Endodontics E-Book: Principles and Practice

Endodontics: Principles and Practice
Copyright
Contents
Preface
List of Contributors
1 - Pathogenesis of Pulp and Periapical Diseases
	Histology and Physiology of Normal Dental Pulp
	Etiology of Pulpal and Periapical Diseases
		Mechanical Irritants
		Chemical Irritants
		Microbial Irritants
	Microbiology of Root Canal Infections
		Routes of Root Canal Infection
	Endodontic Infections Are Biofilm Infections
	The Microbiome of Endodontic Infections
	Pulpal Diseases
		Host Response in the Dental Pulp
		Clinical Classification of Pulpal Conditions
	Normal Pulp
	Reversible Pulpitis
	Irreversible Pulpitis
	Pulp Necrosis
		Periapical Diseases
	Clinical Classification of Periapical (Apical) Conditions
		Normal Periapex
		Symptomatic Apical Periodontitis
		Asymptomatic Apical Periodontitis
		Acute Apical Abscess
		Chronic Apical Abscess
		Condensing Osteitis
	Nonendodontic Pathosis
		Role of Residual Microorganisms in the Outcome of Endodontic Treatment
		Healing of Pulp and Periapical Tissues
		Process of Pulp Healing
		Process of Periapical Healing
		Factors Influencing Healing
2 - Systemic Health Considerations in the Endodontic Patient and Geriatric Endodontics
	Health and Medical History
	The Systemic Health Assessment of the Endodontic Patient
	Physical Examination: Vital Signs
	Systemic Considerations
		Endodontics and Systemic Disease
			Systemic Diseases That May Influence Endodontic Pathosis or Its Treatment
			Endodontic Disease May Initiate or Contribute to Systemic Diseases
		Acute Endodontic Infections
		Chronic Endodontic Infections
	Diabetes Mellitus
	Hypertension
	Risk for Osteoradionecrosis or Osteonecrosis of the Jaw
	Viral Infections
		HIV/AIDS
		Herpes Viruses
	Sickle Cell Anemia
	Smoking
	Genetic Predisposition
	Presentation of Endodontic Disease in the Older Adults
		Physical Limitations
		Restorative Considerations
		Biologic Considerations
	Anatomy
		Pulp Chamber
		Canal Calcification (Calcific Metamorphosis)
	Pulp Response
		Changes With Age
		Chronologic Versus Physiologic
		Structural
		Dimensional
		Nature of Response to Injury
		Irritation
		Systemic Conditions
		Periapical Response
		Additional Considerations
	Root Canal Treatment
		Treatment Considerations
			Time Required
		Anesthesia
			Primary Injections
			Supplemental Injections
		Procedures
			Isolation
			Access Preparation
			Working Length
			Cleaning and Shaping
			Intracanal Medicaments
			Obturation
			Effect of Restoration
			Retreatment
			Endodontic Surgery
			Medical Considerations
			Biologic and Anatomic Factors
	Healing After Surgery
	Identifying Patients for Referral
3 - Endodontic Radiology
	Prologue
	Introduction
	Radiation Biology
	Equipment for 2D Image Capture
		Intraoral X-ray Units
			Standard Wall-Mounted Units
			Handheld Units
		Intraoral Image Receptors
			Types of Digital Image Receptors
			Dental Film
	Techniques for Intraoral Image Capture
	Endodontic Imaging Needs
		Disease Diagnosis
			Identifying Pathosis
		Moving Superimposed Structures
		Locating Roots and Canals
		Evaluating Treatment Progress
			Initial Assessment of Working Lengths
			Determining Working Length
			Master Cone
			Evaluating the Obturation (Intermediary Fill and Final Radiographs)
		Follow-up of Treatment Outcomes
			Determining Root and Pulpal Anatomy
	Cone Beam Computed Tomography
		Equipment and Principles for 3D Image Capture
			Field of View
			Voxel Size and Bit Depth
			Volumetric Data and Projection Data
			Image File Format
			Scatter and Beam Hardening Artifacts
		Indications and Special Applications
4 - Endodontic Diagnosis and Treatment Planning
	Introduction
	Examination
		Subjective Examination
