Tishk International University FACULTY OF DENTISTRY

Department Of Endodontics

3rd Grade ENDO - 352 ATOPIC: INTRODUCTION TO ENDODONTICS

Instructor: Dr. Niladri Maiti

INTRODUCTION

TO ENDODONTICSDR. NILADRI MAITI

MDS(Conservative Dentistry & Endodontics), M.Sc (Laser Dentistry)

PhD(Dental Science)

Fellowship in Aesthetic Dentistry

DEFINITION

Endodontics is that branch of Dentistry concerned

with the morphology, physiology

and pathology of the dental pulp and the peri-

radicular tissues. The study and

practice of Endodontics encompasses the basic

clinical sciences including the biology of the

normal pulp, root and periradicular tissues. It also

includes the aetiology, prevention, diagnosis and

treatment of diseases and injuries that affect the

pulp and the peri-radicular tissues.

AUSTRALIAN SOCIETY OF ENDODONTOLOGY

DR. NILADRI MAITI

Necessity was the mother of invention: experimentingwith new techniques, materials, and instruments, eventhough very rudimentary, the aim of Endodontics hasbeen to relieve pain, treat exposed pulp, and preserveteeth

HISTORY

In 1687, Charles Allen,

describing the techniques of

dental transplants, wrote the

first English-language

book devoted exclusively to the

field of dentistry

DR. NILADRI MAITI

Pierre Fauchard (1678-1761), considered thefounder of modern dentistry, who in histextbook “Le chirurgien dentiste” preciselydescribed the dental pulp and dispelled thelegend of the “tooth worm,” which had beenconsidered the cause of caries and toothachessince the time of the Assyrians

DR. NILADRI MAITI

In 1725, Lazare Riviere introducedthe use of oil of cloves for itssedative properties.In 1746, Pierre Fauchard describedthe removal of pulp tissue.In 1820, Leonard Koeckercauterized exposed pulp with aheated instrument and protectedit with lead foil.

In 1836, Shearjashub Spoonerrecommended arsenic trioxide forpulp devitalization.In 1838, Edwin Maynard ofWashington, D.C. introduced thefirst root canal instrument, whichhe created by filing a watch spring.In 1847, Edwin Truman introducedgutta-percha as a filling material.

DR. NILADRI MAITI

Professor Wilhelm Conrad Roentgen on

November 8th, 1895 : – Discovery of X – RAYS

In 1900, Price described periapicalradiolucencies as “blind abscesses” and advised the use of radiography for establishing the diagnosis of pulplessteeth

1867, Magitot suggested the useof an electric current to test pulpvitality

In 1891, the German dentist OttoWalkhoff introduced the use ofcamphorated chlorophenol as amedication to sterilize root canals.

DR. NILADRI MAITI

In 1859, Albert Niemann refined the coca extract

to the pure alkaloid form and named this new drug

“cocaine.” Niemann recognized the anesthetic effect

of cocaine when he noted that “it benumbs the

nerves of the tongue

American surgeon William Halsted was the first

person to inject cocaine for nerve conduction blockade,

performing infraorbital and inferior alveolar nerve

blocks for dental procedures in November 1884.3

Halsted subsequently developed numerous other

regional nerve block injection techniques, many of

which are still fundamental to dental practice

Endodontic treatment dates all the way back to the

second or third century B.C. In 1985, archeologists

discovered evidence of early root canal surgery in

Israel’s Negev Desert. After examining the jaw of a 2000

year deceased Nabataen soldier, Joseph Zias, of Israel’s

national Department of Antiquities and Museums,

unearthed a one-tenth of an inch bronze wire, which had

been embedded in the nerve cavity of one of the skull’s

teeth. The location of the wire was in the exact spot

of infection, where modern root canal treatment

would be targeted. Apparently, the wire was used to

reduce infected tooth pulp, as the soldier suffered from

three abscesses and a cyst.

DR. NILADRI MAITI

FIELD OF ENDODONTICS

Clinical undergraduate endodontics

should encompass the following areas:

Diagnosis of pulp and periapical conditions.

Endodontic radiography.

Emergency treatment procedures - including

the relief of pain and management of

infections.

Pulp therapy - including dentine desensitisation

and protection; direct pulp capping; indirect pulp

capping; partial pulpotomy; pulpotomy; and

partial pulpectomy.

DR. NILADRI MAITI

Pulpectomy and associated endodontic

procedures - including consideration of:

Indications and contra-indications for

treatment

Diagnosis and management of orofacial

pain

Microbiological and immunological

aspects of endodontics

Materials and instruments

Instrumentation of root canals

Irrigation of root canals

Intra-canal medication

Root filling techniques.

DR. NILADRI MAITI

Treatment of pulpless teeth with or

without associated periapical pathosis.

The role and scope of periapical

surgery.

The management of traumatic injuries

to the teeth and mouth - including

crown

fractures, crown/root fractures, root

fractures, concussion, subluxations,

luxations,

avulsions, alveolar bone fractures,

abrasions, contusions and lacerations.

DR. NILADRI MAITI

Apexification and apexogenesis.

Management of combined

endodontic/periodontal lesions.

