Endodontics E-Book: Principles and Practice 0323624375, 9780323624374

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Endodontics E-Book: Principles and Practice
0323624375, 9780323624374

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Mahmoud Torabinejad
Ashraf Fouad
Shahrkh Shabahang

Table of contents :
Endodontics: Principles and Practice
Copyright
Contents
Preface
List of Contributors
1 - Pathogenesis of Pulp and Periapical Diseases
Histology and Physiology of Normal Dental Pulp
Etiology of Pulpal and Periapical Diseases
Mechanical Irritants
Chemical Irritants
Microbial Irritants
Microbiology of Root Canal Infections
Routes of Root Canal Infection
Endodontic Infections Are Biofilm Infections
The Microbiome of Endodontic Infections
Pulpal Diseases
Host Response in the Dental Pulp
Clinical Classification of Pulpal Conditions
Normal Pulp
Reversible Pulpitis
Irreversible Pulpitis
Pulp Necrosis
Periapical Diseases
Clinical Classification of Periapical (Apical) Conditions
Normal Periapex
Symptomatic Apical Periodontitis
Asymptomatic Apical Periodontitis
Acute Apical Abscess
Chronic Apical Abscess
Condensing Osteitis
Nonendodontic Pathosis
Role of Residual Microorganisms in the Outcome of Endodontic Treatment
Healing of Pulp and Periapical Tissues
Process of Pulp Healing
Process of Periapical Healing
Factors Influencing Healing
2 - Systemic Health Considerations in the Endodontic Patient and Geriatric Endodontics
Health and Medical History
The Systemic Health Assessment of the Endodontic Patient
Physical Examination: Vital Signs
Systemic Considerations
Endodontics and Systemic Disease
Systemic Diseases That May Influence Endodontic Pathosis or Its Treatment
Endodontic Disease May Initiate or Contribute to Systemic Diseases
Acute Endodontic Infections
Chronic Endodontic Infections
Diabetes Mellitus
Hypertension
Risk for Osteoradionecrosis or Osteonecrosis of the Jaw
Viral Infections
HIV/AIDS
Herpes Viruses
Sickle Cell Anemia
Smoking
Genetic Predisposition
Presentation of Endodontic Disease in the Older Adults
Physical Limitations
Restorative Considerations
Biologic Considerations
Anatomy
Pulp Chamber
Canal Calcification (Calcific Metamorphosis)
Pulp Response
Changes With Age
Chronologic Versus Physiologic
Structural
Dimensional
Nature of Response to Injury
Irritation
Systemic Conditions
Periapical Response
Additional Considerations
Root Canal Treatment
Treatment Considerations
Time Required
Anesthesia
Primary Injections
Supplemental Injections
Procedures
Isolation
Access Preparation
Working Length
Cleaning and Shaping
Intracanal Medicaments
Obturation
Effect of Restoration
Retreatment
Endodontic Surgery
Medical Considerations
Biologic and Anatomic Factors
Healing After Surgery
Identifying Patients for Referral
3 - Endodontic Radiology
Prologue
Introduction
Radiation Biology
Equipment for 2D Image Capture
Intraoral X-ray Units
Standard Wall-Mounted Units
Handheld Units
Intraoral Image Receptors
Types of Digital Image Receptors
Dental Film
Techniques for Intraoral Image Capture
Endodontic Imaging Needs
Disease Diagnosis
Identifying Pathosis
Moving Superimposed Structures
Locating Roots and Canals
Evaluating Treatment Progress
Initial Assessment of Working Lengths
Determining Working Length
Master Cone
Evaluating the Obturation (Intermediary Fill and Final Radiographs)
Follow-up of Treatment Outcomes
Determining Root and Pulpal Anatomy
Cone Beam Computed Tomography
Equipment and Principles for 3D Image Capture
Field of View
Voxel Size and Bit Depth
Volumetric Data and Projection Data
Image File Format
Scatter and Beam Hardening Artifacts
Indications and Special Applications
4 - Endodontic Diagnosis and Treatment Planning
Introduction
Examination
Subjective Examination
Chief Complaint
Dental History
Medical History
Objective Examination
Vital Signs
Extraoral Examination
Intraoral Examination
Soft Tissue
Cold Testing
Heat Testing
Electric Pulp Testing
Adjunctive Tests
