Endodontic Therapy

Cover
Copyright
Contents
Contributors
Preface
	*ABOUT THE COVER
CHAPTER 1 Basis for Successful Endodontics
	HISTORY OF ENDODONTICS
		Effect of Hunter's Address
		Early Use of X Rays
		Reacceptance of Endodontics
	PRINCIPLES OF ENDODONTIC THERAPY
		Objective
		Basic Phases of Therapy
			Figure 1-1
		Importance of Debridement
		Use of the Rubber Dam Mandatory
		Great Respect Due the Periapical Tissue During Treatment
			Figure 1-2
		Proper Restoration the Culmination of Success
		Postoperative Observation Necessary
		Case Presentation to Set the Stage
			Figure 1-3
			Figure 1-4
	INDICATIONS AND CONTRAINDICATIONS
		Contraindications
			Patient Unable to Afford Fee.
			Inability of the Dentist.
			Insufficient Periodontal Support.
			Canal Instrumentation Not Practical.
			Nonrestorable Tooth.
				Figure 1-5 Severe furcation caries in mandibular first molar and root caries in second bicuspid necessitated extractions.
			Massive Resorption.
			Nonstrategic Tooth.
			Vertical Fractures.
				Figure 1-6
		Indications
	PROGNOSIS FOR ENDODONTIC THERAPY
		Studies Dealing with Success Ratios
			Figure 1-7
		Prognosis for Older Patients
		Significance of Large or Long-standing Radiolucencies
		Significance of Large, Rapidly Growing Radiolucencies
		Significance of Periodontal Disease
		Reaching the Apex
			Figure 1-8
			Figure 1-9
			Figure 1-10
		Re-treatment of Failures
			Figure 1-11
			Figure 1-12
			Figure 1-13
	ROLE OF ENDODONTICS IN RESTORATIVE DENTISTRY
		Saving the Irreplaceable Tooth
			Figure 1-14
			Figure 1-15
		Retaining the Posterior Bridge Abutment
			Figure 1-16
		Preserving Enough Remaining Teeth for Use with a Fixed Partial Denture
			Figure 1-17
		Lessening the Length of Bridge Span
		Improving Esthetic Results in an Arch with Diastemas and Involved Anterior Teeth
			Figure 1-18
		Avoiding Use of Lower Anterior Teeth as Abutments
		Limiting the Extent of the Problem
			Figure 1-19
			Figure 1-20
		Retaining Involved Teeth with Large Restorations
		Avoiding Loss of Bridge and Abutments
		Facilitating Restoration After Fracture of a Tooth with Insufficient Supragingival Structure for a Crown
			Figure 1-21
	ROLE OF ENDODONTICS IN RECONSTRUCTIVE DENTISTRY
		Preserving Teeth After Reshaping of Crown Contours
		Accommodating an Attachment, or Key and Keyway
		Anticipating the Possibility of Future Pulpal Damage
		Utilizing Bicuspidized and Amputated Teeth
	ROLE OF ENDODONTICS IN PROSTHETIC DENTISTRY
		Limiting the Number of Teeth in the Removable Partial Denture
		Allowing for Retention of Teeth with Greater Bulk as Abutments
		Avoiding Free-End Saddles
		Providing for Splinted Multiple Abutments
			Figure 1-22
		Accommodating an Attachment, or Key and Keyway
		Retaining Alveolar Bone
		Avoiding a Full Denture
			Figure 1-23
	BIBLIOGRAPHY
CHAPTER 2 Diagnosis and Treatment Planning
	IMPORTANCE OF A MEDICAL HISTORY
		Rheumatic Fever
		Artificial Heart Valves
		Coronary Artery Disease
		Hypertension
			Figure 2-1
		Diabetes
		Hepatitis
		Blood Diseases
			Figure 2-2
		Prostheses for Total Replacement of Joints
		Other Serious Diseases
		HIV, Syphilis, and Other Sexually Transmitted Diseases
		Recent Change in Weight
		Psychologic Problems
		Drug and Medication Therapy
	DENTAL HISTORY
		Figure 2-3
	RADIOGRAPHS—THE MOST IMPORTANT DIAGNOSTIC AID
		Film Holder
			Figure 2-4
		Types of Intraoral Views to Take for Endodontic Therapy
			Figure 2-5
			Figure 2-6
			Figure 2-7
			Figure 2-8 Mandibular first molar with sharp distal dilaceration of canal in distal root.
			Figure 2-9
			Figure 2-10
			Figure 2-11
			Figure 2-12
			Figure 2-13
			Figure 2-14
			Figure 2-15
			Figure 2-16
			Figure 2-17
			Figure 2-18
			Figure 2-19
			Figure 2-20
			Figure 2-21
			Figure 2-22
			Figure 2-23
		Radiographs for Tracing
			Figure 2-24
			Figure 2-25
		Newer Types of Radiography
	OTHER DIAGNOSTIC AIDS
		Visual and Digital Examination of Hard and Soft Tissues
			Figure 2-26
		Thermal Pulp Testing
			Figure 2-27
			Figure 2-28
			Figure 2-29 Diagnostic tests useful in endodontic evaluation include (upper left) electric pulp tester and syringe with anesthetic Carpules for selective anesthesia; (lower left to right) radiographs, glasses representing eyes for visual examination of hard and soft tissues, mouth mirror for examination of teeth and butt end for percussion test, and cotton forceps with gutta-percha for hot test.
			Figure 2-30
		Electric Pulp Testing
			Potential Deficiencies of Pulp Testers.
			Ideal Situations for Electric Pulp Testing.
			Carbon Dioxide Snow.
				Figure 2-31
		Percussion
		Test Cavity
		Selective Anesthesia
		Transillumination
	VERTICAL FRACTURES OF POSTERIOR TEETH
		Radiographic Evidence
		External Evidence
			Figure 2-32
		Fractures of Anterior Teeth
		Prognosis
			Figure 2-33
			Figure 2-34
			Figure 2-35 Occlusal amalgam was removed from mandibular first molar to trace down fracture line (arrows).
