The lecture describes the pathology of pulp dan periraducular tissues and the factors which affect the response of the pulp and periradicular area.

1. Endodontics
DB
305C
Module
1
Year
3.
Wan
Noorina
WA

2. ¡ Explain
the
scope
of
endodontic
treatment
¡ Explain
why
root
canal
treament
needs
to
be
carried
out
¡ Describe
the
stages
of
root
canal
treatment
¡ Describe
the
standards
of
treatment
¡ List
the
factors
that
determine
the
success
of
treatment

3. ¡ Characterize
aetiological
factors
causing
pulpal
inflammation
¡ Explain
the
mechanism
of
spread
of
inflammation
in
the
pulp
and
periradicular
tissues
and
its
consequences
¡ Explain
why
the
pulp
has
difficulty
in
recovering
from
severe
injury
¡ Classify
the
pulpal
and
periradicular
lesions
¡ Describe
the
step
involve
in
healing(resolution)
of
periradicular
lesions
following
successful
root
canal
treatment
¡ Identify
in
general,
non-­‐endodontic
lesions
that
may
simulate
endodontic
periradicular
lesions

5. ¡ Injuries
to
and
diseases
of
dental
pulp
and
periradicular
region
¡ The
study
of
form,
function
and
health
¡ The
prevention
of:-­‐
¡ The
treatment
management

8. ¡ The
clinical
management
that
consists
of
procedures
that
are
design
to
maintain
the
health
of
all
or
part
of
dental
pulp
¡ When
pulp
is
diseased
or
injured,
treatment
aimed
at
preserving
the
normal
periradicular
tissues
¡ When
infection
pursues,
treatment
is
aimed
at
restoring
the
periradicular
tissues
to
health
¡ This
is
done
with
root
canal
treatment,
+
surgical
endodontics

9. Healthy
pulp
Infected
Inflamed
Maintain
health
Root
canal
treatment
Pulpectomy
Root
canal
re-­‐treatment
Root
canal
Apical
surgery
treatment
Pulp
capping
Pulpotomy
(Restoring
The
Periradicular
(Preserving
The
Normal
Tissues
To
Health)
Periradicular
Tissues)

10. WHY?

12. ¡ Living
organisms
§ Micro-­‐organisms
▪ Bacteria
▪ Viruses
▪ ?
Others
¡ Non-­‐living
irritants
§ Mechanical
§ Thermal
§ Chemical

13. ¡ Kakehashi
et
al.
The
¡ Moller
et
al.
Influence
effects
of
surgical
on
periapical
tissues
of
exposures
of
dental
indigenous
oral
pulps
in
germ-­‐free
and
bacteria
and
necrotic
conventional
pulp
tissue
in
monkeys.
laboratory
rats.
Oral
Scant
J
Dent
Res
Surg
Oral
Med
Oral
89:475,
1981
Pathol
20:340;
1965

14. ¡ Microorganisms
§ Toxins
§ By
products
¡ Pulp
is
infiltrated
at
the
base
of
the
carious
tubules
by
§ Chronic
inflammatory
cells
§ Macrophages,
lymphocytes
§ Plasma
cells

15. ¡ Pulp
tissue
will
§ Remain
inflamed
for
a
long
time
or
§ Undergo
necrosis
slowly
or
rapidly
¡ Depending
on
¡ Once
pulp
is
exposed,
pulp
§ Bacteria
virulence
is
infiltrated
by
PMN
to
§ Ability
to
release
form
liquefaction
area
at
inflammatory
fluids
the
site
of
exposure
§ Host
§ The
amount
of
circulation
¡ Bacteria
colonize
and
§ Lymph
drainage
persist
at
the
site

16. ¡ By
this
time
pulp
harbors
bacteria
and
by-­‐products.
¡ Pulp
can
only
defend
temporarily
to
impede
the
spread
of
infection
and
tissue
destruction
¡ More
irritantàmore
damage
and
will
spread
throughout
pulp
¡ Subsequently
bac,
toxins
&
by-­‐products
will
diffuse
periapicallyàapical
inflammatory
lesions
¡ Where
is
the
bacteria?

