Endodontics (Proceedings)

Endodontics is the diagnosis and treatment of diseases inside the tooth that affect the tooth pulp and apical periodontal tissues.

Endodontic treatments include root canal therapy and vital pulpotomy.

Standard root canal therapy is performed when the tooth has been fractured for more than 48 hours or the tooth has died from blunt force trauma. When a tooth receives a blow hard enough to cause bleeding of the pulp a pressure necrosis will occur and the tooth will die. The dead tooth will discolor for a purple to a black color.

When root canal therapy is to be done, First X-ray tooth to verify apex is closed and root and alveolar bone is in good shape. An access hole is made so an endodontic file can be inserted straight to apex of tooth. The pulp is removed using a barbed broach when the tooth has not been dead very long. The pulp canal is then cleaned using Hedstrom files or K-files. The pulp canal is flushed with dilute bleach solution and hydrogen peroxide during the filing procedure. X-rays are taken to verify files are at apex of pulp canal. After clean shavings are seen on the files, the pulp canal is flushed with saline. The canal is then dried with paper points. Paper points are then used to line the canal with a zinc-eugenol paste. After the canal is lined with the zinc-eugenol paste, it is then compacted heated gutta-percha. X-rays are then taken to verify a good seal of apex of tooth. The access hole is then sealed with a light cured composite. The tooth should be x-rayed yearly.

A vital pulpotomy is performed when a tooth has been broken less than 48 hours or needs to be shortened due to improper occlusion or for disarming. The goal of a vital pulpotomy will keep the tooth alive. A small amount of pulp is removed with a sterile burr and calcium hydroxide placed into the access hole using an amalgam placer. Calcium hydroxide paste is then placed on top of the calcium hydroxide powder. The calcium hydroxide is a pulpal irritant that causes a secondary layer of dentine to be laid down and make a dentine bridge. The access hole is then sealed with a light cured glass ionomer, and smoothed with finishing burrs. It is very important to x-ray the tooth every 6 moths to one year to insure the tooth is alive. The composite may shrink with time and may allow bacteria to invade the pulp canal and kill the tooth.

The product MTA can also be used in place of the calcium hydroxide.