Endodontics: Principles and Practice

Endodontics: Principles and Practice......Page 2
Copyright......Page 3
Preface......Page 4
List of Contributors......Page 5
Histology and Physiology of Normal Dental Pulp......Page 7
Chemical Irritants......Page 8
Microbial Irritants......Page 10
Endodontic Infections Are Biofilm Infections......Page 11
The Microbiome of Endodontic Infections......Page 12
Host Response in the Dental Pulp......Page 14
Irreversible Pulpitis......Page 17
Periapical Diseases......Page 18
Asymptomatic Apical Periodontitis......Page 19
Chronic Apical Abscess......Page 20
Nonendodontic Pathosis......Page 21
Process of Pulp Healing......Page 22
Factors Influencing Healing......Page 24
Health and Medical History......Page 30
Endodontic Disease May Initiate or Contribute to Systemic Diseases......Page 31
Chronic Endodontic Infections......Page 32
HIV/AIDS......Page 33
Genetic Predisposition......Page 34
Physical Limitations......Page 35
Changes With Age......Page 36
Nature of Response to Injury......Page 37
Access Preparation......Page 38
Effect of Restoration......Page 39
Biologic and Anatomic Factors......Page 40
Identifying Patients for Referral......Page 41
Introduction......Page 46
Standard Wall-Mounted Units......Page 47
Types of Digital Image Receptors......Page 48
Techniques for Intraoral Image Capture......Page 49
Identifying Pathosis......Page 52
Evaluating Treatment Progress......Page 53
Evaluating the Obturation (Intermediary Fill and Final Radiographs)......Page 55
Equipment and Principles for 3D Image Capture......Page 56
Field of View......Page 57
Image File Format......Page 58
Indications and Special Applications......Page 59
Introduction......Page 69
Dental History......Page 70
Soft Tissue......Page 71
Cold Testing......Page 73
Electric Pulp Testing......Page 74
Selective Anesthesia......Page 75
Pulpal Lesions......Page 76
Normal or Reversible Pulpitis......Page 77
Normal......Page 79
Cracked Tooth......Page 80
Internal Root Resorption......Page 82
Invasive Cervical Root Resorption......Page 83
Endodontic–Periodontic Interrelationships......Page 84
Primary Periodontal Defects of Endodontic–Periodontic Origin (True Combined Lesions)......Page 85
Treatment Planning......Page 86
The Comprehensive Treatment Plan......Page 87
Factors That May Alter the Treatment Plan......Page 88
Introduction......Page 92
Diagnostic Process for Nondental Orofacial Pain......Page 93
Periodontal Ligament Pain......Page 94
Musculoskeletal Pain......Page 95
Sinus/Nasal Toothache......Page 96
Radiolucencies of Nonpulpal Origin......Page 97
Histology......Page 98
Radiographic Features......Page 99
Clinical Features......Page 100
Ameloblastic Fibroma......Page 101
Radiographic Features......Page 102
Clinical Features......Page 103
Clinical Features......Page 105
Chondrogenic Sarcoma......Page 106
Clinical Features......Page 107
Histology......Page 108
Introduction......Page 112
What Is Expected of an Endodontist......Page 115
Standard of Care and Endodontic Case Documentation......Page 117
Gag Reflex and Ability to Open Mouth......Page 118
Position in the Arch......Page 119
Canal and Root Morphology......Page 120
Additional Considerations......Page 121
Referral During Treatment......Page 122
Sinus Tract......Page 123
Introduction......Page 127
Radiographic Examination......Page 128
Isolation......Page 129
Length Determination......Page 130
Endodontic Access......Page 131
Cleaning and Shaping Instruments......Page 133
Irrigants, Irrigation Devices, and Intracanal Medicaments......Page 135
Obturation Armamentarium......Page 137
Coronal Seal......Page 139
Root End Surgery (Apicoectomy) Armamentarium......Page 140
Tissue Inflammation......Page 147
Slow Injection......Page 148
Conventional Pulpal Anesthesia for Restorative Dentistry......Page 149
2% Mepivacaine with 1:20,000 Levonordefrin, 4% Prilocaine with 1:200,000 Epinephrine, and Plain Solutions (3% Mepivacaine and 4%.........Page 150
Accuracy of Needle Placement......Page 151
Pain and Inflammation......Page 152
Anesthesia-Related Factors......Page 153
