ENDODONTICSARNALDO CASTELLUCCI MD, DDS

Foreword

JOHN D. WEST, DDS, MSD

IL TRIDENTEEDIZIONI ODONTOIATRICHE NEW E

NGLISH

EDITIO

N

Volume 1

ENDODONTICS

In scientific questions, opinions and views of any kind

should not be transmitted from one man to another,

from one textbook to another, or from one generation

to another, unless they are based upon actual findings.

Opinion cannot be substituted for scientific evidence.

Balint Orban, M.D., J.A.D.A., 1930

This Book is dedicated in memory of

my loving Mother and Father.

IL TRIDENTEEDIZIONI ODONTOIATRICHE

DTP & Cover Sheet: - Florence, Italy

Photolitograph: - Florence, Italy

Printed by: Arti Grafiche - Signa, Italy - 2004, June

Previous italian edition copyrighted 1993

ISBN 88-89411-00-7

FIRST EDITION

Copyright © 2004 by IL TRIDENTEEDIZIONI ODONTOIATRICHE

Edizioni Odontoiatriche Il Tridente S.r.l.

All right reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permission may be sought directly from Edizioni Odontoiatriche Il Tridente S.r.l. in Florence, Italy: phone +39 055 500 1312, fax +39 055 500 0232, e-mail: info@iltridente.it.

Edizioni Odontoiatriche Il Tridente S.r.l.

Viale dei Mille 60

50131 Florence, Italy

ENDODONTICS

Edited by

ARNALDO CASTELLUCCI, MD, DDS

Visiting Professor of Clinical Endodontics, University of Florence Dental School, ItalyPresident, Warm Gutta-Percha Study ClubFounder and Director, Micro-Endodontic Training Center, Florence, Italy

Foreword by

JOHN D. WEST, DDS, MSD

Associate Professor, Department of Endodontics, University of Washington School of Dentistry, Seattle, WashingtonClinical Instructor, Department of Endodontics,Boston University, Henry Goldman School of Dental MedicineGuest Faculty, Pacific Endodontic Research FoundationFounder and Director, Center of Endodontics, Tacoma, Washington

IL TRIDENTEEDIZIONI ODONTOIATRICHE

Edizioni Odontoiatriche Il Tridente - Firenze

FOREWORD TO THE FIRST ITALIAN EDITION

Endodontics world wide has developed rapidly in the last quarter century.In the United States alone more than 3,500 dentists now limit their practices to endodontics and over

100,000 general dentists successfully treat endodontic cases. ere is nothing to prevent similar development of endodontic practice in Europe in the years ahead.

is process will surely be accelerated with the Unifi cation of Europe and the further development of the Common Market, professionally and academically, no less than commercially.

It is signifi cant that Dr. Castellucci’s book ENDODONZIA is being published in Italian, and at this time. Italian dentistry is enjoing a renaissance no less spectacular than the intellectual, cultural, and artistic renaissance experienced in Florence in the 13th century.

Nowhere in Europe presently is modern endodontics so much appreciated and nowhere does the profession reach out for more information about this vital fi eld.

is comprehensive work covers the depth and breadth of endodontics admirably. With great skill and love for the material, Dr. Castellucci has delivered a text that is both interesting and informative. He has organized his book from the early history of endodontics to the restoration of endodontically treated teeth. In between no detail is omitted in describing the methods of treatment necessary for clinical success. e careful reader will fi nd everything here for the proper management of endodontic problems and for the mastery of endodontic technique.

e book is arranged exquisitely, balancing intelligent scholarly text with outstanding visual material. It is eminently readable, making it a happy adventure in obtaining endodontic knowledge.

As is well known, the most critical clinical aspects of endodontics are Cleaning and Shaping of Root Canal Systems and ree Dimensional Obturation, thereafter.

e chapters devoted to these subjects are outstanding as is the chapter on the equally critical subject, Endodontic/Periodontic Relation. ey alone merit the reading of this book, but for the fortunate reader there is more, much more to be found here.

I recommend Dr. Castellucci’s book wholeheartedly to any dentist (colleague) who contemplates incorporating modern endodontics into his/her practice. It is a signifi cant contribution to this fi eld!

Herbert Schilder, DDSProfessor and Chairman

Department of Endodontics

October 6, 1992

For thesecondtimeinadecade,ArnaldoCastelluccihascreatedthebestendodontic textbookin theworld.PerhapsthereasonforthisassertionisthatENDODONTICSaddressestheonewordthatbestdescribesendodonticsinthisfirstdecadeofthethirdmillennium.ThatwordisCHANGE.ArnaldoCastellucciaddressesthischange,teachesushowtolearnfromthischangeandthenchallengesus,allofus,toembraceendodonticchange.

Thisunprecedentedworkpresentsnewwaysofthinkingandthechangesin21stCenturyendodontictechnologies.Castellucci’strilogyofendodonticsisapracticalandprofoundfilterforthemodernendodonticcliniciantolearnwhy,when,andhowtoexperiencenewfoundclinicalartistrybasedonprovenbiologicprinciples.

