Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but...

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Endodontics Endodontics I. I. Morphology Morphology Pulp Pulp disease disease Indication Indication Contraindiction Contraindiction Instrumentarium Instrumentarium

Transcript of Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but...

Page 1: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

EndodonticsEndodontics I.I.

MorphologyMorphologyPulp Pulp diseasedisease

IndicationIndicationContraindictionContraindictionInstrumentariumInstrumentarium

Page 2: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

EndodonticsEndodontics

Pulp Pulp andand

periodontalperiodontal

diseasesdiseases

––diagnosisdiagnosis, , therapytherapy, , preventionprevention

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Aim

of

endodontic treatment

Healing

of

pulp diseases

or

removalbacteria

from

the

root

canal

system

and

regeneration

of

damaged

periodontaltissues. (Canal

shaping, cleaning

and

filling)

„

Endodontist helps nature only “W.D.Miller

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EndodoncieEndodoncie I.I.

MorphologyMorphology

OnemocnOnemocněěnníí

zubnzubníí

ddřřeneněě

Indikace a kontraindikace Indikace a kontraindikace endodontickendodontickééhoho

ooššetetřřeneníí

InstrumentariumInstrumentarium

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Morphology

Enamel

Dentin

Cementum

Periodontium

Pulp

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Meyer

1962

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3D3D

Page 8: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

MeyersMeyers conclusionsconclusionsTheThe rootroot canalcanal isis not not roundround butbut oval (oval (longlongaxisaxis mesiodistalmesiodistal))

TheThe rootroot canalcanal doesdoes not not gogo straightstraight butbut ititdeflectsdeflects distaldistal

TheThe outfalloutfall isis not on not on thethe top top ofof thethe rootroot butbutbelowbelow ((distaldistal oror distooraldistooral))

Page 9: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

MeyerovyMeyerovy zzáávvěěryryTheThe formform ofof thethe outfalloutfall isis funnelfunnel -- shapedshaped

TheThe rootroot canalcanal systemsystem has has usuallyusually more more outfallsoutfalls((ramificationsramifications))

TheThe ramificationsramifications are are situatedsituated mostlymostly in in apicalapicalarea (area (firstfirst apicalapical mm)mm)

AllAll outfallsoutfalls are are situatedsituated in in cementumcementum

Page 10: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

Basic Basic formsforms ofof

thethe rootroot

canalcanal systsystéém (m (WeineWeine))

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Apical

morphology

1.

X –

ray

apex2.

Foramen

apicale

3.

Apical

constrictionA4.

Periodontal

ligament

5.

Root

cementum6.

Dentin

Acc. to Guldener

a Langeland

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CanalCanal shapingshaping terminatesterminates in in apicalapical constrictionconstrictionSmallSmall communicationcommunication

LessLess risk risk ofof periodontalperiodontal damagedamagePreventionPrevention ofof overfillingoverfillingPreventionPrevention ofof apicalapical transport transport ofof infectiousinfectiousmaterialmaterialPossibilityPossibility ofof goodgood bacterialbacterial decontaminationdecontaminationPossibilityPossibility ofof goodgood condensationcondensation ofof thethe rootroot fillingfilling

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Configuration

of

apical constriction

Page 14: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

X-

ray

apex

Real

situation

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MacrocanalMacrocanal systemsystem

MicrocanalMicrocanal systemsystem

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Endodont: dentin

and

pulp (morphological

and

functional

unit)

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OdontoblastyPredentinDentin

Dental pulp

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Defense Defense mechanismsmechanisms ofof

thethe pulppulp

SclerosisSclerosis

TertiarTertiar dentindentin

DentinDentin bridgebridge

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Pulpodentinální

orgán -

endodont

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Pulp Pulp diseasesdiseases

InflammationInflammation

--

pulpitispulpitis

ConsequencesConsequences--

NecrosisNecrosis

--

GangraenaGangraena--

ApicalApical

periodontitisperiodontitis

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ReasonsReasons

BacteriaBacteria

MechanicalMechanical irritantsirritants ((overinstrumentationoverinstrumentation, , trauma)trauma)

ChemickChemickéé ((espesp. . phenolicphenolic basedbased inracanalinracanalmedicamentsmedicaments, , overfillingoverfilling,,irrigantsirrigants))

Page 23: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

ClassificationClassification ofof

pulp pulp diseasesdiseases

HistopatologicalHistopatologicalHyperemiaHyperemia

pulpaepulpae

PulpitisPulpitis

acutaacuta

serosa serosa partialispartialistotalistotalis

PulpitisPulpitis

acutaacuta

purulentapurulenta

partialispartialistotalistotalis

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ClassificationClassification ofof

pulp pulp diseasesdiseases

HistopatologicalHistopatological

PulpitisPulpitis

chronicachronica

clausaclausa

apertaaperta

ulcerosaulcerosa

polyposapolyposa

Page 25: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

ClassificationClassification ofof

pulp pulp diseasesdiseases

ClinicalClinical

ReversibleReversible

pulpitispulpitis

PainPain doesdoes not not lingerlinger afterafter stimulus stimulus isis removedremoved