Caries Removal
Selective Anesthesia
Radiographic Examination
Selection of Appropriate Imaging Modality
Periapical Lesions
Pulpal Lesions
Diagnosis
Developing a Diagnosis
Endodontic Terminology
Pulpal Diagnosis
Normal or Reversible Pulpitis
Periapical Diagnosis
Normal
Adjuncts to the Endodontic Diagnosis
Longitudinal Fractures
Diagnosis of Longitudinal Fractures
Longitudinal Fracture Types57
Classification of Fracture Types
Craze Lines
Fractured Cusp
Cracked Tooth
Split Tooth
Vertical Root Fracture62
Trauma
Resorption
Internal Root Resorption
External Root Resorption
Invasive Cervical Root Resorption
Endodontic–Periodontic Interrelationships
Classification and Differential Diagnosis of Endodontic–Periodontic Lesions
Primary Periodontal Defects of Endodontic Origin
Primary Periodontal Defects
Primary Periodontal Defects of Endodontic–Periodontic Origin (True Combined Lesions)
Treatment Planning
Phasing Treatment
Emergency Treatment
Definitive Treatment
The Comprehensive Treatment Plan
Factors That May Alter the Treatment Plan
5 - Differential Diagnosis of Pains and Radiolucencies of Nonpulpal Origin
Introduction
Pains of Nonpulpal Origin
Toothache of Nonpulpal Origin
Incidence of Orofacial Pain
Basic Terminology in the Understanding and Diagnosis of Pain
Common Terms
Diagnostic Process for Nondental Orofacial Pain
Confusing Dental Pathology
Periodontal Ligament Pain
Psychological Disturbances
Types of Pain
Musculoskeletal Pain
Referred Pain
Cervical Spine Pain
Pain Arising from Vascular Structures
Cardiac Toothache
Sinus/Nasal Toothache
Neoplasias and Other Lesions in the Head
Salivary Gland Dysfunction
Treatment
Radiolucencies of Nonpulpal Origin
Normal Anatomic Structures and Developmental Entities
The Mental Foramen
Clinical Features
Radiographic Features
Histology
Clinical Features
Radiographic Features
Histology
Clinical Features
Radiographic Features
Histology
Odontogenic and Nonodontogenic Cyst, Tumors, and Related Entities
Ameloblastoma
Clinical Features
Dentigerous Cyst and Pericoronal Radiolucencies
Clinical Features
Radiographic Features and Differential Diagnosis
Histology
Differential Diagnosis of a Soft Tissue Mass, With or Without Opacity Obstructing the Eruption of a Permanent Tooth
Odontoma
Clinical Features
Radiographic Features
Ameloblastic Fibroma
Ameloblastic Fibro-odontoma
Clinical Features
Odontogenic Keratocyst
Clinical Features
Squamous Odontogenic Tumor
Clinical Features
Surgical Ciliated Cyst
Radiographic Features
Histology
Traumatic Bone Cyst
Radiographic Features
Histology
Focal Osteoporotic Bone Marrow Defect
Clinical Features
Radiographic Features
Histology
ABC
Clinical Features
Radiographic Features
Histology
Central Giant Cell Lesion
Clinical Features
Radiographic Features
Histology
Osseous Pathology
Clinical Features
Osteoblastoma
Clinical Features
Osteogenic Sarcoma
Clinical Features
Chondrogenic Sarcoma
Ewing’s Sarcoma
Clinical Features
Radiographic Features
Histology
Hematolymphoid Conditions, Malignancies, and Related Disorders
Sickle Cell Anemia
Clinical Features
Lymphoma
Langerhan Cell Disease
Clinical Features
Radiographic Features
Histology
Multiple Myeloma
Clinical Features
Radiographic Features
Histology
6 - Endodontic Case Complexity and Working with the Specialist
Introduction
Advanced Dental Education Programs in Endodontics
Communication Between Endodontists and General Dentists
What Is Expected of a General Practitioner
What Is Expected of an Endodontist
Standard of Care and Endodontic Case Documentation
Case Difficulty Assessment—When to Treat and When to Refer
Patient Considerations
Medical History
Anesthesia
Patient Disposition
Gag Reflex and Ability to Open Mouth
Emergency Condition
Diagnostic and Treatment Considerations
Diagnosis
Radiographic Difficulties
Position in the Arch
Tooth Isolation
Crown Morphology
Canal and Root Morphology
Radiographic Appearance of Canal(s)
Resorption
Additional Considerations
Referral During Treatment
