Cohen's Pathways of the Pulp Expert Consult

Front Cover
Front matter
	Cohen’s Pathways  of the Pulp
Copyright
About the editors
	Louis H. berman
	Kenneth M. hargreaves
	Ilan rotstein
Dedication
Contributors
New to this edition
	New chapter organization
	Digital content
Introduction
Table of Contents
	PART I The core science of endodontics
	PART II Advanced science topics
	PART III Advanced clinical topics
	PART IV Online content
Part I THE CORE SCIENCE OF ENDODONTICS
	1 Diagnosis
		Art and science of diagnosis
			Chief complaint
			Medical history
			Dental history
				History of present dental problem
				Dental history interview
		Examination and testing
			Extraoral examination
			Intraoral examination
				Soft-tissue examination
				Intraoral swelling
				Intraoral sinus tracts
				Palpation
				Percussion
				Mobility
				Periodontal examination
			Pulp tests
				Thermal
				Electric
				Laser doppler flowmetry
				Pulse oximetry
			Special tests
				Bite test
				Test cavity
				Staining and transillumination
				Selective anesthesia
			Radiographic examination and interpretation
				Intraoral radiographs
				Digital radiography
				Cone-beam computerized tomography
				Magnetic resonance imaging
			Cracks and fractures
				Crack types
				Vertical root fractures
			Perforations
		Clinical classification of pulpal and periapical diseases
			Pulpal disease
				Normal pulp
				Pulpitis
				Reversible pulpitis
				Irreversible pulpitis
					Symptomatic irreversible pulpitis.
					Asymptomatic irreversible pulpitis.
				Pulp necrosis
				Previously treated
				Previously initiated therapy
			Apical (periapical) disease
				Normal apical tissues
				Periodontitis
				Symptomatic apical periodontitis
				Asymptomatic apical periodontitis
				Acute apical abscess
				Chronic apical abscess
		Referred pain
		Summary
		References
	2 Radiographic interpretation
		Radiographic interpretation
			Imaging modalities
			Image characteristics and processing
			Digital imaging and communications in medicine
		Diagnostic tasks in endodontics
			Diagnosis and healing
			Three-dimensional imaging
		Principles of cone beam computed tomography
			Voxels and voxel sizes
			Field of view
				Diagnostic task
				Type of patient
				Spatial resolution requirements
		Imaging tasks improved or simplified by cone beam volumetric computed tomography
			Differential diagnosis
				Lesions of endodontic origin
				Lesions of nonendodontic origin
			Evaluation of anatomy and complex morphology
				Dental anomalies
				Root canal system morphology
			Diagnosis of endodontic treatment failures
		Intraoperative or postoperative assessment of endodontic treatment complications
			Vertical root fractures
			Overextended root canal obturation material
			Separated endodontic instruments
			Calcified canals
			Perforations
		Presurgical treatment planning
			Dentoalveolar trauma
			Internal and external root resorption
		Endodontic treatment outcomes assessment
		Dental implant case planning
			3D-guided endodontics
		Image perception and viewing environment
		The future of cone-beam computed tomography
		Magnetic resonance imaging
		Conclusions
		JOINT POSITION STATEMENT OF THE AMERICAN ASSOCIATION OF ENDODONTISTS AND THE AMERICAN ACADEMY OF ORAL AND MAXILLOFACIAL RADIOLOGY ON THE USE OF CONE BEAM COMPUTED TOMOGRAPHY IN ENDODONTICS: 2015/2016 UPDATE
			Introduction
			Volume Size(s)/field of view
			Dose considerations
			Interpretation
			Recommendations
				Diagnosis
				Initial treatment
				Nonsurgical retreatment
				Surgical retreatment
				Special conditions
				Outcome Assessment
		References
	3 Lesions that mimic endodontic pathosis
		Importance of differential diagnosis
		Limits of pulp testing
		Limits of radiology
		Differential diagnosis of periapical pathosis
			Multilocular radiolucencies
				Odontogenic keratocyst
					Radiographic features.
				Ameloblastoma
					Radiographic features.
				Central giant cell lesion
					Radiographic features.
			Radiopacities in the periapical region
				Condensing osteitis
					Radiographic features.
				Maxillary sinusitis of endodontic origin
					Radiographic features.
						Periapical osteoperiostitis.
						Periapical mucositis.
				Osteomyelitis with proliferative periostitis
					Radiographic features.
				Idiopathic osteosclerosis
					Radiographic features.
				Odontoma
					Radiographic features.
				Paget disease of bone
					Radiographic features.
				Exostoses and tori
					Radiographic features.
			Multifocal presentations
				Periapical cemento-osseous dysplasia
					Radiographic features.
				Florid cemento-osseous dysplasia
					Radiographic features.
				Hyperparathyroidism
					Radiographic features.
				Langerhans cell histiocytosis
					Radiographic features.
			Ill-defined pathologies
				Osteomyelitis
					Acute osteomyelitis.
					Chronic osteomyelitis.
				Medication-related osteonecrosis of the jaw
					Radiographic findings.
				Non-hodgkin lymphoma
					Radiographic features.
				Metastatic disease
					Radiographic features.
				Multiple myeloma
					Radiographic features.
			Well-defined unilocular periapical radiolucencies
				Periapical cysts and periapical granulomas
					Radiographic features.
				Lateral radicular cyst
					Radiographic features.
				Lateral periodontal cyst
					Radiographic features.
				Focal cemento-osseous dysplasia
					Radiographic features.
				Nasopalatine duct cyst
					Radiographic features.
				Stafne defect
					Radiographic features.
		Summary
		References
	4 Diagnosis of the nonodontogenic toothache
		Review of neuroanatomy
			Somatic structures
			Neural structures
				Peripheral nervous system
					Primary afferent neurons.
						A-beta fibers.
						A-delta fibers.
						C fibers.
				Central nervous system
					Second-order neurons.
			Autonomic nervous system
		Review of neurophysiology
			Peripheral sensitization
			Central sensitization
			Terminology
		Clinical entities that can present as toothache
			Sources of odontogenic toothache
			Sources of nonodontogenic toothache
				Musculoskeletal and somatic pain
					Myofascial pain.
					Pain of sinus or nasal mucosal origin.
					Salivary gland pain.
				Neurovascular pain
				Neuropathic pain
					Neuralgia.
					Neuroma.
					Neuritis.
					Neuropathy.
				Toothache referred from a distant organic source
					Cardiac and thoracic structures.
					Intracranial structures.
					Throat and neck structures.
					Craniofacial structures.
				Psychogenic toothache
				Frequency of nonodontogenic toothache
		Taking a patient’s history
		Patient examination
			Additional tests
			Case studies
				Case 1
					Subjective history.
					Examination.
						Additional tests.
				Case 2
					Subjective history.
					Examination.
						Additional tests.
		Summary
		References
	5 Case assessment and treatment planning
		Common medical findings that may influence endodontic treatment planning
			Cardiovascular disease
			Diabetes
			Pregnancy
			Malignancy
			Medication-related osteonecrosis of the jaws
			Human immunodeficiency virus and acquired immunodeficiency syndrome
			Prosthetic implants
			Behavioral and psychiatric disorders
			Psychosocial evaluation
		Development of the endodontic treatment plan
		Endodontic prognosis
			Single-visit versus multiple-visit treatment
			Surgical endodontics
			Intentional replantation
			Regenerative endodontics
		Interdisciplinary treatment planning
			Periodontal considerations
			Restorative and prosthodontic considerations
			Endodontic therapy or dental implant
		Other factors that may influence endodontic case selection
			Anxiety
			Scheduling considerations
		References
	6 Pain control
		Local anesthesia
			Mechanisms of action for anesthetics
			Clinically available local anesthetics
			Selection of a local anesthetic: Possible adverse effects and medical history
				Possible adverse effects
					Cardiovascular reactions
					Systemic effects
					Methemoglobinemia
					Peripheral nerve paresthesia
					Allergic reactions
			Effects of systemic diseases or conditions on local anesthetics
			Clinical factors
			Inferior alveolar nerve block
				2% lidocaine and 1:100,000 epinephrine
				Anesthetic success, duration, and difficulty
			Alternative anesthetic solutions for the inferior alveolar nerve block
				Solutions without epinephrine
				Articaine with 1:100,000 or 1:200,000 epinephrine
				Long-acting anesthetics
				Buffered lidocaine
				Diphenhydramine as a local anesthetic agent
			Alternative injection sites
				Gow-gates and vazirani-akinosi techniques
				Articaine infiltrations
			Volume and concentration
			Factors in failure of the inferior alveolar nerve block
				Speed of injection and success
			Supplemental anesthesia for vital pulps in the mandible
				Indications
				Infiltrations
					Supplemental mandibular buccal, lingual, or buccal plus lingual infiltrations of articaine
				Intraosseous anesthesia
					Success and duration
					Success in symptomatic irreversible pulpitis
						Complications/contraindications.
					Systemic effects
						Plasma levels of lidocaine after intraosseous injection.
				Intraligament anesthesia
					Success, onset, and duration
					Success in symptomatic irreversible pulpitis
					Mechanism of action
					Back pressure and amount of solution delivered
					Anesthetic solutions
						Injection discomfort.
						Selective anesthesia.
					Postoperative discomfort
					Systemic effects
					Other factors
					Safety of the periodontium and pulp
					Intraseptal injection
					Intrapulpal injection
			Maxillary anesthesia
			Alternative anesthetic solutions for maxillary infiltrations
				Plain solutions: 3% mepivacaine (carbocaine, polocaine, scandonest) and 4% prilocaine (citanest plain)
				4% prilocaine with 1:200,000 epinephrine (citanest forte), 2% mepivacaine with 1:20,000 levonordefrin (carbocaine with neo-cobefrin), and 4% articaine with 1:100,000 epinephrine (septocaine, articadent, zorcaine)
				0.5% bupivacaine with epinephrine (marcaine)
			Extending the duration of pulpal anesthesia for maxillary teeth
			Alternative maxillary injection techniques
			Management of anesthesia in endodontic cases
			Summary and future directions for effective anesthesia
		Analgesics and therapeutic recommendations
			Nonnarcotic analgesics
				Limitations and drug interactions
				Acetaminophen
			Opioid analgesics
			Corticosteroids
				Intracanal administration
				Systemic administration
			Antibiotics
			Pain management strategies
				Pretreatment
				Long-acting local anesthetics
				Flexible plan
			Future directions
			Summary
		References
	7 Tooth morphology and pulpal access cavities
		Components of the pulp cavity
		Root canal anatomy
			Clinical determination of the root canal configuration
				Coronal considerations
				Midroot considerations
				Apical considerations
		Objectives and guidelines for traditional access cavity preparation
			Objectives
		Key steps to consider in traditional access preparation
			Evaluation of the cementoenamel junction and occlusal tooth anatomy
			Preparation of the access cavity through the lingual and occlusal surfaces
			Removal of all defective restorations and caries before entry into the pulp chamber
			Preparation of access cavity walls that do not restrict straight- or direct-line passage of instruments to the apical foramen or initial canal curvature
		Objectives and guidelines for minimally invasive access cavity preparation
		Mechanical phases of access cavity preparation
			Magnification and illumination
			Burs
			Endodontic explorer and spoon
			Ultrasonic unit and tips
		Access cavity preparations
			Anterior teeth
				External outline form
				Penetration of the pulp chamber roof (fig. 7.26)
				Removal of the chamber roof
				Removal of the lingual shoulder and coronal flaring of the orifice
				Straight-line access determination
				Refinement and smoothing of restorative margins
				Individual anterior teeth
			Posterior teeth
				External outline form
				Penetration of the pulp chamber roof
				Identification of all canal orifices
				Removal of the cervical dentin bulges and orifice and coronal flaring
				Straight-line access determination
				Visual inspection of the pulp chamber floor
					Individual posterior teeth.
		Challenging access preparations
			Access in teeth with presumed calcified canals
			Crowded or rotated teeth
		Morphology of and access cavity preparations for individual teeth
			Maxillary central incisor
			Maxillary lateral incisor
			Maxillary canine
			Maxillary first premolar
			Maxillary second premolar
			Maxillary first molar
			Maxillary second molar
			Maxillary third molar
			Mandibular central and lateral incisors
			Mandibular canine
			Mandibular first premolar
			Mandibular second premolar
			Mandibular first molar
			Mandibular second molar
			Mandibular third molar
			Teeth with C-shaped root canal systems
		References
	8 Cleaning and shaping of the root canal system
		Introduction
		Principles of cleaning and shaping
			Mechanical objective
			Biologic objective
			Technical objective
			Clinical issues
		Endodontic instruments
			General characteristics
				Design elements
					Tip design.
					Longitudinal and cross-sectional design.
					Taper.
				International standards organization norms
				Alloys
					Physical and chemical properties of steel and nickel titanium alloys.
			Manually operated instruments
				K-type instruments
				H-type instruments
					Effectiveness and wear of instruments.
				Barbed broaches
			Low-speed engine-driven instruments
				Burs
				Gates-glidden drills
				Peeso reamers and similar drills
			Engine-driven instruments for canal preparation
				Instrument types
					Group I: Passive preparation; presence of radial lands.
						Lightspeed.
						Profile.
						GT and GTX files.
						K3.
					Summary.
					Group II: Active cutting; triangular cross section.
						Protaper universal, gold.
						Hero 642, hero shaper.
						Race, biorace, BT race.
						Endosequence.
						Twisted file.
						Profile vortex.
						MTWO.
						Edge files.
						Summary.
					Group III, atypical instruments
						Waveone, reciproc, gold, blue.
						Self-adjusting file.
						Trushape.
						XP-shaper, XP-finisher.
						Sonic and ultrasonic shaping instruments.
						Summary.
				Motors
		Steps of cleaning and shaping
			Access—principles
			Coronal modification
			Patency and glide path preparation
			Working length determination
				Devices
				Strategies
			Canal enlargement/preparation
				Rationale
				Techniques
					Standardized technique.
					Step-back technique.
					Step-down technique.
					Crown-down technique.
					Balanced force technique.
					Rotary instrumentation.
				Specific nickel titanium (NITI) instrumentation techniques
					Crown-down.
					Single length.
					Hybrid techniques.
			Final apical enlargement
		Disinfection of the root canal system
			Hydrodynamics of irrigation
			Irrigants
				Sodium hypochlorite
					History.
					Mode of action.
					Allergic reactions to sodium hypochlorite.
					Temperature.
					Concentration.
					Time.
					Toxicity.
				Chlorhexidine
					History.
					Molecular structure.
					Mode of action.
					Substantivity.
					Cytotoxicity.
					Chlorhexidine as an endodontic irrigant.
					Interaction between CHX, NaOCL, and EDTA.
					Allergic reactions to chlorhexidine.
					Decalcifying agents.
				Ethylenediaminetetraacetic acid
					History.
					Mode of action.
					Applications in endodontics.
					Interaction of EDTA and NaOCL.
				HBPT and other phosphate bases tensides
					Combination irrigants.
					Biopure MTAD and tetraclean.
					Mode of action.
					Smear layer removal.
					Antibacterial efficacy.
					Clinical trials.
					Protocol for use.
				Combinations of irrigants
					Protocol.
					Smear layer removal.
					Antibacterial efficacy and effect on biofilms.
					Clinical trials.
					Iodine potassium iodide.
			Intracanal medication
				Calcium hydroxide
					Other uses of Ca(OH)₂.
					Clinical protocol.
					Limitations of calcium hydroxide.
				Chlorhexidine
					Chlorhexidine mixed with calcium hydroxide.
				Phenolic preparations
				Formaldehyde
				Halogens
				Steroids
				Triple-antibiotic paste
				Lubricants
			Disinfection devices and techniques
				Syringe delivery
				Manually activated irrigation
				Sonically activated irrigation
				Ultrasonic-assisted irrigation
				Negative apical pressure irrigation
				Safety-irrigator
				Gentlewave system
				Laser-activated irrigation
				Photoactivated disinfection
				Antibacterial nanoparticles
					Healozone.
					Water preparations.
