#D3/S2/W1
#Endo

Lectures

Week 1

• Endodontic microbiology and infections
• Pulpal and Periradicular Pathosis
• Examination and diagnosis or pulp, root canal and periradicular conditions
• Endodontic Armamentarium
• Dental Dam
• Access for Root Canal Treatment
• Restoration of endodontically treated teeth
  Week 2
• Endodontic Radiography and Working length determination
  Week 3
• Root canal mechanical instrumentation 1, working length, glide path, hand instrumentation methods
• Root canal mechanical instrumentation 2, rotary canal preparation methods
  Week 4
• Root Canal Obturation
• Irrigation, medication, temporisation (single visit root canal treatment debate)
  Week 5
• Endodontic Case Selection and Treatment Planning
• Endodontic emergencies
  Week 6
• Prognosis, recall, evaluation of endodontic treatment outcomes
• Endodontic procedural errors and their management
  Week 7
• Vital Pulp Therapy
• Diagnosis and management of concurrent endodontic and periodontal diseases
  Week 8
• Dentoalveolar Trauma
  Week 9
• Diagnosis and Management of Cracked & Fractured Teeth
• Endodontic Retreatment Case Selection & Procedures
  Week 10
• Introduction to Surgical Endodontics
• Endodontic Management of Immature Teeth
• Bleaching of Endodontically Treated Teeth
  Week 11
• Infection Control in Endodontics (Aseptic Technique)
  Week 12
• Pathological Tooth Resorption

Studies

• Kakehashi et al 1965
• Sundqvist et al 1976
• Fabricius et al 1982
• Nair et al 1996
• Chugal et al 2003
• Siquera and Rocas 2009
• Siqueira Jr, Rocas. 2021

**What is Endo

• morphology, physiology, pathology of human tooth
• vital pulp management, pulpotomy, pulpectomy,
• trauma
• diagnosis of orofacial pain
• structural response of teeth following root canal treatment

Host response to bacterial infection

• Kakehashi et al 1965
  • microorganisms, byproducts and damaged tissue can cause periradicular inflammation (apical periodontitis)
  • teeth with infected root canal has close correlation with periapical disease
  • periradicular inflammation is usually adjacent to portals of exit such as apical foramina, lateral canals
  • periradicular inflammation inhibits spread of infection to surrounding bone
  • teeth with sterile root canals, even with necrotic pulp, generally do not result in periapical disease

**Nature of Microbes in endodontics

• most microbes infecting pulp chambers and root canals are bacteria, sometimes yeasts, viruses and archaea are present
• PCR have shown multitude of bacterial species
• Majority of bacteria in RC are facultative or obligate anaerobes
• longer the infection and deeper the canal the greater proportion of anaerobes
• most root canal infection is in the form of a bacterial biofilm
  • biofilm - dynamic community of bacteria irreversibly attached to a solid surface and embedded in a matrix (EPS)
  • Planktonic - loose or suspended in root canal

BIOFILM

Biologic Basis of endodontics

• primarily bacterial infection, in a biofilm
• biofilm adhere to RC walls, afford a protective mode of growth
• these biofilm result in pulpal and periapical disease
• chemo-mechanical techniques used to address bacterial infection

Aims of endo

• maintain pulp vitality as far as practicable
• prevent bacterial ingress into root canal system
• eradicate infection from root canal system
• ensure there is no re-infection or root canal system

Chemo-mechanical canal disinfection

• Mechanical root canal instrumentation
• Root Canal irrigation
• Intra-canal Medication

Sequence of endodontic Treatment
Step 1: Pre-exam questionnaire and interview including:
Step 2: Pain control
Step 3: Access and length determination
Step 4: Mechanical instrumentation of the root canal system Irrigation
Step 5: Medication and temporization if necessary
Step 6: Ultrasonic activation and Obturation
Step 7: (semi)Permanent coronal restoration
Step 8: Recall, assess disease control and maintenance

Root canal treatment sequence

• Pre-operative radiograph
• Estimate canal length
• Local anaesthesia
• Rubber dam
• Change gloves and open endodontic kit
• Swab site
• Interim restoration
• Access: HS through enamel, SS through dentine
• Locate canal, place NaOCl, use #10 /.02 to length
• Use electronic apex locator
• Confirm length with radiograph and #15 /.02
• Glide path / root canal freeway
• Use NiTi MTwo or EdgeFile X7 with NaOCl
• Ultrasonic activation of irrigant
• Dry canals
• Obturation
• Restoration