Flare-ups
Procedural Accidents
Referral After Treatment
Pain
Persistent Pathosis
Sinus Tract
7 - Endodontic Armamentarium
Introduction
Examination and Diagnosis
Clinical Examination
Radiographic Examination
Magnification
Isolation
Nonsurgical Root Canal Treatment
Nonsurgical Cassette
Length Determination
Instrumentation Armamentarium
Endodontic Access
Cleaning and Shaping Instruments
Irrigants, Irrigation Devices, and Intracanal Medicaments
Obturation Armamentarium
Coronal Seal
Surgical Armamentarium
Incision and Drainage Armamentarium
Root End Surgery (Apicoectomy) Armamentarium
8 - Local Anesthesia
Factors Affecting Endodontic Anesthesia
Apprehension and Anxiety
Fatigue
Tissue Inflammation
Previous Unsuccessful Anesthesia
Initial Management
Psychological Approach
Topics Related to Injection Pain
Obtaining the Patient’s Confidence
Topical Anesthetic
Needle Insertion
Small-Gauge Needles
Slow Injection
Two-Stage Injection
Gender Differences in Pain
When to Anesthetize
Adjunctive Pharmacologic Therapy
Conventional Pulpal Anesthesia for Restorative Dentistry
Mandibular Anesthesia for Restorative Dentistry
Lidocaine with Epinephrine and Vasoconstrictors
Anesthetic Factors Associated with the Inferior Alveolar Nerve Block
Lip Numbness
Soft Tissue Anesthesia
Onset of Pulpal Anesthesia
Duration
Success
Alternative Attempts to Increase Anesthetic Success
Increasing the Volume
Increasing the Epinephrine Concentration
Alternative Solutions
2% Mepivacaine with 1:20,000 Levonordefrin, 4% Prilocaine with 1:200,000 Epinephrine, and Plain Solutions (3% Mepivacaine and 4%...
Long-Acting Agents
Buffered Lidocaine
Alternative Injections and Locations
Gow-Gates and Vizarani-Akinosi Techniques (Fig. 8.5)
Incisive Nerve Block/Infiltration at the Mental Foramen
Lidocaine Infiltration Injections
Articaine Infiltration Injections
Evaluating Mechanisms of Failure with the Inferior Alveolar Nerve Block
Accuracy of Needle Placement
Needle Deflection and Needle Bevel
Accessory Innervation
Cross-Innervation
Red Hair
Patient Position for an Inferior Alveolar Nerve Block
Methods to Increase Success of the Inferior Alveolar Nerve Block
Periodontal Ligament Anesthesia After an Inferior Alveolar Nerve Block
Injection Speed and Success
Pain and Inflammation
Maxillary Anesthesia for Restorative Dentistry
Anesthesia-Related Factors
Lip/Cheek Numbness or Dead Feeling of the Teeth
Success
Onset of Pulpal Anesthesia
Duration of Pulpal Anesthesia
Alternative Anesthetic Solutions
Plain Solutions of Mepivacaine and Prilocaine
4% Prilocaine with 1:200,000 Epinephrine, 2% Mepivacaine with 1:20,000 Levonordefrin, and 4% Articaine with 1:100,000 Epinephrin...
Bupivacaine with Epinephrine
Increasing the Duration of Pulpal Anesthesia
Increasing the Volume of Solution
Increasing the Epinephrine Concentration
Repeating an Infiltration After 30 or 45 Minutes
Alternative Injection Techniques
Pain, Inflammation, and Anxiety
Supplemental Anesthesia for Restorative Dentistry in the Mandible and Maxilla
Indications
Infiltration
Additional Infiltration of Lidocaine in the Maxilla
Infiltration of Articaine in the Mandible
Intraosseous Anesthesia (Figs 8.7–8.11)
Technique for the Stabident System
Success
Failure
Duration
Postoperative Pain and Problems
Systemic Effects
Medical Contraindications
Precautions
Periodontal Ligament Injection
Technique
Mechanism of Action
Injection Discomfort in Asymptomatic Patients
Onset of Anesthesia
Success in Asymptomatic Teeth
Duration in Asymptomatic Teeth
Postoperative Discomfort in Asymptomatic Teeth
Selective Anesthesia
Systemic Effects
Other Factors
Damage to the Periodontium
Damage to the Pulp
Damage to Primary Teeth
Precautions
Anesthesia Difficulties in Endodontics
Success of the Inferior Alveolar Nerve Block with Symptomatic Irreversible Pulpitis
Gow-Gates and Vizarani-Akinosi Techniques
Do Buffered Lidocaine Formulations Increase the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreve...