			Chief Complaint
			Dental History
			Medical History
		Objective Examination
			Vital Signs
			Extraoral Examination
			Intraoral Examination
				Soft Tissue
			Cold Testing
			Heat Testing
			Electric Pulp Testing
			Adjunctive Tests
			Caries Removal
			Selective Anesthesia
		Radiographic Examination
			Selection of Appropriate Imaging Modality
			Periapical Lesions
	Pulpal Lesions
	Diagnosis
		Developing a Diagnosis
		Endodontic Terminology
			Pulpal Diagnosis
				Normal or Reversible Pulpitis
			Periapical Diagnosis
				Normal
		Adjuncts to the Endodontic Diagnosis
		Longitudinal Fractures
		Diagnosis of Longitudinal Fractures
		Longitudinal Fracture Types57
		Classification of Fracture Types
			Craze Lines
			Fractured Cusp
			Cracked Tooth
			Split Tooth
			Vertical Root Fracture62
		Trauma
		Resorption
		Internal Root Resorption
		External Root Resorption
		Invasive Cervical Root Resorption
			Endodontic–Periodontic Interrelationships
		Classification and Differential Diagnosis of Endodontic–Periodontic Lesions
			Primary Periodontal Defects of Endodontic Origin
			Primary Periodontal Defects
			Primary Periodontal Defects of Endodontic–Periodontic Origin (True Combined Lesions)
	Treatment Planning
		Phasing Treatment
			Emergency Treatment
			Definitive Treatment
			The Comprehensive Treatment Plan
		Factors That May Alter the Treatment Plan
5 - Differential Diagnosis of Pains and Radiolucencies of Nonpulpal Origin
	Introduction
	Pains of Nonpulpal Origin
		Toothache of Nonpulpal Origin
		Incidence of Orofacial Pain
			Basic Terminology in the Understanding and Diagnosis of Pain
			Common Terms
			Diagnostic Process for Nondental Orofacial Pain
		Confusing Dental Pathology
			Periodontal Ligament Pain
			Psychological Disturbances
			Types of Pain
				Musculoskeletal Pain
			Referred Pain
				Cervical Spine Pain
			Pain Arising from Vascular Structures
			Cardiac Toothache
			Sinus/Nasal Toothache
			Neoplasias and Other Lesions in the Head
			Salivary Gland Dysfunction
			Treatment
	Radiolucencies of Nonpulpal Origin
	Normal Anatomic Structures and Developmental Entities
		The Mental Foramen
			Clinical Features
			Radiographic Features
			Histology
			Clinical Features
			Radiographic Features
			Histology
			Clinical Features
			Radiographic Features
			Histology
	Odontogenic and Nonodontogenic Cyst, Tumors, and Related Entities
		Ameloblastoma
			Clinical Features
	Dentigerous Cyst and Pericoronal Radiolucencies
		Clinical Features
			Radiographic Features and Differential Diagnosis
			Histology
		Differential Diagnosis of a Soft Tissue Mass, With or Without Opacity Obstructing the Eruption of a Permanent Tooth
		Odontoma
			Clinical Features
			Radiographic Features
			Ameloblastic Fibroma
			Ameloblastic Fibro-odontoma
				Clinical Features
			Odontogenic Keratocyst
				Clinical Features
			Squamous Odontogenic Tumor
				Clinical Features
		Surgical Ciliated Cyst
			Radiographic Features
			Histology
		Traumatic Bone Cyst
			Radiographic Features
			Histology
		Focal Osteoporotic Bone Marrow Defect
			Clinical Features
			Radiographic Features
			Histology
		ABC
			Clinical Features
			Radiographic Features
			Histology
	Central Giant Cell Lesion
		Clinical Features
			Radiographic Features
			Histology
	Osseous Pathology
		Clinical Features
			Osteoblastoma
				Clinical Features
			Osteogenic Sarcoma
				Clinical Features
			Chondrogenic Sarcoma
			Ewing’s Sarcoma
			Clinical Features
			Radiographic Features
			Histology
	Hematolymphoid Conditions, Malignancies, and Related Disorders
		Sickle Cell Anemia
			Clinical Features
			Lymphoma
		Langerhan Cell Disease
			Clinical Features
			Radiographic Features
			Histology