		Causes and Susceptibility of Posterior Fractures
			Figure 2-36
		Treatment
			Table 2-1 Distribution of Cracked Teeth
	ENDODONTIC THERAPY IN TOTAL TREATMENT PLANNING
		Significance of a Total Treatment Plan
		Total Treatment Plan for Complex Cases
		Timing for Endodontics in Total Patient Care
		Case Presentation
			Figure 2-37
		Typical Questions and Simple Answers
	BIBLIOGRAPHY
CHAPTER 3 Endodontic Emergency Treatment
	EFFECTS OF EMERGENCY TREATMENT
		Flare-ups Even with the Best Therapy
		Emergencies in Cases under Construction
		Method for Reaching New Patients
		Demonstration of Continued Interest in Past Patients
		Self-Satisfaction
	INITIAL THERAPY FOR "HOT" TEETH
		Table 3-1 Emergency Treatment for "Hot" Teeth
		Need for Making Diagnosis
		Types of Diagnostic Aids Needed
			Acute Pulpitis.
				Figure 3-1 Radiograph reveals large carious lesion with probable pulp exposure but no deviation from normal in periapical tissues.
				Figure 3-2
			Acute Pulpitis with Apical Periodontitis.
				Figure 3-3
				Figure 3-4
				Figure 3-5
			Pulp Necrosis.
				Figure 3-6
				Figure 3-7
				Figure 3-8
				Figure 3-9 Pulp necrosis of mandibular cuspid with small periapical radiolucency and first bicuspid with a larger lesion.
			Acute Periapical Abscess.
				Figure 3-10
				Figure 3-11
		Culturing the Exudate
		Irrigants Used in Treating Acute Abscesses
		Drainage Through the Tissue and Bone
			Figure 3-12
	EMERGENCY TREATMENT OF TRAUMATIC INJURIES—FRACTURES
		Crown Fracture Without Pulp Exposure
		Crown Fracture with Vital Pulp Exposure
		Crown Fracture with Necrotic Pulp Exposure
		Horizontal Root Fracture
	EMERGENCY TREATMENT OF TRAUMATIC INJURIES—AVULSED TEETH
		Newer Philosophies of Replantation
			Figure 3-13
			Figure 3-14
		Technique
			Suggested Treatment of the Avulsed Tooth.
				Part I: Emergency Treatment at the Site of Injury.
				Part II: Emergency Treatment at the Dental Office.
					Figure 3-15
					Figure 3-15 cont'd
					Part III: Completion of Endodontic Treatment.
			Use of Transport Medium
				Hank's Balanced Salt Solution (HBSS).
				Via Span.
				Saliva.
				Milk.
				Water.
			Stabilization
				Figure 3-16
			Postoperative Instructions and Systemic Treatment
			Replantation After an Extended Extraoral Period
			Typical Posttreatment Sequelae
				Figure 3-17
				Figure 3-17 cont'd
			Ultimate Long-term Prognosis for Replanted Teeth
				Figure 3-18
			Intentional Replantation
				Figure 3-19
				Prognosis for Intentional Replantation.
		EMERGENCY THERAPY FOR INTRATREATMENT PAIN
			Apical Periodontitis Secondary to Treatment
			Incomplete Removal of Pulp Tissue
			Recrudescence of a Chronic Apical Periodontitis
			Recurrent Periapical Abscess
				Figure 3-20
				Figure 3-21
			Preventing Flare-ups During Treatment
				Preventing Postoperative Percussion Sensitivity—Secondary Apical Periodontitis.
				Preventing Flare-ups When Treating a Tooth with a Necrotic Pulp.
				Use of Antibiotic and Other Agents to Prevent Flare-ups.
			Significance of a Chronic Draining Sinus
		BIBLIOGRAPHY
CHAPTER 4 Initiating Endodontic Treatment
	RULES FOR PROPER ACCESS PREPARATION
		Table 4-1 Typical Tooth Lengths, Number of Roots, and Canal Configuration for Anterior Teeth*
		Table 4-2 Typical Tooth Lengths, Number of Roots, and Canal Configuration for Bicuspids*
		Table 4-3 Typical Tooth Lengths, Number of Roots, and Canal Configuration for Molars*
		Figure 4-1
	COMMON CANAL CONFIGURATIONS
		Canal Configuration Studies
			Table 4-4 Canal Configuration Studies for the Mesiobuccal Root of the Maxillary First Molar
		Types of Configurations
			Table 4-5 Canal Configuration Studies for the Mandibular First Bicuspids
			Table 4-6 Canal Configuration Studies for Mesial Root of Mandibular Second Molar
			Table 4-7 Canal Configuration Studies for Mesiobuccal Root of Maxillary Second Molar
			Figure 4-2 Four possible types of canal configuration present in one root are shown: Type I—single canal from pulp chamber to apex; Type II—two canals leaving the chamber and merging to form a single canal short of the apex; Type III—two separate and distinct canals from chamber to apex; Type IV—one canal leaving the chamber and dividing into two separate and distinct canals.
	ARMAMENTARIUM FOR ACCESS PREPARATIONS
	PULP CANAL ANATOMY AND ACCESS PREPARATIONS
		Maxillary Central Incisor
			Figure 4-3
			Figure 4-4
			BOX 4-1 INSTRUMENTS FOR ACCESS PREPARATION TRAY SETUP
			Figure 4-5
			Figure 4-6
		Maxillary Lateral Incisor
			Figure 4-7
		Maxillary Cuspid
			Figure 4-8
		Mandibular Central and Lateral Incisors
			Figure 4-9
			Figure 4-10
			Figure 4-11
		Mandibular Cuspid
			Figure 4-12
		Maxillary First Bicuspid
			Figure 4-13
			Figure 4-14
			Figure 4-15
			Figure 4-16
			Figure 4-16 cont'd
			Figure 4-17
			Figure 4-18
			Figure 4-19
			Figure 4-20
		Maxillary Second Bicuspid
			Figure 4-21
		Mandibular First Bicuspid
			Figure 4-22
		Mandibular Second Bicuspid
			Figure 4-23
		Maxillary First Molar
			Figure 4-24
			Figure 4-25
			Figure 4-26
			Figure 4-27
			Figure 4-28
			Figure 4-29
			Figure 4-30
			Figure 4-31
			Figure 4-32
			Figure 4-33
			Figure 4-34
			Figure 4-35
			Figure 4-36
			Figure 4-37
			Figure 4-38
		Names of Canals in Mesiobuccal Root
			Figure 4-39
		Maxillary Second Molar
			Figure 4-40
			Figure 4-41
			Figure 4-42
			Figure 4-43
			Figure 4-44
		Mandibular First Molar
			Figure 4-45
			Figure 4-46
			Figure 4-46 cont'd
			Figure 4-47
			Figure 4-47 cont'd
			Figure 4-48
			Figure 4-49
		Mandibular Second Molar
			Figure 4-50
			Figure 4-51
			Figure 4-52
	GENERAL SHAPE OF WALLS IN ACCESS PREPARATIONS
		Removal of Obstructions to the Apex
			Figure 4-53
			Figure 4-54
		Need for Divergent Walls
			Figure 4-55
			Figure 4-56
			Figure 4-57
		Access for Badly Worn or Fractured Anterior Teeth
	PREPARATION OF AREA FOR TREATMENT
		Figure 4-58
		Need for Local Anesthesia during Endodontic Therapy
		Pain and Nerve Pathways
		Types of Anesthetic Solutions Used in Endodontics
			Figure 4-59
		Injections Needed for Removal of Vital Pulp Tissue
			Table 4-8 Local Anesthetic for Treating Teeth with Vital Pulp Tissue
		Special Comments about Mandibular Block Injections
			Administer Correct Amount of Solution.
