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Endodontology II 102.305

Lecture #2 Diagnosis- Cont’d Pretreatment and Emergency Treatment. Endodontology II 102.305. Robert Kaufmann DMD CAGS MS(Endo) rmk@endoexperience.com www.endoexperience.com. Fractures in Teeth Two Forms:. Cusp Fractures Cracked teeth. Fractured Teeth Cracked Tooth Syndrome (CTS).

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Endodontology II 102.305

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  1. Lecture #2 Diagnosis- Cont’d Pretreatment and Emergency Treatment Endodontology II 102.305 Robert Kaufmann DMD CAGS MS(Endo) rmk@endoexperience.com www.endoexperience.com Fac. Dentistry - Univ. MB

  2. Fractures in TeethTwo Forms: • Cusp Fractures • Cracked teeth

  3. Fractured TeethCracked Tooth Syndrome (CTS) An incomplete fracture of a vital posterior tooth that occasionally extends into the pulp. • Cusp Fractures • Cusp restore vs. Endo/Crown

  4. Fractured TeethCracked Tooth Syndrome (CTS) Tools • Clenching on a Cotton Roll • Pain upon release – automatically indicates cracks From the Text “Endodontics Vol. 1 Dr. Arnaldo Castellucci

  5. Occlusal Pressure: Tooth Slooth • Helps isolate biting sensitive areas via biting on each cusp • Sharp pain on PressureORRelease may indicate a fracture • Combine these findings with pulp tests to determine whether endo is needed Reversible? OR Irreversible Pulpitis

  6. Equipment : Transillumination • Examine Tooth Color • Can use Fibreoptic handpiece as alternative

  7. Virgin Tooth ! Transillumination • Helps identify crown fracture • Fractured Segments of a crown DO NOT transmit light similarly • Difficult to use with restored teeth • Document What You SEE! • Inconclusive, Possible, Probable, Definitive • Cuspal Fracture +/or Cracked Tooth

  8. Cracked Teeth • Need for immediate cuspal protection • Pulpal status (Reversible vs. Irreversible symptoms) determines whether endo is needed or not. Maybe elective endo? • Deep pocketing associated with crack –->POOR PROGNOSIS !

  9. Vertical split root diagnosis • Coronal fractures extending into PDL • Perio probing into sulcus depth • Epithelium follows root crack • Frequently cause pulp death • May be result of restorative procedures and/or occlusal stress (Bruxism) Fac. Dentistry - Univ. MB

  10. Photo Dr. Uziel Blumenkrantz

  11. Hard tissue examExternal Resorption Diagnosis – Cont’d • Pink tooth • Asymptomatic until resorption perforates • Resorption starts in PDL and perforates enamel or root dentine • Read – Heithersay -Endo Topics 2004 Invasive cervical resorptionin the Diagnosis and Treatment Planning section of the Endo File Cabinet on my site www.endoexperience.com Fac. Dentistry - Univ. MB

  12. External Resorption – Etiology in PDL • Resorption starts in PDL and perforates enamel or root dentine • Often associated with history of trauma • Resorptive cells found • Pulp tissue is most often vital • Prognosis depends on extent and restorability • TX- Elective Endo due to restoration proximity to pulp Fac. Dentistry - Univ. MB

  13. Internal Resorption • Origin is in the PULP - NOT the PDL! • Relatively RARE in comparison to EXT resorption • Treatment is RCT • May need SRCT if the side of the root is perforated. Tx by Dr. G. Carr

  14. Pulpal tests / indirect • Tooth colour • Use natural light to judge shade darkening • May be more yellow • Grey/blue indicates haem. in dentinal tubules • May be rusty in early stages • Trans-illumination is helpful Fac. Dentistry - Univ. MB