Effect of Preemptive Nitrous Oxide in Irreversible Pulpitis
Success of Maxillary Molar Infiltration with Irreversible Pulpitis
Asymptomatic Irreversible Pulpitis Versus Symptomatic Irreversible Pulpitis
Use of Preoperative Analgesic Medications to Increase the Success of the Inferior Alveolar Nerve Block
Adjunctive Pharmacologic Therapy
Reversing Soft-Tissue Numbness
Supplemental Techniques for Mandibular Teeth in Endodontics
Supplemental Intraosseous Injections
Supplemental Periodontal Ligament Injections
Supplemental Intraseptal Injection
Supplemental Intrapulpal Injection
Indications
Advantages and Disadvantages
Mechanism of Action
Technique
What Is the Effect of No Endodontic Débridement on Postoperative Pain for Symptomatic Teeth with Pulpal Necrosis
Anesthetic Management of Pulpal or Periapical Pathoses
Symptomatic Irreversible Pulpitis
General Considerations
Mandibular Posterior Teeth
Mandibular Anterior Teeth
Maxillary Posterior Teeth
Maxillary Anterior Teeth
Symptomatic Pulp Necrosis
Asymptomatic Pulp Necrosis
Anesthesia for Surgical Procedures
Incision for Drainage
Incision and Drainage―Buffered Anesthetics
Outcome of an Incision and Drainage Procedure
Periapical Surgery
9 - Endodontic Emergencies and Therapeutics
Introduction
Definition
Categories
Pretreatment Emergency
Interappointment and Postobturation Emergency
The Challenge
Differentiation of Emergency and Urgency
Development of a System
Pain Perception and Pain Reaction
System of Diagnosis
Medical and Dental Histories
Subjective Examination
Objective Examination
Physical Condition/Extraoral Examination
Intraoral Examination
Pulp Vitality Tests
Periapical Tests
Periodontal Examination
Radiographic Examination
Diagnostic Outcome
Treatment Planning
Pretreatment Emergencies
Patient Management
Profound Anesthesia
Management of Symptomatic Irreversible Pulpitis
With or Without Symptomatic Apical Periodontitis
Postoperative Pharmacologic Management
Management of Pulp Necrosis with Apical Pathosis
Pulp Necrosis/Symptomatic Apical Periodontitis Without Swelling
Postoperative Pharmacologic Management
Pulp Necrosis/Acute Apical Abscess with Localized Intraoral Swelling
Postoperative Pharmacologic Management
Pulp Necrosis with Diffuse Swelling
Postoperative Pharmacologic Management
Postoperative Instructions
Interappointment Emergencies
Incidence
Causative Factors
Prevention
Procedures
Verbal Instructions
Therapeutic Prophylaxis
Diagnosis
Treatment of Flare-Ups
Previously Vital Pulps with Complete Débridement
Previously Vital Pulps with Incomplete Débridement
Previously Necrotic Pulps with No Swelling
Previously Necrotic Pulps with Swelling
Follow-Up Care
Postobturation Emergencies
Causative Factors
Treatment
10 - Management of the Vital Pulp and of Immature Teeth
The Dentin-Pulp Complex
Pulp Defense Mechanisms
Tertiary Dentinogenesis
Pulp Necrosis and Root Development
Etiologic Factors of the Dentin-Pulp Complex Injury
Trauma
Caries
Dental Anomalies
Iatrogenic Factors
Cavity Preparation Aspects and Remaining Dentin
Dental Materials
Vital Pulp Therapy
Capping Procedures
Indirect Pulp Capping
Direct Pulp Capping
Pulpotomies
Treatment of Immature Teeth with Pulp Necrosis
Apexification—Indications, Approach, and Limitations
Apexification—Clinical Protocols
Regenerative Endodontic Procedures (REPs)—Indications, Approach, and Limitations
REP—Clinical Protocols
Tissue Engineering Approaches
Conclusions
11 - Management of Traumatic Dental Injuries
Examination and Diagnosis
Mental Status
History
Medical History
Clinical Examination
Soft Tissue Examination
Facial Skeleton
Teeth and Supporting Structures
Mobility
Displacement
Periodontal Damage
Pulpal Injury
Radiographic Examination