			Use of the Short Needle.
			Use Care When Giving an IAN Block with a Short Needle.
		Intraligamentary Anesthesia
		Application of Rubber Dam for Severely Broken-Down Teeth
			Use of Bands.
				Figure 4-60
				Figure 4-61
			Access When Deep Gingival Decay is Present.
			Aid for a Leaky Rubber Dam.
				Figure 4-62
	BIBLIOGRAPHY
CHAPTER 5 Intracanal Treatment Procedures, Basic and Advanced Topics
	Figure 5-1
	BASIC INTRACANAL INSTRUMENTS
		Broaches
			Figure 5-2 Broach has small barbs protruding from shaft notched by a shredder, highly susceptible to breakage when locked in canal.
		Methods for Using Reamers and Files
			Reaming.
			Filing.
			Circumferential Filing.
				Figure 5-3
		Reamers
			Figure 5-4
			Figure 5-5
		Files
			Need for Flexible Files.
				Table 5-1 Diameters of Standardized (.02 taper) and .04 Taper Instruments
			Hedstrom Files.
				Figure 5-6
			Additional Gouged Instruments Recently Developed.
		Styles of Instruments
		Standardization
			Prestandardization Instruments.
			Landmarks of Standardized Instruments, Original and Revised.
				Figure 5-7
			Quality Control.
	RULES FOR CANAL PREPARATION
		Figure 5-8
		Table 5-2 Correlation Between Files
		Figure 5-9
	DETERMINATION OF CORRECT WIDTH FOR CANAL PREPARATION
		Minimal Instrumentation at Any Appointment—to Reach Size 25
		Determination of Apical Width
		Gaining Sufficient Enlargement for Using Gutta-Percha—the Flared Preparation
		Canal Enlargement in Moderately Wide and/or Straight Canals
			Figure 5-10
			Figure 5-11
		Canal Enlargement in Smaller, Relatively Straight, Canals
		Importance of Using MAF as Final Instrument after Using Flaring Files Short of the Working Length
			Figure 5-12
		Overuse and Abuse of Flaring
		Final Test for Completion of Canal Preparation—Placement of the Finger Spreader
			Figure 5-13
	AIDS FOR PREPARING DIFFICULT CANALS
		Problems Encountered in Canal Preparation
			Figure 5-14
			Figure 5-15
		Precurving of Files
			Table 5-3 Canal Characteristics Not Seen on Routine Radiographs
		Incremental Instrumentation
			Figure 5-16
			Figure 5-17
			Figure 5-18
			Figure 5-19
		New Instruments with Intermediate Sizes
		Need for Remeasurement When Preparing Curved Canals
			Figure 5-20
			Figure 5-21
	PREPARATION IN EXTREMELY CURVED CANALS
		Determination of Canal Curvature
			Figure 5-22
		Observations That Canal Shape Changes
		Plastic Block Studies
			Figure 5-23
			Figure 5-24
		Standard Preparation in the Sharply Curved Canal
		Applications on Extracted Teeth
		Avoiding the Apical Zip and the Elbow
			Figure 5-25
		Application to Clinical Cases by Using Customized Files
			Figure 5-26
			Figure 5-27
			Figure 5-28
		Theories for Flaring in Complex Cases Versus Crown-Down Preparation
			Figure 5-29
			New Instruments for Early Flaring.
				Figure 5-30
				Figure 5-31
		Rules Governing the Use of Non-ISO Tapered Instruments
		Effect of the Non-ISO Tapers on Canal Curvature and Resultant Changes in Canal Shape
		Typical Cases
			Figure 5-32
			Figure 5-33
			Curvatures of 30 to 60 Degrees.
				Figure 5-34
				Figure 5-35
				Table 5-4 Relative Ability of File Systems
				Figure 5-36
				Figure 5-37
			Curvatures of Greater Than 60 Degrees.
			Consequence of Position of the Elbow.
			Preparation of Bayonet-Curved Canals.
				Figure 5-38
	NEW FILE SYSTEMS FOR PREPARATION OF CURVED CANALS
		Effects of Increased Flexibility on Final Canal Shape
			Figure 5-39
			Figure 5-40
			Figure 5-41
		Flexible File Systems
			Figure 5-42
		Nickel-Titanium Files
		Minimizing Zipping by Flute Removal and Modification of Tips
			Figure 5-43
			Figure 5-44
		Disadvantages of Flexible Files
			Figure 5-45
		Non-ISO Taper File for Penetration
			Figure 5-46
	PREPARATION OF TYPE II CANAL SYSTEMS
		Figure 5-47
		Figure 5-48
		Figure 5-49
	COMPLETE ENDODONTIC TREATMENT OF PRIMARY TEETH
		Figure 5-50
	ULTRASONICS
		History of Ultrasonics in Dentistry
			Figure 5-51
		Method for Action
			Figure 5-52
			Figure 5-53
		Techniques for Use
			Figure 5-54
		Canal Preparation
			Figure 5-55
		Related Uses for Ultrasonics
			Figure 5-56
	IRRIGANTS AND CHELATING AGENTS
		Functions of Irrigants
			Figure 5-57
		Useful Irrigants
		Method of Irrigation
		Recent Studies Concerning Irrigants and Their Clinical Implications
			Figure 5-58
		Function of Chelating Agents
			Figure 5-59
			Figure 5-60
			Figure 5-61
			EDTA.
