Causes of pulpal nerve damage: extensive decay moving into the pulp, heat from hand pieces, extensive restorations
Physical irritation
Causes of pulpal nerve damage: blow to a tooth or the jaw
Trauma
Localized area of pus (exudate) originating from an infection. Can be periodontics (around tooth) or endodontic (within the tooth)
Abscesses
This inflammatory reaction to pulpal infection may be chronic or acute onset with pain, tenderness of the tooth in response to pressure, pus formation and swelling of tissue
Endodontic (periradicular) abscess
This inflammatory reaction is frequently caused by bacteria trapped in the periodontal pocket, patient will experience rapid onset of pain, tenderness of the tooth in response to pressure, pus formation and swelling
Periodontal abscess
Diagnosis: chief complaint from patient, character and duration of pain, painful stimuli, sensitivity to biting and pressure
Subjective examination
Diagnosis: conducted by the endodontist, periodontal conditions, extensive restoration, tooth mobility, swelling or discolouration, pulp exposure, extent of decay.
Objective examination
Objective examinations: determine whether the inflammatory process has extended into the periodical tissues. The dentist taps on the Incisal of occlusal surface with the end of a mouth mirror handle parallel to the long axis of the tooth
Percussion test
Objective examination: used to determine whether the inflammatory process has extended into the periodical tissues. The dentist applies firm pressure to the mucosa above the apex of the root
Palpation test
Objective examinations: never used on metallic restoration or gingival tissue. Ice, dry ice or carbon dioxide is used to determine the response of a tooth to cold
Thermal sensitivity cold test
Objective examination: a piece of gutta percha or an instrument handle is heated and applied to the facial surface of the tooth
Thermal sensitivity heat test
What is suspected if the cold relieves pain in the tooth
Irreversible pulpitis
Objective examinations: a small electrical stimulus is delivered to the pulp, determines if the pulp is vital or non vital, placed on cervical third of the tooth
Electric pulp testing
Objective examination: good quality images, most useful diagnostic tool, most ideal for endodontic procedures
Periapical radiograph
Requirements for endodontic film
Must show 4-5mm beyond apex of the tooth and the surrounding bone or pathalogic condition. Must not have elongation or foreshortening, must have good contrast so structures are identifiable
Initial radiograph is taken when and why
At the consultation for diagnosis
Working length image is taken when and why
When the pulp is opened up and to determine the length of canal with files in the canals
Final instrumentation image is taken when and why
Right before the fill with the final size files in all canals
Root canal completion image is taken when and why
Taken after the tooth has been temporized with a temporary filling
Recall Image is taken when and why
Taken at post treatment evals to make sure it is healing properly
Diagnostic conclusion: inflammation of the pulp the pulp tissues become inflamed and can be described as being reversible or irreversible
Pulpitis
Diagnostic conclusion: mild, occurs when pulp is irritated and the patient is experiencing pain in response to thermal stimuli
Reversible pulpitis
Diagnostic conclusion: the tooth displayed symptoms of lingering pain
Irreversible pulpitis
Diagnosis: this type of cyst develops at or near the root of a necrotic tooth , they develop as an inflammatory response to pulpal infection and necrosis if the pulp
Periridicular cyst
Diagnosis: a decrease in living cells within the pulp causes fibrous tissue to take over the pulpal canal
Pulp fibrosis
Diagnosis: the tooth may as be referred to as non vital, describes a tooth that does not respond to sensory stimuli
Necrosis
Procedures: performed on a tooth that has an acute apical abscess usually has severe pain. Incision is made in the gum to drain infection
Incision and drain
Abnormal passage or drainage leading from an abscess to the surface of the skin
Fistula
Procedures: attempt to save the pulp, calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin
Indirect pulp capping
Procedures: Indicated when the pulp has been slightly exposed
Direct pulp calling
Procedure: involves removal of the coronal portion of an exposed vital pulp, used to preserve the vitality of the remaining portion of the pulp within the root of the tooth indicates for primary teeth, teeth with deep carious lesions and emergencies
Pulpotomy
Also referred to as rct, this procedure involves the complete removal of the dental pulp
Pulpectomy
Instruments: working ends positioned at an angle which helps to locate the canal openings
Endodontic explorer
Instruments: similar to spoon excavator but has much longer shank
Endodontic spoon excavator
Instruments: used to obturate the canals condense and adapt gutta percha into canals
Spreaders- lateral pluggers compress down
Instruments: paddle end for placement and shaping of temp restoration, rod shaped can be heated for placement or removal of gutta percha
Glick number 1
Instruments: twisted design for initial debridment of canal and during later stages of shaping and contouring the canal
K type files
Instruments: has greater cutting efficiency because of its design so cutting occurs in the pulling stroke used for final enlargement of canal
Hedstrom file
Instrument: similar to k file but the cutting edges are further apart, used to remove dentin structure and smooth and increase size of canal
Reamer file
Instruments: thin, flexible, tapered tiny projections used to remove vital inflamed pulp tissue (extirpation) from the canal. Can also remove cotton pellets and paper points
Broaches
Rotary burs: football shaped end and very long shank, used to enlarge walls of pulp chamber ( cutting edge is on sides not end)
Gates glidden
Rotary burs: long blades, parallel with non cutting ends, used when tooth requires a post preparation for placement of final restoration
Pesso files
Paper points do what
Absorb and dry irrigation solution out of canals
Medicaments: facilitates the removal of materials from the canal and provides tissue dissolution, bleaching, deodorizing, and hemmorhage control
Irrigation solution
Made from rubber material, solid at room temp but soft when heated used to obturate canals
Gutta-percha points
Cement type material that seals infilled voids during obturation
Root canal sealers
Used in low speed to place sealed and cements into canal
Lentulo spiral
Can reduce number of radiographs taken to determine working length using
Electronic apex locator
Purpose of ___ and ___ is to remove bacteria, smooth and shape the canal so filling material can be completely adapted
Debridement and shaping
Objective is to place a fluid tight seal in the canals form apical tip to coronal surface to prevent re entry of microorganisms (has to be 1mm within the working length )
Obturation
____ may be caused by persistent infection, improper measurement of canals, severely curved roots, perforation of canal, fractured roots, extensive root resorption, pulp stones
Endodontic failure
To surgically remove the apical portion of the root
Apicoectomy
Performed to remove pathological soft tissue around the root of the apex
Apical curettage
Root end filling, completed when the apical seal is not adequate
Retrograde restoration
Remove one or more roots of a multi rooted tooth without removing the crown mostly done on max molars
Root amputation
The root and the crown are cut length wise and removed, mostly done on mand molars
Hemisection
