Intro to Endo

8/2/2019 Intro to Endo

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INTRO TO ENDO


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WHEN TO DO IT

Indications for root canaltreatment:

1.An irreversibly damaged or necroticpulp with or without clinical and/orradiological findings of apical periodontitis.

2.Elective devitalisation, e.g. to providepost space, prior to construction of anoverdenture, doubtful pulp health prior torestorative procedures, likelihood of pulpalexposure when restoring a (misaligned)tooth and prior to root resection or hemisection.

These guidelines are derived from the European Society ofEndodontology: InternationalEndodontic Journal, 39, 921930, 2006
http://www.e-s-e.org/http://www.e-s-e.org/http://www.e-s-e.org/http://www.e-s-e.org/


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WHEN NOT TO DO IT

Contra-indications for root canaltreatment :

1. Teeth that cannot be made functional norrestored.

2. Teeth with insufficient periodontal support.

3.Teeth with poor prognosis, uncooperativepatients or patients where dental treatmentprocedures cannot be undertaken.

4.Teeth of patients with poor oral condition that


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WHEN TO RE-TREAT

Indications for root canalretreatment

1.Teeth with inadequate root canal fillingwith radiological findings of developingor persisting apical periodontitis and/orsymptoms.

2.Teeth with inadequate root canal fillingwhen the coronal restoration re uires


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SURGICAL ENDODONTICS Indications for surgical endodontics

1. Radiological findings of apical periodontitis and/orsymptoms associated with an obstructed canal(obstruction not removable or the risk of damagetoo great).2. Extruded material with clinical / radiologicalfindings of apical periodontitis and/or symptomsover a prolonged period.3. Persisting or emerging disease following RCTwhen retreatment is inappropriate.4. Perforation of the root or the floor of the pulp

chamber and where it is impossible to treat fromwithin the pulp cavity.

Contra-indications for surgical endodontics

1 Local anatomical factors such as an inaccessibleroot end.


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AIM OF RCT

The aim ofroot canal preparation is todebride the pulp space, rendering it asbacteria-free as possible, producing a shapeamenable to obturation.

The aim ofroot canal treatment is toeliminate bacteria from the root canal system,and to seal the canal and tooth to prevent re-

entry.


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REQUIRED OUTCOMES OFRCT

1. Biological:

Pulpal tissue, bacteria, and relatedirritants 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


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THE PRE-OP RADIOGRAPH

A radiograph of the toothto be endodontically treatedshould be available before

treatment starts.The pre-operative radiographallows endodontic treatment tobe planned to suit the

individual tooth, and allows anestimate to be made of thelength of the tooth.

Radiographs should be takenin film h l r n


9/18

WORKING LENGTH

The Estimated WorkingLength is calculated bymeasuring the length of

the tooth on the pre-operative radiograph,then subtracting 1 to 2mm.

It is safe to introduce afile up to the EWLwithout fear of damaging

the apical constriction.


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ACCESS

The initial access cavity allows you toclear the pulp chamber and get to thecanal orifice in a straight line.

Required Outcomes of Initial AccessPreparation

An unimpeded path to the root canalsystem

The pulp chamber roof is entirelyeliminated

The whole pulp chamber floor can be

illuminated and visualisedThere is a strai ht line ath to each


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ACCESS- UPPER TEETH

Upper IncisorsTriangular

1 canal

Upper Canines Ovoid1 canal

Upper 1st PremolarOblong

2 canals

Upper 2nd PremolarOblong

1 canal

Upper Molars


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ACCESS LOWER TEETH

Lower IncisorsTriangular

1 or 2 canals

Lower Canines Ovoid1 canal

Lower Premolars Oblong1 canal,

buccal to centralgroove

Lower MolarsTriangular

3 or 4 canals


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BASIC ROOT & CANALSHAPES:

Pulp morphology is altered by age, irritants,

attrition, caries, abrasion, periodontaldisease etc.

Over 90% of roots are curved.

The only roots which (nearly) always only

have a single canal are maxillary anteriors,Maxillary 1st premolars with two roots, andthe palatal and distobuccal roots ofmaxillary molars.All other roots (including all mandibular)


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ACCESS - PRINCIPLES

Cut the "classical" outline of the access cavity about 2 - 3 mm into dentine.

Search for the largest pulp horn and penetrate the chamberroof.

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.


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INITIAL CORONAL ACCESSPROCEDURES

Anterior Teeth

Enter tooth just above wherethe cingulum meets the

lingual of the crown.

Direct high speed bur towards

pulp chamber.

Rough out access outline

well into dentine

When the pulpchamber is penetrated,

change the bur angle to

parallel to the long axis

of the tooth.

Finish un-roofingthe pulp chamber

with a slow

handpiece bur.

Irrigate the

chamber to clear

debris.


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POSTERIOR TEETH

Rough out

the access

outline well

into dentine.

Begin the search

where the pulp

has greatestbulk, i.e. distal

canal of lower

molars, palatal

canal of uppers.

Finish un-roofing

the pulp chamber

with a slowhandpiece bur. Do

not instrument the

floor - you may

perforate it.

Remove

dentine

overlying or

obscuring

orifices with a

slow speed bur


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UPPER INCISAL ACCESSVIDEO

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).


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LOWER INCISOR ACCESSCAVITY

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

Intro to Endo

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