ENDODONTICSdifferentiatesitselfasasignificantendodonticresourceinfivecriticallydistinctivedomains.First,itsauthor,ArnaldoCastellucci,isatoweringfigureinthedevelopmentofadvancedendodonticsthroughout

theworld,particularlyinEurope.His25-yearloveaffairwithendodonticsischaracterizedbyclinicalexcellence,sacrifice, ethics, integrity and a desire to teach in a way that his students feel reverence for their endodondicexperience. In addition, his students learn essential knowledge and skills.Arnaldohas established a rich legacyofproducing thehighestqualityof education forhis students’ learning. ENDODONTICS is anexpressionofhisdedicationtomakingthatdifference.

Second, ENDODONTICScombines theart and scienceof clinically relevantmodernendodontics. From theevolutionaryhistorytoendodonticpretreatment inVolumeI,cleaningandshapingand3DobturationinVolumeII,and interdisciplinaryendodontics to restoration inVolume III, readerswhobenefit themostare theoneswhounderstandtheprinciplesofthisbook.Doctorswillthenbeabletoadjusttheirtreatmentandtreatmentplanningastechnologieschangeandknowledgegrows.

Third,ArnaldoCastelluccihasassembledanimpressivelistofcontributors.Eachisagreatteacherandagreatthinker.

TheseauthorsareacredittoArnaldo’svisionofcomprehensiveendodonticsthatteachesnotonlyendodonticprinciplesandtechniquesbuttherelationshipofendodonticstoestheticandrestorativedentistry.

Fourth,thesheervolumeofknowledgeandthoroughnessofeverysubjectmakesENDODONTICSanunmatchedone-stopendodonticreference.

Finally,thefirsteditionofENDODONTICSwaslargelyareflectionofProfessorHerbertSchilder’steachingsandwords.InCastellucci’ssecondbook,Schilder’sinfluencecontinuesinCastellucciStyle.

Andso it iswith love,possibility,andan“if Icando it,youcando it”context thatArnaldoCastelluccihaswrittenthismodernendodontictextbook.Ifreadfromcovertocover,thereaderlearnssuccessfulendodonticsandischallengedtowantmore.Arnaldoinvitesustomakeendodonticsplayful.Andthenendodonticswillbefun.

Everyprofessional,atsometimeintheircareer,feelstheneedtodomorethanwhatisrequiredofthem.Theywant toexcel.Theywant tomaster theircraftandhave thatmastery impact their lives throughperformanceandfulfillmentat thehighest levelpossible in theirfield.ENDODONTICS is that invitation…it is the invitation togobeyondourself.

JohnD.West,DDS,MSDAffiliateAssociateProfessor

UniversityofWashingtonSchoolofEndodonticsClinicalInstructor

BostonUniversityHenryM.GoldmanSchoolofDentalMedicine

FOREWORD

April19,2004

COLLEGE OF ENDODONTICSSeattle, Washington, USA

© 1994-2004, University of Washington

U N I V E R S I T Y O F

WASHINGTON

VIII IX

PREFACE AND ACKNOWLEDGEMENTS

In the eleven years that have passed since the publication of the first edition in Italian of my book Endodontics, there has been a real explosion in new technology, new instruments and new materials, necessitating the need for revision and updating. The new rotary instruments in Nichel Titanium are widely and universally accepted, and have simplified the most complex part of the root canal treatment, namely the shaping. Their use in fact makes root canal preparation more rapid, more efficient, with results that are certainly more predictable. Consequently there is reduced stress for both patient and clinician and ultimately one can obtain a preparation that is extremely conservative having the advantage of maintaining the strength of the endodontically treated tooth and therefore increasing its longevity.

Apart from the gutta-percha vertical compaction technique described by Prof. Schilder, well known and widely used around the world, other techniques of heated filling have been affirmed or introduced in the past decade namely, the Thermafil Technique presented by Dr. Ben Johnson and the Continuous Wave Technique described by Dr. Stephen Buchanan.

A new canal obturation material has recently become available as a substitute for gutta-percha: this material is resinous with all the physical characteristics of gutta-percha (thermoplastic, soluble in chloroform) but also guarantees adhesion to the dentinal wall and therefore an even better seal.

Prof. Mamoud Torabinejad, from the Loma Linda University in California, has studied and validated a biocompatible and above all hydrophilic material for the treatment of perforations, immature apices, pulp exposures and that can also be used in surgery for retrograde filling, has literally changed the approach of operators confronted with the above clinical situations enabling large numbers of teeth to be saved, which would have otherwise been condemned to extraction or a certainly long treatment time, with a more uncertain prognosis.

Ultrasonics currently are not used exclusively for oral hygiene procedures on our patients, but have an infinite number of uses in the endodontic field, namely removal of posts and screws, the removal of calcifications, old filling material in the pulp chamber, the finishing of the access cavity, the exposure of the mesio palatine canal of the mesio buccal root of the upper first molar, the removal of fractured instruments and silver cones, as well as retrograde cavity preparation in the endodontic surgery.