Alternative Injection Techniques......Page 154
Technique for the Stabident System......Page 155
Duration in Asymptomatic Teeth......Page 156
Damage to the Pulp......Page 157
Anesthesia Difficulties in Endodontics......Page 159
Reversing Soft-Tissue Numbness......Page 160
Technique......Page 161
Mandibular Anterior Teeth......Page 162
Incision and Drainage―Buffered Anesthetics......Page 163
Periapical Surgery......Page 164
Introduction......Page 171
Differentiation of Emergency and Urgency......Page 172
Subjective Examination......Page 173
Radiographic Examination......Page 174
Management of Symptomatic Irreversible Pulpitis......Page 176
Postoperative Pharmacologic Management......Page 177
Pulp Necrosis/Symptomatic Apical Periodontitis Without Swelling......Page 178
Pulp Necrosis with Diffuse Swelling......Page 179
Postoperative Pharmacologic Management......Page 180
Diagnosis......Page 181
Treatment......Page 182
Pulp Defense Mechanisms......Page 187
Tertiary Dentinogenesis......Page 189
Trauma......Page 190
Cavity Preparation Aspects and Remaining Dentin......Page 191
Direct Pulp Capping......Page 193
Pulpotomies......Page 195
Apexification—Indications, Approach, and Limitations......Page 197
Apexification—Clinical Protocols......Page 198
Regenerative Endodontic Procedures (REPs)—Indications, Approach, and Limitations......Page 200
Tissue Engineering Approaches......Page 201
Conclusions......Page 202
Mental Status......Page 207
Soft Tissue Examination......Page 208
Pulpal Injury......Page 209
Importance of Cone Beam Computed Tomographic Analysis in Trauma......Page 210
Enamel Fractures......Page 211
Complicated Crown Fractures......Page 212
Technique......Page 213
Crown-Root Fractures......Page 214
Emergency Care and Treatment Planning......Page 215
Root Fractures......Page 216
Root Canal Treatment......Page 220
Radiographic Evaluation......Page 221
Concussion......Page 222
Closed Apex......Page 223
Replantation Within 60 Minutes of Avulsion—Tooth with a Closed Apex......Page 224
Teeth with Open Apices......Page 225
Management of Traumatic Injuries in the Primary Dentition......Page 226
Root Fractures......Page 227
Lateral Luxations......Page 228
Avulsions......Page 230
Secondary Management......Page 231
Introduction......Page 236
Methods of Study to Learn Normal and Variations in Tooth Anatomy......Page 237
Root Canal Anatomy Since the Age of Specialization in Endodontics......Page 238
Multiple Canals Within a Single Root......Page 239
Pulp Chamber......Page 240
Root Canal......Page 241
Isthmus......Page 242
Accessory Canals......Page 244
Canal Curvature and Size......Page 245
Taurodontism......Page 246
Dens Invaginatus and Dens Evaginatus......Page 247
Radix......Page 248
C-Shaped Canals......Page 250
Other Anomalies......Page 251
Root Canal Anatomy of Maxillary and Mandibular Teeth......Page 253
Incisors......Page 254
Premolars......Page 257
Molars......Page 261
Influence of Root Canal Anatomy in Endodontic Procedures......Page 265
Conclusions......Page 268
Application......Page 276
Universal Clamp Designs......Page 277
Isolation of Teeth with Inadequate Coronal Structure......Page 279
Access Openings......Page 280
General Considerations......Page 282
Maxillary Premolars......Page 285
Maxillary Molars......Page 286
Mandibular Central and Lateral Incisors......Page 288
Mandibular Canines......Page 289
Mandibular Premolars......Page 290
Mandibular Molars......Page 291
Radiographic Evaluation......Page 292
Electronic Apex Locators......Page 295
Principles of Cleaning and Shaping......Page 309
Termination of Cleaning and Shaping......Page 310
Degree of Apical Enlargement......Page 313
Pretreatment Evaluation......Page 314
Principles of Cleaning and Shaping Techniques......Page 315
Smear Layer Management......Page 316
Sodium Hypochlorite......Page 317
QMix......Page 318
Preparation Errors......Page 319
Working Length Determination......Page 321
Step-Down Technique......Page 322
Anticurvature Filing......Page 324
NiTi Rotary Instruments......Page 325
Criteria for Evaluating Cleaning and Shaping......Page 329