Importance of Cone Beam Computed Tomographic Analysis in Trauma
Injuries to the Hard Dental Tissues and the Pulp
Enamel Fractures
Uncomplicated Crown Fractures
Complicated Crown Fractures
Treatment of Crown Fractures
Vital Pulp Therapy
Case Selection for Vital Pulp Therapy
Technique
Treatment Evaluation
Endodontic Treatment
Crown-Root Fractures
Emergency Care and Treatment Planning
Root Fractures
Sequelae of Root Fractures
Root Canal Treatment
Injuries to the Periodontium
Examination, Diagnosis, and Pulp Testing
Radiographic Evaluation
Crown Color Changes
Concussion
Subluxation
Luxation
Extrusive Luxation
Lateral Luxation
Intrusive Luxation
Treatment for Intrusive Luxation
Open Apex
Closed Apex
Avulsion
Treatment
Immediate Replantation
Replantation Within 60 Minutes of Avulsion—Tooth with a Closed Apex
Replantation Within 60 Minutes of Avulsion—Tooth with an Open Apex
Replantation with Dry Time Longer Than 60 Minutes—Tooth with a Closed Apex
Replantation with Dry Time Longer Than 60 Minutes—Tooth with an Open Apex
Patient Instructions
Sequelae of Dental Trauma
Pulp Necrosis
Teeth with Open Apices
Teeth with Closed Apices
Root Canal Treatment
Pulp Canal Obliteration (Calcific Metamorphosis)
Root Resorption
Surface Resorption
Inflammatory Resorption
External Replacement (PDL-Related) Resorption
Alveolar Fractures
Management of Traumatic Injuries in the Primary Dentition
Enamel fracture
Crown Fractures Without Pulp Exposure
Crown Fractures with Pulp Exposure
Crown-Root Fractures
Root Fractures
Alveolar Fractures
Luxation Injuries
Concussion and Subluxation
Extrusive Luxations
Lateral Luxations
Intrusive Luxations
Avulsions
Patient Instructions
Prevention
Primary Management
Secondary Management
12 - Root Canal Anatomy
Introduction
Gaining Knowledge and Comprehension of Root and Canal Anatomy
Methods of Study to Learn Normal and Variations in Tooth Anatomy
Root Canal Anatomy Since the Age of Specialization in Endodontics
Multiple Canals Within a Single Root
Root Canal Components and Morphology
Pulp Chamber
Root Canal
Isthmus
Accessory Canals
Apical Canal
Canal Curvature and Size
Root Canal Configuration Systems
Root Canal Anomalies and Embryologic Malformations
Taurodontism
Dens Invaginatus and Dens Evaginatus
Radix
C-Shaped Canals
Other Anomalies
Aging
Root Canal Anatomy of Maxillary and Mandibular Teeth
Incisors
Canines
Premolars
Molars
Influence of Root Canal Anatomy in Endodontic Procedures
Clinical Outcome Remarks
Conclusions
13 - Isolation, Endodontic Access, and Length Determination
Rubber Dam Isolation
Application
Rubber Dam Retainers
Types
Universal Clamp Designs
Preparation for Rubber Dam Placement
Isolation of Teeth with Inadequate Coronal Structure
Ligation
Deep-Reaching Clamps
Bonding
Replacement of Coronal Structure
Temporary Restorations
Band Placement
Provisional Crowns
Rubber Dam Placement
Placement as a Unit
Placement of a Clamp, Followed by the Dam and Then the Frame
Placement of the Rubber Dam and Frame and Then the Clamp
Rubber Dam Leakage
Disinfection of the Operating Field
Access Openings
General Principles
Canal Morphologies
General Considerations
1397256787Access Openings and Canal Location*
Maxillary Central and Lateral Incisors
Maxillary Canines
Maxillary Premolars
Maxillary Molars
Mandibular Central and Lateral Incisors
Mandibular Canines
Mandibular Premolars
Mandibular Molars
Errors in Access
Inadequate Preparation
Excessive Removal of Tooth Structure
Length Determination
Radiographic Evaluation
Electronic Apex Locators
14 - Cleaning and Shaping
Principles of Cleaning and Shaping
Apical Canal Preparation
Termination of Cleaning and Shaping
Degree of Apical Enlargement
Elimination of Etiology
Apical Patency
Pretreatment Evaluation
Principles of Cleaning and Shaping Techniques
