INTRODUCTION TO ENDODONTICS

Lecture Outline Introduction Diagnosis of pulpal and

periapical pathosis. Indications for Root canal

treatment (RCT). Endodontic access Length determination Canal preparation Obturation Temporary and final

restoration

Introduction

Endodontics: Is one of the dental specialty that deals with the tooth pulp and the tissues surrounding the root of a tooth.

Endodontists perform a variety of procedures including:• Root canal therapy• Endodontic retreatment• Surgery • Cracked tooth• Dental trauma

Root canal treatment and retreatment

Surgery (apicectomy)

Trauma

Cracked toothEndodontist

Field

Diagnosis of pulpal and periapical pathosis

1. Medical history

2. Dental history

3. Clinical examination

4. Diagnostic tests: A. Pulp tissue: Thermal (cold, hot) Electric pulp test Direct dentinal stimulation (cavity test)

B. Surrounding tissue and tooth structure:

Percussion Palpation Periodontal ligament Selective anesthesia test Transillumination

5. Radiographic examination

Diagnosis of pulpal and periapical pathosis

4. Diagnostic tests:

A. Pulp tissue: Thermal (cold, hot) Electric pulp test Direct dentinal

stimulation (cavity test)

Diagnosis of Pulpal and periapical pathosis

B. Surrounding tissue and tooth structure:

Percussion Palpation Periodontal

ligament Selective

anesthesia test Transillumination

Indications for Root Canal Treatment

When pulp is irreversibly inflamed, or necrotic.

Endodontic Access

The ideal endodontic access as follows:

Complete removal of chamber roof.

Remove coronal pulp.

Straight line access.

Endodontic Access

• Maxillary Incisors Triangualr shaped access centrally between the incisal and cervical parts.

Endodontic Access

• Maxillary canine Ovoid shape with broad buccolingually

Endodontic Access

• Maxillary premolarsThe access is ovoidal shape and never round (2 canals)

Endodontic Access

• Maxillary molarsTrapezoid shape (4 canals usually)

Endodontic Access

• Mandibular incsorsAccess just below the incisal edge (2 canals in 40%)

Endodontic Access

• Mandibular canineOvoidal shape extends buccolingually (occasionally 2 canals)

Endodontic Access

• Mandibular premolarsOviod shape extends buccolingually (25% two canals)

Endodontic Access

• Mandibular molars Triangular with the base of triangle mesially and apex distally (35% four canals)

Length Determination

1. Radiography

Length Determination

2. New technology:

Digital radiography

Electronic apex locator

Canal Preparation

• Canal preparation techniques:

I. Standard techniqueII. Step back

techniqueIII. Step down

techniqueIV. Passive step back

techniqueV. Balanced force

technique

Step back technique: Starting at the apex with the fine instrument and working one’s way back up the canal with progressively larger instrument.

Canal Preparation

Obturation

• By using gutta-percha and endodontic sealer after drying the canal with paper point.

Obturation Obturation techniques

1. Lateral condensation

Obturation

• Obturation techniques:

2. Warm vertical condensation

Obturation

• Obturation techniques:

3. Injection of thermoplasticized Gutta-percha

Obturation

• Obturation techniques:

• Carrier based Gutta- Percha

Oven with thermafil obturator

Temporary and final restoration

• Temporary and final restoration should be made to prevent micro leakage or bacterial entry from coronal restoration

Thank You