		Criteria to evaluate cleaning and shaping⁴
			Well-shaped canals
			Signs of mishaps
				Instrument fracture
				Canal transportation
				Perforation
				Blockage
		Sample protocol for contemporary cleaning and shaping procedures
		Summary
		References
	9 Obturation of the cleaned and shaped root canal system
		Importance of effectively sealing the root canal system
		Historical perspectives
		Timing of obturation
			Vital pulp tissue
			Necrotic pulp tissue
		Length of obturation
		Preparation for obturation
		The ideal root canal obturation materials
		Types of sealers
			Zinc oxide and eugenol
			Calcium hydroxide sealers
			Noneugenol sealers
			Glass ionomer sealers
			Resin sealers
				Epoxy resin sealers
				Methacrylate resin sealers
			Silicone sealers
			Tri/dicalcium silicate sealers
			Medicated sealers
		Sealer placement
		Core materials
			Silver cones
			Gutta-percha
			Activ GP
			Custom cones
		Methods of obturation
			Lateral compaction
			Warm vertical compaction
			Continuous wave compaction technique
			Thermoplastic injection techniques
				Obtura III
				Ultrafil 3D
				Calamus
				Elements
				Hotshot
			Carrier-based gutta-percha
				Thermafil, profile GT obturators, GT series X obturators, and protaper universal obturators
				Successfil
				Simplifill
			Thermomechanical compaction
			Solvent techniques
			Pastes
			Immediate obturation
		Coronal orifice seal
		Future technology and nanodiamond-embedded gutta-percha
		References
	10 Nonsurgical retreatment
		Etiology of posttreatment disease
		Diagnosis of posttreatment disease
		Treatment planning
		Nonsurgical endodontic retreatment
			Coronal access cavity preparation
			Post removal
				Post removal techniques
				Potential complications of post removal
			Regaining access to the apical area
				Gutta-percha removal
				Managing solid core obturators
				Paste retreatment
				Silver point removal
			Removal of separated instruments
				Causes of instrument separation
				Prognosis
				Removal techniques
			Heat generation during retreatment procedures
			Management of canal impediments
			Finishing the retreatment
		Repair of perforations
		Prognosis of retreatment
		Conclusion
		References
	11 Periradicular surgery
		Indications for periradicular surgery
			Etiology of persistent periradicular disease
			Rationale for surgical treatment
			Clinical decision making
		General biologic principles of wound healing
		Soft-tissue wound healing
			Inflammatory phase
				Clot formation
				Early inflammation: Polymorphonuclear neutrophil organization
				Late inflammation: Macrophage organization
			Proliferative phase
				Fibroblasts: Fibroplasia
				Endothelial cells: Angiogenesis
				Epithelium
			Maturation phase
		Hard-tissue healing: Excisional dentoalveolar wound
			Osteoblasts: Osteogenesis
			Cementoblasts: Cementogenesis
		Systemic medications and wound healing
			Bisphosphonates
			Glucocorticoids
			Nonsteroidal antiinflammatory drugs
			Cyclooxygenase-2 inhibitors
		Preoperative evaluation of medically complex patients
		Anatomic considerations
			Posterior mandible
			Posterior maxilla
			Anterior maxilla and mandible
		Cone-beam computed tomography
			Differences between computed tomography and cone-beam computed tomography imaging
			Potential applications of cone-beam computed tomography in the management of endodontic posttreatment disease
		Patient preparation for surgery
			Informed-consent issues specific to surgery
			Premedication: Nonsteroidal antiinflammatory drugs, antibiotics, chlorhexidine, and conscious sedation
		Instruments and operatory setup
		Local anesthesia for surgery
		Surgical access
			Soft-tissue access
			Vertical incision
			Horizontal incision
			Flap design
			Tissue reflection
			Tissue retraction
			Hard-tissue access
		Periradicular curettage and biopsy
		Localized hemostasis
			Preoperative considerations
			Local hemostatic agents
				Collagen-based materials
				Surgicel
				Gelfoam
				Bone wax
				Ferric sulfate
				Calcium sulfate
				Epinephrine pellets
			Cautery/electrosurgery
		Management of the root end
			Determination of the need for root-end resection and filling
			Root-end resection
			Angle of resection
			Root-end surface preparation
			Resected root-end surface topography
			Root-end conditioning
		Root-end cavity preparation
			Ultrasonic root-end preparation and apical fractures
			Significance of ultrasonic tip design
			Temperature changes induced by ultrasonic instruments
			Bonded root-end fillings
		Root-end filling materials
			Zinc oxide–eugenol cements
				Intermediate restorative material
				Super-EBA
			Glass-ionomer cements
			Diaket
			Composite resins and resin-ionomer hybrids
				Retroplast
				Resin-ionomer suspension (geristore) and compomer (dyract)
			Mineral trioxide aggregate
			Bioceramics
			Overview of root-end filling materials
		Closure of the surgical site and selection of suture material
			Closure of the surgical site
			Selection of the suture material
		Guided tissue regeneration and endodontic surgery
			Ridge preservation
		Intentional replantation
		Postoperative care
		Management of surgical complications
		Summary
		References
	12 Regenerative endodontics
		Overview of regenerative dentistry
			Overview of regenerative endodontics
		Preclinical studies on regenerative endodontics
			Stem cells
			Growth factors/morphogens
				Morphogens
			Scaffolds
			Delivery system
			Translational studies
			Summary of basic research on regenerative endodontics
		Clinical studies on regenerative endodontics
			Clinical procedures related to regenerative endodontics
			Overview of clinical regenerative endodontic procedures
			Example of a revascularization protocol
			Clinical measures of treatment outcomes
				Patient-centered outcomes
				Clinician-centered outcomes
				Scientist-based outcomes: Regeneration or repair?
		Summary
		References
Part II ADVANCED SCIENCE TOPICS
	13 Structure and functions of the dentin-pulp complex
		Morphologic zones of the pulp
			The pulp-dentin complex
			Odontoblast layer
			Cell-poor zone
			Cell-rich zone
			Pulp proper
		Cells of the pulp
			Odontoblast
			Odontoblast process
			Relationship of odontoblast structure to secretory function
			Pulp fibroblast
			Macrophage
			Dendritic cell
			Lymphocyte
			Mast cell
		Metabolism
		The pulpal interstitium and ground substance
			Hyaluronan
			Elastic fibers
			The inflamed interstitium
		Connective tissue fibers of the pulp
		The trigeminal system
			Innervation
			Steps and mechanisms in pain perception
			Detection: The first step in pain perception
		Neuropeptides
			Pulp testing
			Sensitivity of dentin
			Peripheral sensitization
			Hyperalgesia and allodynia
			Inflammatory mediators
			Painful pulpitis
			Plasticity of intradental nerve fibers
			Tissue injury and deafferentation
			Processing: The second step in pain perception
				The medullary dorsal horn
				Components of the medullary dorsal horn
				Central sensitization
			Perception: Thalamus to cortex
		Vascular supply
			Regulation of pulpal blood flow
				Local control of blood flow
				Humoral control of blood flow
			Fluid drainage
				Transcapillary fluid exchange
			Circulation in the inflamed pulp
				Vascular permeability
				Clinical aspects
		Pulpal repair
		Pulpal calcifications
		Age changes
		References
	14 Pulp reactions to caries and dental procedures
		Pulp reaction to caries
		Neurogenic mediators
		Correlation between clinical symptoms and actual pulp inflammation
		Dentin hypersensitivity and its management
		Pulp reactions to local anesthetics
		Pulp reactions to restorative procedures
			The degree of inflammation of the pulp preoperatively
			The amount of physical irritation caused by the procedure
				Heat
				Desiccation
				Biological and chemical irritation
			The proximity of the restorative procedures to the dental pulp and the surface area of dentin exposed
			The permeability of dentin and the odontoblastic layer between the area being restored and the pulp
			The age of the patient
		Pulp reactions to restorative materials
		Direct pulp capping with bioceramics
		The use of hemostatic agents and disinfectants on direct pulp exposures
		Pulp reactions to laser procedures
			Lasers in the prevention, diagnosis, and treatment of caries
			Lasers in the treatment of dentin hypersensitivity
		Pulp reactions to vital bleaching techniques
		Pulp reactions to periodontal procedures
		Mechanical irritants: Orthodontic movement
		Pulp reactions to orthodontic surgery
		Biomechanical irritation: Parafunctional habits
		Pulp reactions to implant placement and function
		References
	15 Microbiology of endodontic infections
		Apical periodontitis as an infectious disease
		Routes of root canal infection
		Mechanisms of microbial pathogenicity and virulence factors
		Spatial distribution of the endodontic microbiota
		Biofilm and community-based microbial pathogenesis
			Biofilm and bacterial interactions
			Biofilm resistance to antimicrobial agents
		Apical periodontitis as a biofilm-related disease
		Methods for microbial identification
			The five generations of endodontic microbiology studies
			Impact of molecular methods in endodontic microbiology
		Types of endodontic infections
		Diversity of the endodontic microbiota
		Primary intraradicular infection
			Microbial diversity
			Symptomatic infections
			Geographic influence
			Microbial ecology and the root canal ecosystem
			Other microorganisms in endodontic infections
				Fungi
				Archaea
				Viruses
		Persistent/secondary endodontic infections
			Persistent/secondary infections and treatment failure
			Bacteria at the root canal obturation stage
			Microbiota in root canal–treated teeth
		Extraradicular infections
		References
	16 Pathobiology of apical periodontitis
		Apical periodontitis
			Prevalence
		Etiology
		Infection: A conflict between host and parasites
		Pathogenesis
			Innate immune response
				Specificity of innate immune response
				Nonspecific innate immune response
			Adaptive/specific immune response
			Neurogenic inflammation
		Diagnosis
			Correlation between clinical and histologic findings
			Correlation between radiographic and histologic findings
		Histopathology
		Acute apical periodontitis
			Cell biology
				Mast cells
				Endothelial cells
				Polymorphonuclear neutrophilic leukocytes
				Macrophages
				Platelets
				Natural killer cells
			Inflammatory mediators
			Histopathology
			Clinical features
			Outcomes
		Chronic apical periodontitis
			Cell biology
				Macrophages and lymphocytes
				Dendritic cells
				Osteoclasts
				Epithelial cell rests of malassez
				Fibroblasts
			Inflammatory mediators
			Histopathology
			Clinical features
			Outcomes
		Chronic apical periodontitis with cyst formation
			Cell biology
			Inflammatory mediators
			Histopathology
			Clinical features
			Outcomes
		Chronic apical periodontitis with reactive bone formation: Focal condensing osteitis
			Cell biology
			Histopathology
			Clinical features
			Outcomes
		Periapical lesions of nonendodontic origin
		Extraradicular endodontic infection
		Apical periodontitis and systemic diseases
		Genetic and systemic disease risk factors of persistent apical periodontitis
			Genetic risk factors
			Systemic disease risk factors
		Wound healing of apical periodontitis
			Periapical wound healing after nonsurgical root canal therapy
			Periapical wound healing after surgical endodontic therapy
			Can radicular cysts in apical periodontitis lesions regress after nonsurgical endodontic therapy?
		Factors influencing periapical wound healing after endodontic therapy
		References
Part III ADVANCED CLINICAL TOPICS
	17 Evaluation of outcomes
		Context of evaluating endodontic outcomes
			Types of disease and their treatment
		What are surrogate outcome measures?
			Types of outcome measures
		What is the purpose of evaluating outcomes?
			Effectiveness of procedures
			Factors affecting outcomes
			Value for prognostication
		Outcome measures for endodontic treatment
			Outcome measures for vital pulp therapy procedures
			Outcome measures for nonsurgical root canal treatment and retreatment
			Outcome measures for periapical surgery
		Outcomes of vital pulp therapy procedures
			Indirect pulp capping (one-step versus stepwise excavation)
			Direct pulp capping
			Pulpotomy
			Summary of prognostic factors for vital pulp therapy
		Outcomes of nonsurgical root canal treatment
			Factors affecting periapical health or healing following root canal treatment
				Patient factors
				Treatment factors
					Operator.
					Isolation.
					Magnification and illumination.
					Mechanical preparation: Size, taper, extent, and procedural errors.
					Irrigant.
					Medicament.
					Root canal bacterial culture results prior to obturation.
					Effect of persistent bacteria on root canal treatment outcome.
					Root filling material and technique.
					Apical extent of root filling.
					Quality of root filling.
					Acute exacerbation during treatment.
					Number of treatment visits.
				Post root canal treatment restorative factors
					Effect of quality and type of restoration.
					Use of root treated teeth as abutments for prostheses and occlusal contacts.
				Summary of factors influencing periapical healing following nonsurgical root canal treatment
			Factors affecting tooth survival following root canal treatment
				Patient factors
				Tooth morphologic type and location
				Preoperative conditions of teeth
				Treatment factors
				Restorative factors
				Summary of factors influencing the survival of teeth following root canal treatment
			Impact of root canal treatment on quality of life
		Outcome of nonsurgical retreatment
		Outcome of surgical retreatment
			Factors affecting periapical health or healing following periapical surgery and root-end filling
			Factors affecting periodontal incisional wound healing
			Factors affecting tooth survival following periapical surgery and root-end filling
			Impact of periapical surgery on quality of life
		Concluding remarks
		References
		Figure and Table References
	18 Root resorption
		General histologic features
		External inflammatory resorption
			Introduction
			Etiology and pathogenesis of external inflammatory resorption
			Histologic appearance
			Clinical features
			Radiographic features
			Management
			Follow-up and prognosis of external inflammatory resorption
		External cervical resorption
			Introduction
			Etiology and pathogenesis
			Histologic appearance
			Clinical features
			Radiographic features
			Management
		Internal root resorption
			Introduction
			Etiology and pathogenesis of internal root resorption
			Histologic appearance
			Clinical features
			Radiographic features and diagnosis
			Management
			Chemomechanical debridement of the root canal
			Obturation
		Summary
		References
	19 Management of endodontic emergencies
		Emergency classifications
		Emergency endodontic management
			Teeth with vital pulps
			Reversible pulpitis
			Irreversible pulpitis
			Pulpal necrosis with symptomatic apical periodontitis
				Trephination
				Necrosis and single-visit endodontics
			Pulpal necrosis with acute apical abscess
				Swelling
		Fascial space infections
		Management of abscesses and cellulitis
		Incision for drainage
		Symptomatic teeth with previous endodontic treatment
		Leaving teeth open
		Systemic antibiotics for endodontic infections
		Analgesics
		Laboratory diagnostic adjuncts
		Flare-ups
		Cracked and fractured teeth
		Summary
		References
	20 Managing iatrogenic events
		Sodium hypochlorite
		Instrument separation
			Causes of instrument separation
			Management of separated instruments
			Conditions for separated instrument removal attempts
			Root canal preparation techniques
				Root canal preparation for visible instrument retrieval
				Root canal preparation for nonvisible instrument retrieval
			Instrument retrieval techniques
				Use of ultrasonic oscillation
				Use of the loop
			Prognosis
		Ledge formation
			Causes of ledge formation
			Management of ledge formation
			Bypassing a ledge
				Using hand instruments
				Using ultrasonic tips
				Using rotary instruments
			Potential complications of removal or bypassing a ledge
			Prevention of ledge formation
			Prognosis
		Radicular extrusion of root canal filling materials
			Causes of extrusion of obturation materials beyond the radicular foramen
			Management of obturation materials extruded beyond the radicular foramen
				Nonsurgical management of extrusion of obturation materials
			Management of tissue damage caused by extrusion of root canal filling materials
		Sinus perforation
		Inferior alveolar nerve injury
			Risk assessment for the prevention of endodontic nerve injury
			Operative techniques to minimize nerve injuries
			Management of nerve injuries
		Assessment
			Immediate intervention
			Early intervention
			Watch and wait?
		Cervicofacial subcutaneous emphysema
		References
	21 The role of endodontics after dental traumatic injuries
		Unique aspects of dental trauma
		Most common types of dental trauma
			Crown fractures
			Crown-root fractures
			Root fractures
			Luxation injuries and avulsion
		Follow-up after dental trauma
		Radiographic examinations
			Cone-beam computed tomography and dentoalveolar trauma
			Root resorption
			Horizontal (transverse) root fractures
			Luxation injuries
		Crown fractures
			Crown infraction
				Biologic consequences
			Uncomplicated crown fracture
				Incidence
				Biologic consequences
			Treatment
			Complicated crown fracture
				Incidence
				Biologic consequences
			Treatment
				Stage of development of the tooth
				Time between trauma and treatment
				Concomitant attachment damage
				Restorative treatment plan
			Vital pulp therapy: Requirements for success
			Treatment methods
				Pulp capping
					Indications.
				Partial pulpotomy
					Indications.
					Technique.
					Follow-up.
					Prognosis.
				Full pulpotomy
					Indications.
					Technique.
					Follow-up.
					Prognosis.
				Pulpectomy
					Indications.
			Treatment of the nonvital pulp
				Immature tooth: Apexification
					Indications.
					Biologic consequences.
					Technique
						Disinfection of the canal.
					Hard-tissue apical barrier
						Traditional method.
					Bioceramic barrier.
						Filling the root canal.
						Reinforcement of thin dentinal walls.
						Follow-up.
						Prognosis.
						Pulp revascularization/regenerative endodontic treatment.
				Mature tooth
		Crown-root fracture
		Root fracture
			Diagnosis and clinical presentation
			Treatment
			Healing patterns
			Treatment of complications
				Coronal root fractures
				Midroot and apical root fractures
				Follow-up
				Prognosis
		Luxation injuries
			Definitions
			Incidence
			Treatment
			Biologic consequences
				External root resorption
					Caused by an injury (alone) to the external root surface.
						Localized injury: Healing with cementum.
						Diffuse injury: Healing by replacement resorption.
						Treatment.
					Caused by an injury to the external root surface and inflammatory stimulus in the root canal.
					Consequences of apical neurovascular supply damage
						Pulp canal obliteration (calcification).
						Pulp necrosis.
						Pulp space infection.
						Treatment.
				Internal root resorption
					Etiology.
					Clinical manifestations.
					Radiographic appearance.
					Histologic appearance.
					Treatment.
				Diagnostic features of external versus internal root resorption
					Radiographic features.
					Vitality testing.
					Pink spot.
					Transient apical breakdown.