But the greatest revolution that has occurred in the last decade has certainly been the widespread use of the operatory microscope. This is essentially due to people like Gary Carr of San Diego California. Today in the specialist endodontic schools of North America and in many other parts of the world, endodontics is taught and carried out using the microscope. The canal has ceased to be “a black hole” in which one works aided by tactile sensitivity and that which one can “see” only by attentive examination of a radiograph. Currently, whatever difficulty that is present in the straight part of the root canal, even if in the most apical third, is easily seen and resolved thanks to the magnification and coaxial illumination that an operatory microscope guarantees.

The operating microscope has radicallly transformed Surgical Endodontics into a microsurgical procedure. All the surgical phases can be carried out with the use of the microscope: the incision, the root end preparation and filling as well as the suturing. This has dramatically increased the predictability of the results, improved the prognosis, raised the quality of success and by no means last, reduced the operator’s stress.

In surgical endodontics the microscope enables careful examination of the accuracy of ones incision, preparation, retrograde filling and suturing, with an increase in predictability of results, and a better prognosis and higher percentage of success.

For all these reasons after eleven years since the publication of the first edition I felt the need to update it, making available to students and clinicians the necessary information. Furthermore, driven

VIII IX

by the success which the preceeding edition also had abroad, the work is published in English with the contribution of many colleagues and friends that offered to help me with this by no means easy task.

Concerning this I would like to express my aknowledgement to the numerous Italian and foreign contributors, who with their contribution have given prestige to this work.

Therefore my thanks to:To Dr. Mario Lendini from Turin, Italy, author of the chapter on Digital RadiographyTo Dr. Uziel Blumenkranz from Washington, Washington DC, coauthor of the chapter on Periapical Pathology and in particular on the section about The Cracked Tooth SyndromeTo Dr. Kirk A. Coury from Amarillo, Texas coauthor of the chapter on AnaesthesiaTo Dr. Stefano Patroni from Piacenza and to Dr. Paolo Ferrari from Parma, Italy, authors of the chapter on PretreatmentTo Prof. Elio Berutti from Turin, Italy, coauthor of the chapters on Endodontic Instruments, Shaping and Cleaning and Nickel TitaniumTo Prof. Giuseppe Cantatore from Rome, Italy, coauthor of the chapters on Endodontic Instruments, Nickel Titanium and the Thermafil SystemTo Dr. Michael Scianamblo from San Francisco, California, author of the chapter on The Technique of Precocious Coronal EnlargementTo Dr. Clifford J. Ruddle from Santa Barbara, California, author of the chapter on The Protaper System and the chapter on RetreatmentTo Dr. Stephen L. Buchanan from Santa Barbara, California, author of the chapter on The GT System and The Continuous Wave CondensationTo Dr. Richard E. Mounce from Portland, Oregon, author of the chapter on The K3 SystemTo Dr. John T. McSpadden from Lookout Mountain, Georgia, coauthor of the chapter on The Quantec SystemTo Dr. Gary D. Glassman and Kenneth Serota from Toronto, Canada, coauthor of the chapter on The Quantec SystemTo Dr. W. Ben Johnson from Tulsa, Oklahoma, coauthor of the chapter on The Thermafil SystemTo Prof. Vito Antonio Malagnino and to Dr. Paola Passariello from Rome, Italy, coauthors of the chapter on the Microseal SystemTo Dr.Ronal R. Lemon from New Orleans, Louisiana, coauthor of the chapter on BleachingTo Dr. Gary B. Carr from San Diego, California, coauthor of the chapter on MicroscopesTo Dr. John J. Stropko from Scottsdale, Arizona, author of the chapter on Endodontic MicrosurgeryTo Dr. Riccardo Becciani from Florence, Italy, author of the chapter on the Testoration of the Endodontically Treated Teeth

My thanks go to Dr. Ian Watson from Toronto, Canada and to Dr. John Theunissen from Massa, Italy, for their valuable help with the English translation of this work.

Furthermore I would like to express profound gratitude to my friend John D. West from Tacoma, Wahsington, for the touching words he has seen fit to use in the preface of this work.

Finally I would like to dedicate this book to he, whom I owe everything to, and who has literally changed the course of my life, from whom I learned everything which I am now proud to teach. That is my esteemed Teacher, Prof. Herbert Schilder.

X XI

CONTRIBUTORS

RICCARDO BECCIANI, MD, DDSVisiting Professor of Restorative Dentistry, Univeristy of Siena Dental School, Siena, Italy.

ELIO BERUTTI, MD, DDSProfessor and Chairman of Endodontics, Univeristy of Turin Dental School, Turin, Italy; Past President of the Italian Society of Endodontics.

UZIEL S. BLUMENKRANZ, DDSPrivate Practice limited to Endodontics, Washington, Washington DC, USA; Past President of the Venezuelan Endodontic Society.

