Relationship between conservative Relationship between conservative dentistry and periodontology, dentistry and periodontology,

conservative dentistry and oral conservative dentistry and oral surgery. surgery.

Not correct conservative proceduresNot correct conservative procedures and their effectsand their effects

tto periodontal tissues.o periodontal tissues. Indi Indiccations of the endodontications of the endodontic – –

surgical procedures.surgical procedures.

Endodontics is an important discipline Endodontics is an important discipline in dentistry with a high sucess ratein dentistry with a high sucess rate

All teeth with pulpal or periapical pathology are All teeth with pulpal or periapical pathology are candidates for endodonticscandidates for endodontics

INDICATIONS FOR ENDODONTICS:INDICATIONS FOR ENDODONTICS: When a tooth has lost the majority of coronal When a tooth has lost the majority of coronal

tissue and a crown is to be constructedtissue and a crown is to be constructed

Preservation of the alveolar bone is important Preservation of the alveolar bone is important in prosthodontics, because the root retention in in prosthodontics, because the root retention in the Mandible is recommendedthe Mandible is recommended

Teeth with doubtful pulps – vital teeth, which Teeth with doubtful pulps – vital teeth, which are to be restored with large cast restorations are to be restored with large cast restorations or porcelain – should be assessed or porcelain – should be assessed endodontically beforehand.endodontically beforehand.

Risk of pulp exposure during preparationRisk of pulp exposure during preparation

Pulpal sclerosis following traumaPulpal sclerosis following trauma

PulpotomyPulpotomy

CONTRA – INDICATIONS TO CONTRA – INDICATIONS TO ENDODONTICS: ENDODONTICS:

GENERAL:GENERAL: Small mouthSmall mouth Poor oral hygienePoor oral hygiene PatientPatient´́s general medical conditions general medical condition PatientPatient´́s attitudes attitude

LOCAL:LOCAL: Tooth not restorableTooth not restorable

Insufficient periodontal supportInsufficient periodontal support

Non – strategic toothNon – strategic tooth

Root fractures. Root fractures.

Massive internal or external resorptionMassive internal or external resorption

Bizzare anatomy. All teeth may show unusual Bizzare anatomy. All teeth may show unusual anatomic variations.anatomic variations.

The ways in which restorations The ways in which restorations failfail

(in conserv.dent.)(in conserv.dent.) New disease New disease -caries and tooth wear-caries and tooth wear Pulpal problemsPulpal problems TraumaTrauma Periodontal diseasePeriodontal disease Technical failureTechnical failure Fractured restorationsFractured restorations Marginal breakdownMarginal breakdown Tooth fractureTooth fracture Defective contoursDefective contours AppearanceAppearance Failure of retentionFailure of retention

Problem areasProblem areas This section contains problem areas which frequently

confront the operator and pose particular difficulties with treatment planning. These will be divided into different categories but often several may appear together.

OBSTRUCTED CANALSOBSTRUCTED CANALS Natural obstructions include pulp stones, calcified

canals or anomalies which makes instrumentation impossible

Iatrogenic obstructionsIatrogenic obstructions

Include broken root canal Include broken root canal instruments, posts, gutta percha or instruments, posts, gutta percha or solid cement root fillingsolid cement root filling

Fractured instruments . Problem with larger Fractured instruments . Problem with larger sized instruments.sized instruments.

As the size of root canal instruments increases their flexibility decreases. The larger sizes are stiff and problems arise when they are used to prepare the root canal. These problems are:

The apical portion of many roots is narrow, so that if large instruments are used they could lead to perforation

1. The majority of teeth have curved roots, particularly in the apical one third

As the patient is having symptoms there are As the patient is having symptoms there are three options:three options:

1.1. ExtractionExtraction

2.2. Apicectomy with retrograde amalgam seals in Apicectomy with retrograde amalgam seals in both the mesial and distal canalboth the mesial and distal canal

3.3. Removal of the crown and an attempt to re-Removal of the crown and an attempt to re-root fillroot fill

PERFORATIONSPERFORATIONS

There are three types of perforation according There are three types of perforation according to their position:to their position:

Lateral wall of root . The use of engine-operated rotating instruments such as burs or reamers makes perforation of the wall of the root likely.

Apex. Over- zealous instrumentation of a canal may result in perforation through the apical foramen. Calcium hydroxide may be used to provide an apical barrier

Floor of the pulp chamber. Perforations through the floor of the pulp chamber quickly become periodontal problems with furcal bone loss and pocketing, unless they are treated immediately.

ROOT FILLINGROOT FILLING

The root filling is completed when The root filling is completed when the tooth is symptomless and the the tooth is symptomless and the canal dry or capable of being with canal dry or capable of being with paper points.paper points.

