Root Canal Treatment for Patients & Dentist

The

Root Canal TreatmenT for Dentists & Patients

Everything About

Created & Presented by Dr. Amit T. Suryawanshi

(MDS) Facial Cosmetic SurgeonOral & Maxillofacial Surgeon

Dental Surgeon & ImplantologistHair Transplant Surgeon (Germany)

Consulting Surgeon in Kolhapur, Pune, Sangli & Mumbai (India)

& founder of

Face Art International Super speciality

For International Calls Dial +91 9405622455

(MH, India)

Root Canal Treatment is one of the most common treatments in dentistry that manages the diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth.

Introduction

Physical irritation • Most generally

brought on by extensive decay.

Trauma • Blow to a tooth

or the jaw.

Causes of Pulpal Nerve Damage

Pain when biting down. Pain when chewing. Sensitivity with hot or cold beverages. Facial swelling.

Signs and Symptoms of Pulpal Nerve Damage

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Subjective examination• Chief complaint • Character and duration of pain • Painful stimuli • Sensitivity to biting and pressure

Diagnosis



Objective examination• Extent of decay • Periodontal conditions surrounding

the tooth in question • Presence of an extensive restoration • Tooth mobility • Swelling or discoloration • Pulp exposure

Diagnosis- cont’d



Percussion tests • Used to determine whether the

inflammatory process has extended into the periapical tissues.

• Completed by the dentist tapping on the incisal or occlusal surface of the tooth in question with the end of the mouth mirror handle held parallel to the long axis of the tooth.

Diagnostic Testing




Palpation tests• Used to determine whether the

inflammatory process has extended into the periapical tissues.

• The dentist applies firm pressure to the mucosa above the apex of the root.

Diagnostic Testing- cont’d



Thermal sensitivity• Necrotic pulp will not respond to cold

or hot. Cold test

• Ice, dry ice, or ethyl chloride used to determine the response of a tooth to cold.

Heat test• Piece of gutta-percha or instrument

handle heated and applied to the facial surface of the tooth.




Electric pulp testing• Delivers a small electrical stimulus to

the pulp. Factors that may influence readings:

• Teeth with extensive restorations.• Teeth with more than one canal. • Failing pulp can produce a variety of

responses. • Control teeth may not respond as

anticipated. • Moisture on the tooth during testing.• Batteries in the tester may be weak.




Placement of a pulp tester



Initial radiograph • Diagnosis.

Working length film • Used to determine the length of the

canal. Final instrumentation film

• Taken with the final size files in all canals.

Root canal completion film • Taken after the tooth as been

temporized. Recall films

• Taken at evaluations.

Radiographs in Endodontics



Show 4-5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition.

Present an accurate image of the tooth without elongation or fore-shortening.

Exhibit good contrast so all pertinent structures are readily identifiable.

Requirements of Endodontic Films

Normal pulp• There are no subjective symptoms or

objective signs. The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp.

Diagnostic Conclusions



Pulpitis • The pulp tissues have become inflamed.

Reversible pulpitis• The pulp is irritated, and the patient is

experiencing pain to thermal stimuli. Irreversible pulpitis

• The tooth will display symptoms of lingering pain.

Diagnostic Conclusions- cont’d



Periradicular abscess• An inflammatory reaction to pulpal

infection that can be chronic or have rapid onset with pain, tenderness of the tooth to pressure, pus formation, and swelling of the tissues.




Periodontal abscess • An inflammatory reaction frequently

caused by bacteria entrapped in the periodontal sulcus. A patient will experience rapid onset, pain, tenderness of the tooth to pressure, pus formation, and swelling.




Periradicular cyst• A cyst that develops at or near the

root of a necrotic tooth. These types of cysts develop as an inflammatory response to pulpal infection and necrosis of the pulp.




Pulp fibrosis• The decrease of living cells within the

pulp causing fibrous tissue to take over the pulpal canal.




Necrotic tooth• Also referred to as nonvital. Used to

describe a tooth that does not respond to sensory stimulus.




Pulp capping• A covering of calcium hydroxide is

placed over an exposed or nearly exposed pulp to encourage the formation of irritated dentin at the site of injury.

Indirect pulp cap is indicated when a thin partition of dentin is still intact.

Direct pulp cap is indicated when the pulp has been slightly exposed.

Endodontic Procedures



Spreaders



Pulpotomy • Involves the removal of the coronal

portion of an exposed vital pulp.• Completed to preserve the vitality of

the remaining portion of the pulp within the root of the tooth.

• This procedure is commonly indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations.

Endodontic Procedures- cont’d



Pulpotomy



Pulpectomy • Also referred to as root canal therapy;

procedure involves the complete removal of the dental pulp.

Endodontic Procedures- cont’d



Pulpectomy



Endodontic explorer Endodontic spoon excavator Broaches Endodontic files

• K-type• Hedstrom

Instruments and Accessories for Endodontic Procedures



Colors and Sizes of Endodontic Files



Rubber stops Paper points Spreaders Pluggers Glick No. 1 Millimeter ruler

Instruments and Accessories for Endodontic Procedures- cont’d



Rotary instruments • Gates-Glidden bur • Pesso reamer • Lentulo spiral

Instruments and Accessories for Endodontic Procedures- cont’d



Irrigation solution • Sodium hypochlorite • Hydrogen peroxide • Parachlorophenol (PCP)

Medicaments and Dental Materials in Endodontics



Gutta-percha points Formocresol Root canal sealer

Medicaments and Dental Materials in Endodontics- cont’d



Anesthesia and pain control Isolation and disinfection of the site Access preparation Debridement and shaping the canal Obturation

Overview of Root Canal Therapy



Indications for surgical intervention• Endodontic failure caused by

persistent infection, severely curved roots, perforation of the canal, fractured roots, extensive root resorption, pulp stones, or accessory canals that cannot be treated.

• Exploratory surgery to determine why healing has not occurred.

• Biopsy

Surgical Endodontics



To surgically remove the apical portion of the root with the use of a high‑speed handpiece and bur.

To evaluate:• Inadequate sealing of

the canal. • Accessory canals. • Fractures of the root. • Pathological tissue

around the root apex.

Apicoectomy and Apical Curettage



Completed when an apical seal is not adequate. A small class I preparation is made at the apex and sealed with filling materials such as gutta-percha, amalgam, or composite.

Retrograde Restoration



Root amputation• A surgery performed

to remove one or more roots of a multirooted tooth without removing the crown.

Hemisection• A procedure in which

the root and the crown are cut lengthwise and removed.

Root Amputation and Hemisection

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Root Canal Treatment for Patients & Dentist

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