STEPHEN L. BUCHANAN, DDS, FACD, FICDFounder, Dental Education Laboratories; Adjunct Clinical Professor, Department of Endodontics, University of the Pacific School of Dentistry, San Francisco, California, USA; Diplomate, American Board of Endodontics.

GIUSEPPE CANTATORE, MD, DDSAssociate Professor, Department of Endodontics, University of Verona Dental School, Verona, Italy; Private Practice limited to Endodontics, Rome, Italy.

GARY B. CARR, DDS, MSDFounder and Director, Pacific Endodontic Research Foundation, San Diego, California, USA; Lecturer, University of California at Los Angeles; Consultant in Endodontics, VA Medical Center Long Beach, California; Diplomate, American Board of Endodontics.

ARNALDO CASTELLUCCI, MD, DDSVisiting Professor of Clinical Endodontics, University of Florence Dental School, Florence, Italy; President, Warm Gutta-Percha Study Club; Founder and Director, Micro-Endodontic Training Center, Florence. Past President of the Italian Society of Endodontics; Past President of the International Federation of Endodontic Associations; Editor of the “Italian Journal of Endodontics” and of “The Endodontic Informer”.

KIRK A. COURY, DDS, MSPrivate Practice Limited to Endodontics, Amarilli, Texas, USA; Diplomate, American Board of Endodontics.

PAOLO FERRARI, DDSL.M.D. University of Geneva; Private Practice, Parma and Piacenza, Italy.

GARY D. GLASSMAN, DDS, FRCD(C)Fellow and Examiner for the Royal College of Dentist of Canada; Fellow of the Academy of Dentistry International; Fellow of the Academy of Dental-Facial Aesthetics; Endodontic Editor for Oral Health; Past President of the Gorge Hare Endodontic Study Club.

W. BEN JOHNSON, DDSClinical Professor Louisiana State University School of Dentistry, New Orleans, Louisiana; Clinical Associate Professor Baylor College of Dentistry, Dallas, Texas; Fellow of the Pierre Fauchard Academy; Fellow International College of Dentists; Private Practice limited to Endodontics, Tulsa, Oklahoma, USA.

RONALD R. LEMON, DMDProfessor and Chairman, Department of Endodontics, LSUHSC School of Dentistry, New Orleans, Louisiana, USA; Diplomate, American Board of Endodontics.

X XI

MARIO LENDINI, DDSPrivate Practice, Turin, Italy.

VITO ANTONIO MALAGNINOProfessor and Chairman of Endodontics, Univeristy of Chieti Dental School “G. D’Annunzio”, Chieti, Italy; Past President of the Italian Society of Endodontics; Past President of the Italian Society of Restorative Dentistry, S.I.D.O.C.; Editor of the Italian Journal of Endodontics; Co-Editor of the Italian Journal of Restorative Dentistry; Honorary Member of the French Society of Endodontics.

JOHN T. MCSPADDEN, DDSInternational lecturer and researcher, Lookout Mountain, Georgia, USA.

RICHARD E. MOUNCE, DDSPrivate Practice limited to Endodontics, Portland, Oregon, USA.

PAOLA PASSARIELLOVisiting Professor of Endodontics, Univeristy of Chieti Dental Scool “G. D’Annunzio”, Chieti, Italy; Private Practice limited to Endodontics, Rome, Italy.

STEFANO PATRONI, MD, DDSL.M.D. University of Geneva, Private Practice, Piacenza, Italy.

CLIFFORD J. RUDDLE, DDS, FACD, FICDAssistant Professor, Deparment of Graduate Endodontics, Loma Linda University, Loma linda, California, USA; Adjunct Assistant Professor, Department of Endodontics University of the Pacific School of Dentistry, San Francisco, California; Consultant Department of Graduate Endodontics Long Beach Veterans Medical Center, Long Beach, California, USA.

MICHAEL J. SCIANAMBLO, DDSAssociate Professor at the University of California, School of Dentistry, San Francisco; Fellow of the Harvard School of Dental Medicine, USA.

KENNETH S. SEROTA, DDS, MMSCFellow of the Academy of Dentistry International; Fellow of the Pierre Fauchard Academy; Founder of ROOTS – www.rxroots.com; Program Coordinator, Continuing Education Department, University of Toronto Faculty of Dentistry, Toronto, Canada.

JOHN J. STROPKO, DDSPrivate Practice of Endodontics, Scottsdale, Arizona, USA; Visiting Clinical Instructor, Pacific Endodontic Research Foundation, San Diego, California; Adjunct Assistant Professor Graduate Endodontics Goldman School of Dental Medicine, Boston, Massachusetts; Assistant Professor Graduate Clinical Endodontics Loma Linda University School of Dentistry, Loma Linda, California; Instructor and Co-Founder Clinical Endodontic Seminars, Scottsdale, Arizona.