Smear Layer Management
Irrigants
Sodium Hypochlorite
Chlorhexidine
MTAD
QMix
Irrigants for Cryotherapy
Ultrasonics
Lubricants
Preparation Errors
Preparation Techniques
Working Length Determination
Hand Instrumentation
Watch Winding
Reaming
Filing
Circumferential Filing
Standardized Preparation
Step-Back Technique
Step-Down Technique
Passive Step-Back Technique
Anticurvature Filing
Balanced Force Technique
Recapitulation
Shaping Modifications
Engine-Driven Instruments
Gates-Glidden Drills
NiTi Rotary Instruments
Criteria for Evaluating Cleaning and Shaping
Intracanal Medicaments
Calcium Hydroxide
Phenols and Aldehydes
Corticosteroids
Chlorhexidine
15 - Obturation and Temporization
Objectives of Obturation
When to Obturate
One versus Two Visits
Smear Layer Removal
Obturation Materials
Ideal Properties of an Obturation Material
Core Obturating Materials
Gutta-Percha
Mineral Trioxide Aggregate
Silver Points
Resin
Pastes (Semisolids)
Sealers
Types of Sealers
Zinc Oxide Eugenol Sealers
Calcium Hydroxide Sealers
Resin Sealers
Bioceramic Sealers
Silicone Based Sealers
Urethane Methacrylate Sealers
Evaluation and Comparison of Sealers
Obturation Techniques with Gutta-Percha
Cold Lateral Condensation
Warm Vertical Condensation
Continuous Wave
Formed Cones
Carrier-Based Obturation
Single Cone Obturation
Evaluation of Obturation
How Obturation Materials and Techniques Are Evaluated in Research
How Obturation Is Evaluated Clinically—Radiographic Evaluation
Length of Obturation—Outcomes Studies
Temporization
Intraorifice Barriers
Temporary Filling Materials
16 - Restoration of Endodontically Treated Teeth
Criteria for a Restorable Tooth
Amount of Remaining Coronal Tooth Structure
Ferrule Wall Height
Ferrule Wall Thickness
Re-Establishing Coronal Tooth Structure
Surgical Crown Lengthening
Orthodontic Extrusion
Complications Associated with Endodontically Treated Teeth
Structural, Esthetic, and Restorative Considerations
Structural Changes in Dentin
Biomechanical Factors
Esthetic Considerations
Requirements for an Adequate Restoration
Coronal Seal
Restoration Timing
Restoration Design
Guiding Principles
Planning the Definitive Restoration
Anterior Teeth
Posterior Teeth
Posts
Coronal Tooth Preparation
Ferrule
Post Selection
Post Space Length
Removal of Gutta-Percha
Completing the Post Space Preparation
Post Cementation
Restoring Access Through an Existing Restoration
Essential Precepts
17 - Bleaching Discolored Nonvital Teeth
Causes of Discoloration
Acquired (Natural) Discolorations
Pulp Necrosis
Intrapulpal Hemorrhage
Calcific Metamorphosis
Age
Location
Developmental Defects
Inflicted (Iatrogenic) Discolorations
Endodontically Related Discolorations
Obturating Materials
Remnants of Pulpal Tissue
Intracanal Medicaments
Coronal Restorations
Metallic Restorations
Composite Restorations
Bleaching Materials
Hydrogen Peroxide
Sodium Perborate
Carbamide Peroxide
Other Agents
Mechanism of Tooth Bleaching
Internal (Nonvital) Bleaching Techniques
Thermocatalytic Technique
Walking Bleach
Final Restoration
Future Rediscoloration
When to Bleach
Complications and Safety
External Root Resorption
Coronal Fracture
Chemical Burns
Intrinsic Discolorations
Tetracycline
Other Intrinsic Discolorations
Extrinsic Discolorations
When and What to Refer
18 - Procedural Accidents
Introduction
Perforations During Access Cavity Preparation
Causes
Prevention
Clinical Examination
Operative Procedures
Recognition and Treatment
Lateral Root Perforation
Furcation Perforation
Nonsurgical Treatment
Surgical Treatment
Prognosis
Accidents During Cleaning and Shaping
Ledge Formation
Prevention of a Ledge
Preoperative Evaluation
Management of a Ledge
Prognosis
Creating an Artificial Canal
Cause and Prevention