			RC-Prep.*
	INTRACANAL MEDICAMENTS
		Figure 5-62
		Function of Intracanal Medicaments
		Phenol and Related Volatile Compounds
			Figure 5-63
		Calcium Hydroxide as a Medicament for "Weeping" Cases
			Figure 5-64
	SEALING AGENTS FOR INTERTREATMENT DRESSINGS
		Need for Sealing Agents
			Figure 5-65
			Figure 5-66
		Types of Available Sealing Agents
	TREATMENT OF OPERATIVE PERFORATIONS
		Figure 5-67
		General Rules for Treating Operative Perforations
			Figure 5-68
		Treatment of Furcation Perforations by Packing the Chamber
			Figure 5-69
		Treatment of Perforations by Enlargement and Filling as an Additional Canal
		Perforations Treated Surgically or Orthodontically
		New Materials for Perforation Repair
	NONINSTRUMENTATION TECHNOLOGY (NIT)
		Figure 5-70
		Figure 5-71
		Figure 5-72
	BIBLIOGRAPHY
CHAPTER 6 Calculation of Working Length
	HISTORICAL PERSPECTIVES
	METHODS FOR CALCULATION OF WORKING LENGTH
		Results
		Use of the Radiographic Apex as Termination Point
			Figure 6-1
			Figure 6-2
			Is the Radiographic Apex Reproducible?
			Advantages.
				Figure 6-3
			Disadvantages.
		Specific Distances Short of the Radiographic Apex
			Figure 6-4
		According to the Studies of Kuttler
			Figure 6-5
			Figure 6-6
			Advantages.
				Figure 6-7
			Disadvantages.
			Technique for Calculating Working Length.
				Figure 6-8
				Figure 6-9
				Figure 6-10
				Figure 6-11
			Additional Considerations.
				Short Exiting.
				Effect of Periapical Radiolucency with Resorption.
					Figure 6-12
			Symptoms of Overinstrumentation.
			Conclusions.
		Use of the Apex Locator
			Figure 6-13
			History.
				Figure 6-14
				Figure 6-15
				Figure 6-16
				Figure 6-17
				Figure 6-18
				Table 6-1 Studies on the Effectiveness of Apex Locators
			Development of Differing Types of Apex Locators.
				Figure 6-19
				Figure 6-20
			Technique for Calculating Working Length Using the Resistance Locators.
			Use of Frequency-Dependent Machines.
			Advantages.
			Disadvantages.
			Apex Locators versus Radiographs.
			Combination Apex Locator and Mechanical Filing.
			Conclusions.
	USE OF REFERENCE POINTS
	USING THE BUCCAL OBJECT RULE AND DETERMINING WORKING LENGTHS FOR POSTERIOR TEETH
		Figure 6-21
		Figure 6-22
		Figure 6-23
		Figure 6-24
		Figure 6-25
		Figure 6-26
	BIBLIOGRAPHY
CHAPTER 7 Canal Filling with Semisolid Materials
	READINESS OF THE CANAL FOR FILLING
		Figure 7-1
		Problems Stemming from Reliance on Negative Culture
		Significance of Foul Odor
		No Excessive Exudate
		Lack of Periapical Sensitivity
			Figure 7-2
	NEED FOR FILLING CANALS
	RATIONALE FOR USING SEMISOLID MATERIALS
		Effect of Canal Preparation
		Effect of Original Shape
		Indications
	GUTTA-PERCHA
		Figure 7-3
		Phase Transitions of Trans-Polyisoprene
			Figure 7-4
			Figure 7-5 Radiograph of mandibular incisor 2 years postoperatively with internal resorption, filled with semisolid materials.
		Advantages
		Disadvantages
		Composition of Gutta-Percha Cones
		Importance of Canal Preparation
			Figure 7-6
			Figure 7-7
			Figure 7-8
			Table 7-1 Constituents of Commercial Gutta-Percha Cones
		Availability of Cones
			Figure 7-9
	CANAL FILLING IN NONCOMPLICATED CASES
		Filling Large, Relatively Straight Canals
			Obtaining Master Cone.
				Figure 7-10
				Figure 7-11 Radiolucent line (arrow) apical to master cone reveals that the cone is not reaching far enough apically.
		Customized Master Cone Development
			Figure 7-12
			Figure 7-13
			Figure 7-14
		Lateral Condensation in Larger Canals
			Armamentarium.
				Figure 7-15
				Figure 7-16
			Technique.
				Figure 7-17
				Table 7-2 Bacteria Found by Sundqvist in Teeth Without and with Pain
				Figure 7-18
				Figure 7-19
	CANAL FILLING IN COMPLICATED CASES
		Filling Smaller Curved Canals
			Fitting the Finger Spreader.
			Obtaining the Master Cone.
			Lateral Condensation.
				Figure 7-20
				Figure 7-20 cont'd
				Figure 7-21
		Filling Molar Teeth
			Fitting the Finger Spreader.
				Figure 7-22
			Obtaining the Master Cone.
			Lateral Condensation.
				Figure 7-23
				Figure 7-24
				Figure 7-24 cont'd
				Figure 7-24 cont'd
			Role of the Smear Layer.
			Arrangement for Restoration.
		Care of Finger Spreaders
	ALTERNATIVE CANAL FILLING METHODS
		Warm Gutta-Percha
			Rationale.
			Technique.
			Comparison with Other Methods.
				Figure 7-25
			Indications.
				Figure 7-26
				Figure 7-27
				Figure 7-28
				Figure 7-29
				Figure 7-30
	THERMOPLASTIC GUTTA-PERCHA DELIVERY SYSTEMS
		Compacted Gutta-Percha
		Injection-Molded Techniques
			Obtura II.
				Figure 7-31
				Figure 7-32
				Figure 7-33
			Ultrafil.
			Use of Sealers with Thermoplastics.
			Need for Apical Dentin Matrix.
		Partially Dissolved Gutta-Percha
			Disadvantages.
		Modified Chloropercha
			Figure 7-34
			Indications.