XII XV

CONTENTS

VOLUME I

CHAPTER 1 A BRIEF HISTORY OF ENDODONTICS by Arnaldo Castellucci

CHAPTER 2 EMBRIOLOGY by Arnaldo Castellucci

CHAPTER 3 DEFINITION, SCOPE AND INDICATIONS by Arnaldo Castellucci FOR ENDODONTIC THERAPY

CHAPTER 4 DIAGNOSIS IN ENDODONTICS by Arnaldo Castellucci

CHAPTER 5 ENDODONTIC RADIOGRAPHY by Arnaldo Castellucci

CHAPTER 6 DIGITAL RADIOGRAPHY SYSTEMS (DRS) by Mario Lendini

CHAPTER 7 PULPAL PATHOLOGY by Arnaldo Castellucci

CHAPTER 8 PERIAPICAL DISEASE by Arnaldo Castellucci and Uziel Blumenkranz

CHAPTER 9 THE USE OF ANESTHESIA IN ENDODONTICS by Arnaldo Castellucci and Kirk A. Coury

CHAPTER 10 TOOTH ISOLATION: THE RUBBER DAM by Arnaldo Castellucci

CHAPTER 11 ACCESS CAVITY AND ENDODONTIC ANATOMY by Arnaldo Castellucci

CHAPTER 12 PRETREATMENT: by Stefano Patroni PREPARATION TECHNIQUES FOR ENDODONTIC THERAPY and Paolo Ferrari

VOLUME II

CHAPTER 13 ENDODONTIC INSTRUMENTS by Elio Berutti and Giuseppe Cantatore

CHAPTER 14 CLEANING AND SHAPING THE ROOT CANAL SYSTEM by Arnaldo Castellucci and Elio Berutti

CHAPTER 15 SCHILDER’S TECHNIQUE FOR SHAPING THE ROOT CANAL SYSTEM by Arnaldo CastelluccI

CHAPTER 16 A CONTEMPORARY APPROACH TO CLEANING AND SHAPING by Michael Scianamblo THE ROOT CANAL SYSTEM EMPHASIZING

“EARLY CORONAL ENLARGEMENT”

CHAPTER 17 CURVED CANALS by Arnaldo Castellucci

XIV XIII

CHAPTER 18 ROTARY INSTRUMENTS IN NICKEL-TITANIUM by Elio Berutti and Giuseppe Cantatore

CHAPTER 19 THE PROTAPER TECHNIQUE by Clifford Ruddle

CHAPTER 20 THE PREDEFINED ENDODONTIC PREPARATION. by Stephen L. Buchanan CONCEPTS, INSTRUMENTS, AND TECHNIQUES FOR THE GREATER TAPER SYSTEM

CHAPTER 21 THE K3 ROTARY NICKEL TITANIUM INSTRUMENTS SYSTEM by Richard E. Mounce

CHAPTER 22 THE QUANTEC ROTARY NITI INSTRUMENTATION SYSTEM by John McSpadden, Gary Glassman and Kenneth S. Serota

CHAPTER 23 OBTURATION OF THE ROOT CANAL SYSTEM: by Arnaldo Castellucci BIOLOGICAL PRINCIPLES, MATERIALS AND TECHNIQUES

CHAPTER 24 THE SCHILDER TECHNIQUE OF VERTICAL COMPACTION OF by Arnaldo Castellucci WARM GUTTA-PERCHA

CHAPTER 25 THE CONTINUOUS WAVE OF CONDENSATION by Stephen L. Buchanan

CHAPTER 26 THE THERMAFIL SYSTEM by Giuseppe Cantatore and W. Ben Johnson

CHAPTER 27 THE MICROSEAL TECHNIQUE by Vito Antonio Malagnino and Paola Passariello

VOLUME III

CHAPTER 28 ENDODONTIC-PERIODONTIC INTERRELATIONSHIP by Arnaldo Castellucci

CHAPTER 29 THE TREATMENT OF TEETH WITH IMMATURE APICES by Arnaldo Castellucci

CHAPTER 30 ROOT RESORPTIONS by Arnaldo Castellucci

CHPATER 31 BLEACHING ENDODONTICALLY TREATED TEETH by Arnaldo Castellucci and Ronald Lemon

CHAPTER 32 THE USE OF THE SURGICAL OPERATIVE MICROSCOPE by Gary B. Carr IN ENDODONTICS and Arnaldo Castellucci

CHAPTER 33 MICRO-ENDODONTIC NONSURGICAL RETREATMENT by Clifford J. Ruddle

CHAPTER 34 MICRO-SURGICAL ENDODONTICS by John J. Stropko

CHAPTER 35 RESTORATION OF THE ENDODONTICALLY TREATED TEETH by Riccardo Becciani

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Dr. Castellucci graduated in Medicine at the University of Florence in 1973 and he specialized in Dentistry at the same University in 1977. From 1978 to 1980 he attended the Continuing Education Courses on Endodontics at Boston University School of Graduate Dentistry and in 1980 he spent four months in the Endodontic Department of Prof. Herbert Schilder. Since then, he has a limited practice on Endodontics.