		Multiple Myeloma
			Clinical Features
			Radiographic Features
			Histology
6 - Endodontic Case Complexity and Working with the Specialist
	Introduction
	Advanced Dental Education Programs in Endodontics
	Communication Between Endodontists and General Dentists
	What Is Expected of a General Practitioner
	What Is Expected of an Endodontist
	Standard of Care and Endodontic Case Documentation
	Case Difficulty Assessment—When to Treat and When to Refer
	Patient Considerations
		Medical History
		Anesthesia
		Patient Disposition
		Gag Reflex and Ability to Open Mouth
		Emergency Condition
	Diagnostic and Treatment Considerations
		Diagnosis
		Radiographic Difficulties
		Position in the Arch
		Tooth Isolation
		Crown Morphology
		Canal and Root Morphology
		Radiographic Appearance of Canal(s)
		Resorption
		Additional Considerations
	Referral During Treatment
		Flare-ups
		Procedural Accidents
	Referral After Treatment
		Pain
		Persistent Pathosis
		Sinus Tract
7 - Endodontic Armamentarium
	Introduction
	Examination and Diagnosis
		Clinical Examination
		Radiographic Examination
	Magnification
	Isolation
	Nonsurgical Root Canal Treatment
		Nonsurgical Cassette
		Length Determination
	Instrumentation Armamentarium
		Endodontic Access
		Cleaning and Shaping Instruments
		Irrigants, Irrigation Devices, and Intracanal Medicaments
		Obturation Armamentarium
	Coronal Seal
	Surgical Armamentarium
		Incision and Drainage Armamentarium
		Root End Surgery (Apicoectomy) Armamentarium
8 - Local Anesthesia
	Factors Affecting Endodontic Anesthesia
		Apprehension and Anxiety
		Fatigue
		Tissue Inflammation
		Previous Unsuccessful Anesthesia
	Initial Management
		Psychological Approach
		Topics Related to Injection Pain
			Obtaining the Patient’s Confidence
			Topical Anesthetic
			Needle Insertion
			Small-Gauge Needles
			Slow Injection
			Two-Stage Injection
			Gender Differences in Pain
		When to Anesthetize
		Adjunctive Pharmacologic Therapy
	Conventional Pulpal Anesthesia for Restorative Dentistry
	Mandibular Anesthesia for Restorative Dentistry
		Lidocaine with Epinephrine and Vasoconstrictors
		Anesthetic Factors Associated with the Inferior Alveolar Nerve Block
			Lip Numbness
			Soft Tissue Anesthesia
			Onset of Pulpal Anesthesia
			Duration
			Success
	Alternative Attempts to Increase Anesthetic Success
		Increasing the Volume
			Increasing the Epinephrine Concentration
		Alternative Solutions
			2% Mepivacaine with 1:20,000 Levonordefrin, 4% Prilocaine with 1:200,000 Epinephrine, and Plain Solutions (3% Mepivacaine and 4%...
			Long-Acting Agents
			Buffered Lidocaine
		Alternative Injections and Locations
			Gow-Gates and Vizarani-Akinosi Techniques (Fig. 8.5)
			Incisive Nerve Block/Infiltration at the Mental Foramen
			Lidocaine Infiltration Injections
			Articaine Infiltration Injections
	Evaluating Mechanisms of Failure with the Inferior Alveolar Nerve Block
		Accuracy of Needle Placement
			Needle Deflection and Needle Bevel
			Accessory Innervation
			Cross-Innervation
			Red Hair
			Patient Position for an Inferior Alveolar Nerve Block
	Methods to Increase Success of the Inferior Alveolar Nerve Block
		Periodontal Ligament Anesthesia After an Inferior Alveolar Nerve Block
			Injection Speed and Success
			Pain and Inflammation
	Maxillary Anesthesia for Restorative Dentistry
		Anesthesia-Related Factors
		Lip/Cheek Numbness or Dead Feeling of the Teeth
			Success
			Onset of Pulpal Anesthesia
			Duration of Pulpal Anesthesia
		Alternative Anesthetic Solutions
			Plain Solutions of Mepivacaine and Prilocaine
			4% Prilocaine with 1:200,000 Epinephrine, 2% Mepivacaine with 1:20,000 Levonordefrin, and 4% Articaine with 1:100,000 Epinephrin...