PainPain isis difficultdifficult to to localizelocalize

NormalNormal periradicularperiradicular appearanceappearance

TeethTeeth are not tender to are not tender to percussionpercussion

Page 26: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

ClassificationClassification ofof

pulp pulp diseasesdiseases

ClinicalClinical

IrreversibleIrreversible

pulpitispulpitisPainPain maymay developdevelop spontaneouslyspontaneously oror fromfromstimulistimuliIn In laterlater stagesstages heatheat isis more more significantsignificantResponse Response lastslasts fromfrom minutesminutes to to hourshoursWhenWhen thethe periodontalperiodontal ligamentligament isis involvedinvolved, , thethe painpainisis localizedlocalized

A A widenedwidened periodontalperiodontal ligamentligament maymay bebe seenseen in in laterlater stagesstages

Page 27: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

Úprava ad integrum

?

PeriodontitidaPeriodontitida

akutnakutníí

chronickchronickááenoseenoseáálnlníí, , subperiostsubperiostáálnlníí, , submuksubmukóóznzníí

ffááze ze

CCAkutnAkutníí ChronickýChronický

GangrGangréénanaNekrNekróózaza

Page 28: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

CummulativeCummulative trauma trauma pfpf

dental dental pulppulp

Page 29: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

DiagnosisDiagnosisHistoryHistory

PresentingPresenting

complaintcomplaintMedicalMedical

historyhistory

Dental Dental historyhistoryPainPain

historyhistory

LocationLocationType Type andand intensity intensity ofof painpainDurationDurationStimulusStimulusReliefRelief ((analgeticsanalgetics, , antibioticsantibiotics, , sippingsipping coldcold drinksdrinks) )

Page 30: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

DiagnosisDiagnosis

ClinicalClinical

examinationexamination

ExtraoralExtraoral

((swellingswelling, , rednessredness, , extraoralextraoral

sinusessinuses, , lymphlymph

nodesnodes, , degreedegree

ofof

mouthmouth

openingopening))

IntraoralIntraoral

examinationexamination

SwellingSwelling, , rednessredness,,palpationpalpation, , percussionpercussion, sinus, sinus

tracttract

examinationexamination, , teethteeth

mobility,mobility,pocketspockets

Page 31: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

DiagnosisDiagnosis

ClinicalClinical

examinationexamination

Pulp sensitivity Pulp sensitivity teststests, , radiographicradiographic

examinationexamination, , transilluminationtransillumination..

Page 32: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

Metody zachovávající

vitalitu dřeněa podporující

tvorbu vlastních tvrdých tkání

Page 33: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

Ca (OH)2

pH 12,5

Page 34: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

SuspenzeCementySubbaseKořenová

výplň

-

krátkodobě- střednědobě-

dlouhodobě

Antiflogistický

Dentinogenní

Antimikrobiální

efekt

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NepNepřříímméé ppřřekrytekrytíí zubnzubníí ddřřeneněě

Nepřímé

překrytícementsuspenze

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IntermitentnIntermitentníí exkavaceexkavace

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Podložka s dostatečnoumechanickou odolností, nedráždivá, pokud možnos remineralizačními

vlastnostmi

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PPřříímméé ppřřekrytekrytíí zubnzubníí ddřřeneněě

NekrózaReparativní

zánětDentinový

můstek

Page 40: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

DentinovýDentinový mmůůstekstek

Zbytky preparZbytky preparáátutuKalcifikovanKalcifikovanéé vazivovazivoDentinDentinPredentinPredentinOdontoblastyOdontoblasty

Page 41: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

PPřříímméé ppřřekrytekrytíí zubnzubníí ddřřeneněě

Přímé

překrytí

– bodová

preforace

ve zdravém dentinu, okamžitě

po

vzniku. Zvážit rizika!

Page 42: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

Vitální

amputace

Page 43: Endodontics I. - Masarykova univerzita · Meyers conclusions ¾ The root canal is not round but oval (long axis mesiodistal) ¾ The root canal does not go straight but it deflects

PhasesPhases ofof

thethe endodontic endodontic treatmenttreatment

DiagnosisDiagnosis

ConsiderationConsideration

LocalLocal anaesthesiaanaesthesia

RemovalRemoval ofof oldold fillingsfillings aneane cariescaries

Access to Access to thethe pulp pulp chamberchamber


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Calcium hydroxide Temporary root canal filling Temporary root canal fillingSubbase Component of sealers.

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