Management
Prognosis
Root Perforations
Apical Perforations
Lateral (Midroot) Perforations
Etiology and Treatment
Coronal Root Perforations
Etiology and Indicators
Instrument Separation
Etiology
Recognition
Prevention
Treatment
Prognosis
Role of 3D Imaging in Prevention
Accidents During Obturation
Underfilling
Etiology
Treatment and Prognosis
Overfilling
Etiology
Prevention
Treatment and Prognosis
Vertical Root Fracture
Etiology
Prevention
Indicators
Prognosis and Treatment
Accidents During Post Space Preparation
Indicators
Treatment and Prognosis
Other Accidents
Aspiration or Ingestion
Extrusion of Irrigant
Accidental Injections
19 - Nonsurgical Retreatment
Introduction
Causes of Nonhealing of Initial Root Canal Treatment
Diagnosis and Retreatment Options
Indications for Nonsurgical Endodontic Retreatment
Contraindications for Nonsurgical Endodontic Retreatment
Treatment Planning for Nonsurgical Retreatment
Risks and Benefits of Retreatment
Endodontic Retreatment Procedures
Access Through Full-Coverage or Preexisting Restorations
Removal of Existing Restorations
Removal of Canal Obstructions
Post and Core Removal
Removal of Gutta-Percha
Removal of Carrier-Based Gutta-Percha Obturators
Removal of Silver Cones (Points)
Removal of Soft and Hard Pastes
Removal of Calcifications
Management of Biofilms
Root Canal Preparation in Retreatment
Irrigation in Retreatment
Obturation After Retreatment
Restorative Options
Follow-Up Care and Posttreatment Complications
Prognosis
Acknowledgment
20 - Apical Microsurgery
A Brief History
Indications for Apical Surgery
Failing Root Canal Treatments
Procedural Accidents
Irretrievable Filling Materials
Anatomic Complexity of the Root Canal System
Symptomatic Cases
Adjunctive Surgeries
Exploratory Surgery
Contraindications for Apical Surgery
Case Selection and Contemporary Treatment Planning
Apical Microsurgery
Flap Design
Apical Preparation
Piezosurgery
Apical Preparation Evaluation
Hemostasis
Selecting Retrofilling Materials
Mixing, Placing, Condensing, Carving, and Finishing Retrofilling Materials
Placing Bone Grafts and Membranes
Flap Closure
Postoperative Instructions
Suture Removal
Prognosis
21 - Adjunctive Procedures
Introduction
Incision for Drainage
Indications
Contraindications
Procedures
Anesthesia
Incision
Drainage
Root Resection
Indications
Contraindications
Procedures
Hemisection
Procedures
Crown Lengthening
Indications
Contraindications
Procedures
Root Extrusion
Indications and Contraindications
Procedures
Tooth Replantation
Transplantation
Guided Tissue Regeneration and Guided Bone Regeneration in Endodontics
Indications
Contraindications
Procedure
Prognosis
Socket Preservation
Indication
Contraindications
Procedure
22 - Endodontic Treatment Outcomes
Introduction
Definitions of Success and Failure
When to Evaluate
Methods for Evaluation of Endodontic Outcomes
Patient History
Clinical Examination
Radiographic Findings
Histologic Examination
Success Rates
Survival Rates
Patient-Based Outcomes
Postoperative Complications
Prognostic Indicators
Causes of Nonhealed, Failed Root Canal Treatment
Preoperative Causes
Operative Causes
Postoperative Causes
Outcomes of Treatments After Failure of Initial Nonsurgical Endodontics
Nonsurgical Retreatment
Endodontic Surgery
Single Tooth Implant
Fixed Dental Prostheses
Replantation and Transplantation
Extraction Without Replacement
Reasons for Extraction of Endodontically Treated Teeth
1 - Summary Table of the Root Numbers of the Permanent Maxillary Teeth
2 - Summary Table of the Root CanalSystems of the Permanent Maxillary Teeth
3 - Summary Table of the Root Numbers of the Permanent Mandibular Teeth
4 - Summary Table of the Root CanalSystems of the Permanent Mandibular Teeth