			Bupivacaine with Epinephrine
		Increasing the Duration of Pulpal Anesthesia
			Increasing the Volume of Solution
			Increasing the Epinephrine Concentration
		Repeating an Infiltration After 30 or 45 Minutes
		Alternative Injection Techniques
			Pain, Inflammation, and Anxiety
	Supplemental Anesthesia for Restorative Dentistry in the Mandible and Maxilla
		Indications
		Infiltration
			Additional Infiltration of Lidocaine in the Maxilla
			Infiltration of Articaine in the Mandible
		Intraosseous Anesthesia (Figs 8.7–8.11)
			Technique for the Stabident System
			Success
			Failure
			Duration
			Postoperative Pain and Problems
			Systemic Effects
			Medical Contraindications
			Precautions
		Periodontal Ligament Injection
			Technique
			Mechanism of Action
			Injection Discomfort in Asymptomatic Patients
			Onset of Anesthesia
			Success in Asymptomatic Teeth
			Duration in Asymptomatic Teeth
			Postoperative Discomfort in Asymptomatic Teeth
			Selective Anesthesia
			Systemic Effects
			Other Factors
			Damage to the Periodontium
			Damage to the Pulp
			Damage to Primary Teeth
			Precautions
	Anesthesia Difficulties in Endodontics
		Success of the Inferior Alveolar Nerve Block with Symptomatic Irreversible Pulpitis
			Gow-Gates and Vizarani-Akinosi Techniques
			Do Buffered Lidocaine Formulations Increase the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreve...
			Effect of Preemptive Nitrous Oxide in Irreversible Pulpitis
		Success of Maxillary Molar Infiltration with Irreversible Pulpitis
		Asymptomatic Irreversible Pulpitis Versus Symptomatic Irreversible Pulpitis
			Use of Preoperative Analgesic Medications to Increase the Success of the Inferior Alveolar Nerve Block
		Adjunctive Pharmacologic Therapy
			Reversing Soft-Tissue Numbness
	Supplemental Techniques for Mandibular Teeth in Endodontics
		Supplemental Intraosseous Injections
		Supplemental Periodontal Ligament Injections
			Supplemental Intraseptal Injection
		Supplemental Intrapulpal Injection
			Indications
			Advantages and Disadvantages
			Mechanism of Action
			Technique
			What Is the Effect of No Endodontic Débridement on Postoperative Pain for Symptomatic Teeth with Pulpal Necrosis
	Anesthetic Management of Pulpal or Periapical Pathoses
		Symptomatic Irreversible Pulpitis
			General Considerations
			Mandibular Posterior Teeth
			Mandibular Anterior Teeth
			Maxillary Posterior Teeth
			Maxillary Anterior Teeth
		Symptomatic Pulp Necrosis
		Asymptomatic Pulp Necrosis
	Anesthesia for Surgical Procedures
		Incision for Drainage
			Incision and Drainage―Buffered Anesthetics
			Outcome of an Incision and Drainage Procedure
		Periapical Surgery
9 - Endodontic Emergencies and Therapeutics
	Introduction
	Definition
	Categories
		Pretreatment Emergency
		Interappointment and Postobturation Emergency
	The Challenge
		Differentiation of Emergency and Urgency
		Development of a System
	Pain Perception and Pain Reaction
	System of Diagnosis
		Medical and Dental Histories
		Subjective Examination
		Objective Examination
		Physical Condition/Extraoral Examination
		Intraoral Examination
	Pulp Vitality Tests
	Periapical Tests
		Periodontal Examination
		Radiographic Examination
		Diagnostic Outcome
	Treatment Planning
		Pretreatment Emergencies
		Patient Management
		Profound Anesthesia
		Management of Symptomatic Irreversible Pulpitis
			With or Without Symptomatic Apical Periodontitis
		Postoperative Pharmacologic Management
		Management of Pulp Necrosis with Apical Pathosis
