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    Intro To Endo

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    Gareth Doody
    This document provides guidelines for endodontic treatment, including indications for root canal treatment, retreatment, and surgical endodontics. It outlines the goals of eliminating bacteria from the root canal system and sealing the tooth. Key steps like taking a pre-operative x-ray, determining working length, gaining initial access to the pulp chamber, and locating canals are discussed. Basic root and canal shapes are also covered.

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    Intro To Endo

    Uploaded by

    Gareth Doody
    106 views18 pages
    This document provides guidelines for endodontic treatment, including indications for root canal treatment, retreatment, and surgical endodontics. It outlines the goals of eliminating bacteria from the root canal system and sealing the tooth. Key steps like taking a pre-operative x-ray, determining working length, gaining initial access to the pulp chamber, and locating canals are discussed. Basic root and canal shapes are also covered.

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    Intro to Endo

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    This document provides guidelines for endodontic treatment, including indications for root canal treatment, retreatment, and surgical endodontics. It outlines the goals of eliminating bacteria from the root canal system and sealing the tooth. Key steps like taking a pre-operative x-ray, determining working length, gaining initial access to the pulp chamber, and locating canals are discussed. Basic root and canal shapes are also covered.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    106 views18 pages

    Intro To Endo

    Uploaded by

    Gareth Doody
    This document provides guidelines for endodontic treatment, including indications for root canal treatment, retreatment, and surgical endodontics. It outlines the goals of eliminating bacteria from the root canal system and sealing the tooth. Key steps like taking a pre-operative x-ray, determining working length, gaining initial access to the pulp chamber, and locating canals are discussed. Basic root and canal shapes are also covered.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 18

    INTRO TO ENDO

    WHEN TO DO IT
    Indications for root canal treatment:
    1. An irreversibly damaged or necrotic pulp with or without clinical and/or radiological findings of apical periodontitis. 2. Elective devitalisation, e.g. to provide post space, prior to construction of an overdenture, doubtful pulp health prior to restorative procedures, likelihood of pulpal exposure when restoring a (misaligned) tooth and prior to root resection or hemi section.
    These guidelines are derived from the European Society of Endodontology: International Endodontic Journal, 39, 921930, 2006

    WHEN NOT TO DO IT
    Contra-indications for root canal treatment :
    1. Teeth that cannot be made functional nor restored. 2. Teeth with insufficient periodontal support. 3.Teeth with poor prognosis, uncooperative patients or patients where dental treatment procedures cannot be undertaken. 4.Teeth of patients with poor oral condition that

    WHEN TO RE-TREAT
    Indications for root canal retreatment 1.Teeth with inadequate root canal filling with radiological findings of developing or persisting apical periodontitis and/or symptoms. 2.Teeth with inadequate root canal filling when the coronal restoration requires

    Indications for surgical endodontics

    SURGICAL ENDODONTICS

    1. Radiological findings of apical periodontitis and/or symptoms associated with an obstructed canal (obstruction not removable or the risk of damage too great). 2. Extruded material with clinical / radiological findings of apical periodontitis and/or symptoms over a prolonged period. 3. Persisting or emerging disease following RCT when retreatment is inappropriate. 4. Perforation of the root or the floor of the pulp chamber and where it is impossible to treat from within the pulp cavity. Contra-indications for surgical endodontics 1 Local anatomical factors such as an inaccessible root end.

    AIM OF RCT
    The aim of root canal preparation is to debride the pulp space, rendering it as bacteria-free as possible, producing a shape amenable to obturation. The aim of root canal treatment is to eliminate bacteria from the root canal system, and to seal the canal and tooth to prevent reentry.

    REQUIRED OUTCOMES OF RCT


    1. Biological: Pulpal tissue, bacteria, and related irritants from the root canal system are eliminated 2. Mechanical: A continuously tapered preparation is produced The original anatomy is maintained The foramen position is maintained The apical foramen is kept as small as

    THE PRE-OP RADIOGRAPH


    A radiograph of the tooth to be endodontically treated should be available before treatment starts. The pre-operative radiograph allows endodontic treatment to be planned to suit the individual tooth, and allows an estimate to be made of the length of the tooth. Radiographs should be taken using film holders and a

    WORKING LENGTH
    The Estimated Working Length is calculated by measuring the length of the tooth on the preoperative radiograph, then subtracting 1 to 2 mm. It is safe to introduce a file up to the EWL without fear of damaging the apical constriction.

    ACCESS
    The initial access cavity allows you to clear the pulp chamber and get to the canal orifice in a straight line. Required Outcomes of Initial Access Preparation An unimpeded path to the root canal system The pulp chamber roof is entirely eliminated The whole pulp chamber floor can be illuminated and visualised There is a straight line path to each

    ACCESS- UPPER TEETH


    Upper Incisors Triangular 1 canal Upper Canines Ovoid 1 canal

    Upper 1st Premolar Oblong 2 canals Upper 2nd Premolar Oblong 1 canal Upper Molars

    ACCESS LOWER TEETH


    Lower Incisors Triangular 1 or 2 canals Lower Canines Lower Premolars buccal to groove Lower Molars Triangular 3 or 4 canals Ovoid 1 canal Oblong 1 canal, central

    BASIC ROOT & CANAL SHAPES:


    Pulp morphology is altered by age, irritants, attrition, caries, abrasion, periodontal disease etc. Over 90% of roots are curved. The onlyrootswhich (nearly) always only have a single canal are maxillary anteriors, Maxillary 1st premolars with two roots, and the palatal and distobuccal roots of maxillary molars. All other roots (includingallmandibular)

    ACCESS - PRINCIPLES

    Cut the "classical" outline of the access cavity about 2 - 3 mm into dentine. Search for the largestpulp horn and penetrate the chamber roof. Remove the roof with a small rosehead, using a pulling action. Do not push down - insert the bur and pull up. This avoids damaging the chamber floor. Smooth the walls so they create a slight open taper.

    INITIAL CORONAL ACCESS PROCEDURES


    Anterior Teeth

    Enter tooth just above where the cingulum meets the lingual of the crown. Direct high speed bur towards pulp chamber. Rough out access outline well into dentine

    When the pulp chamber is penetrated, change the bur angle to parallel to the long axis of the tooth.

    Finish un-roofing the pulp chamber with a slow handpiece bur. Irrigate the chamber to clear debris.

    POSTERIOR TEETH

    Rough out the access outline well into dentine.

    Begin the search where the pulp has greatest bulk, i.e. distal canal of lower molars, palatal canal of uppers.

    Finish un-roofing the pulp chamber with a slow handpiece bur. Do not instrument the floor - you may perforate it.

    Remove dentine overlying or obscuring orifices with a slow speed bur

    UPPER INCISAL ACCESS VIDEO

    Rough out the outline shape into dentine. Stop as soon as the pulp chamber roof is penetrated. De-roof the chamber with a low speed rosehead bur, using a "pull-back" motion. Extend cavity to incorporate pulp horns. Smooth &refine walls with a non-end-cutting instrument (to avoid damaging the floor).

    LOWER INCISOR ACCESS CAVITY

    Note the use of a round bur for the initial access. This prevents the ledges and ridges that form with a flat-ended bur, allowing files to glide smoothly down the chamber walls into the canals

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