				Summary of possible diagnostic features
		Clinical management of the avulsed tooth
			Consequences of tooth avulsion
			Treatment objectives
			Clinical management
				Emergency treatment at the accident site
				Management in the dental office
					Emergency visit.
			Diagnosis and treatment planning
		Preparation of the root
			Extraoral dry time less than 60 minutes
				Closed apex
				Open apex
			Extraoral dry time more than 60 minutes
				Closed apex
				Open apex
		Preparation of the socket
		Splinting
		Management of the soft tissues
		Adjunctive therapy
			Second visit
		Endodontic treatment
			Extraoral time less than 60 minutes
				Closed apex
				Open apex
			Extraoral time more than 60 minutes
				Closed apex
				Open apex (if replanted)
		Temporary restoration
			Root filling visit
		Permanent restoration
			Follow-up care
				Late complications
				Dentoalveolar trauma to the primary dentition
		References
	22 Chronic cracks and fractures
		Impact trauma
		Diagnostic challenge
		Fracture mechanics
		Cracked and fractured cusps
			Definition
			Diagnosis
				Patient history
				Clinical manifestation
					Early manifestation.
					Late manifestation.
				Diagnosis
			Etiology
			Treatment planning
				Cracked cusp
				Fractured cusp
		Cracked and split teeth
			Definition
			Diagnosis
				Patient history
				Clinical manifestation
					Early manifestation.
					Late manifestation.
				Diagnosis
			Etiology
			Treatment planning
				Cracked tooth
				Split tooth
		Vertical root fracture
			Definition
			Diagnosis
				Patient history
				Clinical manifestations
					Susceptible teeth and vertical root fracture location.
					Early manifestation.
					Late manifestation.
				Diagnosis
					Importance of early diagnosis.
					Misdiagnosis of vertical root fractures.
					Vertical root fracture pockets.
					Coronally located sinus tract.
					Radiographic features.
					Osseous radiolucency adjacent to the root.
					Radiograph of empty canal.
					Cone-beam computed tomography in vertical root fracture diagnosis.
					Exploratory surgery.
			Etiology
				Natural predisposing factors
					Shape of root cross section.
					Occlusal factors.
					Preexisting microcracks.
				Iatrogenic predisposing factors
					Root canal treatment.
					Excessive root canal preparation.
					Microcracks caused by rotary instrumentation.
					Uneven thickness of remaining dentin.
					Methods of obturation.
					Type of spreader used.
					Post design.
					Crown design.
		Treatment planning
		Summary
		References
	23 Restoration of the endodontically treated tooth
		Special features of endodontically treated teeth
			Compositional changes in nonvital teeth and the influence of endodontic therapy
			Dentin structure and properties in nonvital and endodontically treated teeth
			Fracture resistance and tooth stiffness of nonvital and endodontically treated teeth
			Aesthetic changes in nonvital and endodontically treated teeth
		Restorative materials and options
			Direct composite restorations
			Indirect restorations: Composite or ceramic onlays and overlays
			Full crowns
				The foundation restoration: General considerations
				Why roots fracture
				Direct foundation restorations
					Posts.
						Prefabricated metallic posts.
						Fiber posts.
					Core materials.
						Composite resin core.
						Amalgam core.
						Glass ionomer core and modified glass ionomer core.
				Indirect foundation restorations: Cast post and core
			Luting cements
				Traditional cements
				Glass ionomer luting cements
				Resin-based luting cements
				Self-adhesive cements
		Pretreatment evaluation and treatment strategy
			Pretreatment evaluation
				Endodontic evaluation
				Periodontal evaluation
				Biomechanical evaluation
				Tooth position, occlusal forces, and parafunctions
				Aesthetic evaluation and requirements
			Treatment strategy
				General principles and guidelines
				Structurally sound anterior teeth
				Nonvital posterior teeth with minimal/reduced tissue loss
				Structurally compromised teeth
				Structurally compromised anterior teeth
				Structurally compromised posterior teeth
				Additional procedures
		Clinical procedures
			Tooth preparation
			Post placement
			Adhesive procedures
			Partial restorations
			Foundation restoration underneath full crowns
				Amalgam core
				Cast gold post and core
					Direct technique.
					Indirect technique.
			Crown preparation and temporary restoration
		Summary
		References
	24 Vital pulp therapy
		The living pulp
		Loss of pulp vitality
		Pulpal response to cariesª
		Dentin regeneration and reparative tissue formation
			Tertiary dentin formation
			Mineralized tissue formation after loss of the primary odontoblasts
		Indications for vital pulp therapy
		Procedures generating mineralized tissue barriers
			Indirect pulp capping
			Direct pulp capping
			Partial pulpotomy
			Complete pulpotomy
		Materials for vital pulp therapy
			Aqueous calcium hydroxide suspensions
			Hard setting calcium hydroxide cements
			Light-curing liners and cements
			Composite resins, dentin adhesives, and resin-modified glass ionomer cements
			Mineral trioxide aggregate
			Calcium silicate cements
		Calcium silicate cement applications in vital pulp therapy
			Direct pulp capping with calcium silicate cements
			Pulpotomy with calcium silicate cements
		Vital pulp therapy techniques
			Diagnosis
			Caries removal
			Hemostatic agents
			Treatment considerations
		Treatment recommendations†
			Pulp capping and pulpotomy
		The permanent restoration
		Postoperative follow-up and recall
		Acknowledgment
		References
	25 Endo-perio
		Intercommunication between pulpal and periodontal tissue
		Influence of pulpal pathologic condition on the periodontium
		Influence of periodontal inflammation on the pulp
		Theoretic pathways of osseous lesion formation
			Primary endodontic lesions
			Primary endodontic lesions with secondary periodontal involvement
			Primary periodontal lesions
			Primary periodontal lesions with secondary endodontic involvement
			True combined lesions
			Concomitant pulpal and periodontal lesions
		Differential diagnosis
			Lateral periodontal cysts
		Treatment alternatives
			Forced eruption or extrusion
		Summary
		References
Part IV ONLINE CONTENT
	26 Bleaching procedures
		Etiology of tooth discolorations
			Systemic intrinsic causes
				Genetic causes
				Disease-related causes
				Metabolic causes
				Drug-related causes
			Local intrinsic causes
				Pulpal hemorrhage
				Pulp necrosis
				Pulp tissue remnants
				Restorative materials
				Intracanal medicaments and root filling materials
				Dental caries
				Calcific metamorphosis/dystrophic calcification
				Root resorption
				Aging
			Extrinsic causes
		Treatment planning for internal bleaching
		Contraindications of bleaching
		Alternatives to bleaching
		Chemistry of bleaching
			Walking bleach technique
				Walking bleach clinical protocol
			Thermocatalytic bleaching
		Definitive restoration of teeth following internal bleaching
		External bleaching
			In-office external bleaching
			Power bleaching
				Power bleaching clinical protocol
			At-home external bleaching
		Risks and complications associated with tooth bleaching
			Risks associated with internal tooth bleaching
				Cervical root resorption
				Enamel and dentin damage
				Inhibition of adhesive bonding
			Risks associated with external tooth bleaching
				Tooth sensitivity
				Gingival irritation
				Mercury release from amalgam restorations
			Prognosis of bleaching
		References
	27 Endodontic records and legal responsibilities
		Endodontic record excellence
			Importance
				Content
				Office records
				Function
			Patient information form
			Medical health history
			Dental history
			Diagnostic and progress records
			Electronic records
			Radiographs
			Evaluation and differential diagnosis
			Diagnostic tests
			Treatment plan
				Examination
				Diagnosis
				Patient consultation
				Treatment
			Informed consent form
			Treatment record: Endodontic chart
				General patient data
				Dental history
				Medical history
				Periodontal disease
				Periodontal examination
				Drug history
			Preoperative and postoperative radiographs
			Digital radiography
			Radiation safety
		Endodontics and heart disease
			Abbreviations
			Computerized treatment records
			Health information technology for economic and clinical health act pitfalls
			Health insurance portability and accountability act
			Record size
			Identity of entry author
			Patient record request
			Patient education materials
			Postoperative instructions
			Recording referrals
			Dental fees related to quality care
			Record correction
			Spoliation
			False claims
		Legal responsibilities
			Malpractice claims
			Incidence of negligence
			Malpractice prophylaxis: Importance of records
			Standard of care
			Standards of care: Generalist versus endodontist
			Ethical guidelines
				Standard of care for endodontics
			Ordinary care equals prudent care
			Customary practice versus negligence
				Health maintenance organization care versus standard of care
			Employment law
			Dental negligence defined
			Locality rule
			Continuing education
			Evidence-based endodontics
			Holistic dentistry
			Ozone therapy
			New products
			U.S. food and drug administration approval
			U.S. food and drug administration’s drug approval
			U.S. food and drug administration clearance
			Adverse drug events
				Primary medication nonadherence: Unfilled prescriptions
			U.S. food and drug administration medwatch
			Compounding pharmacies
			Dietary supplements
			Negligence per SE
			Prescription drugs
			Ability to foresee unreasonable risk
			Consent
				Informed consent principles
				Informed consent
				Informed consent application
				Endodontic informed consent
					Video-informed consent.
			Alternative technique choices
			Referrals to other specialists
			Surgical versus nonsurgical endodontics
			Microscopic endodontics
				Microscope
					Magnification.
			Separated instruments
			Equipment and supplies
			Waterlines
			Pulpotomy
			Clinician’s liability for staff’s acts or omissions
			Abandonment
			Expert testimony
			National practitioner data bank
		Malpractice incidents
			What to do if you are sued
			Screw posts
			Paresthesia prevention
			Overfills
				Sealant overfills
			Treatment failure
			Full disclosure
			Slips of the drill
			Fear factor
			Pain management
			Leakage
			Implant risk factors
				Fluoride for caries prevention
			Reasonable versus unreasonable errors in judgment
				Incorrect tooth treatment
				Post retrieval
				Broken files
				Swallowing or aspirating an endodontic instrument
				Overextensions and overfills
				Compartment syndrome
				Periradicular surgery
				Avoiding the inferior alveolar nerve canal
				Mental nerve injuries
				Local anesthesia: Septocaine
				Implant versus endodontics
				Current use of silver points
				N2 (sargenti paste)
				Defective restorations
				Restoration marginal integrity
			Malpractice prophylaxis
			Allergies
			One-visit versus two-visit endodontics
			Disclosure errors
			Temporomandibular disorders
			Patient rapport
				Rapport building blocks
				Telephone communications
			Post perforation
			Perforation prevention
			Bleach injury
			Esthetic bleaching
			Cores
			Absorbable hemostatic agents causing neuropathy
			Pneumomediastinum (air embolus)
			Broken needle
			Sterilization
			Medication errors
			Posttrauma therapy
			Millennium management of endodontic advances
			Statistical research
			Other clinicians’ substandard treatment
			Peer review
			Human immunodeficiency virus and endodontics
		Summary
		References
		Suggested readings
	28 Key principles of endodontic practice management
		Endodontic management systems
			Systems design
		Management
			Vision
				Short vision statement
				Long vision statement
			Mission
			Goal setting
			Target setting
			Key production indicators
			Staff training and development
			Scheduling
				Schedule for production
				Set the daily production target
				Perform procedural time studies
				Create the ideal day
				Manage emergencies
			Customer service
		Marketing
			Endodontic marketing
			Endodontic referral marketing
			Social media
			Transitions
		Leadership
			The endodontic leader
				Interpersonal communication
				Decision making
				Motivation
				Pursuit of knowledge
				Teamwork
				Time management
				Leading by example
		Summary
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z
Cohen's Pathways of the Pulp 2.pdf
	Front Cover
	Front matter
		Cohen’s Pathways  of the Pulp
	Copyright
	About the editors
		Louis H. berman
		Kenneth M. hargreaves
		Ilan rotstein
	Dedication
	Contributors
	New to this edition
		New chapter organization
		Digital content
	Introduction
	Table of Contents
		PART I The core science of endodontics
		PART II Advanced science topics
		PART III Advanced clinical topics
		PART IV Online content
	Part I THE CORE SCIENCE OF ENDODONTICS
		1 Diagnosis
			Art and science of diagnosis
				Chief complaint
				Medical history
				Dental history
					History of present dental problem
					Dental history interview
			Examination and testing
				Extraoral examination
				Intraoral examination
					Soft-tissue examination
					Intraoral swelling
					Intraoral sinus tracts
					Palpation
					Percussion
					Mobility
					Periodontal examination
				Pulp tests
					Thermal
					Electric
					Laser doppler flowmetry
					Pulse oximetry
				Special tests
					Bite test
					Test cavity
					Staining and transillumination
					Selective anesthesia
				Radiographic examination and interpretation
					Intraoral radiographs
					Digital radiography
					Cone-beam computerized tomography
					Magnetic resonance imaging
				Cracks and fractures
					Crack types
					Vertical root fractures
				Perforations
			Clinical classification of pulpal and periapical diseases
				Pulpal disease
					Normal pulp
					Pulpitis
					Reversible pulpitis
					Irreversible pulpitis
						Symptomatic irreversible pulpitis.
						Asymptomatic irreversible pulpitis.
					Pulp necrosis
					Previously treated
					Previously initiated therapy
				Apical (periapical) disease
					Normal apical tissues
					Periodontitis
					Symptomatic apical periodontitis
					Asymptomatic apical periodontitis
					Acute apical abscess
					Chronic apical abscess
			Referred pain
			Summary
			References
		2 Radiographic interpretation
			Radiographic interpretation
				Imaging modalities
				Image characteristics and processing
				Digital imaging and communications in medicine
			Diagnostic tasks in endodontics
				Diagnosis and healing
				Three-dimensional imaging
			Principles of cone beam computed tomography
				Voxels and voxel sizes
				Field of view
					Diagnostic task
					Type of patient
					Spatial resolution requirements
			Imaging tasks improved or simplified by cone beam volumetric computed tomography
				Differential diagnosis
					Lesions of endodontic origin
					Lesions of nonendodontic origin
				Evaluation of anatomy and complex morphology
					Dental anomalies
					Root canal system morphology
				Diagnosis of endodontic treatment failures
			Intraoperative or postoperative assessment of endodontic treatment complications
				Vertical root fractures
				Overextended root canal obturation material
				Separated endodontic instruments
				Calcified canals
				Perforations
			Presurgical treatment planning
				Dentoalveolar trauma
				Internal and external root resorption
			Endodontic treatment outcomes assessment
			Dental implant case planning
				3D-guided endodontics
			Image perception and viewing environment
			The future of cone-beam computed tomography
			Magnetic resonance imaging
			Conclusions
			JOINT POSITION STATEMENT OF THE AMERICAN ASSOCIATION OF ENDODONTISTS AND THE AMERICAN ACADEMY OF ORAL AND MAXILLOFACIAL RADIOLOGY ON THE USE OF CONE BEAM COMPUTED TOMOGRAPHY IN ENDODONTICS: 2015/2016 UPDATE
				Introduction
				Volume Size(s)/field of view
				Dose considerations
				Interpretation
				Recommendations
					Diagnosis
					Initial treatment
					Nonsurgical retreatment
					Surgical retreatment
					Special conditions
					Outcome Assessment
			References
		3 Lesions that mimic endodontic pathosis
			Importance of differential diagnosis
			Limits of pulp testing
			Limits of radiology
			Differential diagnosis of periapical pathosis
				Multilocular radiolucencies
					Odontogenic keratocyst
						Radiographic features.
					Ameloblastoma
						Radiographic features.
					Central giant cell lesion
						Radiographic features.
				Radiopacities in the periapical region
					Condensing osteitis
						Radiographic features.
					Maxillary sinusitis of endodontic origin
						Radiographic features.
							Periapical osteoperiostitis.
							Periapical mucositis.
					Osteomyelitis with proliferative periostitis
						Radiographic features.
					Idiopathic osteosclerosis
						Radiographic features.
					Odontoma
						Radiographic features.
					Paget disease of bone
						Radiographic features.
					Exostoses and tori
						Radiographic features.
				Multifocal presentations
					Periapical cemento-osseous dysplasia
						Radiographic features.
					Florid cemento-osseous dysplasia
						Radiographic features.
					Hyperparathyroidism
						Radiographic features.
					Langerhans cell histiocytosis
						Radiographic features.
				Ill-defined pathologies
					Osteomyelitis
						Acute osteomyelitis.
						Chronic osteomyelitis.
					Medication-related osteonecrosis of the jaw
						Radiographic findings.
					Non-hodgkin lymphoma
						Radiographic features.
					Metastatic disease
						Radiographic features.
					Multiple myeloma
						Radiographic features.
				Well-defined unilocular periapical radiolucencies
					Periapical cysts and periapical granulomas
						Radiographic features.
					Lateral radicular cyst
						Radiographic features.
					Lateral periodontal cyst
						Radiographic features.
					Focal cemento-osseous dysplasia
						Radiographic features.
					Nasopalatine duct cyst
						Radiographic features.
					Stafne defect
						Radiographic features.
			Summary
			References
		4 Diagnosis of the nonodontogenic toothache
			Review of neuroanatomy
				Somatic structures
				Neural structures
					Peripheral nervous system
						Primary afferent neurons.
							A-beta fibers.
							A-delta fibers.