			Pulp Necrosis/Symptomatic Apical Periodontitis Without Swelling
			Postoperative Pharmacologic Management
			Pulp Necrosis/Acute Apical Abscess with Localized Intraoral Swelling
			Postoperative Pharmacologic Management
			Pulp Necrosis with Diffuse Swelling
			Postoperative Pharmacologic Management
		Postoperative Instructions
	Interappointment Emergencies
		Incidence
		Causative Factors
		Prevention
			Procedures
			Verbal Instructions
			Therapeutic Prophylaxis
		Diagnosis
		Treatment of Flare-Ups
			Previously Vital Pulps with Complete Débridement
			Previously Vital Pulps with Incomplete Débridement
			Previously Necrotic Pulps with No Swelling
			Previously Necrotic Pulps with Swelling
			Follow-Up Care
	Postobturation Emergencies
		Causative Factors
		Treatment
10 - Management of the Vital Pulp and of Immature Teeth
	The Dentin-Pulp Complex
		Pulp Defense Mechanisms
		Tertiary Dentinogenesis
		Pulp Necrosis and Root Development
	Etiologic Factors of the Dentin-Pulp Complex Injury
		Trauma
		Caries
		Dental Anomalies
		Iatrogenic Factors
			Cavity Preparation Aspects and Remaining Dentin
			Dental Materials
	Vital Pulp Therapy
	Capping Procedures
		Indirect Pulp Capping
		Direct Pulp Capping
		Pulpotomies
	Treatment of Immature Teeth with Pulp Necrosis
		Apexification—Indications, Approach, and Limitations
		Apexification—Clinical Protocols
		Regenerative Endodontic Procedures (REPs)—Indications, Approach, and Limitations
		REP—Clinical Protocols
		Tissue Engineering Approaches
	Conclusions
11 - Management of Traumatic Dental Injuries
	Examination and Diagnosis
		Mental Status
		History
	Medical History
	Clinical Examination
		Soft Tissue Examination
		Facial Skeleton
	Teeth and Supporting Structures
		Mobility
		Displacement
		Periodontal Damage
		Pulpal Injury
		Radiographic Examination
	Importance of Cone Beam Computed Tomographic Analysis in Trauma
	Injuries to the Hard Dental Tissues and the Pulp
		Enamel Fractures
		Uncomplicated Crown Fractures
		Complicated Crown Fractures
		Treatment of Crown Fractures
		Vital Pulp Therapy
		Case Selection for Vital Pulp Therapy
		Technique
		Treatment Evaluation
		Endodontic Treatment
		Crown-Root Fractures
		Emergency Care and Treatment Planning
		Root Fractures
		Sequelae of Root Fractures
		Root Canal Treatment
	Injuries to the Periodontium
		Examination, Diagnosis, and Pulp Testing
		Radiographic Evaluation
			Crown Color Changes
		Concussion
		Subluxation
		Luxation
			Extrusive Luxation
			Lateral Luxation
			Intrusive Luxation
			Treatment for Intrusive Luxation
			Open Apex
			Closed Apex
		Avulsion
		Treatment
			Immediate Replantation
			Replantation Within 60 Minutes of Avulsion—Tooth with a Closed Apex
			Replantation Within 60 Minutes of Avulsion—Tooth with an Open Apex
			Replantation with Dry Time Longer Than 60 Minutes—Tooth with a Closed Apex
			Replantation with Dry Time Longer Than 60 Minutes—Tooth with an Open Apex
	Patient Instructions
		Sequelae of Dental Trauma
			Pulp Necrosis
			Teeth with Open Apices
			Teeth with Closed Apices
				Root Canal Treatment
		Pulp Canal Obliteration (Calcific Metamorphosis)
		Root Resorption
			Surface Resorption
			Inflammatory Resorption
			External Replacement (PDL-Related) Resorption
		Alveolar Fractures
	Management of Traumatic Injuries in the Primary Dentition
		Enamel fracture
		Crown Fractures Without Pulp Exposure
		Crown Fractures with Pulp Exposure
		Crown-Root Fractures
		Root Fractures