Recognition and treatment of resorptive

defects.

Bleaching of teeth.

Treatment of medically compromised

patients.

Assessment of treatment outcomes following

endodontic management of teeth.

Restoration of endodontically treated teeth.

Alternatives to endodontic therapy -

including the role of endodontics in preserving

bone for potential implant therapy

DR. NILADRI MAITI

ENDODONTICS -- YESTERDAY, TODAY & TOMORROW

Dr. Grossman, the pioneer of

endodontics, published an

excellent history of

endodontics in the July 1976

issue of JADA in which he

divides the evolution of the

science of endodontics over

four half centuries from 1776

to 1976.

DR. NILADRI MAITI

DENTAL PULP

MEAN VOLUME OF SINGLE ADULT HUMAN PULP : 0.02CC

TOTAL VOLUMES OF ALL PERMANENT TEETH

PULP ORGAN IS: 0.38CC

The dental pulp resides in a rigid chamber

comprising dentine, enamel and

cementum, which provide strong

mechanical support and protection from

the microbial rich oral environment

DR. NILADRI MAITI

An inflamed or injured pulp may have to be removedand replaced with a root filling – a procedure termedpulpectomy. This measure is undertaken especially incases when the condition of the pulp is such that aninflammatory breakdown is deemed imminent.

The objective of endodontic treatment

The consequences of inflammatory lesions in the pulp and periapical tissue have tormented humankind for thousands of years.

Historically, therefore, the main task of endodontic treatment has been to cure toothache due to inflammatory lesions in the pulp (pulpitis) and the periapical tissue (apical periodontitis).

The vital pulp

Under normal, physiological conditions the pulp is wellprotected from injury and injurious elements in the oralcavity by the outer hard tissue encasement of the tooth and an intact periodontium

When the integrity of these tissue barriers is breached for any reason, microorganisms and the substances they produce may gain access to the pulp and adversely affect its healthy condition. The most common microbial challenge of the pulp derives from caries.

DR. NILADRI MAITI

An inflamed or injured pulp may have to be removed and replaced with a root filling – a procedure termed pulpectomy.

DR. NILADRI MAITI

A pulpectomy procedure is carried out under localanesthesia and with the use of specially designed root canal instruments.

These instruments remove the diseased pulp and prepare the canal system so that it can be filled properly. The purpose of the filling is to preventmicrobial growth and multiplication in the pulpal chamber.

The necrotic pulp

As mentioned above, injury to the pulp may lead tonecrosis of the tissue . The necrotic pulp isdefenseless against microbial invasion and will allowmicroorganisms indigenous to the oral cavity to reachthe pulp chamber, either along an open direct exposureor through uncovered dentinal tubules or cracks in theenamel and dentin.

The specific environment in the root canal, characterized by the degrading pulp tissue and lack of oxygen, will favor a microbiota dominated by proteolytic, anaerobic bacteria. These microorganisms may organize themselves in clusters and in microbial communities attached to the root canal walls as well as inside the dentinal tubules of the root.

A chronic inflammatory lesion will ensue, normally aroundthe root tip, and remain for as long as no treatment isinitiated.

Response to deep caries

Once the carious lesion with its bacterial front has penetrated the primary dentin and progressed into reparative dentin and/or to the pulp tissue proper, a massive mobilization of the inflammatory defense will take place

A most conspicuous feature is the aggregation of neutrophils. Often a local abscess develops. Clinically, upon excavation of caries, a dropletof pus may sometimes appear at the exposure site.

Treatment of the necrotic pulp is by root canal treatment (RCT) and is aimed to combat the intracanal infection.The canal is cleaned with files in order to remove microbes as well as their growth substrate.

SCOPE OF ENDODONTICSThere has been massive growth in

endodontic treatment in recent years.

By the early 1960’s about 3 million

teeth were endodontically treated in

the United States annually.

In the early 1990’s, U.S. dentists were

treating 40 million cases per year, and currently the profession is performing over 50 million endodontic procedures

each year.

DR. NILADRI MAITI

The good news is: hundreds of millions of

teeth are salvaged through combinations of

endodontics, periodontics, and restorative

dentistry. The bad news is: if we treat 50

million

cases per year and if the failure rate is just

10%, then there would be 5 million treatment

failures per year.

Extrapolating over the past three

to four decades reveals that the

number of failing endodontically

treated teeth is massive, and

could approach tens of millions!

The most important innovations have been the utilization of the dental operating microscope, ultrasonic technologyand related instruments, nickel-titanium (NiTi) rotaryshaping files, and mineral trioxide aggregate (MTA) LASERS etc.

There are many advantages

for utilizing NiTi rotary

instruments for shaping root

canals. Traditionally, canal

preparations have been

performed using a series of

stainless steel files, oftentimes

in conjunction with gates

glidden drills or peeso

reamers

DR. NILADRI MAITI

Advantageously, NiTi rotary

shaping files have nearly

eliminated these iatrogenic

events.

Other important advantages of

shaping canals with NiTi files

are improved efficiency, the

opportunity to schedule more

“one visit” endodontic

procedures, and improved

profitability.

DR. NILADRI MAITI