Minimally Invasive Approaches in Endodontic Practice

Preface
Contents
1: The Role of Modern Technologies for Dentin Preservation in Root Canal Treatment
	1.1	 Introduction
	1.2	 Technologies for Dentin Preservation: Phase 1—Planning
		1.2.1	 Cone-Beam Computed Tomography (CBCT) Imaging
			1.2.1.1	 Detection of Periradicular Lesions
			1.2.1.2	 Determination of the Point of Entry for Root Canal Treatment
			1.2.1.3	 Assessing Anatomical Details
				Size and Position of the Pulp Chamber
				Number of Roots and Root Canals
				Root Canal Configuration
				Root Canal Curvatures
				Working Length Determination
				Root Canal Splitting
				Horizontal Root Bulk and Canal Dimension at Pericervical Region
	1.3	 Technologies for Dentin Preservation: Phase 2—Treatment
		1.3.1	 Image-Guided Endodontic Access
		1.3.2	 Magnification Aids in Root Canal Treatment
		1.3.3	 Ultrasonic Tips
		1.3.4	 Heat-Treated Ni-Ti Files
	1.4	 Conclusive Remarks
	References
2: Vital Pulp Therapy
	2.1	 Introduction
	2.2	 Pulp Inflammation and Healing
	2.3	 Pulp Capping and Biomaterials
	2.4	 Step-by-Step Procedure
		2.4.1	 Pulp Capping (Fig. 2.3)
		2.4.2	 Pulp Chamber Pulpotomy (Fig. 2.5)
	2.5	 Application of Pulp Capping and ‘Bio-Products’ to Stimulate Regeneration
	2.6	 Short- and Long-Term Future Developments
	2.7	 Conclusions
	References
3: Minimally Invasive Access to the Root Canal System
	3.1	 Introduction
	3.2	 Access Cavity Designs in Endodontics
	3.3	 Anatomy of the Pulp Chamber
	3.4	 Traditional Access Cavity (Fig. 3.3)
	3.5	 Minimal Invasive Dentistry
	3.6	 Conservative Access Cavity
	3.7	 Access Cavity Terminology
	3.8	 Conservative Access Cavity Equipment
		3.8.1	 Burs
		3.8.2	 Mirrors
		3.8.3	 Endodontic Explorers
		3.8.4	 Handle Files
		3.8.5	 Microscopes and Loupes
		3.8.6	 Ultrasonic Devices and Ultrasonic Tips
		3.8.7	 CBCT
		3.8.8	 Time
	3.9	 Conservative Access Cavity Drawbacks
	3.10	 Research Evaluation of Conservative Access Cavities
	3.11	 The “Less Is More” Concept in Endodontics
	3.12	 Dynamic Access Cavity Design
	3.13	 The Future Concept of Biological Repair of Access Cavities
	References
4: Minimally Invasive Root Canal Instrumentation
	4.1	 Minimally Invasive Shaping: A Matter of Size
	4.2	 Limitations of the Current Technology for Mechanical Shaping
	4.3	 Preservation of Pericervical Dentin—Is Coronal Pre-flaring Still Necessary?
		4.3.1	 The Role of the Danger Zone
	4.4	 Evolution of NiTi-Based Preparations
		4.4.1	 NiTi Alloys
		4.4.2	 Shaping Kinematics
	4.5	 Apical Size and the Limits of Shaping
	4.6	 Taper of Root Canal Instrumentation
	4.7	 Concluding Remarks
	References
5: Root Canal Debridement and Disinfection in Minimally Invasive Preparation
	5.1	 Introduction
	5.2	 Chemical Debridement of the Root Canal System
	5.3	 Clinical Factors and Minimally Invasive Cleaning and Shaping Procedures
	5.4	 Chemical Cleaning of the Pulp Chamber
	5.5	 Minimally Instrumentation and Irrigation Procedures
	5.6	 Adjunctive Systems to Clean Minimally Instrumented Root Canals
	5.7	 Concluding Remarks
	References
6: Filling of Root Canals After Minimally Invasive Preparation
	6.1	 Introduction
	6.2	 Terminology
	6.3	 Rational for Root Canal Filling
	6.4	 Materials and Techniques
		6.4.1	 Core Materials
		6.4.2	 Types of Sealers
		6.4.3	 How Well Do Traditional Filling Materials and Methods Perform?
	6.5	 Attempts to Improve Root Canal Fillings
	6.6	 Bioceramic Materials