  15. Pulpal Tests - L.A. Block • Anesthetic test to isolate quadrant • Careful maxillary infiltration 1-2 teeth • Intra-ligamentalinjection to isolate one tooth in mandible • Referred pain disappears when pulp anaesthetized fully. MAKE THIS YOUR FINAL DIAGNOSTIC TEST – WHY? Fac. Dentistry - Univ. MB

  16. Endodontic Examination Review • Review medical history • Listen to chief complaint & history • Record subjective symptoms of pain • Examine from peripheral to internal tooth • Record periodontal tests • Perform pulpal tests • Interpret radiograph - crown to periapex • Formulate ENDODONTIC DIAGNOSIS of pulp/periapical pathology from positive results. Fac. Dentistry - Univ. MB

  17. NonSurgical Root Canal Therapy • STAGES of TREATMENT for ENDO : • Examination & Diagnosis • Endodontic Access Opening • Canal System Instrumentation in 3D • Biomechanical preparation • Chemical disinfection & preparation for seal • 3D Canal System Obturation • Coronal Restoration ALL CASES REQUIRE DIAGNOSIS on the day you start comprehensive Endodontic Treatment Fac. Dentistry - Univ. MB

  18. Endodontic Examination • Record findings on ENDODONTIC RECORD SHEET • INSTRUCTOR must sign-out your Diagnosis & Tx Plan. Fac. Dentistry - Univ. MB

  19. Endodontic Pretreatment – Why? To facilitate placement of rubber dam To allow proper access cavity form Prevent leakage of saliva into access during treatment Prevents cusp fracture ( loss of landmarks) between appointments. ALL BANDS MUST BE CEMENTED Prevent recontamination of canals and leakage of medicaments between appointments To make room for placement of medicaments Fac. of Dentistry, Univ. MB, WHC copywrite

  20. PreTx- Anterior teeth • No Endodontic treatment can proceed without marginal seal • ALL caries must be removed before entering pulp space • Defective & suspect restorations should be replaced with IRM or restorative filling. Fac. of Dentistry, Univ. MB, WHC copywrite

  21. PreTx - Posterior teeth • First requirement is a stable clamp • Large IRM or composite filling may add seal to chamber • Chamber should be located & protected before restoration • Copper band or Ortho band may have to be cemented for seal Fac. of Dentistry, Univ. MB, WHC copywrite

  22. Copper Band pretreatment • Depends upon remaining tooth enamel • Remove all caries and unsupported enamel • Assess stability of clamp and marginal seal • Locate pulp chamber, protect with small cotton pellet & layer of Cavit Fac. of Dentistry, Univ. MB, WHC copywrite

  23. Copper Band pretreatment • Contour correct size copper band • Contour & crimp for 1 mm+ gingival margin • Dry crown & enamel with air syringe • Cement band with Polycarboxylatecement & stabilize until fully set. • Polish and check for sharp edges Fac. of Dentistry, Univ. MB, WHC copywrite

  24. Copper Band pretreatment • Place IRM in central portion of band to rebuild crown shape • Reduce any projecting enamel cusps • Check occlusion with rubber dam off • Normal access can be made through occlusal Fac. of Dentistry, Univ. MB, WHC copywrite

  25. Copper Band pretreatment • Band should NOThave overhanging margins • 1-2 mm cement layer necessary to replace missing coronal substance • Saliva must NOT leak under margin • Perio irritant develops Fac. of Dentistry, Univ. MB, WHC copywrite

  26. Copper Band errors • Band MUST be cemented to crown • Contouring and sizing very important • Never remove band between appointments • Crown should be restored with more permanent restoration as soon as Tx done. Fac. of Dentistry, Univ. MB, WHC copywrite

  27. S.S. (Ortho) Band pretreatment • Ortho SS band may fit some cases if margin level • When cemented, normal clamp should be stable • Band should not move or impinge on gingival tissues • Sometimes, gingival soft tissue contouring may be needed before pretreatment Fac. of Dentistry, Univ. MB, WHC copywrite

  28. Questions?

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