							C fibers.
					Central nervous system
						Second-order neurons.
				Autonomic nervous system
			Review of neurophysiology
				Peripheral sensitization
				Central sensitization
				Terminology
			Clinical entities that can present as toothache
				Sources of odontogenic toothache
				Sources of nonodontogenic toothache
					Musculoskeletal and somatic pain
						Myofascial pain.
						Pain of sinus or nasal mucosal origin.
						Salivary gland pain.
					Neurovascular pain
					Neuropathic pain
						Neuralgia.
						Neuroma.
						Neuritis.
						Neuropathy.
					Toothache referred from a distant organic source
						Cardiac and thoracic structures.
						Intracranial structures.
						Throat and neck structures.
						Craniofacial structures.
					Psychogenic toothache
					Frequency of nonodontogenic toothache
			Taking a patient’s history
			Patient examination
				Additional tests
				Case studies
					Case 1
						Subjective history.
						Examination.
							Additional tests.
					Case 2
						Subjective history.
						Examination.
							Additional tests.
			Summary
			References
		5 Case assessment and treatment planning
			Common medical findings that may influence endodontic treatment planning
				Cardiovascular disease
				Diabetes
				Pregnancy
				Malignancy
				Medication-related osteonecrosis of the jaws
				Human immunodeficiency virus and acquired immunodeficiency syndrome
				Prosthetic implants
				Behavioral and psychiatric disorders
				Psychosocial evaluation
			Development of the endodontic treatment plan
			Endodontic prognosis
				Single-visit versus multiple-visit treatment
				Surgical endodontics
				Intentional replantation
				Regenerative endodontics
			Interdisciplinary treatment planning
				Periodontal considerations
				Restorative and prosthodontic considerations
				Endodontic therapy or dental implant
			Other factors that may influence endodontic case selection
				Anxiety
				Scheduling considerations
			References
		6 Pain control
			Local anesthesia
				Mechanisms of action for anesthetics
				Clinically available local anesthetics
				Selection of a local anesthetic: Possible adverse effects and medical history
					Possible adverse effects
						Cardiovascular reactions
						Systemic effects
						Methemoglobinemia
						Peripheral nerve paresthesia
						Allergic reactions
				Effects of systemic diseases or conditions on local anesthetics
				Clinical factors
				Inferior alveolar nerve block
					2% lidocaine and 1:100,000 epinephrine
					Anesthetic success, duration, and difficulty
				Alternative anesthetic solutions for the inferior alveolar nerve block
					Solutions without epinephrine
					Articaine with 1:100,000 or 1:200,000 epinephrine
					Long-acting anesthetics
					Buffered lidocaine
					Diphenhydramine as a local anesthetic agent
				Alternative injection sites
					Gow-gates and vazirani-akinosi techniques
					Articaine infiltrations
				Volume and concentration
				Factors in failure of the inferior alveolar nerve block
					Speed of injection and success
				Supplemental anesthesia for vital pulps in the mandible
					Indications
					Infiltrations
						Supplemental mandibular buccal, lingual, or buccal plus lingual infiltrations of articaine
					Intraosseous anesthesia
						Success and duration
						Success in symptomatic irreversible pulpitis
							Complications/contraindications.
						Systemic effects
							Plasma levels of lidocaine after intraosseous injection.
					Intraligament anesthesia
						Success, onset, and duration
						Success in symptomatic irreversible pulpitis
						Mechanism of action
						Back pressure and amount of solution delivered
						Anesthetic solutions
							Injection discomfort.
							Selective anesthesia.
						Postoperative discomfort
						Systemic effects
						Other factors
						Safety of the periodontium and pulp
						Intraseptal injection
						Intrapulpal injection
				Maxillary anesthesia
				Alternative anesthetic solutions for maxillary infiltrations
					Plain solutions: 3% mepivacaine (carbocaine, polocaine, scandonest) and 4% prilocaine (citanest plain)
					4% prilocaine with 1:200,000 epinephrine (citanest forte), 2% mepivacaine with 1:20,000 levonordefrin (carbocaine with neo-cobefrin), and 4% articaine with 1:100,000 epinephrine (septocaine, articadent, zorcaine)
					0.5% bupivacaine with epinephrine (marcaine)
				Extending the duration of pulpal anesthesia for maxillary teeth
				Alternative maxillary injection techniques
				Management of anesthesia in endodontic cases
				Summary and future directions for effective anesthesia
			Analgesics and therapeutic recommendations
				Nonnarcotic analgesics
					Limitations and drug interactions
					Acetaminophen
				Opioid analgesics
				Corticosteroids
					Intracanal administration
					Systemic administration
				Antibiotics
				Pain management strategies
					Pretreatment
					Long-acting local anesthetics
					Flexible plan
				Future directions
				Summary
			References
		7 Tooth morphology and pulpal access cavities
			Components of the pulp cavity
			Root canal anatomy
				Clinical determination of the root canal configuration
					Coronal considerations
					Midroot considerations
					Apical considerations
			Objectives and guidelines for traditional access cavity preparation
				Objectives
			Key steps to consider in traditional access preparation
				Evaluation of the cementoenamel junction and occlusal tooth anatomy
				Preparation of the access cavity through the lingual and occlusal surfaces
				Removal of all defective restorations and caries before entry into the pulp chamber
				Preparation of access cavity walls that do not restrict straight- or direct-line passage of instruments to the apical foramen or initial canal curvature
			Objectives and guidelines for minimally invasive access cavity preparation
			Mechanical phases of access cavity preparation
				Magnification and illumination
				Burs
				Endodontic explorer and spoon
				Ultrasonic unit and tips
			Access cavity preparations
				Anterior teeth
					External outline form
					Penetration of the pulp chamber roof (fig. 7.26)
					Removal of the chamber roof
					Removal of the lingual shoulder and coronal flaring of the orifice
					Straight-line access determination
					Refinement and smoothing of restorative margins
					Individual anterior teeth
				Posterior teeth
					External outline form
					Penetration of the pulp chamber roof
					Identification of all canal orifices
					Removal of the cervical dentin bulges and orifice and coronal flaring
					Straight-line access determination
					Visual inspection of the pulp chamber floor
						Individual posterior teeth.
			Challenging access preparations
				Access in teeth with presumed calcified canals
				Crowded or rotated teeth
			Morphology of and access cavity preparations for individual teeth
				Maxillary central incisor
				Maxillary lateral incisor
				Maxillary canine
				Maxillary first premolar
				Maxillary second premolar
				Maxillary first molar
				Maxillary second molar
				Maxillary third molar
				Mandibular central and lateral incisors
				Mandibular canine
				Mandibular first premolar
				Mandibular second premolar
				Mandibular first molar
				Mandibular second molar
				Mandibular third molar
				Teeth with C-shaped root canal systems
			References
		8 Cleaning and shaping of the root canal system
			Introduction
			Principles of cleaning and shaping
				Mechanical objective
				Biologic objective
				Technical objective
				Clinical issues
			Endodontic instruments
				General characteristics
					Design elements
						Tip design.
						Longitudinal and cross-sectional design.
						Taper.
					International standards organization norms
					Alloys
						Physical and chemical properties of steel and nickel titanium alloys.
				Manually operated instruments
					K-type instruments
					H-type instruments
						Effectiveness and wear of instruments.
					Barbed broaches
				Low-speed engine-driven instruments
					Burs
					Gates-glidden drills
					Peeso reamers and similar drills
				Engine-driven instruments for canal preparation
					Instrument types
						Group I: Passive preparation; presence of radial lands.
							Lightspeed.
							Profile.
							GT and GTX files.
							K3.
						Summary.
						Group II: Active cutting; triangular cross section.
							Protaper universal, gold.
							Hero 642, hero shaper.
							Race, biorace, BT race.
							Endosequence.
							Twisted file.
							Profile vortex.
							MTWO.
							Edge files.
							Summary.
						Group III, atypical instruments
							Waveone, reciproc, gold, blue.
							Self-adjusting file.
							Trushape.
							XP-shaper, XP-finisher.
							Sonic and ultrasonic shaping instruments.
							Summary.
					Motors
			Steps of cleaning and shaping
				Access—principles
				Coronal modification
				Patency and glide path preparation
				Working length determination
					Devices
					Strategies
				Canal enlargement/preparation
					Rationale
					Techniques
						Standardized technique.
						Step-back technique.
						Step-down technique.
						Crown-down technique.
						Balanced force technique.
						Rotary instrumentation.
					Specific nickel titanium (NITI) instrumentation techniques
						Crown-down.
						Single length.
						Hybrid techniques.
				Final apical enlargement
			Disinfection of the root canal system
				Hydrodynamics of irrigation
				Irrigants
					Sodium hypochlorite
						History.
						Mode of action.
						Allergic reactions to sodium hypochlorite.
						Temperature.
						Concentration.
						Time.
						Toxicity.
					Chlorhexidine
						History.
						Molecular structure.
						Mode of action.
						Substantivity.
						Cytotoxicity.
						Chlorhexidine as an endodontic irrigant.
						Interaction between CHX, NaOCL, and EDTA.
						Allergic reactions to chlorhexidine.
						Decalcifying agents.
					Ethylenediaminetetraacetic acid
						History.
						Mode of action.
						Applications in endodontics.
						Interaction of EDTA and NaOCL.
					HBPT and other phosphate bases tensides
						Combination irrigants.
						Biopure MTAD and tetraclean.
						Mode of action.
						Smear layer removal.
						Antibacterial efficacy.
						Clinical trials.
						Protocol for use.
					Combinations of irrigants
						Protocol.
						Smear layer removal.
						Antibacterial efficacy and effect on biofilms.
						Clinical trials.
						Iodine potassium iodide.
				Intracanal medication
					Calcium hydroxide
						Other uses of Ca(OH)₂.
						Clinical protocol.
						Limitations of calcium hydroxide.
					Chlorhexidine
						Chlorhexidine mixed with calcium hydroxide.
					Phenolic preparations
					Formaldehyde
					Halogens
					Steroids
					Triple-antibiotic paste
					Lubricants
				Disinfection devices and techniques
					Syringe delivery
					Manually activated irrigation
					Sonically activated irrigation
					Ultrasonic-assisted irrigation
					Negative apical pressure irrigation
					Safety-irrigator
					Gentlewave system
					Laser-activated irrigation
					Photoactivated disinfection
					Antibacterial nanoparticles
						Healozone.
						Water preparations.
			Criteria to evaluate cleaning and shaping⁴
				Well-shaped canals
				Signs of mishaps
					Instrument fracture
					Canal transportation
					Perforation
					Blockage
			Sample protocol for contemporary cleaning and shaping procedures
			Summary
			References
		9 Obturation of the cleaned and shaped root canal system
			Importance of effectively sealing the root canal system
			Historical perspectives
			Timing of obturation
				Vital pulp tissue
				Necrotic pulp tissue
			Length of obturation
			Preparation for obturation
			The ideal root canal obturation materials
			Types of sealers
				Zinc oxide and eugenol
				Calcium hydroxide sealers
				Noneugenol sealers
				Glass ionomer sealers
				Resin sealers
					Epoxy resin sealers
					Methacrylate resin sealers
				Silicone sealers
				Tri/dicalcium silicate sealers
				Medicated sealers
			Sealer placement
			Core materials
				Silver cones
				Gutta-percha
				Activ GP
				Custom cones
			Methods of obturation
				Lateral compaction
				Warm vertical compaction
				Continuous wave compaction technique
				Thermoplastic injection techniques
					Obtura III
					Ultrafil 3D
					Calamus
					Elements
					Hotshot
				Carrier-based gutta-percha
					Thermafil, profile GT obturators, GT series X obturators, and protaper universal obturators
					Successfil
					Simplifill
				Thermomechanical compaction
				Solvent techniques
				Pastes
				Immediate obturation
			Coronal orifice seal
			Future technology and nanodiamond-embedded gutta-percha
			References
		10 Nonsurgical retreatment
			Etiology of posttreatment disease
			Diagnosis of posttreatment disease
			Treatment planning
			Nonsurgical endodontic retreatment
				Coronal access cavity preparation
				Post removal
					Post removal techniques
					Potential complications of post removal
				Regaining access to the apical area
					Gutta-percha removal
					Managing solid core obturators
					Paste retreatment
					Silver point removal
				Removal of separated instruments
					Causes of instrument separation
					Prognosis
					Removal techniques
				Heat generation during retreatment procedures
				Management of canal impediments
				Finishing the retreatment
			Repair of perforations
			Prognosis of retreatment
			Conclusion
			References
		11 Periradicular surgery
			Indications for periradicular surgery
				Etiology of persistent periradicular disease
				Rationale for surgical treatment
				Clinical decision making
			General biologic principles of wound healing
			Soft-tissue wound healing
				Inflammatory phase
					Clot formation
					Early inflammation: Polymorphonuclear neutrophil organization
					Late inflammation: Macrophage organization
				Proliferative phase
					Fibroblasts: Fibroplasia
					Endothelial cells: Angiogenesis
					Epithelium
				Maturation phase
			Hard-tissue healing: Excisional dentoalveolar wound
				Osteoblasts: Osteogenesis
				Cementoblasts: Cementogenesis
			Systemic medications and wound healing
				Bisphosphonates
				Glucocorticoids
				Nonsteroidal antiinflammatory drugs
				Cyclooxygenase-2 inhibitors
			Preoperative evaluation of medically complex patients
			Anatomic considerations
				Posterior mandible
				Posterior maxilla
				Anterior maxilla and mandible
			Cone-beam computed tomography
				Differences between computed tomography and cone-beam computed tomography imaging
				Potential applications of cone-beam computed tomography in the management of endodontic posttreatment disease
			Patient preparation for surgery
				Informed-consent issues specific to surgery
				Premedication: Nonsteroidal antiinflammatory drugs, antibiotics, chlorhexidine, and conscious sedation
			Instruments and operatory setup
			Local anesthesia for surgery
			Surgical access
				Soft-tissue access
				Vertical incision
				Horizontal incision
				Flap design
				Tissue reflection
				Tissue retraction
				Hard-tissue access
			Periradicular curettage and biopsy
			Localized hemostasis
				Preoperative considerations
				Local hemostatic agents
					Collagen-based materials
					Surgicel
					Gelfoam
					Bone wax
					Ferric sulfate
					Calcium sulfate
					Epinephrine pellets
				Cautery/electrosurgery
			Management of the root end
				Determination of the need for root-end resection and filling
				Root-end resection
				Angle of resection
				Root-end surface preparation
				Resected root-end surface topography
				Root-end conditioning
			Root-end cavity preparation
				Ultrasonic root-end preparation and apical fractures
				Significance of ultrasonic tip design
				Temperature changes induced by ultrasonic instruments
				Bonded root-end fillings
			Root-end filling materials
				Zinc oxide–eugenol cements
					Intermediate restorative material
					Super-EBA
				Glass-ionomer cements
				Diaket
				Composite resins and resin-ionomer hybrids
					Retroplast
					Resin-ionomer suspension (geristore) and compomer (dyract)
				Mineral trioxide aggregate
				Bioceramics
				Overview of root-end filling materials
			Closure of the surgical site and selection of suture material
				Closure of the surgical site
				Selection of the suture material
			Guided tissue regeneration and endodontic surgery
				Ridge preservation
			Intentional replantation
			Postoperative care
			Management of surgical complications
			Summary
			References
		12 Regenerative endodontics
			Overview of regenerative dentistry
				Overview of regenerative endodontics
			Preclinical studies on regenerative endodontics
				Stem cells
				Growth factors/morphogens
					Morphogens
				Scaffolds
				Delivery system
				Translational studies
				Summary of basic research on regenerative endodontics
			Clinical studies on regenerative endodontics
				Clinical procedures related to regenerative endodontics
				Overview of clinical regenerative endodontic procedures
				Example of a revascularization protocol
				Clinical measures of treatment outcomes
					Patient-centered outcomes
					Clinician-centered outcomes
					Scientist-based outcomes: Regeneration or repair?