	RE-TREATING FAILING GUTTA-PERCHA CASES
		Analyze the Failure
			Figure 7-35
		Re-treating Short Fills
		Re-treating for Insufficient Canal Preparation and/or Condensation
	SEALERS TO BE USED WITH SEMISOLID MATERIALS
		Functions of Sealers
			Figure 7-36
			Figure 7-37
		The Sealers
			ZOE Types.
				Figure 7-38
				Figure 7-39
				Figure 7-40
				Figure 7-41
				Figure 7-42 Well-filled treated tooth has considerable discoloration because of failure to remove excess sealer from the crown after filling.
				Figure 7-43 For Wach's paste to be at correct consistency, a spatula must draw 1 inch of sealer when raised from the mass.
			Resin Type Sealers.
				Figure 7-44
			Calcium Hydroxide Sealers.
			Glass Ionomer Sealer.
		Selection of Sealer
			Table 7-3 Sealers
	BIBLIOGRAPHY
CHAPTER 8 Solid-Core Canal Filling Materials: Theory, Technique, and Re-Treatment
	HISTORY OF SOLID-CORE FILLINGS
		Overuse of Silver Points
		Binding of Silver Points into Dentin
			Figure 8-1
			Figure 8-2
		Corrosion Potential of Silver Points
		Evaluation of Well-Treated Silver Point Cases
			Figure 8-3
		Future for Solid-Core Filling Materials
			Figure 8-4
			Figure 8-5
			Figure 8-6
			Figure 8-7
			Figure 8-8
			Figure 8-9
	TECHNIQUE FOR FILLING WITH SILVER POINTS
		Readiness of the Canal for Filling
		Armamentarium
			Figure 8-10
			Figure 8-11
			Figure 8-12
			Figure 8-13
		Selection of the Trial Point
		Preparation of the Trial Point
		Placement of the Trial Point
			Figure 8-14
		Filling the Canal
			Figure 8-15
		Final Temporary Filling with Silver Points
	SECTIONAL OR "TWIST-OFF" TECHNIQUE
		Problems of Gaining Room for a Post
			Figure 8-16
		Indications for Sectional Technique
			Technique.
				Figure 8-17
			Determination of Position for Notching.
			Use of Twist-off to Terminate at Chamber Floor.
			Finishing and Temporization.
	TREATMENT OF FRACTURES OF MIDDLE THIRD OF ROOT
		Figure 8-18
		Figure 8-19
		Figure 8-20
	THERMOPLASTIC SEMISOLID + SOLID-CORE = THERMAFIL* †
		History
			Figure 8-21
		Basis for Success
			Figure 8-22
			Figure 8-23
			Figure 8-24
			Figure 8-25
		Size Verification
		Importance of Canal Preparation
			Figure 8-26
		Carriers
			Figure 8-27
			Figure 8-28
		Sealer with Thermafil
		Steps for Thermafil Obturation
	SEALERS WITH SOLID MATERIALS
		Filling of Voids
		Other Functions of Sealer
			Figure 8-29
	RE-TREATMENT OF SILVER POINT CASES
		Points That Offer No Problem in Removal
			Figure 8-30
		Points That Cannot Be Easily Gripped
			Figure 8-31
			Figure 8-32
		Ultrasonic Treatment to Remove Tightly Fitting Points and Posts
			Figure 8-33
			Figure 8-34
			Figure 8-35
			Figure 8-36
			Figure 8-37
			Figure 8-38
			Figure 8-39
			Figure 8-40
			Figure 8-41
		Potential Danger of the Ultrasonic
		Re-Treating a Portion Rather Than the Entire Tooth
			Figure 8-42
		Re-Treating Thermafil Failures
			Figure 8-43
			Figure 8-44
	BIBLIOGRAPHY
CHAPTER 9 Periapical Surgery; Intraoral Imaging and Its Use with Surgery and Other Procedures*
	FALSE INDICATIONS
		Figure 9-1
		Figure 9-2
		Figure 9-3
	SURGERY FOR CONVENIENCE OF TREATMENT
		Teeth with Radiolucencies and Brief Period of Time Available for Completion of Therapy
			Figure 9-4
		Recurrent Acute Exacerbations
			Figure 9-5
		Root Configurations Presenting a Strong Possibility of Failure If Treated Nonsurgically
			Figure 9-6
		Teeth with Most Convenient Access Available by Way of the Apex
			Figure 9-7
	SURGERY TO RE-TREAT A FAILURE OR SYMPTOMATIC CASE
		Failure of an Incompletely Formed Apex to Close
		Marked Overextended Canal Filling Associated with Failure
		Persistent Pain
		Acute Exacerbation after Canal Filling
		Lack of Apical Seal
			Figure 9-8
			Figure 9-9
			Figure 9-10
			Figure 9-11
		Unfilled Portion of the Canal
		Failures for Unknown Clinical Reason
	SURGERY AFTER PROCEDURAL ACCIDENT
		Broken Instruments
			Figure 9-12
			Figure 9-13
		Broken Filling Materials
			Figure 9-14
		Ledging
		Root Perforation
	SURGERY TO GAIN INFORMATION FROM A BIOPSY
		Medical History of a Malignancy
			Figure 9-15
		Findings of a Periapical Lesion, Vital Pulp, and Extensive Apical Resorption
		Lip Paresthesia
			Figure 9-16
	FLAPS AND INCISIONS
		Functions of a Flap
		Requirements of an Ideal Flap
			Making Sure Base Is Widest Point of Flap.
			Avoiding Incision over a Bony Defect.
			Including the Full Extent of the Lesion.
			Avoiding Sharp Corners.
			Avoiding Incision across a Bony Eminence.
			Guarding Against Possible Dehiscence.
			Placing a Horizontal Incision in the Gingival Sulcus or Keeping It Away from the Gingival Margin.
			Avoiding Incisions in the Mucogingival Junction.
			Avoiding Improper Treatment of Periosteum.
				Figure 9-17
			Taking Care during Retraction.
		Types of Flaps
			Semilunar Flap.
			Vertical Flaps.
				Figure 9-18
				Figure 9-19
			Palatal Flaps.
				Figure 9-20
			Ochsenbein-Luebke Flap.
