Transcript Relationship between conservative dentistry and

Relationship between conservative
dentistry and periodontology,
conservative dentistry and oral
surgery.
Not correct conservative procedures
and their effects
to periodontal tissues.
Indications of the endodontic –
surgical procedures.
Endodontics is an important discipline
in dentistry with a high sucess rate
All teeth with pulpal or periapical pathology are
candidates for endodontics
INDICATIONS FOR ENDODONTICS:
 When a tooth has lost the majority of coronal
tissue and a crown is to be constructed
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Preservation of the alveolar bone is important
in prosthodontics, because the root retention in
the Mandible is recommended
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Teeth with doubtful pulps – vital teeth, which
are to be restored with large cast restorations
or porcelain – should be assessed
endodontically beforehand.
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Risk of pulp exposure during preparation
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Pulpal sclerosis following trauma
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Pulpotomy
CONTRA – INDICATIONS TO
ENDODONTICS:
GENERAL:
 Small mouth
 Poor oral hygiene
 Patient´s general medical condition
 Patient´s attitude
LOCAL:
 Tooth not restorable
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Insufficient periodontal support
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Non – strategic tooth
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Root fractures.
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Massive internal or external resorption
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Bizzare anatomy. All teeth may show unusual
anatomic variations.
The ways in which restorations fail
(in conserv.dent.)
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New disease
-caries and tooth wear
Pulpal problems
Trauma
Periodontal disease
Technical failure
Fractured restorations
Marginal breakdown
Tooth fracture
Defective contours
Appearance
Failure of retention
Problem areas
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This section contains problem areas which frequently
confront the operator and pose particular difficulties
with treatment planning. These will be divided into
different categories but often several may appear
together.
OBSTRUCTED CANALS
Natural obstructions include pulp stones, calcified
canals or anomalies which makes instrumentation
impossible
Iatrogenic obstructions
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Include broken root canal instruments,
posts, gutta percha or solid cement root
filling
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Fractured instruments . Problem with larger
sized instruments.
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As the size of root canal instruments increases their
flexibility decreases. The larger sizes are stiff and
problems arise when they are used to prepare the
root canal. These problems are:
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The apical portion of many roots is narrow, so that
if large instruments are used they could lead to
perforation
The majority of teeth have curved roots,
particularly in the apical one third
1.
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As the patient is having symptoms there are
three options:
1.
Extraction
Apicectomy with retrograde amalgam seals in
both the mesial and distal canal
Removal of the crown and an attempt to reroot fill
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3.
PERFORATIONS
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There are three types of perforation according
to their position:
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Lateral wall of root . The use of engine-operated
rotating instruments such as burs or reamers makes
perforation of the wall of the root likely.
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Apex. Over- zealous instrumentation of a canal may
result in perforation through the apical foramen.
Calcium hydroxide may be used to provide an apical
barrier
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Floor of the pulp chamber. Perforations
through the floor of the pulp chamber quickly
become periodontal problems with furcal bone
loss and pocketing, unless they are treated
immediately.
ROOT FILLING
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The root filling is completed when the
tooth is symptomless and the canal dry or
capable of being with paper points.
Root cannal with periapical lessions, the
accepted technique has been two or more
visits
21-years old woman-non
successful endodontic
treatment tooth N.22,apical
clear radiolucency
confirming an established
lesion bigger than 3mm,it
shows features of lamina dura
disruption and bone structural
changes
Measurement of the
tooth canal length
Final endodontic
treatment Foredent
and gutapercha
ENDODONTIC SURGERY
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Is indicated in the caseses of failed
conservative treatmented.
APICECTOMY
INDICATIONS:
Access to the root canal is prevented due to
dystrophic calcification
The presence of large periapical lesion
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Chronic periapical infection associated with
the introduction of a large quantity of root
filling material into the periapical bone
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Fracture of the root with gross displacement of
the apical portion
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Perforation of the root, resulting from
injudicious instrumentation, internal or
external resorption
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When conservative treatment has failed, when
symptoms persist despite numerous dressings,
or after a canal has been filled with an
irremovable filling
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In order to confirm the presence of a suspected
fracture of the root
CONTRA-INDICATIONS:
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Individual anatomical problems, such as a small
mouth, trismus, or severe facial scaring
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Proximity of inferior dental canal, mental nerve an
maxillary antrum when operating on the roots of
premolars and molars
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Systemic factors: neurosis, history of rheumatic fever
or chorea, pregnancy, haemorrhagic diatheses, cardiac
disease,....
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Poor oral hygiene associated with periodontal
disease or severe caries
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The strategic importance of the tooth and the
subsequent possibility that cannot restored to
full function
Tooth resection
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Is often the treatment of choice in deep grade II
and grade III furcation involvements.
It is also treatment of choice where teeth are to
be included in a fixed prosthesis
Hemisection- the mesial root has been sectioned
and the distal root, following endo and osseous
surgery, has been utilized as a bridge abutment.
(resection of mesial root on the mandibular first
molar)
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Osseous surgery is often necessary following
both root amputation and tooth resection, so
that osseous craters are eliminated and to blend
the bony contours around the remaining root or
roots into the adjacent bone, so that there is no
precipitous drop in levels.
Where a tooth has been treated by resection,
osseous surgery is often necessary around the
remaining root to establish a biological width for
the development of a new connective tissue and
junctional epithelial attachment on root structure
apical to the cut.
RESECTION OF THE APEX
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It is considered essential to remove the apical third of
the root in order to eliminate the apical delta and the
zone of infected cementum.Contemporary attitudes
favour minimum shortening of the root, consistent
with the provision of access to the cut end, so that the
apical seal can be verified or provided by cutting and
filling an apical cavity., the majority of periapical
lesions can be dealt with by the bodys defences, thus
obviating the need for a surgical approach.
Intraoral image
D.22-Cystis
radicularis processus
alveolaris maxillae
reg.frontalis
purulenta
3months after the therapyCystectomio
sec.PARTSCH II. et
resectio apicis dentis N.22
Retrograde root canal
endodontic therapy with
amalgam
Egalisatio,suturae