			Summary
			References
	Part II ADVANCED SCIENCE TOPICS
		13 Structure and functions of the dentin-pulp complex
			Morphologic zones of the pulp
				The pulp-dentin complex
				Odontoblast layer
				Cell-poor zone
				Cell-rich zone
				Pulp proper
			Cells of the pulp
				Odontoblast
				Odontoblast process
				Relationship of odontoblast structure to secretory function
				Pulp fibroblast
				Macrophage
				Dendritic cell
				Lymphocyte
				Mast cell
			Metabolism
			The pulpal interstitium and ground substance
				Hyaluronan
				Elastic fibers
				The inflamed interstitium
			Connective tissue fibers of the pulp
			The trigeminal system
				Innervation
				Steps and mechanisms in pain perception
				Detection: The first step in pain perception
			Neuropeptides
				Pulp testing
				Sensitivity of dentin
				Peripheral sensitization
				Hyperalgesia and allodynia
				Inflammatory mediators
				Painful pulpitis
				Plasticity of intradental nerve fibers
				Tissue injury and deafferentation
				Processing: The second step in pain perception
					The medullary dorsal horn
					Components of the medullary dorsal horn
					Central sensitization
				Perception: Thalamus to cortex
			Vascular supply
				Regulation of pulpal blood flow
					Local control of blood flow
					Humoral control of blood flow
				Fluid drainage
					Transcapillary fluid exchange
				Circulation in the inflamed pulp
					Vascular permeability
					Clinical aspects
			Pulpal repair
			Pulpal calcifications
			Age changes
			References
		14 Pulp reactions to caries and dental procedures
			Pulp reaction to caries
			Neurogenic mediators
			Correlation between clinical symptoms and actual pulp inflammation
			Dentin hypersensitivity and its management
			Pulp reactions to local anesthetics
			Pulp reactions to restorative procedures
				The degree of inflammation of the pulp preoperatively
				The amount of physical irritation caused by the procedure
					Heat
					Desiccation
					Biological and chemical irritation
				The proximity of the restorative procedures to the dental pulp and the surface area of dentin exposed
				The permeability of dentin and the odontoblastic layer between the area being restored and the pulp
				The age of the patient
			Pulp reactions to restorative materials
			Direct pulp capping with bioceramics
			The use of hemostatic agents and disinfectants on direct pulp exposures
			Pulp reactions to laser procedures
				Lasers in the prevention, diagnosis, and treatment of caries
				Lasers in the treatment of dentin hypersensitivity
			Pulp reactions to vital bleaching techniques
			Pulp reactions to periodontal procedures
			Mechanical irritants: Orthodontic movement
			Pulp reactions to orthodontic surgery
			Biomechanical irritation: Parafunctional habits
			Pulp reactions to implant placement and function
			References
		15 Microbiology of endodontic infections
			Apical periodontitis as an infectious disease
			Routes of root canal infection
			Mechanisms of microbial pathogenicity and virulence factors
			Spatial distribution of the endodontic microbiota
			Biofilm and community-based microbial pathogenesis
				Biofilm and bacterial interactions
				Biofilm resistance to antimicrobial agents
			Apical periodontitis as a biofilm-related disease
			Methods for microbial identification
				The five generations of endodontic microbiology studies
				Impact of molecular methods in endodontic microbiology
			Types of endodontic infections
			Diversity of the endodontic microbiota
			Primary intraradicular infection
				Microbial diversity
				Symptomatic infections
				Geographic influence
				Microbial ecology and the root canal ecosystem
				Other microorganisms in endodontic infections
					Fungi
					Archaea
					Viruses
			Persistent/secondary endodontic infections
				Persistent/secondary infections and treatment failure
				Bacteria at the root canal obturation stage
				Microbiota in root canal–treated teeth
			Extraradicular infections
			References
		16 Pathobiology of apical periodontitis
			Apical periodontitis
				Prevalence
			Etiology
			Infection: A conflict between host and parasites
			Pathogenesis
				Innate immune response
					Specificity of innate immune response
					Nonspecific innate immune response
				Adaptive/specific immune response
				Neurogenic inflammation
			Diagnosis
				Correlation between clinical and histologic findings
				Correlation between radiographic and histologic findings
			Histopathology
			Acute apical periodontitis
				Cell biology
					Mast cells
					Endothelial cells
					Polymorphonuclear neutrophilic leukocytes
					Macrophages
					Platelets
					Natural killer cells
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis
				Cell biology
					Macrophages and lymphocytes
					Dendritic cells
					Osteoclasts
					Epithelial cell rests of malassez
					Fibroblasts
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis with cyst formation
				Cell biology
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis with reactive bone formation: Focal condensing osteitis
				Cell biology
				Histopathology
				Clinical features
				Outcomes
			Periapical lesions of nonendodontic origin
			Extraradicular endodontic infection
			Apical periodontitis and systemic diseases
			Genetic and systemic disease risk factors of persistent apical periodontitis
				Genetic risk factors
				Systemic disease risk factors
			Wound healing of apical periodontitis
				Periapical wound healing after nonsurgical root canal therapy
				Periapical wound healing after surgical endodontic therapy
				Can radicular cysts in apical periodontitis lesions regress after nonsurgical endodontic therapy?
			Factors influencing periapical wound healing after endodontic therapy
			References
	Part III ADVANCED CLINICAL TOPICS
		17 Evaluation of outcomes
			Context of evaluating endodontic outcomes
				Types of disease and their treatment
			What are surrogate outcome measures?
				Types of outcome measures
			What is the purpose of evaluating outcomes?
				Effectiveness of procedures
				Factors affecting outcomes
				Value for prognostication
			Outcome measures for endodontic treatment
				Outcome measures for vital pulp therapy procedures
				Outcome measures for nonsurgical root canal treatment and retreatment
				Outcome measures for periapical surgery
			Outcomes of vital pulp therapy procedures
				Indirect pulp capping (one-step versus stepwise excavation)
				Direct pulp capping
				Pulpotomy
				Summary of prognostic factors for vital pulp therapy
			Outcomes of nonsurgical root canal treatment
				Factors affecting periapical health or healing following root canal treatment
					Patient factors
					Treatment factors
						Operator.
						Isolation.
						Magnification and illumination.
						Mechanical preparation: Size, taper, extent, and procedural errors.
						Irrigant.
						Medicament.
						Root canal bacterial culture results prior to obturation.
						Effect of persistent bacteria on root canal treatment outcome.
						Root filling material and technique.
						Apical extent of root filling.
						Quality of root filling.
						Acute exacerbation during treatment.
						Number of treatment visits.
					Post root canal treatment restorative factors
						Effect of quality and type of restoration.
						Use of root treated teeth as abutments for prostheses and occlusal contacts.
					Summary of factors influencing periapical healing following nonsurgical root canal treatment
				Factors affecting tooth survival following root canal treatment
					Patient factors
					Tooth morphologic type and location
					Preoperative conditions of teeth
					Treatment factors
					Restorative factors
					Summary of factors influencing the survival of teeth following root canal treatment
				Impact of root canal treatment on quality of life
			Outcome of nonsurgical retreatment
			Outcome of surgical retreatment
				Factors affecting periapical health or healing following periapical surgery and root-end filling
				Factors affecting periodontal incisional wound healing
				Factors affecting tooth survival following periapical surgery and root-end filling
				Impact of periapical surgery on quality of life
			Concluding remarks
			References
			Figure and Table References
		18 Root resorption
			General histologic features
			External inflammatory resorption
				Introduction
				Etiology and pathogenesis of external inflammatory resorption
				Histologic appearance
				Clinical features
				Radiographic features
				Management
				Follow-up and prognosis of external inflammatory resorption
			External cervical resorption
				Introduction
				Etiology and pathogenesis
				Histologic appearance
				Clinical features
				Radiographic features
				Management
			Internal root resorption
				Introduction
				Etiology and pathogenesis of internal root resorption
				Histologic appearance
				Clinical features
				Radiographic features and diagnosis
				Management
				Chemomechanical debridement of the root canal
				Obturation
			Summary
			References
		19 Management of endodontic emergencies
			Emergency classifications
			Emergency endodontic management
				Teeth with vital pulps
				Reversible pulpitis
				Irreversible pulpitis
				Pulpal necrosis with symptomatic apical periodontitis
					Trephination
					Necrosis and single-visit endodontics
				Pulpal necrosis with acute apical abscess
					Swelling
			Fascial space infections
			Management of abscesses and cellulitis
			Incision for drainage
			Symptomatic teeth with previous endodontic treatment
			Leaving teeth open
			Systemic antibiotics for endodontic infections
			Analgesics
			Laboratory diagnostic adjuncts
			Flare-ups
			Cracked and fractured teeth
			Summary
			References
		20 Managing iatrogenic events
			Sodium hypochlorite
			Instrument separation
				Causes of instrument separation
				Management of separated instruments
				Conditions for separated instrument removal attempts
				Root canal preparation techniques
					Root canal preparation for visible instrument retrieval
					Root canal preparation for nonvisible instrument retrieval
				Instrument retrieval techniques
					Use of ultrasonic oscillation
					Use of the loop
				Prognosis
			Ledge formation
				Causes of ledge formation
				Management of ledge formation
				Bypassing a ledge
					Using hand instruments
					Using ultrasonic tips
					Using rotary instruments
				Potential complications of removal or bypassing a ledge
				Prevention of ledge formation
				Prognosis
			Radicular extrusion of root canal filling materials
				Causes of extrusion of obturation materials beyond the radicular foramen
				Management of obturation materials extruded beyond the radicular foramen
					Nonsurgical management of extrusion of obturation materials
				Management of tissue damage caused by extrusion of root canal filling materials
			Sinus perforation
			Inferior alveolar nerve injury
				Risk assessment for the prevention of endodontic nerve injury
				Operative techniques to minimize nerve injuries
				Management of nerve injuries
			Assessment
				Immediate intervention
				Early intervention
				Watch and wait?
			Cervicofacial subcutaneous emphysema
			References
		21 The role of endodontics after dental traumatic injuries
			Unique aspects of dental trauma
			Most common types of dental trauma
				Crown fractures
				Crown-root fractures
				Root fractures
				Luxation injuries and avulsion
			Follow-up after dental trauma
			Radiographic examinations
				Cone-beam computed tomography and dentoalveolar trauma
				Root resorption
				Horizontal (transverse) root fractures
				Luxation injuries
			Crown fractures
				Crown infraction
					Biologic consequences
				Uncomplicated crown fracture
					Incidence
					Biologic consequences
				Treatment
				Complicated crown fracture
					Incidence
					Biologic consequences
				Treatment
					Stage of development of the tooth
					Time between trauma and treatment
					Concomitant attachment damage
					Restorative treatment plan
				Vital pulp therapy: Requirements for success
				Treatment methods
					Pulp capping
						Indications.
					Partial pulpotomy
						Indications.
						Technique.
						Follow-up.
						Prognosis.
					Full pulpotomy
						Indications.
						Technique.
						Follow-up.
						Prognosis.
					Pulpectomy
						Indications.
				Treatment of the nonvital pulp
					Immature tooth: Apexification
						Indications.
						Biologic consequences.
						Technique
							Disinfection of the canal.
						Hard-tissue apical barrier
							Traditional method.
						Bioceramic barrier.
							Filling the root canal.
							Reinforcement of thin dentinal walls.
							Follow-up.
							Prognosis.
							Pulp revascularization/regenerative endodontic treatment.
					Mature tooth
			Crown-root fracture
			Root fracture
				Diagnosis and clinical presentation
				Treatment
				Healing patterns
				Treatment of complications
					Coronal root fractures
					Midroot and apical root fractures
					Follow-up
					Prognosis
			Luxation injuries
				Definitions
				Incidence
				Treatment
				Biologic consequences
					External root resorption
						Caused by an injury (alone) to the external root surface.
							Localized injury: Healing with cementum.
							Diffuse injury: Healing by replacement resorption.
							Treatment.
						Caused by an injury to the external root surface and inflammatory stimulus in the root canal.
						Consequences of apical neurovascular supply damage
							Pulp canal obliteration (calcification).
							Pulp necrosis.
							Pulp space infection.
							Treatment.
					Internal root resorption
						Etiology.
						Clinical manifestations.
						Radiographic appearance.
						Histologic appearance.
						Treatment.
					Diagnostic features of external versus internal root resorption
						Radiographic features.
						Vitality testing.
						Pink spot.
						Transient apical breakdown.
					Summary of possible diagnostic features
			Clinical management of the avulsed tooth
				Consequences of tooth avulsion
				Treatment objectives
				Clinical management
					Emergency treatment at the accident site
					Management in the dental office
						Emergency visit.
				Diagnosis and treatment planning
			Preparation of the root
				Extraoral dry time less than 60 minutes
					Closed apex
					Open apex
				Extraoral dry time more than 60 minutes
					Closed apex
					Open apex
			Preparation of the socket
			Splinting
			Management of the soft tissues
			Adjunctive therapy
				Second visit
			Endodontic treatment
				Extraoral time less than 60 minutes
					Closed apex
					Open apex
				Extraoral time more than 60 minutes
					Closed apex
					Open apex (if replanted)
			Temporary restoration
				Root filling visit
			Permanent restoration
				Follow-up care
					Late complications
					Dentoalveolar trauma to the primary dentition
			References
		22 Chronic cracks and fractures
			Impact trauma
			Diagnostic challenge
			Fracture mechanics
			Cracked and fractured cusps
				Definition
				Diagnosis
					Patient history
					Clinical manifestation
						Early manifestation.
						Late manifestation.
					Diagnosis
				Etiology
				Treatment planning
					Cracked cusp
					Fractured cusp
			Cracked and split teeth
				Definition
				Diagnosis
					Patient history
					Clinical manifestation
						Early manifestation.
						Late manifestation.
					Diagnosis
				Etiology
				Treatment planning
					Cracked tooth
					Split tooth
			Vertical root fracture
				Definition
				Diagnosis
					Patient history
					Clinical manifestations
						Susceptible teeth and vertical root fracture location.
						Early manifestation.
						Late manifestation.
					Diagnosis
						Importance of early diagnosis.
						Misdiagnosis of vertical root fractures.
						Vertical root fracture pockets.
						Coronally located sinus tract.
						Radiographic features.
						Osseous radiolucency adjacent to the root.
						Radiograph of empty canal.
						Cone-beam computed tomography in vertical root fracture diagnosis.
						Exploratory surgery.
				Etiology
					Natural predisposing factors
						Shape of root cross section.
						Occlusal factors.
						Preexisting microcracks.
					Iatrogenic predisposing factors
						Root canal treatment.
						Excessive root canal preparation.
						Microcracks caused by rotary instrumentation.
						Uneven thickness of remaining dentin.
						Methods of obturation.
						Type of spreader used.
						Post design.
						Crown design.
			Treatment planning
			Summary
			References
		23 Restoration of the endodontically treated tooth
			Special features of endodontically treated teeth
				Compositional changes in nonvital teeth and the influence of endodontic therapy
				Dentin structure and properties in nonvital and endodontically treated teeth
				Fracture resistance and tooth stiffness of nonvital and endodontically treated teeth
				Aesthetic changes in nonvital and endodontically treated teeth
			Restorative materials and options
				Direct composite restorations
				Indirect restorations: Composite or ceramic onlays and overlays
				Full crowns
					The foundation restoration: General considerations
					Why roots fracture
					Direct foundation restorations
						Posts.
							Prefabricated metallic posts.
							Fiber posts.
						Core materials.
							Composite resin core.
							Amalgam core.
							Glass ionomer core and modified glass ionomer core.
					Indirect foundation restorations: Cast post and core
				Luting cements
					Traditional cements
					Glass ionomer luting cements
					Resin-based luting cements
					Self-adhesive cements
			Pretreatment evaluation and treatment strategy
				Pretreatment evaluation
					Endodontic evaluation
					Periodontal evaluation
					Biomechanical evaluation
					Tooth position, occlusal forces, and parafunctions
					Aesthetic evaluation and requirements
				Treatment strategy
					General principles and guidelines
					Structurally sound anterior teeth
					Nonvital posterior teeth with minimal/reduced tissue loss
					Structurally compromised teeth
					Structurally compromised anterior teeth
					Structurally compromised posterior teeth
					Additional procedures
			Clinical procedures
				Tooth preparation
				Post placement
				Adhesive procedures
				Partial restorations
				Foundation restoration underneath full crowns
					Amalgam core
					Cast gold post and core
						Direct technique.
						Indirect technique.