				Figure 9-21
	ARMAMENTARIUM
		BOX 9-1 ITEMS ON A STANDARD TRAY FOR ENDODONTIC SURGERY
		BOX 9-2 INSTRUMENTS FOR APICAL PLACEMENT OF FILLINGS
		Figure 9-22
		Figure 9-23
		Figure 9-24
		Figure 9-25
		Patient Preparation
	TWO-STEP OR FILLING-FIRST TECHNIQUE
		Canal Preparation before Filling
			Figure 9-26
		Disinfection Immediately Prior to Filling
		Canal Filling
	CURETTAGE AND APICOECTOMY
		Preparation of the Surgical Site
		Opening the Flap
		Locating the Root Apex
			Figure 9-27
		Curettage
			Figure 9-28
		Curettage as Opposed to Apicoectomy
		Completing the Surgery
		Surgery from Palatal Access
			Figure 9-29
	POSTRESECTION FILLING TECHNIQUE
		Disadvantages and Advantages
		Armamentarium
			Figure 9-30
		Technique
		Removing Broken Instruments and Filling Materials
	REVERSE FILLING PROCEDURES
		Indications
			Figure 9-31
			Figure 9-32
			Figure 9-33
		Use of Ultrasonic Tips for Reverse Filling Preparations
			Figure 9-34
		Types of Preparation
			Figure 9-35
			Figure 9-36
			Figure 9-37
			Figure 9-38
			Figure 9-39
			Figure 9-40
			Figure 9-41
			Figure 9-42
		Types of Filling Materials
			Figure 9-43
			Figure 9-44
		Miniature Carriers and Pluggers
		Reverse Filling of a Tooth with an Incompletely Formed Apex
		Reverse Filling Incompletely Sealed Cases
		Reverse Filling of Significant Lateral Canals
		Reverse Filling to Seal Perforation
			Figure 9-45
			Figure 9-46
		Reverse Filling When the Most Convenient Access Is from the Apex
		Filling When Enlargement Access Is Obtained from the Apex
			Figure 9-47
			Figure 9-48
			Figure 9-49
			Figure 9-50
		Handling of the Surrounding Tissues during Reverse Filling
		Re-Treating Reverse Filling Failures
	SURGERY FOR ROOT FRACTURES
		Importance of Diagnosis
		Choices of Surgical Therapy
		Removing an Apical Fragment
		Placing a Chrome-Cobalt Alloy Pin
			Figure 9-51
			Figure 9-52
			Figure 9-53
			Figure 9-54
			Figure 9-55
			Figure 9-56
	USE OF THE DENTAL OPERATING MICROSCOPE (DOM)
		History
			Figure 9-57
		Common Problems
			Figure 9-58
		Use of the DOM
			Figure 9-59
			Figure 9-60
		Key Areas for DOM Use
		Procedure
			Figure 9-61
		Getting Started
			Figure 9-62
		Degree of Success
	USE OF ORASCOPY
		Rod-Lens Endoscope
		Fiberoptic Orascope
			Figure 9-63
		General Orascopic Visualization Technique
		Orascopic Use during Conventional Endodontics
		Orascopic Use in Surgical Endodontic Treatment
			Figure 9-64
		Documentation
	SUTURING
		Figure 9-65
		Figure 9-66
		Figure 9-67
	POSTOPERATIVE INSTRUCTIONS
		BOX 9-3 TYPICAL POSTOPERATIVE INSTRUCTIONS FOR THE PATIENT
	BIBLIOGRAPHY
CHAPTER 10 Root Amputations
	Figure 10-1
	CAUSES OF FAILURE
		Figure 10-2
	ALTERNATIVES IN PERIODONTAL THERAPY
	INDICATIONS AND CONTRAINDICATIONS
		Cautions to Observe before Starting Amputation Procedures
			Sufficient Support Available for the Segment to be Retained.
			Proper Restoration of Retained Segment Practical.
				Figure 10-3
		Periodontal Indications for Root Amputation
			Figure 10-4
		Endodontic and Restorative Indications for Root Amputation
			Figure 10-5
		Contraindications for Root Amputation
			Figure 10-6
			Figure 10-7
			Figure 10-8
	ARMAMENTARIUM
		Figure 10-9
	GENERAL RULES FOR ROOT AMPUTATION
		Importance of Root Anatomy
		Endodontic Therapy Prior to Root Amputation
			Figure 10-10
		Root Amputation on Periodontally Involved Teeth
			Figure 10-11
		Root Amputation on Teeth Having Normal Periodontal Support
		Vertical-Cut Method
		Presurgical Crown-Contouring Method
			Figure 10-12
		Vertical as Opposed to Horizontal Preparation
	ROOT AMPUTATION FOR MAXILLARY FIRST MOLAR
		Root Anatomy
			Figure 10-13
		Amputation of the Mesiobuccal Root
			Figure 10-14
		Amputation of the Distobuccal Root
			Figure 10-15
		Amputation of a Palatal Root
			Figure 10-16
		Amputation of Both Buccal Roots
		Amputation of the Palatal and Distobuccal Roots
			Figure 10-17
	ROOT AMPUTATIONS FOR MAXILLARY SECOND MOLAR
		Root Anatomy
			Figure 10-18
		Amputation of the Mesiobuccal Root
		Amputation of the Distobuccal Root
		Amputation of Both Buccal Roots
		Amputation of Adjacent Roots of the Maxillary Molars
			Figure 10-19
		Amputation of the Distobuccal Root of Both the First and Second Molars
			Figure 10-20
	AMPUTATION PROCEDURES ON MANDIBULAR MOLARS
		Root Anatomy
			Figure 10-21
			Figure 10-22
			Figure 10-23
		Amputation of the Mesial Root
			Figure 10-24
		Amputation of the Distal Root
			Figure 10-25
			Figure 10-26
			Figure 10-27
		Bicuspidization
		Retaining the Distal Root of the First Molar with the Mesial Root of the Second Molar
			Figure 10-28
	POSTOPERATIVE INSTRUCTIONS
		Figure 10-29
	TREATMENT PLANNING PROBLEMS IN ROOT AMPUTATION CASES
		Difficulties Encountered in Determining When Amputation Is Needed
			Figure 10-30
		Problems of Vital Root Amputation
			Figure 10-31
			Figure 10-32
		Technique for Emergency Treatment Following Vital Root Amputation
	BIBLIOGRAPHY
CHAPTER 11 Endodontic-Periodontal Problems
	CLASSIFICATION OF ENDODONTIC-PERIODONTAL PROBLEMS
		Types of Endodontic-Periodontal Problems
			Class I.
