Endodontics

• Endodontics is the branch of dentistry concerned with the anatomy, physiology, and pathology of the human dental pulp and the periapical tissues, including their prevention and treatment
• • Treatment procedures related to coronal restorations
• Scope of Endodontics includes:

  • Differential diagnosis
  • Treatment of oral pain of pulpal or periapical origin
  • Vital pulp therapy (Pulp capping, Pulpotomy)
  • Non-surgical treatment of root canal system with or without periapical pathology of pulpal origin
  • Selective surgical removal of pathological tissues resulting from pulpal pathology
  • Intentional replantation and replantation of avulsed teeth
  • Surgical removal of tooth structure (Root end resection, Bicuspidization, Hemisection, Apicoectomy)
  • Bleaching of discolored dentin and enamel
  • Retreatment of teeth
• Objectives of Endodontics:

  • Retain a tooth inside the oral cavity which may otherwise require extraction
  • Relief of pain, if present
  • Removal of pulp from the root(s) of tooth
  • Disinfection of root and surrounding bone by cleaning and shaping the root canal walls
  • Complete filling of root canals (obturation)
  • Placement of final restoration
• History of Endodontics:

  • Pre-Science period (2nd – 3rd Century BC to 1826)
  • Age of Discovery (1826 – 1876)
  • Dark Age (1876 – 1926)
  • Renaissance (1926 – 1976)
  • Innovation Era (1976 onwards)
• Basic Principles of Endodontics:

  • Chain of asepsis
  • Correct diagnosis and treatment planning
  • Atraumatic handling of tissues
  • Cleaning of the canal: Debridement and removal of the biofilm sticking to the canal walls
  • Shaping of the canals
  • Complete obturation
  • Restoration
  • Recall and maintenance care
• Factors Affecting Root Canal Morphology:

  • Age
  • Dental caries
  • Irritants
  • Developmental anomalies
  • Physical changes
  • Trauma
• Root Canal System:

  • The morphology of the root canal system is unique and diverse among teeth
  • Pre-operative radiographs are essential before beginning endodontic treatment
  • Factors like age, dental caries, irritants, developmental anomalies, physical changes, and trauma affect root canal morphology
• Vertucci's Classification of Root Canal Systems:

  • Type I: Single canal from pulp chamber to apex
  • Type II: Two separate canals join short of the apex
  • Type III: One canal divides into two in the root and merges to exit as one canal
  • Type IV: Two separate distinct canals from pulp chamber to apex
  • Type V: One canal divides into two separate canals short of the apex
  • Type VI: Two canals merge in the root and re-divide short of the apex
  • Type VII: One canal divides and rejoins in the root, then re-divides into two distinct canals short of the apex
• Maxillary central incisor landmarks:

  • Long axis of the tooth in disto-axial inclination
  • Exact center of the lingual fossa
  • Cingulum
  • Mesial and distal pulp horns
• Maxillary lateral incisor landmarks:

  • Long axis of the tooth in disto-axial inclination
  • Exact center of the lingual fossa
  • Cingulum
  • Mesial and distal pulp horns
• Maxillary canine landmarks:

  • Long axis of the tooth
  • Exact center of lingual ridge/fossa
  • Cingulum
  • Incisal cusp tip
• Maxillary 1st Premolar landmarks:

  • Long axis of tooth and depth of pulp chamber
  • Exact center of central groove
  • Buccal cusp tip
  • Palatal cusp tip
• Maxillary 2nd Premolar landmarks:

  • Long axis of the tooth in disto-axial inclination
  • Exact center of the lingual fossa
  • Cingulum
  • Mesial and distal pulp horns
• Maxillary Molars landmarks:

  • Long axis of tooth and depth of pulp chamber
  • Central groove between mesiobuccal and palatal triangular ridge
  • Palatal cusp tip
  • Distopalatal position
• Mandibular Incisors landmarks:

  • Long axis of tooth in disto-axial inclination
  • Exact center of lingual fossa
  • Cingulum
  • Mesial and distal pulp horns
• Mandibular Canine landmarks:

  • Long axis of the tooth
  • Exact center of lingual ridge/fossa
  • Cingulum
  • Incisal cusp tip
• Mandibular Premolars landmarks:

  • Long axis of tooth
  • Depth of pulp chamber
  • Middle of central groove
• Mandibular Molars landmarks:

  • Long axis of tooth and depth of pulp chamber
  • Central groove between MB and ML triangular ridge
  • Distal position
  • MB and ML cusp tip