				Crown preparation and temporary restoration
			Summary
			References
		24 Vital pulp therapy
			The living pulp
			Loss of pulp vitality
			Pulpal response to cariesª
			Dentin regeneration and reparative tissue formation
				Tertiary dentin formation
				Mineralized tissue formation after loss of the primary odontoblasts
			Indications for vital pulp therapy
			Procedures generating mineralized tissue barriers
				Indirect pulp capping
				Direct pulp capping
				Partial pulpotomy
				Complete pulpotomy
			Materials for vital pulp therapy
				Aqueous calcium hydroxide suspensions
				Hard setting calcium hydroxide cements
				Light-curing liners and cements
				Composite resins, dentin adhesives, and resin-modified glass ionomer cements
				Mineral trioxide aggregate
				Calcium silicate cements
			Calcium silicate cement applications in vital pulp therapy
				Direct pulp capping with calcium silicate cements
				Pulpotomy with calcium silicate cements
			Vital pulp therapy techniques
				Diagnosis
				Caries removal
				Hemostatic agents
				Treatment considerations
			Treatment recommendations†
				Pulp capping and pulpotomy
			The permanent restoration
			Postoperative follow-up and recall
			Acknowledgment
			References
		25 Endo-perio
			Intercommunication between pulpal and periodontal tissue
			Influence of pulpal pathologic condition on the periodontium
			Influence of periodontal inflammation on the pulp
			Theoretic pathways of osseous lesion formation
				Primary endodontic lesions
				Primary endodontic lesions with secondary periodontal involvement
				Primary periodontal lesions
				Primary periodontal lesions with secondary endodontic involvement
				True combined lesions
				Concomitant pulpal and periodontal lesions
			Differential diagnosis
				Lateral periodontal cysts
			Treatment alternatives
				Forced eruption or extrusion
			Summary
			References
	Part IV ONLINE CONTENT
		26 Bleaching procedures
			Etiology of tooth discolorations
				Systemic intrinsic causes
					Genetic causes
					Disease-related causes
					Metabolic causes
					Drug-related causes
				Local intrinsic causes
					Pulpal hemorrhage
					Pulp necrosis
					Pulp tissue remnants
					Restorative materials
					Intracanal medicaments and root filling materials
					Dental caries
					Calcific metamorphosis/dystrophic calcification
					Root resorption
					Aging
				Extrinsic causes
			Treatment planning for internal bleaching
			Contraindications of bleaching
			Alternatives to bleaching
			Chemistry of bleaching
				Walking bleach technique
					Walking bleach clinical protocol
				Thermocatalytic bleaching
			Definitive restoration of teeth following internal bleaching
			External bleaching
				In-office external bleaching
				Power bleaching
					Power bleaching clinical protocol
				At-home external bleaching
			Risks and complications associated with tooth bleaching
				Risks associated with internal tooth bleaching
					Cervical root resorption
					Enamel and dentin damage
					Inhibition of adhesive bonding
				Risks associated with external tooth bleaching
					Tooth sensitivity
					Gingival irritation
					Mercury release from amalgam restorations
				Prognosis of bleaching
			References
		27 Endodontic records and legal responsibilities
			Endodontic record excellence
				Importance
					Content
					Office records
					Function
				Patient information form
				Medical health history
				Dental history
				Diagnostic and progress records
				Electronic records
				Radiographs
				Evaluation and differential diagnosis
				Diagnostic tests
				Treatment plan
					Examination
					Diagnosis
					Patient consultation
					Treatment
				Informed consent form
				Treatment record: Endodontic chart
					General patient data
					Dental history
					Medical history
					Periodontal disease
					Periodontal examination
					Drug history
				Preoperative and postoperative radiographs
				Digital radiography
				Radiation safety
			Endodontics and heart disease
				Abbreviations
				Computerized treatment records
				Health information technology for economic and clinical health act pitfalls
				Health insurance portability and accountability act
				Record size
				Identity of entry author
				Patient record request
				Patient education materials
				Postoperative instructions
				Recording referrals
				Dental fees related to quality care
				Record correction
				Spoliation
				False claims
			Legal responsibilities
				Malpractice claims
				Incidence of negligence
				Malpractice prophylaxis: Importance of records
				Standard of care
				Standards of care: Generalist versus endodontist
				Ethical guidelines
					Standard of care for endodontics
				Ordinary care equals prudent care
				Customary practice versus negligence
					Health maintenance organization care versus standard of care
				Employment law
				Dental negligence defined
				Locality rule
				Continuing education
				Evidence-based endodontics
				Holistic dentistry
				Ozone therapy
				New products
				U.S. food and drug administration approval
				U.S. food and drug administration’s drug approval
				U.S. food and drug administration clearance
				Adverse drug events
					Primary medication nonadherence: Unfilled prescriptions
				U.S. food and drug administration medwatch
				Compounding pharmacies
				Dietary supplements
				Negligence per SE
				Prescription drugs
				Ability to foresee unreasonable risk
				Consent
					Informed consent principles
					Informed consent
					Informed consent application
					Endodontic informed consent
						Video-informed consent.
				Alternative technique choices
				Referrals to other specialists
				Surgical versus nonsurgical endodontics
				Microscopic endodontics
					Microscope
						Magnification.
				Separated instruments
				Equipment and supplies
				Waterlines
				Pulpotomy
				Clinician’s liability for staff’s acts or omissions
				Abandonment
				Expert testimony
				National practitioner data bank
			Malpractice incidents
				What to do if you are sued
				Screw posts
				Paresthesia prevention
				Overfills
					Sealant overfills
				Treatment failure
				Full disclosure
				Slips of the drill
				Fear factor
				Pain management
				Leakage
				Implant risk factors
					Fluoride for caries prevention
				Reasonable versus unreasonable errors in judgment
					Incorrect tooth treatment
					Post retrieval
					Broken files
					Swallowing or aspirating an endodontic instrument
					Overextensions and overfills
					Compartment syndrome
					Periradicular surgery
					Avoiding the inferior alveolar nerve canal
					Mental nerve injuries
					Local anesthesia: Septocaine
					Implant versus endodontics
					Current use of silver points
					N2 (sargenti paste)
					Defective restorations
					Restoration marginal integrity
				Malpractice prophylaxis
				Allergies
				One-visit versus two-visit endodontics
				Disclosure errors
				Temporomandibular disorders
				Patient rapport
					Rapport building blocks
					Telephone communications
				Post perforation
				Perforation prevention
				Bleach injury
				Esthetic bleaching
				Cores
				Absorbable hemostatic agents causing neuropathy
				Pneumomediastinum (air embolus)
				Broken needle
				Sterilization
				Medication errors
				Posttrauma therapy
				Millennium management of endodontic advances
				Statistical research
				Other clinicians’ substandard treatment
				Peer review
				Human immunodeficiency virus and endodontics
			Summary
			References
			Suggested readings
		28 Key principles of endodontic practice management
			Endodontic management systems
				Systems design
			Management
				Vision
					Short vision statement
					Long vision statement
				Mission
				Goal setting
				Target setting
				Key production indicators
				Staff training and development
				Scheduling
					Schedule for production
					Set the daily production target
					Perform procedural time studies
					Create the ideal day
					Manage emergencies
				Customer service
			Marketing
				Endodontic marketing
				Endodontic referral marketing
				Social media
				Transitions
			Leadership
				The endodontic leader
					Interpersonal communication
					Decision making
					Motivation
					Pursuit of knowledge
					Teamwork
					Time management
					Leading by example
			Summary
	Index
		A
		B
		C
		D
		E
		F
		G
		H
		I
		J
		K
		L
		M
		N
		O
		P
		Q
		R
		S
		T
		U
		V
		W
		X
		Y
		Z
Cohen's Pathways of the Pulp 3.pdf
	Front Cover
	Front matter
		Cohen’s Pathways  of the Pulp
	Copyright
	About the editors
		Louis H. berman
		Kenneth M. hargreaves
		Ilan rotstein
	Dedication
	Contributors
	New to this edition
		New chapter organization
		Digital content
	Introduction
	Table of Contents
		PART I The core science of endodontics
		PART II Advanced science topics
		PART III Advanced clinical topics
		PART IV Online content
	Part I THE CORE SCIENCE OF ENDODONTICS
		1 Diagnosis
			Art and science of diagnosis
				Chief complaint
				Medical history
				Dental history
					History of present dental problem
					Dental history interview
			Examination and testing
				Extraoral examination
				Intraoral examination
					Soft-tissue examination
					Intraoral swelling
					Intraoral sinus tracts
					Palpation
					Percussion
					Mobility
					Periodontal examination
				Pulp tests
					Thermal
					Electric
					Laser doppler flowmetry
					Pulse oximetry
				Special tests
					Bite test
					Test cavity
					Staining and transillumination
					Selective anesthesia
				Radiographic examination and interpretation
					Intraoral radiographs
					Digital radiography
					Cone-beam computerized tomography
					Magnetic resonance imaging
				Cracks and fractures
					Crack types
					Vertical root fractures
				Perforations
			Clinical classification of pulpal and periapical diseases
				Pulpal disease
					Normal pulp
					Pulpitis
					Reversible pulpitis
					Irreversible pulpitis
						Symptomatic irreversible pulpitis.
						Asymptomatic irreversible pulpitis.
					Pulp necrosis
					Previously treated
					Previously initiated therapy
				Apical (periapical) disease
					Normal apical tissues
					Periodontitis
					Symptomatic apical periodontitis
					Asymptomatic apical periodontitis
					Acute apical abscess
					Chronic apical abscess
			Referred pain
			Summary
			References
		2 Radiographic interpretation
			Radiographic interpretation
				Imaging modalities
				Image characteristics and processing
				Digital imaging and communications in medicine
			Diagnostic tasks in endodontics
				Diagnosis and healing
				Three-dimensional imaging
			Principles of cone beam computed tomography
				Voxels and voxel sizes
				Field of view
					Diagnostic task
					Type of patient
					Spatial resolution requirements
			Imaging tasks improved or simplified by cone beam volumetric computed tomography
				Differential diagnosis
					Lesions of endodontic origin
					Lesions of nonendodontic origin
				Evaluation of anatomy and complex morphology
					Dental anomalies
					Root canal system morphology
				Diagnosis of endodontic treatment failures
			Intraoperative or postoperative assessment of endodontic treatment complications
				Vertical root fractures
				Overextended root canal obturation material
				Separated endodontic instruments
				Calcified canals
				Perforations
			Presurgical treatment planning
				Dentoalveolar trauma
				Internal and external root resorption
			Endodontic treatment outcomes assessment
			Dental implant case planning
				3D-guided endodontics
			Image perception and viewing environment
			The future of cone-beam computed tomography
			Magnetic resonance imaging
			Conclusions
			JOINT POSITION STATEMENT OF THE AMERICAN ASSOCIATION OF ENDODONTISTS AND THE AMERICAN ACADEMY OF ORAL AND MAXILLOFACIAL RADIOLOGY ON THE USE OF CONE BEAM COMPUTED TOMOGRAPHY IN ENDODONTICS: 2015/2016 UPDATE
				Introduction
				Volume Size(s)/field of view
				Dose considerations
				Interpretation
				Recommendations
					Diagnosis
					Initial treatment
					Nonsurgical retreatment
					Surgical retreatment
					Special conditions
					Outcome Assessment
			References
		3 Lesions that mimic endodontic pathosis
			Importance of differential diagnosis
			Limits of pulp testing
			Limits of radiology
			Differential diagnosis of periapical pathosis
				Multilocular radiolucencies
					Odontogenic keratocyst
						Radiographic features.
					Ameloblastoma
						Radiographic features.
					Central giant cell lesion
						Radiographic features.
				Radiopacities in the periapical region
					Condensing osteitis
						Radiographic features.
					Maxillary sinusitis of endodontic origin
						Radiographic features.
							Periapical osteoperiostitis.
							Periapical mucositis.
					Osteomyelitis with proliferative periostitis
						Radiographic features.
					Idiopathic osteosclerosis
						Radiographic features.
					Odontoma
						Radiographic features.
					Paget disease of bone
						Radiographic features.
					Exostoses and tori
						Radiographic features.
				Multifocal presentations
					Periapical cemento-osseous dysplasia
						Radiographic features.
					Florid cemento-osseous dysplasia
						Radiographic features.
					Hyperparathyroidism
						Radiographic features.
					Langerhans cell histiocytosis
						Radiographic features.
				Ill-defined pathologies
					Osteomyelitis
						Acute osteomyelitis.
						Chronic osteomyelitis.
					Medication-related osteonecrosis of the jaw
						Radiographic findings.
					Non-hodgkin lymphoma
						Radiographic features.
					Metastatic disease
						Radiographic features.
					Multiple myeloma
						Radiographic features.
				Well-defined unilocular periapical radiolucencies
					Periapical cysts and periapical granulomas
						Radiographic features.
					Lateral radicular cyst
						Radiographic features.
					Lateral periodontal cyst
						Radiographic features.
					Focal cemento-osseous dysplasia
						Radiographic features.
					Nasopalatine duct cyst
						Radiographic features.
					Stafne defect
						Radiographic features.
			Summary
			References
		4 Diagnosis of the nonodontogenic toothache
			Review of neuroanatomy
				Somatic structures
				Neural structures
					Peripheral nervous system
						Primary afferent neurons.
							A-beta fibers.
							A-delta fibers.
							C fibers.
					Central nervous system
						Second-order neurons.
				Autonomic nervous system
			Review of neurophysiology
				Peripheral sensitization
				Central sensitization
				Terminology
			Clinical entities that can present as toothache
				Sources of odontogenic toothache
				Sources of nonodontogenic toothache
					Musculoskeletal and somatic pain
						Myofascial pain.
						Pain of sinus or nasal mucosal origin.
						Salivary gland pain.
					Neurovascular pain
					Neuropathic pain
						Neuralgia.
						Neuroma.
						Neuritis.
						Neuropathy.
					Toothache referred from a distant organic source
						Cardiac and thoracic structures.
						Intracranial structures.
						Throat and neck structures.
						Craniofacial structures.
					Psychogenic toothache
					Frequency of nonodontogenic toothache
			Taking a patient’s history
			Patient examination
				Additional tests
				Case studies
					Case 1
						Subjective history.
						Examination.
							Additional tests.
					Case 2
						Subjective history.
						Examination.
							Additional tests.
			Summary
			References
		5 Case assessment and treatment planning
			Common medical findings that may influence endodontic treatment planning
				Cardiovascular disease
				Diabetes
				Pregnancy
				Malignancy
				Medication-related osteonecrosis of the jaws
				Human immunodeficiency virus and acquired immunodeficiency syndrome
				Prosthetic implants
				Behavioral and psychiatric disorders
				Psychosocial evaluation
			Development of the endodontic treatment plan
			Endodontic prognosis
				Single-visit versus multiple-visit treatment
				Surgical endodontics
				Intentional replantation
				Regenerative endodontics
			Interdisciplinary treatment planning
				Periodontal considerations
				Restorative and prosthodontic considerations
				Endodontic therapy or dental implant
			Other factors that may influence endodontic case selection
				Anxiety
				Scheduling considerations
			References
		6 Pain control
			Local anesthesia
				Mechanisms of action for anesthetics
				Clinically available local anesthetics
				Selection of a local anesthetic: Possible adverse effects and medical history
					Possible adverse effects
						Cardiovascular reactions
						Systemic effects
						Methemoglobinemia
						Peripheral nerve paresthesia
						Allergic reactions
				Effects of systemic diseases or conditions on local anesthetics
				Clinical factors
				Inferior alveolar nerve block
					2% lidocaine and 1:100,000 epinephrine
					Anesthetic success, duration, and difficulty
				Alternative anesthetic solutions for the inferior alveolar nerve block
					Solutions without epinephrine
					Articaine with 1:100,000 or 1:200,000 epinephrine
					Long-acting anesthetics
					Buffered lidocaine
					Diphenhydramine as a local anesthetic agent
				Alternative injection sites
					Gow-gates and vazirani-akinosi techniques
					Articaine infiltrations
				Volume and concentration
				Factors in failure of the inferior alveolar nerve block
					Speed of injection and success
				Supplemental anesthesia for vital pulps in the mandible
					Indications
					Infiltrations
						Supplemental mandibular buccal, lingual, or buccal plus lingual infiltrations of articaine
					Intraosseous anesthesia
						Success and duration
						Success in symptomatic irreversible pulpitis
							Complications/contraindications.
						Systemic effects
							Plasma levels of lidocaine after intraosseous injection.
					Intraligament anesthesia
						Success, onset, and duration
						Success in symptomatic irreversible pulpitis
						Mechanism of action
						Back pressure and amount of solution delivered
						Anesthetic solutions
							Injection discomfort.
							Selective anesthesia.
						Postoperative discomfort
						Systemic effects
						Other factors
						Safety of the periodontium and pulp
						Intraseptal injection
						Intrapulpal injection
				Maxillary anesthesia
				Alternative anesthetic solutions for maxillary infiltrations
					Plain solutions: 3% mepivacaine (carbocaine, polocaine, scandonest) and 4% prilocaine (citanest plain)
					4% prilocaine with 1:200,000 epinephrine (citanest forte), 2% mepivacaine with 1:20,000 levonordefrin (carbocaine with neo-cobefrin), and 4% articaine with 1:100,000 epinephrine (septocaine, articadent, zorcaine)
					0.5% bupivacaine with epinephrine (marcaine)
				Extending the duration of pulpal anesthesia for maxillary teeth
				Alternative maxillary injection techniques
				Management of anesthesia in endodontic cases
				Summary and future directions for effective anesthesia
			Analgesics and therapeutic recommendations
				Nonnarcotic analgesics
					Limitations and drug interactions
					Acetaminophen
				Opioid analgesics
				Corticosteroids
					Intracanal administration
					Systemic administration
				Antibiotics
				Pain management strategies
					Pretreatment
					Long-acting local anesthetics
					Flexible plan
				Future directions
				Summary
			References
		7 Tooth morphology and pulpal access cavities
			Components of the pulp cavity
			Root canal anatomy
				Clinical determination of the root canal configuration
					Coronal considerations
					Midroot considerations
					Apical considerations
			Objectives and guidelines for traditional access cavity preparation
				Objectives
			Key steps to consider in traditional access preparation
				Evaluation of the cementoenamel junction and occlusal tooth anatomy
				Preparation of the access cavity through the lingual and occlusal surfaces
				Removal of all defective restorations and caries before entry into the pulp chamber
				Preparation of access cavity walls that do not restrict straight- or direct-line passage of instruments to the apical foramen or initial canal curvature
			Objectives and guidelines for minimally invasive access cavity preparation
			Mechanical phases of access cavity preparation
				Magnification and illumination
				Burs
				Endodontic explorer and spoon
				Ultrasonic unit and tips
			Access cavity preparations
				Anterior teeth
					External outline form
					Penetration of the pulp chamber roof (fig. 7.26)
					Removal of the chamber roof
					Removal of the lingual shoulder and coronal flaring of the orifice
					Straight-line access determination
					Refinement and smoothing of restorative margins
					Individual anterior teeth
				Posterior teeth
					External outline form
					Penetration of the pulp chamber roof
					Identification of all canal orifices
					Removal of the cervical dentin bulges and orifice and coronal flaring
					Straight-line access determination
					Visual inspection of the pulp chamber floor
						Individual posterior teeth.