Active Member of the Italian Endodontic Society S.I.E. since 1981, in 1982 he was elected in the Board of Directors of the Society where he worked as Scientific Advisor, Secretary Treasurer, Vice President and lately as President in 1993-95.

Active Member of the European Society of Endodontology E.S.E., he was the Secretary in 1981-83.

He is Active Member of the American Association of Endodontists A.A.E. since 1985.He is Active Member of the Italian Society of Restorative Dentistry S.I.D.O.C. since 1992.He has been the President of the International Federation of Endodontic Associations I.F.E.A.

in 1990-92.From 1983 to 2000 he has been Professor of Endodontics at the University of Siena Dental

School. Now is Visiting Professor of Endodontics at the University of Florence Dental School.He translated into Italian the text on “Clinical and Surgical Endodontics. Concepts in

Practice”, by Frank, Glick, Simon and Abou-Rass.He is the Editor of “The Italian Endodontic Journal” and of “The Endodontic Informer”. He is

also the Founder and President of the “Warm Gutta-Percha Study Club”.He published articles on Endodontics in the most prestigious Endodontic Journals.He is the author of the text “Endodonzia”, which now is available in the English language.He is Founder and President of the Micro-Endodontic Training Center in Florence, where he

teaches and gives hands-on courses on nonsurgical and surgical Endodontics.International lecturer, he gave presentations at National and International Congresses in Brasil,

Canada, Colombia, England, France, Germany, Israel, Lebanon, Mexico, Monaco, Russia, Spain, Switzerland, United States, Venezuela.

CURRICULUM VITAE

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CONTRIBUTORSVolume I

UZIEL BLUMENKRANZ, DDSPrivate Practice limited to Endodontics, Washington, Washington DC, USAPast President of the Venezuelan Endodontic Society.

ARNALDO CASTELLUCCI, MD, DDSVisiting Professor of Clinical Endodontics, University of Florence Dental School, Italy; President, Warm Gutta-Percha Study Club; Founder and Director, Micro-Endodontic Training Center, Florence, Italy

KIRK A. COURY, DDS, MSDiplomate, American Board of Endodontics

PAOLO FERRARI, DDSL.M.D. University of Geneva, SwitzerlandPrivate Practice, Parma and Piacenza, Italy.

MARIO LENDINI, DDSPractice limited to Endodontics, Turin, Italy

STEFANO PATRONI, DDSL.M.D. University of Geneva, SwitzerlandPrivate Practice, Piacenza, Italy.

XVI XVII

CHAPTER 1 A BRIEF HISTORY OF ENDODONTICS .................................................................................. 2ARNALDO CASTELLUCCI

Bibliography.......................................................................................................................... 5

CHAPTER 2 EMBRYOLOGY ........................................................................................................................ 6ARNALDO CASTELLUCCI

Crown formation .................................................................................................................. 6Root formation...................................................................................................................... 14Single- and multiple-root formation .................................................................................... 16The formation of lateral canals ............................................................................................ 17Exposed dentin and enamel pearls ..................................................................................... 20Function and fate of dental lamina...................................................................................... 21Bibliography.......................................................................................................................... 23

CHAPTER 3 DEFINITION, SCOPE, AND INDICATIONS FOR ENDODONTIC THERAPY............................... 24ARNALDO CASTELLUCCI

Basic phases of endodontic therapy.................................................................................... 25Indications and contraindications ........................................................................................ 26

True contraindications ..................................................................................................... 27False contraindications .................................................................................................... 29True indications ............................................................................................................... 39Strategic endodontics....................................................................................................... 40

Bibliography.......................................................................................................................... 43

CHAPTER 4 DIAGNOSIS IN ENDODONTICS ............................................................................................... 44ARNALDO CASTELLUCCI

Subjective information.......................................................................................................... 44Medical history................................................................................................................. 44Dental history................................................................................................................... 44

Objective information........................................................................................................... 46Examination ..................................................................................................................... 46Percussion ........................................................................................................................ 47

CONTENTSVolume I

XVI XVII

Palpation .......................................................................................................................... 47Radiographic examination............................................................................................... 48Thermal tests.................................................................................................................... 56Electric pulp test .............................................................................................................. 59Cavity test......................................................................................................................... 62Anesthesia test ................................................................................................................. 62Transillumination ............................................................................................................. 64Bite test............................................................................................................................. 64

Bibliography.......................................................................................................................... 65

CHAPTER 5 ENDODONTIC RADIOGRAPHY ............................................................................................... 66ARNALDO CASTELLUCCI

Basic principles of radiology ............................................................................................... 67Principles of x-ray formation ............................................................................................... 67The quality of the radiograph.............................................................................................. 68Factors controlling the x-ray beam...................................................................................... 69

Kilovoltage ....................................................................................................................... 69Exposure time.................................................................................................................. 71Milliamperage................................................................................................................... 71Filter.................................................................................................................................. 72Collimator......................................................................................................................... 72Target-object distance...................................................................................................... 74