		Alveolar Fractures
		Luxation Injuries
			Concussion and Subluxation
			Extrusive Luxations
			Lateral Luxations
			Intrusive Luxations
		Avulsions
		Patient Instructions
	Prevention
		Primary Management
		Secondary Management
12 - Root Canal Anatomy
	Introduction
		Gaining Knowledge and Comprehension of Root and Canal Anatomy
		Methods of Study to Learn Normal and Variations in Tooth Anatomy
		Root Canal Anatomy Since the Age of Specialization in Endodontics
		Multiple Canals Within a Single Root
	Root Canal Components and Morphology
		Pulp Chamber
		Root Canal
			Isthmus
			Accessory Canals
			Apical Canal
			Canal Curvature and Size
	Root Canal Configuration Systems
	Root Canal Anomalies and Embryologic Malformations
		Taurodontism
		Dens Invaginatus and Dens Evaginatus
		Radix
		C-Shaped Canals
		Other Anomalies
		Aging
	Root Canal Anatomy of Maxillary and Mandibular Teeth
		Incisors
		Canines
		Premolars
		Molars
	Influence of Root Canal Anatomy in Endodontic Procedures
	Clinical Outcome Remarks
	Conclusions
13 - Isolation, Endodontic Access, and Length Determination
	Rubber Dam Isolation
		Application
		Rubber Dam Retainers
			Types
			Universal Clamp Designs
		Preparation for Rubber Dam Placement
		Isolation of Teeth with Inadequate Coronal Structure
			Ligation
			Deep-Reaching Clamps
			Bonding
		Replacement of Coronal Structure
			Temporary Restorations
			Band Placement
			Provisional Crowns
		Rubber Dam Placement
			Placement as a Unit
			Placement of a Clamp, Followed by the Dam and Then the Frame
			Placement of the Rubber Dam and Frame and Then the Clamp
		Rubber Dam Leakage
		Disinfection of the Operating Field
	Access Openings
		General Principles
		Canal Morphologies
		General Considerations
	1397256787Access Openings and Canal Location*
		Maxillary Central and Lateral Incisors
		Maxillary Canines
		Maxillary Premolars
		Maxillary Molars
		Mandibular Central and Lateral Incisors
		Mandibular Canines
		Mandibular Premolars
		Mandibular Molars
	Errors in Access
		Inadequate Preparation
		Excessive Removal of Tooth Structure
	Length Determination
		Radiographic Evaluation
		Electronic Apex Locators
14 - Cleaning and Shaping
	Principles of Cleaning and Shaping
	Apical Canal Preparation
		Termination of Cleaning and Shaping
		Degree of Apical Enlargement
		Elimination of Etiology
		Apical Patency
	Pretreatment Evaluation
	Principles of Cleaning and Shaping Techniques
	Smear Layer Management
	Irrigants
		Sodium Hypochlorite
		Chlorhexidine
		MTAD
		QMix
		Irrigants for Cryotherapy
		Ultrasonics
	Lubricants
	Preparation Errors
	Preparation Techniques
		Working Length Determination
		Hand Instrumentation
			Watch Winding
			Reaming
			Filing
			Circumferential Filing
			Standardized Preparation
			Step-Back Technique
			Step-Down Technique
			Passive Step-Back Technique
			Anticurvature Filing
			Balanced Force Technique
			Recapitulation
			Shaping Modifications
		Engine-Driven Instruments
			Gates-Glidden Drills
			NiTi Rotary Instruments
	Criteria for Evaluating Cleaning and Shaping
	Intracanal Medicaments
		Calcium Hydroxide
		Phenols and Aldehydes
		Corticosteroids
		Chlorhexidine
15 - Obturation and Temporization
	Objectives of Obturation
	When to Obturate
		One versus Two Visits
			Smear Layer Removal
	Obturation Materials
		Ideal Properties of an Obturation Material
		Core Obturating Materials
			Gutta-Percha
			Mineral Trioxide Aggregate
			Silver Points
			Resin
			Pastes (Semisolids)
	Sealers
		Types of Sealers
