  • xiv PDQ ENDODONTICS

    Id be remiss if I failed to thank those countless associates who,as contributing authors, were so generous with their time and knowl-edge to make the text Endodontics the success it has been. I haveborrowed unsparingly from their writings and research in produc-ing this condensed version.

    Finally, I must acknowledge those at BC Decker, Publisher, whoworked so diligently on editing, indexing, publishing, and market-ing this text. They include Brian Decker, Paula Mucci, Susan Ball,and Petrice Custance.

    John I. Ingle, DDS, MSDSan Diego, CA, 2005

    The Loma Linda Three Musketeers: Left to right, Leif Bakland,John Ingle, Mahmoud Torabinejad at the 2004 meeting of theAmerican Association of Endodontists. Dr. Torabinejad was presi-dent of the AAE in 20032004, Dr. Ingle was president of the AAEin 19661967, and Dr. Bakland was president of the AmericanBoard of Endodontics in 19921993.

    PDQ EndodonticsCopyrightDedicationContentsPrefaceAcknowledgmentsCh01: EXAMINATION, DIAGNOSIS, AND TREATMENTCh02: ENDODONTIC TREATMENT PROCEDURESCh03: ACCESS TO THE ROOT CANAL SYSTEM: PREPARATION FOR TREATMENTCh04: ACCESS TO THE ROOT CANAL SYSTEM: CORONAL CAVITY PREPARATIONCh05: ROOT CANAL PREPARATIONCh06: OBTURATION OF THE RADICULAR SPACECh07: ENDODONTIC SURGERYCh08: ENDODONTIC MISHAPSCh09: MANAGEMENT OF ENDODONTIC EMERGENCIESCh10: RESTORATION OF ENDODONTICALLY TREATED TEETHCh11: DISCOLORATION AND BLEACHINGIndexExit

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