		6.6.1	 Bioceramics in Endodontics
		6.6.2	 Available Hydraulic Endodontic Cements (Tables 6.1–6.3)
		6.6.3	 Hydraulic Endodontic Cements for Root Filling
		6.6.4	 Properties of Hydraulic Endodontic Cements
			6.6.4.1	 Biocompatibility and Cytotoxicity
			6.6.4.2	 pH and Antibacterial Properties
			6.6.4.3	 Bioactivity
			6.6.4.4	 Bond Strength
			6.6.4.5	 Resistance to Fracture
			6.6.4.6	 Microleakage
			6.6.4.7	 Solubility
			6.6.4.8	 Retreatment
		6.6.5	 Hydraulic Endodontic Cements: An Ideal Core-Sealer System for Filling Minimally Invasive Preparation?
		6.6.6	 Root Filling Technique with the Hydraulic Endodontic Cements
	6.7	 Use of Dental Operating Microscope During the Root Filling Phase on Minimally Invasive Canal Preparation
	6.8	 Conclusions
	References
7: Minimally Invasive Approach to Endodontic Retreatment and Surgical Endodontics
	7.1	 Endodontic Retreatment
	7.2	 Conventional Retreatment of Gutta-Percha
		7.2.1	 Case Planning
		7.2.2	 Endodontic Retreatment Access
		7.2.3	 Retreatment Protocol
			7.2.3.1	 Gutta-Percha Removal
			7.2.3.2	 Determining Working Length—Location of the Foramen or Apical Limit of the New Preparation
			7.2.3.3	 New Canal Preparation and Final Repreparation Diameter
		7.2.4	 Clinical Protocol
	7.3	 Making Invasive Procedures During Nonsurgical Endodontic Retreatment Less Invasive
	7.4	 Predictability of Nonsurgical Retreatments
	7.5	 Endodontic Microsurgery
	7.6	 Access to the Periapical Region
		7.6.1	 Flap Design
		7.6.2	 Osteotomy
		7.6.3	 Apical Curettage
	7.7	 Surgical Management of the Apical Root Region
		7.7.1	 Apicectomy
		7.7.2	 Retropreparation
		7.7.3	 Retrofilling
	7.8	 Suture
	7.9	 Conclusions
	References
8: Strategies for the Restoration of Minimally Invasive Endodontically Treated Teeth
	8.1	 Introduction
	8.2	 Minimally Invasive Approach to Restorative Procedures
	8.3	 Post-endodontic Restoration: How and Why
	8.4	 Parameters Influencing Restoration of Endodontically Treated Anterior Teeth
	8.5	 Parameters Influencing Restoration of Endodontically Treated Premolar Teeth
	8.6	 Parameters Influencing Restoration of Endodontically Treated Molar Teeth
	8.7	 Restoration of Endodontically Treated Teeth with Fiber Posts
		8.7.1	 Basic Concepts
		8.7.2	 Strategical Fiber Posts
		8.7.3	 Minimally Invasive Procedures for the Cementation of Fiber Posts
	8.8	 Conclusive Remarks
	References
9: Minimally Invasive Alternatives to Dental Extraction and Implant Placement
	9.1	 Introduction to Autotransplantation of Teeth
		9.1.1	 Clinical Examination and Diagnosis
		9.1.2	 Advantages and Disadvantages
	9.2	 Biological Basis
		9.2.1	 Periodontal Ligament (PDL) and Bone Healing
		9.2.2	 Pulp Regeneration and Root Development
	9.3	 Mechanisms of Root Resorption
		9.3.1	 Replacement Resorption or Ankylosis (Fig. 9.1)
		9.3.2	 External Inflammatory Resorption (Fig. 9.2)
		9.3.3	 External Surface Resorption (Fig. 9.3)
	9.4	 Clinical Indications and Procedures
		9.4.1	 Classification
		9.4.2	 Surgical Extrusion: Indications and Technique
			9.4.2.1	 Diagnosis and Treatment Planning
			9.4.2.2	 Surgical Procedure
		9.4.3	 Intentional Replantation: Indications and Technique
			9.4.3.1	 Diagnosis and Treatment Planning
			9.4.3.2	 Surgical Procedure
		9.4.4	 Conventional Tooth Autotransplantation: Indications and Technique
			9.4.4.1	 Diagnosis and Treatment Planning
			9.4.4.2	 Surgical Procedure (Fig. 9.13)
	9.5	 Concluding Remarks
	References