Basic principles of image formation.................................................................................... 74Image sharpness .............................................................................................................. 74Image magnification ........................................................................................................ 79Image distortion............................................................................................................... 79

Intraoral radiographic techniques........................................................................................ 80Bisecting angle technique ............................................................................................... 80Paralleling technique ....................................................................................................... 83

Spatial localization: buccal object rule ................................................................................ 85Radiographic orientation ...................................................................................................... 93Endoral radiographic examinations ..................................................................................... 94A) Preoperative or diagnostic radiographs.......................................................................... 94

Upper incisors.................................................................................................................. 95Upper canine ................................................................................................................... 97Upper premolars.............................................................................................................. 98Upper molars ................................................................................................................... 99Lower incisors .................................................................................................................. 100Lower canine.................................................................................................................... 101Lower premolars.............................................................................................................. 102Lower molars ................................................................................................................... 103

B) Intraoperative radiographs.............................................................................................. 104Upper incisors and canines............................................................................................. 104Upper premolars.............................................................................................................. 104Upper molars ................................................................................................................... 105Lower incisors and canines............................................................................................. 106Lower premolars.............................................................................................................. 106Lower molars ................................................................................................................... 106

Common causes of errors .................................................................................................... 110

XVIII XIX

1) Light radiographs ............................................................................................................. 1102) Dark radiographs ............................................................................................................. 1103) Radiographs with poor contrast ...................................................................................... 1114) Dark stains........................................................................................................................ 1115) Light stains........................................................................................................................ 1116) Yellow or brown stains.................................................................................................... 1127) Blurry radiographs ........................................................................................................... 1128) Radiographs with partial images ..................................................................................... 112Protection of the patient, dentist, and auxiliary personnel ................................................ 115Bibliography.......................................................................................................................... 118

CHAPTER 6 DIGITAL RADIOGRAPHY SYSTEMS (DRS) .......................................................................... 120MARIO LENDINI

Origins and technological evolution ................................................................................... 120Features of the DRS image................................................................................................... 123

Reading and processing of DRS images......................................................................... 124Quality of DRS images .................................................................................................... 127

Hardware..................................................................................................................... 127Acquisition Sensors..................................................................................................... 127Software....................................................................................................................... 128

Execution and processing time............................................................................................ 129Supplied dosage ................................................................................................................... 130Adaptation and repetitiveness.............................................................................................. 131Filing...................................................................................................................................... 132Large formats ........................................................................................................................ 133Bibliography.......................................................................................................................... 134

CHAPTER 7 PULPAL PATHOLOGY ............................................................................................................. 136ARNALDO CASTELLUCCI

The reparative capacity of pulp tissue ................................................................................ 136Pulpal diseases...................................................................................................................... 139

Clinical classification........................................................................................................ 139Healthy pulp .................................................................................................................... 139Hyperemia........................................................................................................................ 142

Clinical symptoms....................................................................................................... 142Diagnosis..................................................................................................................... 143Therapy ....................................................................................................................... 144

Pulpitis.............................................................................................................................. 144Symptomatology ......................................................................................................... 144Diagnosis..................................................................................................................... 144Pulp tests ..................................................................................................................... 145Radiographic examination.......................................................................................... 145Therapy ....................................................................................................................... 147

Necrosis ............................................................................................................................ 150Symptomatology ......................................................................................................... 152Radiographic examination.......................................................................................... 153Pulp tests ..................................................................................................................... 153

XVIII XIX

Therapy ....................................................................................................................... 153Vital pulp therapy................................................................................................................. 153

Pulp capping with MTA.............................................................................................. 155Operative sequence for pulp capping....................................................................... 156

Bibliography.......................................................................................................................... 158

CHAPTER 8 PERIAPICAL DISEASE............................................................................................................. 160ARNALDO CASTELLUCCI, UZIEL BLUMENKRANZ

The reparative capacity of periapical tissues ...................................................................... 160Classification of the lesionsof endodontic origin................................................................ 163

Chronic apical periodontitis ............................................................................................ 163Granuloma and cyst ................................................................................................... 171Granuloma .................................................................................................................. 172

Cysts ....................................................................................................................... 176Reactivation of chronic apical periodontitis................................................................... 184Acute apical periodontitis................................................................................................ 185Acute alveolar abscess..................................................................................................... 185

The Cracked-Tooth Syndrome ............................................................................................. 191Introduction ..................................................................................................................... 191Definition ......................................................................................................................... 191

Cracked tooth syndrome...................................................................................................... 191Etiology ............................................................................................................................ 192Symptoms......................................................................................................................... 194Clinical findings ............................................................................................................... 196Diagnosis.......................................................................................................................... 197Classification .................................................................................................................... 199Treatment ......................................................................................................................... 199Class I ............................................................................................................................... 200Class II.............................................................................................................................. 201Class III............................................................................................................................. 201Class IV............................................................................................................................. 203Conclusion ....................................................................................................................... 203