				Figure 11-1
				Figure 11-2
			Class II.
				Figure 11-3
				Figure 11-4
				Figure 11-5
			Class III.
			Class IV.
				Figure 11-6
				Figure 11-7
	EFFECT OF PERIODONTAL TISSUES ON THE PULP
		Exposure or Irritation through Auxiliary Canals
			Figure 11-8
			Figure 11-9
		Furcation Canals
			Figure 11-10
		Vital but Not Normal Pulp
			Figure 11-11
		Effect of Periodontal Therapy on the Pulp
	EFFECT OF PULP ON PERIODONTAL TISSUES
		Furcation Canals—Possible Role in the Development of Class I Endodontic-Periodontal Lesions in Molars
			Figure 11-12
			Figure 11-13
		Other Types of Class I Endodontic-Periodontal Problems
			Figure 11-14
	RATIONALE FOR TREATMENT OF CLASS I ENDODONTIC-PERIODONTAL CASES
		Similarity to a Sinus Tract
		Recording of the Defect
			Figure 11-15
		When a Class I Lesion Is Not a Class I Lesion
			Figure 11-16
	TREATMENT OF COMBINED-LESION CASES
		Figure 11-17
		Separate and Unrelated Lesions
		Single Lesions with Both Endodontic and Periodontal Components
			Figure 11-18
			Figure 11-19
		Periodontal and Endodontic Lesions That Have Merged
	ENDODONTIC STABILIZERS
		Figure 11-20
		Armamentarium
		One-Sitting as Opposed to Three-Sitting Treatment
			Figure 11-21
			BOX 11-1 SUPPLIES NEEDED FOR AN ENDODONTIC STABILIZER
		Procedure for Treatment
			Figure 11-22
		Problems of Canal Enlargement
		Reasons for Partial Effectiveness Yet Ultimate Failure of Stabilizers
			Figure 11-23
	BIBLIOGRAPHY
CHAPTER 12 Endodontic-Orthodontic Relationships
	EFFECT OF ORTHODONTICS ON THE TOOTH BEING MOVED
		Orthodontics as the Etiologic Agent for Endodontics
			Figure 12-1
			Figure 12-2
			Figure 12-3
		Resorptive Defects
		Necessary Monitoring by the Orthodontist and the General Dentist
			Figure 12-4
		Treating Teeth after Orthodontic Treatment
		Treating Teeth during Orthodontic Treatment
			Figure 12-5
	ENDODONTIC-ORTHODONTIC COMBINED THERAPY
		Figure 12-6
		Basic Periodontal Principles for Forced Eruption
			Figure 12-7
			Figure 12-8
			Figure 12-9
		Basic Endodontic Principles for Forced Eruption
			Figure 12-10
			Figure 12-11
		Basic Orthodontic Principles for Tooth Movement
			Figure 12-12
		Forced Eruption—Methods and Materials
			Tooth Lacking a Clinical Crown.
			Tooth Having an Intact Clinical Crown.
	BIBLIOGRAPHY
CHAPTER 13 Microbiology and Sterilization in Endodontics
	ROUTES OF MICROORGANISM INGRESS
		Through the Open Cavity
		Through the Dentinal Tubules
		Through the Gingival Sulcus or Periodontal Ligament
		Through the Bloodstream
		Through a Broken Occlusal Seal or Faulty Restoration of a Tooth Previously Treated by Endodontic Therapy
		Through Extension of a Periapical Infection from Adjacent Infected Teeth
	MICROORGANISMS FOUND IN ROOT CANALS AND ASSOCIATED PERIRADICULAR LESIONS—HISTORIC AND CURRENT VIEWS
		Aerobes and Their Significance
			BOX 13-1 MICROORGANISMS REPORTED FOUND IN HUMAN ROOT CANALS PRIOR TO 1969
		Anaerobes—Disease Production and Symptoms
			Table 13-1 Bacteria found by Sundqvist in teeth without and with pain
			Table 13-2 More recent studies reporting anaerobic growth in teeth with necrotic pulps
			BOX 13-2 COMPARISON OF OLD AND NEW NOMENCLATURE USED IN THE IDENTIFICATION OF HUMAN ORAL BLACKPIGMENTED ANAEROBIC RODS
	SIGNIFICANCE OF MICROORGANISMS IN ENDODONTIC THERAPY
	TROUBLESHOOTING
		BOX 13-3 ISSUES TO CONSIDER IN NONRESPONSIVE/REFRACTORY ENDODONTIC CASES
	BACTERIA AND IDENTIFICATION
		Other Microbiologic Identification Techniques
	STERILIZATION AND DISINFECTION
		Office Infection Control Plan
		The Operatory
			Figure 13-1 Patient care with personal protective equipment and universal precautions in use.
			Figure 13-2 Typical endodontic instrument display of working area.
		Sterilization Procedures
			Figure 13-3 Perforated tray with endodontic instruments.
			Figure 13-4
			Table 13-3 Methods and times required for sterilization in endodontics
		Disinfecting Solutions
		Sterilization Monitoring
	BIBLIOGRAPHY
CHAPTER 14 Alternatives to Routine Endodontic Treatment
	VITAL PULP THERAPY
		History and Review of the Literature
			Figure 14-1
		Consequences of Calcium Hydroxide Pulp Cappings
		Pulp Capping as Opposed to Pulpotomy
		Best Indications for Successful Vital Pulp Therapy
			Figure 14-2
			Figure 14-3
		Contraindications for Vital Pulp Therapy
			Figure 14-4
			Figure 14-5
		Pulp Capping of Posterior Teeth
			Figure 14-6
		Formocresol Pulpotomy for Posterior Teeth
		Pulpotomy Treatment of Anterior Teeth
		Follow-up after Vital Pulp Therapy
	TREATMENT OF TEETH WITH INCOMPLETE APICAL DEVELOPMENT
		Problems of the Open Apex
			Figure 14-7
			Treatment of Open Apex with Vital Pulp.
				Figure 14-8
			Apexification Procedures—Treatment of Open Apex with Nonvital Pulp.
