Transcript Introduction to endodontics, pathohistological and

Introduction to
endodontics,
pathohistological and
clinical classification of
pulpal diseases,
indication and contraindication
of endodontic treatment
4.Year - Dental Medicine
Pulp normality
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histologic normality
clinical normality
The CLINICALLY NORMAL PULP
vital to testing procedures
responcive to a variety of excitations
free of spontaneous symptoms !!!
The MICROSCOPICALLY NORMAL PULP demonstrates
only those histologic features that are compatible with its age.
It is free of inflammatory change of any type!!!
Dental pulp - healthy
Dental pulp - inflamed, infected
Acute
pulpitis
Dental pulp
DP : dental pulp
OB : odontoblast
D : dentin
PD : predentin
TF : Tom's fiber
The response of the pulp
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The response of the pulp to injury or irritants occcur very soon,
when the stimuly are mild
Pulpodentonal reactions occurs when chemical, mechanical,
bacterial irritants attack the odontoblasts, namely Tome´s fibers,
transmit a excitation to the pulp
The response of the pulp depends on the character and intensity of
stimuly
Histopathologic classification
of pulpal diseases
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A. Regresive changes
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B. Inflammatory changes
Pulpal hyperemy
Acute pulpitis
Chronic pulpitis
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C. Necrosis of the pulp
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D. Gangraena of the pulp
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Acute pulpitis
serose
partial
total
purulent partial
total
Chronic pulpitis
clausa
a tergo
granulomatosa interna
aperta ulcerosa
aperta hypertrophica
A. Regresive changes
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vacuolar degeneration of odontoblasts
hyalinic degeneration of the pulp
lipidic degeneration of the pulp
reticular atrophy
pathological calcification
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Regresive changes:
Vacuolar degeneration of odontoblasts
Odontoblasts react very quickly
for many stimulies.
We can often find parts with
vacuolization of odontoblasts.
This change can be result of
pathologic damage of the pulp
It is the result of intracellular or
extracellular break - down of
cells metabolism
A.
Regresive changes:
Hyalinic degeneration of the pulp
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In this regresiva change, we can find an albumenic
substances in the pulp
This type of degeneratin is typical in teeth:
of old people
with chronic inflammation
A. Regresive changes:
Lipidic degeneration of the pulp
Reticular atrophy
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LIPIDIC DEGENERATION:
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We can find it in pulp with chronic inflammation
It is break - down of metabolism, and the result is
the lipids in cells
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RETICULAR ATROPHY:
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It is regresive change present in pulp of old people
Lost odontoblasts and pulpal cells are compensated by tissue
A.
Regresive changes:
Pathological calcification
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Normal pulp doesn´t contain hard calcified substances
PULPAL DENTICUL - is hard, mineralisated substance located in
the pulpal tissue
Usually in pulp we can find 1 - 12 denticuls
Sometimes they are small microscopic, sometimes biggist and they
can fill pulp chamber or root canal, or obliterate it totally.
Clinical classification
of pulpal diseases
1. HEALTHY PULP:
without clinical symptoms
2. REVERSIBLE FORM OF PULP INFLAMMATION:
pulp with clinical symptoms, in which we can preserve the vitality
of the pulp by treatment
3. IRREVERSIBLE FORM OF PULP INFLAMMATION:
pulp with clinical symptoms, in which we cannot preserve the vitality
of the pulp by treatment
4. DEATH OF THE PULP:
pulp with lost vitality, necrotic, gangrenous
Symptoms typical for
reversible process
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pain present only for impulse, never spontaneous
patient can localize the pain
pain is of short duration,
analgetics stop the pain
Vitality test: short sensation, it leaves immediately
pain for percussion is never present
RTG: caries, filling next to the pulp
tercial dentine is present
periapical finding is negative
Symptoms typical for
irreversible process
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spontaneous pain through day, intervals without pain are shorter,
intervals with pain start to be longer
pain through night is present
pain is neuralgiformic
analgetics do not stop the pain
Vitality test: attack of neuralgiformic painwhich leaves very slowly
pulzating pain
patient cannot localize the tooth, sometimes even the jaw
pain for percussion is present, periapex is inflammed
RTG: caries, filling close to the pulp, or in pulp
tercial dentine is not present
Right diagnosis
How do the right diagnosis?
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anamnesis
symptomatology
clinical examinations
knowlwdges of pathology of the pulp
clinical experiences
From all this points we make the clinical dg.:
REVERSIBLE OR IRREVERSIBLE PULPAL DISEASE
Reversible or irreversible pulpal disease?
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Reversible form of pulp inflammation turns
into irreversible form of pulp inflammation
- to pulpitis.
In clinical practice this moment play the key role in decision of
the TREATMENT CHOICE  to treat hyperemia without pulpotomy or extirpation and
preserve the pulp vitality or
 to treat pulpitis as irreversible inflammation with endodontic
treatment.
Reversible or irreversible pulpal disease?
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The appropriate decision is not easy because the histologic
changes are frequently not in correlation with
the clinical symptoms.
for appropriate diagnosis we have clinical symptoms
Reversible or irreversible
pulpal disease?
B. INFLAMMATORY CHANGES:
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Hyperemy
reversible
Acute pulpitis
- acute serous partial pulpitis
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- acute serous total pulpitis
- acute purulent partial pulpitis
irreversible
- acute purulent total pulpitis
Chronic pulpitis
C. NECROSIS
D. GANGRAENA
Endodontic
Endodontic treatment
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What is endodontics?
Endodontics is the area of dentistry
concerned with the prevention,
diagnosis and treatment of disorders
of the dental pulp
Years ago, such teeth with diseased
or injured pulps were extracted.
Today endodontic treatment offers a
way for a safe and effective means of
saving the teeth.
Considerations
for endodontic therapy
1. Is the tooth needed or important? Does it have an opponent? Could it some
day serve as an abutment for prosthesis?
2. Is the tooth salvageable, or is it so badly destroyed that it cannot be restored?
3. Is the entire dentition so completely broken down that it would be virtually
impossible to restore?
4. Is the tooth serving esthetically, or would the patient be better served by its
extraction and a more cosmetic replacement?
5. Is the tooth so severely involved periodontally that it would be lost soon for
this reason?
6. Is the practitioner capable of performing the needed endodontic procedures?
Indications
for endodontic therapy
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Presence of irreversible pulpal disease
Prophylactic pulpal therapy which may be needed
prior to other treatment procedures (restorative
dentistry, prosthodontics & periodontics)
Contraindications
for endodontic therapy
The objections are listed according to:
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status of the patient
dental reasons
local reasons
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Status of the patient:
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Age - past middle life
Health of the patient - DM, leukemia, terminal cancer, radiation
necrosis, tuberculosis, syphilis ...
Too many treated pulpless teeth
Contraindications
for endodontic therapy
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Dental reasons:
Pulpless teeth are not salvageable if there are associated periapical and
periodontal lesions
Local reasons:
the
the
the
the
the
the
periapical lesion is an apical cyst
tooth is badly broken down by caries
involved tooth is badly fractured
involved tooth has a mechanical root perforation
involved tooth has perforating internal or external root resorption
involved tooth is wholly or partially luxated
Contraindications
for endodontic therapy
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Severe, untreatable periodontal disease
Condition of remaining teeth
Non-restorable teeth
Extensive resorption
Vertical root fractures
Malpositioning of teeth
Limited accessibility
Non-strategic tooth
Aberrant root morphology
Unfavorable crown:root ratio
Predicatable failures
Proximity to vital structures
Thank you
for attention !