Treatment of Pulpal
and Periapical Diseases
Fan B,et al,C-shaped canal system,J Endodon,2004
Endodontic treatment is to clean
the root canal system thoroughly
Reamer
扩孔钻 K fileK锉
H file
H 锉
H file
H 锉
REAMER 扩孔钻
Gates Glidden burs G钻
Lightspeed
1,Treatment Planning
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Direct pulp capping
Indirect pulp capping
Pulpotomy
Preservation of pulp vitality
Pulpal and Periapical diagnosis
? Root canal therapy
? Resinfying therapy
? Mumification therapy
? Apical surgery
? Intentional replantation
Endodontic therapy
Pulpal and Periapical diagnosis
Preoperative view showing a periapical lesion
associated with the second mandibular molar
A
Radiograph of MAF with
paralleling projection
Radiograph of MAF with angle
projection
B C
Obturation with lateral condensation
D
Emergency treatment
Pulpal and Periapical diagnosis
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Restorability of tooth
Restorability of tooth
Restorability of tooth
Restorability of tooth
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Periodontal considerations
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Difficulty of case
Difficulty of case
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
System considerations
? Uncontrolled Diabete
? Cancer and chronic leukemia
? Pregnancy
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Financial considerations
Treatment decisions are based on:
? Pulpal and Periapical diagnosis
? Restorability of tooth
? Periodontal considerations
? Difficulty of case
? System considerations
? Financial considerations
Summary
2,Anaesthesia in Endodontics
Most commonly used anaesthetic solutions
Lidocaine 2%
Maximum safe dosage of 2% lidocaine
4.4 mg/kg (2mg/lb)
Vasoconstrictors in local anesthetics
? Prolong duration of anesthesia
via slower rate of absorption
? Decrease drug toxicity via
slower rate of absorption
? Decrease tissue hemorrhage
Maximum safe dosage of Epinephrine
In a normal patient,No more than 0.2 mg
In a cardiac patient,No more than 0.04 mg
In a 1:100,000 concentration
Methods
Conventional block anaesthesia
Local infiltration
Supplemental anesthesia techniques
Inferior Alveolar Nerve
Posterior Superior Alveolar Nerve
Infraorbital Nerve
Conventional Block Anaesthesia
Local infiltration
Anaesthetic solution is infiltrated slowly just
beneath the mucosal surface at the periapical
level and massaged gently towards the bone,
after a delay of 30 seconds to allow the onset
of analgesia,the needle is directed again
towards the apex,insinuating the point
beneath the periosteum,a further 0.5ml of
solution is injected slowly.
Supplemental anesthesia techniques
? Periodontal Ligament Injection
? Intraosseous Injection
? Intrapulpal Injection
3,Tooth Isolation
Rubber Dam Isolation
Greatly reduces bacterial contamination during root canal
treatment
Prevent swallowing of instruments
Prevent from rotary burs,NaOCl accidents
Faster,more convenient and less frustrating than the
repeated changing of cotton rolles and saliva-evacuating
devices
DON’T PERFORM RCT WITHOUT RD!! Must remain
in place from access to finish*
Isolation set up
?Rubber dam (RD)
?RD frame
?RD punch
?RD forceps
?RD Clamp
Frame
Frame and rubber dam
Forceps and Punch
Punch holes
Ash no,0/1 Ash no,9 Ferrier
Ash no,10/11 No,7a Wingless
Clamp
Forceps and Punch
clamping
restoration
Removal
4,Access opening
ACCESS OPENING
Burs
1157
Round burs #2 or #4
Endo-Z
General Principles,
– Location
– Shape
– Preoperative radiograph
Maxillary Central Incisors
Maxillary Central Incisors
? Average length = 22.5mm
? Conical taper
? Type I = 100%
Access Opening =
Triangular shape
ACCESS OPENING
Maxillary Incisors
ACCESS OPENING
Maxillary Incisors
Maxillary Incisors
ACCESS OPENING
ACCESS OPENING
Maxillary Incisors
? Enlarge the access opening by
withdrawing the rotating bur
Mandibular Molars
ACCESS OPENING
Mandibular Molars
ACCESS OPENING
Mandibular Molars
ACCESS OPENING
Thanks