Root Canal Anatomy
Learning Objectives After reading this chapter, the student should be able to: 1. Recognize errors that may cause difficulties or failures in root canal treatment owing to lack of knowledge…
Endodontics
Endodontic Armamentarium
Learning Objectives At the end of this chapter, the student should be able to: 1. Define the basic set of armamentarium appropriate for diagnosis, emergency treatment, canal preparation, obturation, and…
Local Anesthesia
Learning Objectives After reading this chapter, the student should be able to: 1. Explain why apprehension and anxiety, fatigue, and tissue inflammation create difficulties in obtaining profound anesthesia. 2. Define…
Endodontic Case Complexity and Working with the Specialist
Learning Objectives After reading this chapter, the student should be able to: 1. Evaluate the multiple factors that determine case difficulty and potential need for referral. 2. Identify the indications…
Differential Diagnosis of Pains and Radiolucencies of Nonpulpal Origin
Learning Objectives After reading this chapter, the student should be able to: 1. Identify the personal and societal effect that orofacial pain conditions can have. 2. Understand the classification systems…
Endodontic Diagnosis and Treatment Planning
Learning Objectives After reading this chapter, the student should be able to: 1. Recognize that diagnosis and treatment planning for pulpal and periapical conditions should be part of a broader…
Endodontic Radiology
Learning Objectives After reading this chapter, the student should be able to: 1. Differentiate between stochastic and deterministic dental x-radiation biorisks and recognize which poses the greatest endodontic patient risk….
Systemic Health Considerations in the Endodontic Patient and Geriatric Endodontics
Learning Objectives After reading this chapter, the student should be able to: 1. Recognize the various ways in which endodontic pathosis and systemic disease interact and some of the mechanisms…
Pathogenesis of Pulp and Periapical Diseases
Learning Objectives After reading this chapter, the student should be able to: 1. Describe the histology and physiology of the normal dental pulp. 2. Identify etiologic factors causing pulp inflammation….
Therapeutic Options for the Management of Fractured Instruments
Fig. 4.1 Nonrestorable roots of a mandibular second molar with a fragment in the apical third of the distal root. Tooth extraction is the treatment of choice in this case…
Complications During Attempts of Retrieval or Bypassing of Fractured Instruments
Fig. 7.1 (a) Preoperative radiograph. (b) Fractured instrument in the apical third of the curved distal root of a first mandibular molar. (c) Root perforation and creation of “iatrogenic” canal…
Factors Affecting Intracanal Instrument Fracture
Factors affecting intracanal instrument fracture Operator related Skill, proficiency, judgment Anatomy related Access cavity Root canal anatomy Instrument related Material Design Manufacturing process and errors Technique/use related Motors operating parameters…
Introduction: Prevalence of Fractured Instruments
Fig. 1.1 Fragments of various endodontic instruments Fig. 1.2 (a) Fragment of an irrigation needle in the mesiobuccal root canal of a maxillary molar. (b) Fragment of the notched end…
Mechanisms of Instrument Failure
Fig. 3.1 Image showing H-files discarded after clinical use due to plastic deformation of the cutting tip Fig. 3.2 Distribution of fractured and plastically deformed instruments within different ISO sizes…
Prognosis of Root Canal Treatment with Retained Instrument Fragment(s)
Study Lesiona No lesion Healing (%) Effect on healing Strindberg (1956) 2/4 9/11 11/15 (73%) Overall 19% reduction (although lower when lesion is present) Grahnén and Hansson (1961) NR NR…
Parameters Influencing the Removal of Fractured Instruments
Fig. 5.1 (a) Preoperative radiograph of a mandibular right first molar with a fragment in the middle third of the mesial root. (b, c) Operative microscope photographs of the pulp…
Prevention
Steps Procedure First Ten vigorous strokes in a scouring sponge soaked in 0.2% chlorhexidine solution Second 30-min presoak in an enzymatic cleaning solution Third 15-min ultrasonication in the same solution…
Comparative Evaluation of Techniques and Devices for the Removal of Fractured Instruments
Author(s) Study design and sample size Methods, devices, instruments, techniques, and protocol used Microscope Definition of success Success rate Shiyakov and Vasileva (2014) In vivo (n = 26) Ultrasonics Yes…
Complications
Fig. 4.1 Large MODB pin-retained amalgam restoration. The loss of original occlusal anatomy landmarks and pulp canal space calcification will make this a more challenging tooth to access for root…
Relationship
Fig. 10.1 Anatomic relationship between pulp and periodontium In case of endodontic lesions, the pathway of inflammation is through the apical foramen, furcation canals, and lateral accessory canals to the…