Root cannal with periapical lessions, Root cannal with periapical lessions, the accepted technique has been two the accepted technique has been two or more visitsor more visits

21-years old woman-non 21-years old woman-non successful endodontic successful endodontic

treatmenttreatment tooth N.22,apical tooth N.22,apical

clear radiolucency clear radiolucency confirming an established confirming an established lesion bigger than 3mm,it lesion bigger than 3mm,it

shows features of lamina dura shows features of lamina dura disruption and bone structural disruption and bone structural

changeschanges

Measurement of the Measurement of the tooth canal lengthtooth canal length

Final endodontic Final endodontic treatment Foredent treatment Foredent

and gutaperchaand gutapercha

ENDODONTIC SURGERY

Is indicated in the caseses of failed Is indicated in the caseses of failed conservative treatmented.conservative treatmented.

APICECTOMYAPICECTOMY INDICATIONS:INDICATIONS: Access to the root canal is prevented due to

dystrophic calcification The presence of large periapical lesion The presence of large periapical lesion

Chronic periapical infection associated with Chronic periapical infection associated with the introduction of a large quantity of root the introduction of a large quantity of root filling material into the periapical bonefilling material into the periapical bone

Fracture of the root with gross displacement of Fracture of the root with gross displacement of the apical portionthe apical portion

Perforation of the root, resulting from Perforation of the root, resulting from injudicious instrumentation, internal or injudicious instrumentation, internal or external resorptionexternal resorption

When conservative treatment has failed, when When conservative treatment has failed, when symptoms persist despite numerous dressings, symptoms persist despite numerous dressings, or after a canal has been filled with an or after a canal has been filled with an irremovable fillingirremovable filling

In order to confirm the presence of a suspected In order to confirm the presence of a suspected fracture of the rootfracture of the root

CONTRA-INDICATIONS:CONTRA-INDICATIONS:

Individual anatomical problems, such as a small Individual anatomical problems, such as a small mouth, trismus, or severe facial scaringmouth, trismus, or severe facial scaring

Proximity of inferior dental canal, mental nerve an Proximity of inferior dental canal, mental nerve an maxillary antrum when operating on the roots of maxillary antrum when operating on the roots of premolars and molarspremolars and molars

Systemic factors: neurosis, history of rheumatic fever Systemic factors: neurosis, history of rheumatic fever or chorea, pregnancy, haemorrhagic diatheses, or chorea, pregnancy, haemorrhagic diatheses, cardiac disease,....cardiac disease,....

Poor oral hygiene associated with periodontal Poor oral hygiene associated with periodontal disease or severe cariesdisease or severe caries

The strategic importance of the tooth and the The strategic importance of the tooth and the subsequent possibility that cannot restored to subsequent possibility that cannot restored to full functionfull function

Tooth resectionTooth resection

Is often the treatment of choice in deep Is often the treatment of choice in deep grade II and grade III furcation involvements.grade II and grade III furcation involvements.

It is also treatment of choice where teeth are It is also treatment of choice where teeth are to be included in a fixed prosthesisto be included in a fixed prosthesis

HemisectionHemisection- the mesial root has been - the mesial root has been sectioned and the distal root, following endo sectioned and the distal root, following endo and osseous surgery, has been utilized as a and osseous surgery, has been utilized as a bridge abutment. (resection of mesial root bridge abutment. (resection of mesial root on the mandibular first molar)on the mandibular first molar)

Osseous surgery is often necessary following Osseous surgery is often necessary following both root amputation and tooth resection, so both root amputation and tooth resection, so that osseous craters are eliminated and to that osseous craters are eliminated and to blend the bony contours around the remaining blend the bony contours around the remaining root or roots into the adjacent bone, so that root or roots into the adjacent bone, so that there is no precipitous drop in levels.there is no precipitous drop in levels.

Where a tooth has been treated by resection, Where a tooth has been treated by resection, osseous surgery is often necessary around the osseous surgery is often necessary around the remaining root to establish a biological width remaining root to establish a biological width for the development of a new connective for the development of a new connective tissue and junctional epithelial attachment on tissue and junctional epithelial attachment on root structure apical to the cut.root structure apical to the cut.

RESECTION OF THE APEXRESECTION OF THE APEX

It is considered essential to remove the apical third of It is considered essential to remove the apical third of the root in order to eliminate the apical delta and the the root in order to eliminate the apical delta and the zone of infected cementum.Contemporary attitudes zone of infected cementum.Contemporary attitudes favour minimum shortening of the root, consistent favour minimum shortening of the root, consistent with the provision of access to the cut end, so that the with the provision of access to the cut end, so that the apical seal can be verified or provided by cutting and apical seal can be verified or provided by cutting and filling an apical cavity., the majority of periapical filling an apical cavity., the majority of periapical lesions can be dealt with by the bodys defences, thus lesions can be dealt with by the bodys defences, thus obviating the need for a surgical approach.obviating the need for a surgical approach.

Intraoral image Intraoral image D.22-Cystis D.22-Cystis

radicularis processus radicularis processus alveolaris maxillae alveolaris maxillae

reg.frontalis reg.frontalis purulentapurulenta

3months after the therapy-3months after the therapy-Cystectomio Cystectomio

sec.PARTSCH II. et sec.PARTSCH II. et resectio apicis dentis N.22resectio apicis dentis N.22

Retrograde root canal Retrograde root canal endodontic therapy with endodontic therapy with

amalgamamalgam

Egalisatio,suturaeEgalisatio,suturae