Phenols and Aldehydes......Page 332
Chlorhexidine......Page 333
One versus Two Visits......Page 340
Gutta-Percha......Page 341
Silver Points......Page 343
Pastes (Semisolids)......Page 344
Calcium Hydroxide Sealers......Page 345
Urethane Methacrylate Sealers......Page 346
Obturation Techniques with Gutta-Percha......Page 347
Cold Lateral Condensation......Page 348
Warm Vertical Condensation......Page 351
Formed Cones......Page 352
How Obturation Materials and Techniques Are Evaluated in Research......Page 354
How Obturation Is Evaluated Clinically—Radiographic Evaluation......Page 355
Length of Obturation—Outcomes Studies......Page 356
Temporary Filling Materials......Page 358
Amount of Remaining Coronal Tooth Structure......Page 364
Re-Establishing Coronal Tooth Structure......Page 365
Structural, Esthetic, and Restorative Considerations......Page 366
Restoration Timing......Page 367
Anterior Teeth......Page 368
Posterior Teeth......Page 370
Post Selection......Page 373
Post Space Length......Page 375
Removal of Gutta-Percha......Page 376
Restoring Access Through an Existing Restoration......Page 377
Essential Precepts......Page 378
Pulp Necrosis......Page 382
Location......Page 383
Developmental Defects......Page 384
Remnants of Pulpal Tissue......Page 385
Metallic Restorations......Page 387
Hydrogen Peroxide......Page 388
Mechanism of Tooth Bleaching......Page 389
Final Restoration......Page 390
When to Bleach......Page 391
External Root Resorption......Page 392
When and What to Refer......Page 393
Causes......Page 398
Operative Procedures......Page 399
Surgical Treatment......Page 401
Prognosis......Page 402
Preoperative Evaluation......Page 405
Management of a Ledge......Page 406
Apical Perforations......Page 407
Prevention......Page 409
Treatment......Page 411
Role of 3D Imaging in Prevention......Page 412
Indicators......Page 413
Treatment and Prognosis......Page 414
Accidental Injections......Page 415
Causes of Nonhealing of Initial Root Canal Treatment......Page 421
Diagnosis and Retreatment Options......Page 422
Risks and Benefits of Retreatment......Page 425
Access Through Full-Coverage or Preexisting Restorations......Page 426
Removal of Canal Obstructions......Page 427
Post and Core Removal......Page 429
Removal of Carrier-Based Gutta-Percha Obturators......Page 430
Removal of Silver Cones (Points)......Page 431
Removal of Soft and Hard Pastes......Page 433
Management of Biofilms......Page 434
Root Canal Preparation in Retreatment......Page 436
Obturation After Retreatment......Page 437
Prognosis......Page 438
Acknowledgment......Page 439
Indications for Apical Surgery......Page 445
Exploratory Surgery......Page 446
Flap Design......Page 447
Piezosurgery......Page 451
Apical Preparation Evaluation......Page 453
Mixing, Placing, Condensing, Carving, and Finishing Retrofilling Materials......Page 454
Postoperative Instructions......Page 456
Prognosis......Page 457
Contraindications......Page 460
Indications......Page 461
Procedures......Page 462
Procedures......Page 463
Guided Tissue Regeneration and Guided Bone Regeneration in Endodontics......Page 464
Prognosis......Page 468
Procedure......Page 469
Introduction......Page 471
Clinical Examination......Page 472
Radiographic Findings......Page 473
Success Rates......Page 474
Postoperative Complications......Page 475
Prognostic Indicators......Page 476
Preoperative Causes......Page 478
Operative Causes......Page 479
Outcomes of Treatments After Failure of Initial Nonsurgical Endodontics......Page 480
Endodontic Surgery......Page 481
Single Tooth Implant......Page 482
Fixed Dental Prostheses......Page 483
Reasons for Extraction of Endodontically Treated Teeth......Page 484
1 - Summary Table of the Root Numbers of the Permanent Maxillary Teeth......Page 489
2 - Summary Table of the Root CanalSystems of the Permanent Maxillary Teeth......Page 493
3 - Summary Table of the Root Numbers of the Permanent Mandibular Teeth......Page 497
4 - Summary Table of the Root CanalSystems of the Permanent Mandibular Teeth......Page 502