				Figure 14-9
				Figure 14-10
				Figure 14-11
				Figure 14-11 cont'd
				Figure 14-12
		Canal Filling after Completion of Apexification
			Figure 14-13
			Figure 14-14
		Mechanisms of Apexification
		Long-Term Results of Apexification
			Figure 14-15
		Apexification in Molars
			Figure 14-16
		Treatment of Perforating Internal Resorption
			Figure 14-17
			Figure 14-18
		Treatment of Aggressive External Resorption
	THEORY OF REPEATED TRAUMAS
		Figure 14-19
		Figure 14-20
		Figure 14-21
		Figure 14-21 cont'd
	PASTES AS CANAL FILLING MATERIALS
		Figure 14-21 cont'd
		Disadvantages
			Figure 14-22
		Indications
			Figure 14-23
		Technique
			Figure 14-24 Canals of this primary molar are filled with a paste containing zinc oxide, eugenol, and formocresol.
	THE N2-SARGENTI TECHNIQUE
		Figure 14-25
		Sargenti Method
		Opposition by American Endodontists
			Table 14-1 Basic science research with N2
			Figure 14-26
			Figure 14-27
			Figure 14-28
		Re-Treatment of Failing N2 Cases
	BIBLIOGRAPHY
CHAPTER 15 Restoration of the Endodontically Treated Tooth
	PHILOSOPHY OF RESTORING TEETH AFTER ENDODONTIC THERAPY
		Figure 15-1
		Need for Posts
		Possible Overuse of Posts
			Figure 15-2
			Figure 15-3
	BIOMECHANICAL PRINCIPLES OF POST SELECTION
		Figure 15-4
		Types of Posts
		Use of Bonded Fiber Posts
		Importance of Post Length
		Cementation
			Table 15-1 Suggested Widths of Post Preparations*
		Other Considerations
	CHOICES FOR RESTORATION
	PREPARATION OF POST AND CORE
		Figure 15-5
	PREPARATION OF THE ORIFICE
		Figure 15-6
	TYPES OF CORES
		Figure 15-7
	CAST VERSUS PREFABRICATED POST AND CORES
		Figure 15-8
	CAST POST AND CORES
		Types of Materials Available for Fabricating Posts
			Figure 15-9
		Tooth with an Adequate Clinical Crown
			Figure 15-10
		Tooth with an Inadequate Clinical Crown
			Figure 15-11
		Additional Considerations in Post-and-Core Procedures for a Tooth with Little or No Clinical Crown
		Selection and Setting of Post
	TAKING IMPRESSION FOR POST AND CORE
		Figure 15-12
	TEMPORIZATION
		Figure 15-13
		Figure 15-14
		Figure 15-15
	LABORATORY TECHNIQUES FOR INDIRECT POST-AND-CORE FABRICATION
		Figure 15-16
	FABRICATION OF POST AND CORE BY DIRECT METHOD
		Figure 15-17
	CEMENTATION OF POST AND CORE
		Figure 15-18
		Figure 15-19
	METAL POST AND COMPOSITE RESIN COMBINATION
		Figure 15-20
	SCREW POST METHOD FOR REBUILDING TREATED TEETH
		Advantages and Disadvantages
			Figure 15-21
	ENDODONTICS PERFORMED AFTER FINAL PREPARATION OF TEETH
		Figure 15-22
	RESTORATION OF TEETH AFTER ROOT AMPUTATION
		Figure 15-23
		Mandibular Molar—Retaining the Distal Root
			Figure 15-24
		Mandibular Molar—Retaining the Mesial Root
			Figure 15-25
		Mandibular Molar—Retaining the Mesial and Distal Roots
		Maxillary Molar—Retaining the Mesiobuccal or Distobuccal and Palatal Roots
			Figure 15-26
			Figure 15-27
		Maxillary Molar—Retaining the Buccal Roots
		Maxillary Molar—Retaining the Palatal Root
	OVERLAY DENTURE
		Figure 15-28
		Figure 15-29
		Figure 15-30
		Figure 15-31
		Minimum Restoration of Abutments
		Restoration of Abutments with Telescopes
	BLEACHING
		Figure 15-32
		Figure 15-33
	BIBLIOGRAPHY
CHAPTER 16 Endodontic Timetables
	REFERENCES FOR THE STEPS OF TREATMENT
	NEED FOR HAVING PREDETERMINED OBJECTIVES
	DEGREE OF CANAL ENLARGEMENT
		Table 16-1 Timetable for Treating Teeth with One Canal
	TIME REQUIREMENTS
		Table 16-2 Timetable for Treating Teeth with Two Canals
	FILLING CANALS OF MOLAR TEETH AT DIFFERENT APPOINTMENTS
		Table 16-3 Timetable for Treating Molars
		Table 16-4 Timetable for Treating Teeth To Be Left Open* or Those Already Left Open†
		Table 16-5 Timetable for One-Sitting Treatment
	LEAVING TEETH WITH ACUTE ABSCESSES OPEN VERSUS KEEPING THEM CLOSED
	THIRD APPOINTMENT WHEN TREATING TEETH LEFT OPEN
	FOURTH APPOINTMENT WHEN TREATING TEETH LEFT OPEN
	TIMETABLES NECESSARILY SUBJECT TO CHANGE BY THE CLINICIAN
		Figure 16-1
	ONE-SITTING ENDODONTIC TREATMENT
		Figure 16-2
		Figure 16-3
		Figure 16-4
	TEETH THAT SHOULD NOT BE COMPLETED IN ONE APPOINTMENT
		Figure 16-5
	MY PERSONAL VIEW CONCERNING ONE-SITTING TREATMENT
	FILLING ROOTS OF MOLAR TEETH SEVERAL YEARS APART
		Figure 16-6
		Figure 16-7
	BIBLIOGRAPHY
CHAPTER 17 Drug Therapy Useful in Endodontics
	Table 17-1 Analgesics for Relief of Mild to Moderate Pain
	Table 17-2 Analgesics to Relieve Moderate to Severe Pain
	Table 17-3 Suggested Analgesics after Certain Endodontic Procedures or Conditions
	IMPORTANCE OF MEDICAL HISTORY
		Table 17-4 Types of Penicillin for Use during Endodontic Therapy
	ANALGESICS
		Table 17-5 Nonpenicillin Antibiotics for Use during Endodontic Therapy
		Table 17-6 Sedatives and Tranquilizers Useful during Endodontics
	ANTIBIOTICS
	SEDATIVES AND TRANQUILIZERS
	DRUGS FOR CHILDREN
	BIBLIOGRAPHY