			Zinc Oxide Eugenol Sealers
			Calcium Hydroxide Sealers
			Resin Sealers
			Bioceramic Sealers
			Silicone Based Sealers
			Urethane Methacrylate Sealers
		Evaluation and Comparison of Sealers
	Obturation Techniques with Gutta-Percha
		Cold Lateral Condensation
		Warm Vertical Condensation
		Continuous Wave
		Formed Cones
		Carrier-Based Obturation
		Single Cone Obturation
	Evaluation of Obturation
		How Obturation Materials and Techniques Are Evaluated in Research
		How Obturation Is Evaluated Clinically—Radiographic Evaluation
		Length of Obturation—Outcomes Studies
	Temporization
		Intraorifice Barriers
		Temporary Filling Materials
16 - Restoration of Endodontically Treated Teeth
	Criteria for a Restorable Tooth
		Amount of Remaining Coronal Tooth Structure
		Ferrule Wall Height
		Ferrule Wall Thickness
		Re-Establishing Coronal Tooth Structure
		Surgical Crown Lengthening
		Orthodontic Extrusion
	Complications Associated with Endodontically Treated Teeth
	Structural, Esthetic, and Restorative Considerations
		Structural Changes in Dentin
		Biomechanical Factors
		Esthetic Considerations
		Requirements for an Adequate Restoration
	Coronal Seal
	Restoration Timing
	Restoration Design
		Guiding Principles
		Planning the Definitive Restoration
			Anterior Teeth
			Posterior Teeth
	Posts
		Coronal Tooth Preparation
		Ferrule
		Post Selection
		Post Space Length
			Removal of Gutta-Percha
			Completing the Post Space Preparation
			Post Cementation
	Restoring Access Through an Existing Restoration
		Essential Precepts
17 - Bleaching Discolored Nonvital Teeth
	Causes of Discoloration
		Acquired (Natural) Discolorations
			Pulp Necrosis
			Intrapulpal Hemorrhage
			Calcific Metamorphosis
			Age
			Location
			Developmental Defects
			Inflicted (Iatrogenic) Discolorations
	Endodontically Related Discolorations
		Obturating Materials
		Remnants of Pulpal Tissue
		Intracanal Medicaments
		Coronal Restorations
			Metallic Restorations
			Composite Restorations
	Bleaching Materials
		Hydrogen Peroxide
		Sodium Perborate
		Carbamide Peroxide
		Other Agents
	Mechanism of Tooth Bleaching
	Internal (Nonvital) Bleaching Techniques
		Thermocatalytic Technique
		Walking Bleach
		Final Restoration
		Future Rediscoloration
		When to Bleach
	Complications and Safety
		External Root Resorption
		Coronal Fracture
		Chemical Burns
	Intrinsic Discolorations
		Tetracycline
		Other Intrinsic Discolorations
	Extrinsic Discolorations
	When and What to Refer
18 - Procedural Accidents
	Introduction
	Perforations During Access Cavity Preparation
		Causes
		Prevention
			Clinical Examination
			Operative Procedures
		Recognition and Treatment
			Lateral Root Perforation
			Furcation Perforation
			Nonsurgical Treatment
			Surgical Treatment
		Prognosis
	Accidents During Cleaning and Shaping
		Ledge Formation
			Prevention of a Ledge
				Preoperative Evaluation
			Management of a Ledge
			Prognosis
		Creating an Artificial Canal
			Cause and Prevention
			Management
			Prognosis
		Root Perforations
			Apical Perforations
			Lateral (Midroot) Perforations
				Etiology and Treatment
			Coronal Root Perforations
				Etiology and Indicators
		Instrument Separation
			Etiology
			Recognition
			Prevention
			Treatment
			Prognosis
			Role of 3D Imaging in Prevention
	Accidents During Obturation
		Underfilling
			Etiology
			Treatment and Prognosis
		Overfilling
			Etiology
			Prevention
			Treatment and Prognosis
		Vertical Root Fracture
			Etiology
			Prevention