Bibliography.......................................................................................................................... 204

CHAPTER 9 THE USE OF ANESTHESIA IN ENDODONTICS ....................................................................... 208ARNALDO CASTELLUCCI, KIRK A. COURY

Topical anesthesia ................................................................................................................ 208Local infiltration .................................................................................................................... 209Regional anesthesia or nerve blocks ................................................................................... 210

Inferior alveolar nerve block........................................................................................... 210Indirect technique....................................................................................................... 210Direct technique ......................................................................................................... 210

Mental nerve block.......................................................................................................... 212Nasopalatine nerve block................................................................................................ 213Anterior palatine nerve block ......................................................................................... 213

Supplemental anesthetic techniques ................................................................................... 214Anesthetic solutions and inflammation .......................................................................... 214

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Lingual infiltration............................................................................................................ 215Intraseptal injection ......................................................................................................... 215Intraligamental infiltration ............................................................................................... 216Intrapulpal infiltration...................................................................................................... 218

Intraosseous anesthesia ........................................................................................................ 219The intraosseous technique ............................................................................................ 219

Step 1: anesthetize the attached gingiva ................................................................... 219Step 2: Cortical plate perforation ............................................................................... 220Step 3: Injecting into the cancellous bone ................................................................ 221

Dosage reccomendations ................................................................................................ 222Duration of anesthesia..................................................................................................... 222Considerations for intraosseous anesthesia.................................................................... 222

Anatomical considerations ......................................................................................... 222Patient considerations...................................................................................................... 223Other considerations ....................................................................................................... 223

Bibliography.......................................................................................................................... 224

CHAPTER 10 TOOTH ISOLATION: THE RUBBER DAM ............................................................................... 226ARNALDO CASTELLUCCI

Instruments ........................................................................................................................... 2281) Rubber dam................................................................................................................. 2282) Rubber dam punches.................................................................................................. 2283) Rubber dam clamps .................................................................................................... 2284) Rubber dam clamp forceps ........................................................................................ 2295) Rubber dam frame ...................................................................................................... 2306) Lubricant ...................................................................................................................... 2317) Rubber dam napkins................................................................................................... 2318) Dental floss.................................................................................................................. 2319) Assistant ....................................................................................................................... 231

Positioning of the dam ......................................................................................................... 231Bibliography.......................................................................................................................... 243

CHAPTER 11 ACCESS CAVITY AND ENDODONTIC ANATOMY ................................................................... 244ARNALDO CASTELLUCCI

Requirements of the access cavity ....................................................................................... 244Rules for the preparation of an adequate access cavity ..................................................... 249General principles for the preparation of the access cavity............................................... 250

Penetration phase ............................................................................................................ 250Enlargement phase .......................................................................................................... 251Finishing and flaring phase............................................................................................. 252

Upper central incisor ............................................................................................................ 253Upper lateral incisor ............................................................................................................. 257Upper canine ........................................................................................................................ 258Upper first premolar ............................................................................................................. 259Upper second premolar ....................................................................................................... 264Upper first molar .................................................................................................................. 266Upper second molar............................................................................................................. 277

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Upper third molar................................................................................................................. 279Lower central incisor ............................................................................................................ 280Lower lateral incisor ............................................................................................................. 284Lower canine ........................................................................................................................ 285Lower first premolar ............................................................................................................. 287Lower second premolar ....................................................................................................... 289Lower first molar................................................................................................................... 291Lower second molar ............................................................................................................. 299Lower third molar ................................................................................................................. 312The access cavity in prosthetically prepared teeth............................................................. 315The access cavity through prosthetic crowns ..................................................................... 317Common errors in the preparation of the access cavity .................................................... 319

Errors related to inadequate preparation ....................................................................... 319Errors related to over-aggressive preparation ................................................................ 325

Bibliography.......................................................................................................................... 327

CHAPTER 12 PRETREATMENT: PREPARATION TECHNIQUES FOR ENDODONTIC THERAPHY.................... 330STEFANO PATRONI, PAOLO FERRARI

Introduction .......................................................................................................................... 330Pretreatment.......................................................................................................................... 331

Modern indications forendodontic pre-treatment.......................................................... 332Classification ......................................................................................................................... 332Periodontal pretreatment...................................................................................................... 334

Gingivectomy-gingivoplasty............................................................................................ 334The apically repositioned flap ........................................................................................ 334

Prosthetic restorative pretreatment ...................................................................................... 335Hollow posts .................................................................................................................... 336

Conservative restorative pretreatment ................................................................................. 339Reconstruction of the fourth wall ................................................................................... 339Copper and orthodontic bands....................................................................................... 339Amalgam anchored with posts or amalgam pins .......................................................... 343

Pre-endodontic composite ......................................................................................... 344Orthodontic pretreatment..................................................................................................... 347Bibliography.......................................................................................................................... 351

INDEX ............................................................................................................................................... 352