			Challenging access preparations
				Access in teeth with presumed calcified canals
				Crowded or rotated teeth
			Morphology of and access cavity preparations for individual teeth
				Maxillary central incisor
				Maxillary lateral incisor
				Maxillary canine
				Maxillary first premolar
				Maxillary second premolar
				Maxillary first molar
				Maxillary second molar
				Maxillary third molar
				Mandibular central and lateral incisors
				Mandibular canine
				Mandibular first premolar
				Mandibular second premolar
				Mandibular first molar
				Mandibular second molar
				Mandibular third molar
				Teeth with C-shaped root canal systems
			References
		8 Cleaning and shaping of the root canal system
			Introduction
			Principles of cleaning and shaping
				Mechanical objective
				Biologic objective
				Technical objective
				Clinical issues
			Endodontic instruments
				General characteristics
					Design elements
						Tip design.
						Longitudinal and cross-sectional design.
						Taper.
					International standards organization norms
					Alloys
						Physical and chemical properties of steel and nickel titanium alloys.
				Manually operated instruments
					K-type instruments
					H-type instruments
						Effectiveness and wear of instruments.
					Barbed broaches
				Low-speed engine-driven instruments
					Burs
					Gates-glidden drills
					Peeso reamers and similar drills
				Engine-driven instruments for canal preparation
					Instrument types
						Group I: Passive preparation; presence of radial lands.
							Lightspeed.
							Profile.
							GT and GTX files.
							K3.
						Summary.
						Group II: Active cutting; triangular cross section.
							Protaper universal, gold.
							Hero 642, hero shaper.
							Race, biorace, BT race.
							Endosequence.
							Twisted file.
							Profile vortex.
							MTWO.
							Edge files.
							Summary.
						Group III, atypical instruments
							Waveone, reciproc, gold, blue.
							Self-adjusting file.
							Trushape.
							XP-shaper, XP-finisher.
							Sonic and ultrasonic shaping instruments.
							Summary.
					Motors
			Steps of cleaning and shaping
				Access—principles
				Coronal modification
				Patency and glide path preparation
				Working length determination
					Devices
					Strategies
				Canal enlargement/preparation
					Rationale
					Techniques
						Standardized technique.
						Step-back technique.
						Step-down technique.
						Crown-down technique.
						Balanced force technique.
						Rotary instrumentation.
					Specific nickel titanium (NITI) instrumentation techniques
						Crown-down.
						Single length.
						Hybrid techniques.
				Final apical enlargement
			Disinfection of the root canal system
				Hydrodynamics of irrigation
				Irrigants
					Sodium hypochlorite
						History.
						Mode of action.
						Allergic reactions to sodium hypochlorite.
						Temperature.
						Concentration.
						Time.
						Toxicity.
					Chlorhexidine
						History.
						Molecular structure.
						Mode of action.
						Substantivity.
						Cytotoxicity.
						Chlorhexidine as an endodontic irrigant.
						Interaction between CHX, NaOCL, and EDTA.
						Allergic reactions to chlorhexidine.
						Decalcifying agents.
					Ethylenediaminetetraacetic acid
						History.
						Mode of action.
						Applications in endodontics.
						Interaction of EDTA and NaOCL.
					HBPT and other phosphate bases tensides
						Combination irrigants.
						Biopure MTAD and tetraclean.
						Mode of action.
						Smear layer removal.
						Antibacterial efficacy.
						Clinical trials.
						Protocol for use.
					Combinations of irrigants
						Protocol.
						Smear layer removal.
						Antibacterial efficacy and effect on biofilms.
						Clinical trials.
						Iodine potassium iodide.
				Intracanal medication
					Calcium hydroxide
						Other uses of Ca(OH)₂.
						Clinical protocol.
						Limitations of calcium hydroxide.
					Chlorhexidine
						Chlorhexidine mixed with calcium hydroxide.
					Phenolic preparations
					Formaldehyde
					Halogens
					Steroids
					Triple-antibiotic paste
					Lubricants
				Disinfection devices and techniques
					Syringe delivery
					Manually activated irrigation
					Sonically activated irrigation
					Ultrasonic-assisted irrigation
					Negative apical pressure irrigation
					Safety-irrigator
					Gentlewave system
					Laser-activated irrigation
					Photoactivated disinfection
					Antibacterial nanoparticles
						Healozone.
						Water preparations.
			Criteria to evaluate cleaning and shaping⁴
				Well-shaped canals
				Signs of mishaps
					Instrument fracture
					Canal transportation
					Perforation
					Blockage
			Sample protocol for contemporary cleaning and shaping procedures
			Summary
			References
		9 Obturation of the cleaned and shaped root canal system
			Importance of effectively sealing the root canal system
			Historical perspectives
			Timing of obturation
				Vital pulp tissue
				Necrotic pulp tissue
			Length of obturation
			Preparation for obturation
			The ideal root canal obturation materials
			Types of sealers
				Zinc oxide and eugenol
				Calcium hydroxide sealers
				Noneugenol sealers
				Glass ionomer sealers
				Resin sealers
					Epoxy resin sealers
					Methacrylate resin sealers
				Silicone sealers
				Tri/dicalcium silicate sealers
				Medicated sealers
			Sealer placement
			Core materials
				Silver cones
				Gutta-percha
				Activ GP
				Custom cones
			Methods of obturation
				Lateral compaction
				Warm vertical compaction
				Continuous wave compaction technique
				Thermoplastic injection techniques
					Obtura III
					Ultrafil 3D
					Calamus
					Elements
					Hotshot
				Carrier-based gutta-percha
					Thermafil, profile GT obturators, GT series X obturators, and protaper universal obturators
					Successfil
					Simplifill
				Thermomechanical compaction
				Solvent techniques
				Pastes
				Immediate obturation
			Coronal orifice seal
			Future technology and nanodiamond-embedded gutta-percha
			References
		10 Nonsurgical retreatment
			Etiology of posttreatment disease
			Diagnosis of posttreatment disease
			Treatment planning
			Nonsurgical endodontic retreatment
				Coronal access cavity preparation
				Post removal
					Post removal techniques
					Potential complications of post removal
				Regaining access to the apical area
					Gutta-percha removal
					Managing solid core obturators
					Paste retreatment
					Silver point removal
				Removal of separated instruments
					Causes of instrument separation
					Prognosis
					Removal techniques
				Heat generation during retreatment procedures
				Management of canal impediments
				Finishing the retreatment
			Repair of perforations
			Prognosis of retreatment
			Conclusion
			References
		11 Periradicular surgery
			Indications for periradicular surgery
				Etiology of persistent periradicular disease
				Rationale for surgical treatment
				Clinical decision making
			General biologic principles of wound healing
			Soft-tissue wound healing
				Inflammatory phase
					Clot formation
					Early inflammation: Polymorphonuclear neutrophil organization
					Late inflammation: Macrophage organization
				Proliferative phase
					Fibroblasts: Fibroplasia
					Endothelial cells: Angiogenesis
					Epithelium
				Maturation phase
			Hard-tissue healing: Excisional dentoalveolar wound
				Osteoblasts: Osteogenesis
				Cementoblasts: Cementogenesis
			Systemic medications and wound healing
				Bisphosphonates
				Glucocorticoids
				Nonsteroidal antiinflammatory drugs
				Cyclooxygenase-2 inhibitors
			Preoperative evaluation of medically complex patients
			Anatomic considerations
				Posterior mandible
				Posterior maxilla
				Anterior maxilla and mandible
			Cone-beam computed tomography
				Differences between computed tomography and cone-beam computed tomography imaging
				Potential applications of cone-beam computed tomography in the management of endodontic posttreatment disease
			Patient preparation for surgery
				Informed-consent issues specific to surgery
				Premedication: Nonsteroidal antiinflammatory drugs, antibiotics, chlorhexidine, and conscious sedation
			Instruments and operatory setup
			Local anesthesia for surgery
			Surgical access
				Soft-tissue access
				Vertical incision
				Horizontal incision
				Flap design
				Tissue reflection
				Tissue retraction
				Hard-tissue access
			Periradicular curettage and biopsy
			Localized hemostasis
				Preoperative considerations
				Local hemostatic agents
					Collagen-based materials
					Surgicel
					Gelfoam
					Bone wax
					Ferric sulfate
					Calcium sulfate
					Epinephrine pellets
				Cautery/electrosurgery
			Management of the root end
				Determination of the need for root-end resection and filling
				Root-end resection
				Angle of resection
				Root-end surface preparation
				Resected root-end surface topography
				Root-end conditioning
			Root-end cavity preparation
				Ultrasonic root-end preparation and apical fractures
				Significance of ultrasonic tip design
				Temperature changes induced by ultrasonic instruments
				Bonded root-end fillings
			Root-end filling materials
				Zinc oxide–eugenol cements
					Intermediate restorative material
					Super-EBA
				Glass-ionomer cements
				Diaket
				Composite resins and resin-ionomer hybrids
					Retroplast
					Resin-ionomer suspension (geristore) and compomer (dyract)
				Mineral trioxide aggregate
				Bioceramics
				Overview of root-end filling materials
			Closure of the surgical site and selection of suture material
				Closure of the surgical site
				Selection of the suture material
			Guided tissue regeneration and endodontic surgery
				Ridge preservation
			Intentional replantation
			Postoperative care
			Management of surgical complications
			Summary
			References
		12 Regenerative endodontics
			Overview of regenerative dentistry
				Overview of regenerative endodontics
			Preclinical studies on regenerative endodontics
				Stem cells
				Growth factors/morphogens
					Morphogens
				Scaffolds
				Delivery system
				Translational studies
				Summary of basic research on regenerative endodontics
			Clinical studies on regenerative endodontics
				Clinical procedures related to regenerative endodontics
				Overview of clinical regenerative endodontic procedures
				Example of a revascularization protocol
				Clinical measures of treatment outcomes
					Patient-centered outcomes
					Clinician-centered outcomes
					Scientist-based outcomes: Regeneration or repair?
			Summary
			References
	Part II ADVANCED SCIENCE TOPICS
		13 Structure and functions of the dentin-pulp complex
			Morphologic zones of the pulp
				The pulp-dentin complex
				Odontoblast layer
				Cell-poor zone
				Cell-rich zone
				Pulp proper
			Cells of the pulp
				Odontoblast
				Odontoblast process
				Relationship of odontoblast structure to secretory function
				Pulp fibroblast
				Macrophage
				Dendritic cell
				Lymphocyte
				Mast cell
			Metabolism
			The pulpal interstitium and ground substance
				Hyaluronan
				Elastic fibers
				The inflamed interstitium
			Connective tissue fibers of the pulp
			The trigeminal system
				Innervation
				Steps and mechanisms in pain perception
				Detection: The first step in pain perception
			Neuropeptides
				Pulp testing
				Sensitivity of dentin
				Peripheral sensitization
				Hyperalgesia and allodynia
				Inflammatory mediators
				Painful pulpitis
				Plasticity of intradental nerve fibers
				Tissue injury and deafferentation
				Processing: The second step in pain perception
					The medullary dorsal horn
					Components of the medullary dorsal horn
					Central sensitization
				Perception: Thalamus to cortex
			Vascular supply
				Regulation of pulpal blood flow
					Local control of blood flow
					Humoral control of blood flow
				Fluid drainage
					Transcapillary fluid exchange
				Circulation in the inflamed pulp
					Vascular permeability
					Clinical aspects
			Pulpal repair
			Pulpal calcifications
			Age changes
			References
		14 Pulp reactions to caries and dental procedures
			Pulp reaction to caries
			Neurogenic mediators
			Correlation between clinical symptoms and actual pulp inflammation
			Dentin hypersensitivity and its management
			Pulp reactions to local anesthetics
			Pulp reactions to restorative procedures
				The degree of inflammation of the pulp preoperatively
				The amount of physical irritation caused by the procedure
					Heat
					Desiccation
					Biological and chemical irritation
				The proximity of the restorative procedures to the dental pulp and the surface area of dentin exposed
				The permeability of dentin and the odontoblastic layer between the area being restored and the pulp
				The age of the patient
			Pulp reactions to restorative materials
			Direct pulp capping with bioceramics
			The use of hemostatic agents and disinfectants on direct pulp exposures
			Pulp reactions to laser procedures
				Lasers in the prevention, diagnosis, and treatment of caries
				Lasers in the treatment of dentin hypersensitivity
			Pulp reactions to vital bleaching techniques
			Pulp reactions to periodontal procedures
			Mechanical irritants: Orthodontic movement
			Pulp reactions to orthodontic surgery
			Biomechanical irritation: Parafunctional habits
			Pulp reactions to implant placement and function
			References
		15 Microbiology of endodontic infections
			Apical periodontitis as an infectious disease
			Routes of root canal infection
			Mechanisms of microbial pathogenicity and virulence factors
			Spatial distribution of the endodontic microbiota
			Biofilm and community-based microbial pathogenesis
				Biofilm and bacterial interactions
				Biofilm resistance to antimicrobial agents
			Apical periodontitis as a biofilm-related disease
			Methods for microbial identification
				The five generations of endodontic microbiology studies
				Impact of molecular methods in endodontic microbiology
			Types of endodontic infections
			Diversity of the endodontic microbiota
			Primary intraradicular infection
				Microbial diversity
				Symptomatic infections
				Geographic influence
				Microbial ecology and the root canal ecosystem
				Other microorganisms in endodontic infections
					Fungi
					Archaea
					Viruses
			Persistent/secondary endodontic infections
				Persistent/secondary infections and treatment failure
				Bacteria at the root canal obturation stage
				Microbiota in root canal–treated teeth
			Extraradicular infections
			References
		16 Pathobiology of apical periodontitis
			Apical periodontitis
				Prevalence
			Etiology
			Infection: A conflict between host and parasites
			Pathogenesis
				Innate immune response
					Specificity of innate immune response
					Nonspecific innate immune response
				Adaptive/specific immune response
				Neurogenic inflammation
			Diagnosis
				Correlation between clinical and histologic findings
				Correlation between radiographic and histologic findings
			Histopathology
			Acute apical periodontitis
				Cell biology
					Mast cells
					Endothelial cells
					Polymorphonuclear neutrophilic leukocytes
					Macrophages
					Platelets
					Natural killer cells
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis
				Cell biology
					Macrophages and lymphocytes
					Dendritic cells
					Osteoclasts
					Epithelial cell rests of malassez
					Fibroblasts
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis with cyst formation
				Cell biology
				Inflammatory mediators
				Histopathology
				Clinical features
				Outcomes
			Chronic apical periodontitis with reactive bone formation: Focal condensing osteitis
				Cell biology
				Histopathology
				Clinical features
				Outcomes
			Periapical lesions of nonendodontic origin
			Extraradicular endodontic infection
			Apical periodontitis and systemic diseases
			Genetic and systemic disease risk factors of persistent apical periodontitis
				Genetic risk factors
				Systemic disease risk factors
			Wound healing of apical periodontitis
				Periapical wound healing after nonsurgical root canal therapy
				Periapical wound healing after surgical endodontic therapy
				Can radicular cysts in apical periodontitis lesions regress after nonsurgical endodontic therapy?
			Factors influencing periapical wound healing after endodontic therapy
			References
	Part III ADVANCED CLINICAL TOPICS
		17 Evaluation of outcomes
			Context of evaluating endodontic outcomes
				Types of disease and their treatment
			What are surrogate outcome measures?
				Types of outcome measures
			What is the purpose of evaluating outcomes?
				Effectiveness of procedures
				Factors affecting outcomes
				Value for prognostication
			Outcome measures for endodontic treatment
				Outcome measures for vital pulp therapy procedures
				Outcome measures for nonsurgical root canal treatment and retreatment
				Outcome measures for periapical surgery
			Outcomes of vital pulp therapy procedures
				Indirect pulp capping (one-step versus stepwise excavation)
				Direct pulp capping
				Pulpotomy
				Summary of prognostic factors for vital pulp therapy
			Outcomes of nonsurgical root canal treatment
				Factors affecting periapical health or healing following root canal treatment
					Patient factors
					Treatment factors
						Operator.
						Isolation.
						Magnification and illumination.
						Mechanical preparation: Size, taper, extent, and procedural errors.
						Irrigant.
						Medicament.
						Root canal bacterial culture results prior to obturation.
						Effect of persistent bacteria on root canal treatment outcome.
						Root filling material and technique.
						Apical extent of root filling.
						Quality of root filling.
						Acute exacerbation during treatment.
						Number of treatment visits.
					Post root canal treatment restorative factors
						Effect of quality and type of restoration.
						Use of root treated teeth as abutments for prostheses and occlusal contacts.
