Dr. Özkan ADIGÜZEL

1. Diagnosis and treatment planning
in Root Canal Therapy
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2. Examination Procedure
a) General medical history
b) C/O- Currant symptoms, past & recent treatment
c) H/O/C Pain – location,nature,duration,stimuli,relief,referred
d) Clinical examination- swelling, facial asymmetry, periodontal
disease, discharging sinuous, caries, restoration, fracture, attrition,
abrasion, erosion, and abfraction
e) Diagnosis tests – percussion, palpation, mobility, pocket
f) Pulp sensibility test – electric, cold, heat
g) Radiographic test - IOPA, tube sift, bite wing, panoramic
h) Other test – biting on individual cusp, trans-illumination, local
anaesthesia test, test cavity
i) Investigations –removal of caries of restoration, trans- illumination
of cavity.
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3. History
• All the problems be determined diagnosis
maid, appropriate treatment discussed and
informed consent should be obtained.
• Demographic, medical and dental history
should be recorded
• Radiograph is Mandatory. early stages of
pulpitis are not evident
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4. Patient selection limitations
1. Medically compromised patient
2. Very old patient
3. Poor oral hygiene
4. Retain roots
5. Calculi
6. Carious teeth
7. Restricted mouth opening
8. Patient’s attitude
9. Patient’s compliance
10. Cost
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5. Patents requiring antibiotic cover
1. Hisory of infective endodarditis
2. Ventricular septal defect
3. Ductus arteriosus
4
4. Coarctation of the aorta
5. Prosthetic heart valve
6
6. Degenerative valve disease
7. Rheumatic heart disease
8. Persistent heart murmur
9. Atrial septal defect repaired with a
patch
10. Chronic debilitating disease
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6. Pain
• How long have you had the pain
• Do you know which tooth it is
• What initiate the pain
• How would you describe the pain
• Sharp or dull, throbbing mile or severe, localize
or radiation
• How long does the pain last
• Does it pain most during the day or night
• Does anything relieve the pain
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7. Examination
• Standard oral Hygiene
• Amount and quality of Restorative work
• Prevalence of caries
• Missing and unopposed teeth
• General medical condition
• Presence of soft or hard swelling
• Presence of any sinus tracts
• Discolored teeth
• Tooth wear and facets
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8. Intra--oral Swelling
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9. Extra--oral Swelling
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10. Extra--oral Swelling
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11. Facial asymmetry
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12. Periodontal disease
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13. Intra--oral discharging sinuous
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14. Extra--oral discharging sinuous
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15. Caries
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16. Heavily restored teeth
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17. Fractured teeth
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18. Pulp Testing
• Moribund pulp may give possitive results, multi
rooted teeth give complicated results. Ideal way
of measuring vitality leiser dopler flowmeter
messure blood flow to the pulp
• Electronic gives false possitive reading due to
stimulation of PDL
• Thermol pulp test
• Heat guttapercha sticks
• Cold ethil chloride
• ice sticks
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19. Palpation
• Palpation the sight and
size of any soft or hard
swelling – examine for
fluctuation and crepitus
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20. Percussion
• Percussion –
gentle tapping with
finger – both
lateral and vertical
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21. Mobility
• Mobility – slight
moderate and
extensive – lateral
and vertical
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22. Pockets depth
• Standard oral
Hygiene
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23. Biting on individual cusp
•Wooden stick test
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24. Mouth opening
• restricted
mouth
opening
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25. • Local aneasthetics
• Intra ligamental injection
• Fibro-optic light trans illumination teeth to
show inter-proximal caries, fracture,
opacity or discoloration
• Cutting a test cavity
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26. Indication for root canal treatment
• Post space insufficient tooth substance for
normal restoration
• Over denture
• Teeth with doubtful pulp
• Periodontal disease
• Pulpal sclerosis following trauma
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27. Tooth selection limitations
1. Unrestorable tooth
2
2. Insufficient periodontal support
3. Root fracture
4. Bizarre anatomy
5. Non-strategic tooth
6
6. External/external resorption
7. Procedural accident
8. Calcified canal
9. Post retained crowns
10. Open apex
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28. Anatomical complications
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29. Non--functional tooth
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30. External / Internal resorption
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31. Anatomical defects
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32. Anatomical defects
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33. Procedural accident
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34. Procedural accident - zip perporation
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35. Obstruction of canal – foreign body
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36. Obstruction of canal – fractured instrument
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37. Obstruction of canal – calcified canal
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38. Open apex
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39. Contra indication (general)
• Inadequate access –
Restricted mouth opening
• Poor oral hygiene – patient should be able to
maintain a healthy mouth
Patients general medical condition –
• Chronic debilitating disease or very old age
• Patients attitude –
Patient should be sufficiently educated and
motivated
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40. Contra indication (Local)
• Tooth non restorable supra-gingival and supra-
crestal
• Insufficient periodontal support
• Non strategic tooth
• Root fracture
• Internal or external resorption
• Bizarre anatomy – exceptionally curved tooth,
dilacerated teeth, congenital palatal roots,
unusual anatomy
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41. Indication for re-treatment
1. Signs of infected root canal
2
2. Signs of periapical pathology
3. Technically inadequate RCF
4
4. Dislodge of post retain crown
5. Broken down crown restorations
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42. • 90-95% success – no
periapical lesion
• 80--85%success – preoperative
periapical lesion
• 60-65% success – re root
filling
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