18. § Cavity
prep
(physical)
§ Cavity
prep
without
water
(physical
with
thermal)
§ Physical
pressure
on
the
prepared
tooth
(physical)
§ Deep
periodontal
curettage
(physical)
§ Occlusal
trauma
(physical)
§ Orthodontic
movement
(physical)
§ Dentine
expose
§ Dental
materials
▪ Restorative
materials
▪ Cements

19. Chemical
irritants?
Leakage?
IEJ
42,
422-­‐444,
2009

20. ¡ Mixed
pulpal
response
to
Dycal
after
3
months.
CP
(restorative
material
along
with
Dycal)
C:
Distinct
but
incomplete
hard
tissue
bridge
(BR),
revealing
gaps
on
either
side
of
BR
with
infiltrate
of
chronic
inflammatory
cells

21. ¡ Who
can
survive
after
an
injury?
¡ Type
of
injury
¡ The
condition
of
the
pulp
¡ Tissue
involve
§ Pulp
tissue

22. ¡ Initial
response
§ Hard
tissue
formation
§ Examples?
§ How?
¡ Moderate
to
severe
response
§ Inflammatory
process
§ Non
specific
inflammatory
mediators
and
specific
immune
reactions

24. ¡ Direct
irritation
§ Hyper-­‐occlusion
§ Occlusal
trauma
§ Endodontic
procedural
accidents
§ Overinstrumentation
§ Overextention
of
GP
▪ Physical
▪ Chemical
¡ Bacteria?

25. 31
Jan
2005
16
Apr
2005
25
June
2005

27. ¡ Healing
¡ Osteoclastic
resorption
§ Regeneration
stops
resorbing
bone.
§ Repair
¡ How
can
you
tell?
¡ The
aim
of
RCT
is
to
¡ In
healing
process,
remove
the
irritant
within
osteoblast
cells
will
start
the
canal
depositing
new
bone
and
¡ Healing
by
repair
will
take
deposit
new
matrix.
place
once
the
irritant
is
removed
and
‘inflammation’
process
for
healing
will
take
its
course
¡ Immune
system
will
take
its
course

28. REGENERATION
OR
REPAIR?

29. ¡ Normal
pulp,
Healthy
pulp
¡ Reversible
pulpitis
§ Symptoms
§ Treatment
¡ Irreversible
pulpitis
§ Symptoms?
Asymptomatic?
§ Signs-­‐
PA?
§ Treatment
§ Hyperplastic
pulpitis
▪ Chronically
inflamed
young
pulp

30. ¡ Pulp
calcification
¡ Internal
resorption
§ Lectures
in
Year
4
¡ Pulpal
necrosis
§ Symptoms
§ Test
&
treatment
§ Not
responsive
§ PA
radiographs=
normal

31. ¡ Normal
Periapical
tissues
¡ Apical
abscess
¡ Apical
periodontitis
§ Acute
apical
abscess
§ Acute
§ Rapid
onset,
painful
▪ Moderate
to
severe
pain
§ No
swelling
if
confined
to
▪ Tender
to
palpation
bone,
otherwise
swelling
is
▪ Excruciatingly
painful
to
positive
as
collection
of
pus
percussion
seeps
through
path
of
least
▪ May
or
may
not
respond
to
EPT
resistance:
soft
tissue
▪ PA-­‐
Slight
widening
of
lamina
§ Tender
to
palpation
and
dura
percussion
§ Chronic
apical
periodontitis
§ PA-­‐
no
lesion,
+
ve
widening,
▪ May
not
be
in
severe
pain
and
obvious
▪ Tender
to
palpation
▪ Tender
to
percussion
▪ Not
responsive
to
EPT
§ Chronic
abscess
▪ PA-­‐
apical
radiolucency
▪ Presented
with
sinus
tract
▪ +
PA
radiolucency

32. ACUTE
APICAL
PERIODONTITIS
46

33. ¡ CHRONIC
APICAL
PERIODONTITIS

34. ¡ Acute
apical
abscess

35. ¡ Chronic
Apical
Abscess

36. ¡ Very
similar
to
¡ Normal
structures
odontogenic
lesions
¡ Non
odontogenic
¡ Must
be
vigilant
diseases
¡ Use
tests
to
guide
§ Early
stage
of
§ Clinical
findings
monostotic
fibro
§ Sensibility
testing
dysplasia
§ Ossifying
fibroma
§ PA
radiographs
¡ Usually
response
to
§ Dentigerous
cysts
EPTs
§ Central
giant
cell
granuloma

37.
Ameloblastoma

38. Periapical
cemento-­‐osseous
dysplasia

39. ¡ Harty’s,
Endodontics
in
Questions?
Clinical
Practice,
BS
Chong
2010
¡ Endodontics
Principles
and
Practice
T
and
Walton