			Indicators
			Prognosis and Treatment
	Accidents During Post Space Preparation
		Indicators
		Treatment and Prognosis
		Other Accidents
			Aspiration or Ingestion
			Extrusion of Irrigant
			Accidental Injections
19 - Nonsurgical Retreatment
	Introduction
	Causes of Nonhealing of Initial Root Canal Treatment
	Diagnosis and Retreatment Options
		Indications for Nonsurgical Endodontic Retreatment
		Contraindications for Nonsurgical Endodontic Retreatment
		Treatment Planning for Nonsurgical Retreatment
	Risks and Benefits of Retreatment
		Endodontic Retreatment Procedures
			Access Through Full-Coverage or Preexisting Restorations
			Removal of Existing Restorations
			Removal of Canal Obstructions
			Post and Core Removal
			Removal of Gutta-Percha
			Removal of Carrier-Based Gutta-Percha Obturators
			Removal of Silver Cones (Points)
			Removal of Soft and Hard Pastes
			Removal of Calcifications
			Management of Biofilms
			Root Canal Preparation in Retreatment
			Irrigation in Retreatment
			Obturation After Retreatment
		Restorative Options
		Follow-Up Care and Posttreatment Complications
	Prognosis
	Acknowledgment
20 - Apical Microsurgery
	A Brief History
	Indications for Apical Surgery
	Failing Root Canal Treatments
	Procedural Accidents
	Irretrievable Filling Materials
	Anatomic Complexity of the Root Canal System
	Symptomatic Cases
		Adjunctive Surgeries
		Exploratory Surgery
		Contraindications for Apical Surgery
		Case Selection and Contemporary Treatment Planning
		Apical Microsurgery
			Flap Design
	Apical Preparation
		Piezosurgery
		Apical Preparation Evaluation
		Hemostasis
		Selecting Retrofilling Materials
		Mixing, Placing, Condensing, Carving, and Finishing Retrofilling Materials
		Placing Bone Grafts and Membranes
			Flap Closure
			Postoperative Instructions
		Suture Removal
		Prognosis
21 - Adjunctive Procedures
	Introduction
	Incision for Drainage
		Indications
		Contraindications
		Procedures
			Anesthesia
			Incision
			Drainage
	Root Resection
		Indications
		Contraindications
		Procedures
	Hemisection
		Procedures
	Crown Lengthening
		Indications
		Contraindications
		Procedures
	Root Extrusion
		Indications and Contraindications
		Procedures
	Tooth Replantation
	Transplantation
	Guided Tissue Regeneration and Guided Bone Regeneration in Endodontics
		Indications
		Contraindications
		Procedure
		Prognosis
	Socket Preservation
		Indication
		Contraindications
		Procedure
22 - Endodontic Treatment Outcomes
	Introduction
	Definitions of Success and Failure
	When to Evaluate
	Methods for Evaluation of Endodontic Outcomes
		Patient History
		Clinical Examination
		Radiographic Findings
		Histologic Examination
	Success Rates
	Survival Rates
	Patient-Based Outcomes
	Postoperative Complications
	Prognostic Indicators
	Causes of Nonhealed, Failed Root Canal Treatment
		Preoperative Causes
		Operative Causes
		Postoperative Causes
	Outcomes of Treatments After Failure of Initial Nonsurgical Endodontics
		Nonsurgical Retreatment
		Endodontic Surgery
		Single Tooth Implant
		Fixed Dental Prostheses
		Replantation and Transplantation
		Extraction Without Replacement
	Reasons for Extraction of Endodontically Treated Teeth
1 - Summary Table of the Root Numbers of the Permanent Maxillary Teeth
2 - Summary Table of the Root CanalSystems of the Permanent Maxillary Teeth
3 - Summary Table of the Root Numbers of the Permanent Mandibular Teeth
4 - Summary Table of the Root CanalSystems of the Permanent Mandibular Teeth