					Summary of factors influencing periapical healing following nonsurgical root canal treatment
				Factors affecting tooth survival following root canal treatment
					Patient factors
					Tooth morphologic type and location
					Preoperative conditions of teeth
					Treatment factors
					Restorative factors
					Summary of factors influencing the survival of teeth following root canal treatment
				Impact of root canal treatment on quality of life
			Outcome of nonsurgical retreatment
			Outcome of surgical retreatment
				Factors affecting periapical health or healing following periapical surgery and root-end filling
				Factors affecting periodontal incisional wound healing
				Factors affecting tooth survival following periapical surgery and root-end filling
				Impact of periapical surgery on quality of life
			Concluding remarks
			References
			Figure and Table References
		18 Root resorption
			General histologic features
			External inflammatory resorption
				Introduction
				Etiology and pathogenesis of external inflammatory resorption
				Histologic appearance
				Clinical features
				Radiographic features
				Management
				Follow-up and prognosis of external inflammatory resorption
			External cervical resorption
				Introduction
				Etiology and pathogenesis
				Histologic appearance
				Clinical features
				Radiographic features
				Management
			Internal root resorption
				Introduction
				Etiology and pathogenesis of internal root resorption
				Histologic appearance
				Clinical features
				Radiographic features and diagnosis
				Management
				Chemomechanical debridement of the root canal
				Obturation
			Summary
			References
		19 Management of endodontic emergencies
			Emergency classifications
			Emergency endodontic management
				Teeth with vital pulps
				Reversible pulpitis
				Irreversible pulpitis
				Pulpal necrosis with symptomatic apical periodontitis
					Trephination
					Necrosis and single-visit endodontics
				Pulpal necrosis with acute apical abscess
					Swelling
			Fascial space infections
			Management of abscesses and cellulitis
			Incision for drainage
			Symptomatic teeth with previous endodontic treatment
			Leaving teeth open
			Systemic antibiotics for endodontic infections
			Analgesics
			Laboratory diagnostic adjuncts
			Flare-ups
			Cracked and fractured teeth
			Summary
			References
		20 Managing iatrogenic events
			Sodium hypochlorite
			Instrument separation
				Causes of instrument separation
				Management of separated instruments
				Conditions for separated instrument removal attempts
				Root canal preparation techniques
					Root canal preparation for visible instrument retrieval
					Root canal preparation for nonvisible instrument retrieval
				Instrument retrieval techniques
					Use of ultrasonic oscillation
					Use of the loop
				Prognosis
			Ledge formation
				Causes of ledge formation
				Management of ledge formation
				Bypassing a ledge
					Using hand instruments
					Using ultrasonic tips
					Using rotary instruments
				Potential complications of removal or bypassing a ledge
				Prevention of ledge formation
				Prognosis
			Radicular extrusion of root canal filling materials
				Causes of extrusion of obturation materials beyond the radicular foramen
				Management of obturation materials extruded beyond the radicular foramen
					Nonsurgical management of extrusion of obturation materials
				Management of tissue damage caused by extrusion of root canal filling materials
			Sinus perforation
			Inferior alveolar nerve injury
				Risk assessment for the prevention of endodontic nerve injury
				Operative techniques to minimize nerve injuries
				Management of nerve injuries
			Assessment
				Immediate intervention
				Early intervention
				Watch and wait?
			Cervicofacial subcutaneous emphysema
			References
		21 The role of endodontics after dental traumatic injuries
			Unique aspects of dental trauma
			Most common types of dental trauma
				Crown fractures
				Crown-root fractures
				Root fractures
				Luxation injuries and avulsion
			Follow-up after dental trauma
			Radiographic examinations
				Cone-beam computed tomography and dentoalveolar trauma
				Root resorption
				Horizontal (transverse) root fractures
				Luxation injuries
			Crown fractures
				Crown infraction
					Biologic consequences
				Uncomplicated crown fracture
					Incidence
					Biologic consequences
				Treatment
				Complicated crown fracture
					Incidence
					Biologic consequences
				Treatment
					Stage of development of the tooth
					Time between trauma and treatment
					Concomitant attachment damage
					Restorative treatment plan
				Vital pulp therapy: Requirements for success
				Treatment methods
					Pulp capping
						Indications.
					Partial pulpotomy
						Indications.
						Technique.
						Follow-up.
						Prognosis.
					Full pulpotomy
						Indications.
						Technique.
						Follow-up.
						Prognosis.
					Pulpectomy
						Indications.
				Treatment of the nonvital pulp
					Immature tooth: Apexification
						Indications.
						Biologic consequences.
						Technique
							Disinfection of the canal.
						Hard-tissue apical barrier
							Traditional method.
						Bioceramic barrier.
							Filling the root canal.
							Reinforcement of thin dentinal walls.
							Follow-up.
							Prognosis.
							Pulp revascularization/regenerative endodontic treatment.
					Mature tooth
			Crown-root fracture
			Root fracture
				Diagnosis and clinical presentation
				Treatment
				Healing patterns
				Treatment of complications
					Coronal root fractures
					Midroot and apical root fractures
					Follow-up
					Prognosis
			Luxation injuries
				Definitions
				Incidence
				Treatment
				Biologic consequences
					External root resorption
						Caused by an injury (alone) to the external root surface.
							Localized injury: Healing with cementum.
							Diffuse injury: Healing by replacement resorption.
							Treatment.
						Caused by an injury to the external root surface and inflammatory stimulus in the root canal.
						Consequences of apical neurovascular supply damage
							Pulp canal obliteration (calcification).
							Pulp necrosis.
							Pulp space infection.
							Treatment.
					Internal root resorption
						Etiology.
						Clinical manifestations.
						Radiographic appearance.
						Histologic appearance.
						Treatment.
					Diagnostic features of external versus internal root resorption
						Radiographic features.
						Vitality testing.
						Pink spot.
						Transient apical breakdown.
					Summary of possible diagnostic features
			Clinical management of the avulsed tooth
				Consequences of tooth avulsion
				Treatment objectives
				Clinical management
					Emergency treatment at the accident site
					Management in the dental office
						Emergency visit.
				Diagnosis and treatment planning
			Preparation of the root
				Extraoral dry time less than 60 minutes
					Closed apex
					Open apex
				Extraoral dry time more than 60 minutes
					Closed apex
					Open apex
			Preparation of the socket
			Splinting
			Management of the soft tissues
			Adjunctive therapy
				Second visit
			Endodontic treatment
				Extraoral time less than 60 minutes
					Closed apex
					Open apex
				Extraoral time more than 60 minutes
					Closed apex
					Open apex (if replanted)
			Temporary restoration
				Root filling visit
			Permanent restoration
				Follow-up care
					Late complications
					Dentoalveolar trauma to the primary dentition
			References
		22 Chronic cracks and fractures
			Impact trauma
			Diagnostic challenge
			Fracture mechanics
			Cracked and fractured cusps
				Definition
				Diagnosis
					Patient history
					Clinical manifestation
						Early manifestation.
						Late manifestation.
					Diagnosis
				Etiology
				Treatment planning
					Cracked cusp
					Fractured cusp
			Cracked and split teeth
				Definition
				Diagnosis
					Patient history
					Clinical manifestation
						Early manifestation.
						Late manifestation.
					Diagnosis
				Etiology
				Treatment planning
					Cracked tooth
					Split tooth
			Vertical root fracture
				Definition
				Diagnosis
					Patient history
					Clinical manifestations
						Susceptible teeth and vertical root fracture location.
						Early manifestation.
						Late manifestation.
					Diagnosis
						Importance of early diagnosis.
						Misdiagnosis of vertical root fractures.
						Vertical root fracture pockets.
						Coronally located sinus tract.
						Radiographic features.
						Osseous radiolucency adjacent to the root.
						Radiograph of empty canal.
						Cone-beam computed tomography in vertical root fracture diagnosis.
						Exploratory surgery.
				Etiology
					Natural predisposing factors
						Shape of root cross section.
						Occlusal factors.
						Preexisting microcracks.
					Iatrogenic predisposing factors
						Root canal treatment.
						Excessive root canal preparation.
						Microcracks caused by rotary instrumentation.
						Uneven thickness of remaining dentin.
						Methods of obturation.
						Type of spreader used.
						Post design.
						Crown design.
			Treatment planning
			Summary
			References
		23 Restoration of the endodontically treated tooth
			Special features of endodontically treated teeth
				Compositional changes in nonvital teeth and the influence of endodontic therapy
				Dentin structure and properties in nonvital and endodontically treated teeth
				Fracture resistance and tooth stiffness of nonvital and endodontically treated teeth
				Aesthetic changes in nonvital and endodontically treated teeth
			Restorative materials and options
				Direct composite restorations
				Indirect restorations: Composite or ceramic onlays and overlays
				Full crowns
					The foundation restoration: General considerations
					Why roots fracture
					Direct foundation restorations
						Posts.
							Prefabricated metallic posts.
							Fiber posts.
						Core materials.
							Composite resin core.
							Amalgam core.
							Glass ionomer core and modified glass ionomer core.
					Indirect foundation restorations: Cast post and core
				Luting cements
					Traditional cements
					Glass ionomer luting cements
					Resin-based luting cements
					Self-adhesive cements
			Pretreatment evaluation and treatment strategy
				Pretreatment evaluation
					Endodontic evaluation
					Periodontal evaluation
					Biomechanical evaluation
					Tooth position, occlusal forces, and parafunctions
					Aesthetic evaluation and requirements
				Treatment strategy
					General principles and guidelines
					Structurally sound anterior teeth
					Nonvital posterior teeth with minimal/reduced tissue loss
					Structurally compromised teeth
					Structurally compromised anterior teeth
					Structurally compromised posterior teeth
					Additional procedures
			Clinical procedures
				Tooth preparation
				Post placement
				Adhesive procedures
				Partial restorations
				Foundation restoration underneath full crowns
					Amalgam core
					Cast gold post and core
						Direct technique.
						Indirect technique.
				Crown preparation and temporary restoration
			Summary
			References
		24 Vital pulp therapy
			The living pulp
			Loss of pulp vitality
			Pulpal response to cariesª
			Dentin regeneration and reparative tissue formation
				Tertiary dentin formation
				Mineralized tissue formation after loss of the primary odontoblasts
			Indications for vital pulp therapy
			Procedures generating mineralized tissue barriers
				Indirect pulp capping
				Direct pulp capping
				Partial pulpotomy
				Complete pulpotomy
			Materials for vital pulp therapy
				Aqueous calcium hydroxide suspensions
				Hard setting calcium hydroxide cements
				Light-curing liners and cements
				Composite resins, dentin adhesives, and resin-modified glass ionomer cements
				Mineral trioxide aggregate
				Calcium silicate cements
			Calcium silicate cement applications in vital pulp therapy
				Direct pulp capping with calcium silicate cements
				Pulpotomy with calcium silicate cements
			Vital pulp therapy techniques
				Diagnosis
				Caries removal
				Hemostatic agents
				Treatment considerations
			Treatment recommendations†
				Pulp capping and pulpotomy
			The permanent restoration
			Postoperative follow-up and recall
			Acknowledgment
			References
		25 Endo-perio
			Intercommunication between pulpal and periodontal tissue
			Influence of pulpal pathologic condition on the periodontium
			Influence of periodontal inflammation on the pulp
			Theoretic pathways of osseous lesion formation
				Primary endodontic lesions
				Primary endodontic lesions with secondary periodontal involvement
				Primary periodontal lesions
				Primary periodontal lesions with secondary endodontic involvement
				True combined lesions
				Concomitant pulpal and periodontal lesions
			Differential diagnosis
				Lateral periodontal cysts
			Treatment alternatives
				Forced eruption or extrusion
			Summary
			References
	Part IV ONLINE CONTENT
		26 Bleaching procedures
			Etiology of tooth discolorations
				Systemic intrinsic causes
					Genetic causes
					Disease-related causes
					Metabolic causes
					Drug-related causes
				Local intrinsic causes
					Pulpal hemorrhage
					Pulp necrosis
					Pulp tissue remnants
					Restorative materials
					Intracanal medicaments and root filling materials
					Dental caries
					Calcific metamorphosis/dystrophic calcification
					Root resorption
					Aging
				Extrinsic causes
			Treatment planning for internal bleaching
			Contraindications of bleaching
			Alternatives to bleaching
			Chemistry of bleaching
				Walking bleach technique
					Walking bleach clinical protocol
				Thermocatalytic bleaching
			Definitive restoration of teeth following internal bleaching
			External bleaching
				In-office external bleaching
				Power bleaching
					Power bleaching clinical protocol
				At-home external bleaching
			Risks and complications associated with tooth bleaching
				Risks associated with internal tooth bleaching
					Cervical root resorption
					Enamel and dentin damage
					Inhibition of adhesive bonding
				Risks associated with external tooth bleaching
					Tooth sensitivity
					Gingival irritation
					Mercury release from amalgam restorations
				Prognosis of bleaching
			References
		27 Endodontic records and legal responsibilities
			Endodontic record excellence
				Importance
					Content
					Office records
					Function
				Patient information form
				Medical health history
				Dental history
				Diagnostic and progress records
				Electronic records
				Radiographs
				Evaluation and differential diagnosis
				Diagnostic tests
				Treatment plan
					Examination
					Diagnosis
					Patient consultation
					Treatment
				Informed consent form
				Treatment record: Endodontic chart
					General patient data
					Dental history
					Medical history
					Periodontal disease
					Periodontal examination
					Drug history
				Preoperative and postoperative radiographs
				Digital radiography
				Radiation safety
			Endodontics and heart disease
				Abbreviations
				Computerized treatment records
				Health information technology for economic and clinical health act pitfalls
				Health insurance portability and accountability act
				Record size
				Identity of entry author
				Patient record request
				Patient education materials
				Postoperative instructions
				Recording referrals
				Dental fees related to quality care
				Record correction
				Spoliation
				False claims
			Legal responsibilities
				Malpractice claims
				Incidence of negligence
				Malpractice prophylaxis: Importance of records
				Standard of care
				Standards of care: Generalist versus endodontist
				Ethical guidelines
					Standard of care for endodontics
				Ordinary care equals prudent care
				Customary practice versus negligence
					Health maintenance organization care versus standard of care
				Employment law
				Dental negligence defined
				Locality rule
				Continuing education
				Evidence-based endodontics
				Holistic dentistry
				Ozone therapy
				New products
				U.S. food and drug administration approval
				U.S. food and drug administration’s drug approval
				U.S. food and drug administration clearance
				Adverse drug events
					Primary medication nonadherence: Unfilled prescriptions
				U.S. food and drug administration medwatch
				Compounding pharmacies
				Dietary supplements
				Negligence per SE
				Prescription drugs
				Ability to foresee unreasonable risk
				Consent
					Informed consent principles
					Informed consent
					Informed consent application
					Endodontic informed consent
						Video-informed consent.
				Alternative technique choices
				Referrals to other specialists
				Surgical versus nonsurgical endodontics
				Microscopic endodontics
					Microscope
						Magnification.
				Separated instruments
				Equipment and supplies
				Waterlines
				Pulpotomy
				Clinician’s liability for staff’s acts or omissions
				Abandonment
				Expert testimony
				National practitioner data bank
			Malpractice incidents
				What to do if you are sued
				Screw posts
				Paresthesia prevention
				Overfills
					Sealant overfills
				Treatment failure
				Full disclosure
				Slips of the drill
				Fear factor
				Pain management
				Leakage
				Implant risk factors
					Fluoride for caries prevention
				Reasonable versus unreasonable errors in judgment
					Incorrect tooth treatment
					Post retrieval
					Broken files
					Swallowing or aspirating an endodontic instrument
					Overextensions and overfills
					Compartment syndrome
					Periradicular surgery
					Avoiding the inferior alveolar nerve canal
					Mental nerve injuries
					Local anesthesia: Septocaine
					Implant versus endodontics
					Current use of silver points
					N2 (sargenti paste)
					Defective restorations
					Restoration marginal integrity
				Malpractice prophylaxis
				Allergies
				One-visit versus two-visit endodontics
				Disclosure errors
				Temporomandibular disorders
				Patient rapport
					Rapport building blocks
					Telephone communications
				Post perforation
				Perforation prevention
				Bleach injury
				Esthetic bleaching
				Cores
				Absorbable hemostatic agents causing neuropathy
				Pneumomediastinum (air embolus)
				Broken needle
				Sterilization
				Medication errors
				Posttrauma therapy
				Millennium management of endodontic advances
				Statistical research
				Other clinicians’ substandard treatment
				Peer review
				Human immunodeficiency virus and endodontics
			Summary
			References
			Suggested readings
		28 Key principles of endodontic practice management
			Endodontic management systems
				Systems design
			Management
				Vision
					Short vision statement
					Long vision statement
				Mission
				Goal setting
				Target setting
				Key production indicators
				Staff training and development
				Scheduling
					Schedule for production
					Set the daily production target
					Perform procedural time studies
					Create the ideal day
					Manage emergencies
				Customer service
			Marketing
				Endodontic marketing
				Endodontic referral marketing
				Social media
				Transitions
			Leadership
				The endodontic leader
					Interpersonal communication
					Decision making
					Motivation
					Pursuit of knowledge
					Teamwork
					Time management
					Leading by example
			Summary
	Index
		A
		B
		C
		D
		E
		F
		G
		H
		I
		J
		K
		L
		M
		N
		O
		P
		Q
		R
		S
		T
		U
		V
		W
		X
		Y
		Z