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Endodontics is the field of dentistry dealing with the tooth pulp, tooth root, and associated structures and pathologies. The primary procedure involved in endodontics is root canal therapy.
In addition to root canal therapy, other endodontic procedures include draining infections in and around tooth roots, periradicular surgery known as apicoectomies, stabilizing root fractures, and internal bleaching.
Endodontic therapy or root canal therapy is a sequence of treatment for the infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbialinvasion. Root canals, and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Together, these items constitute the dental pulp. Endodontic therapy involves the removal of these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation(filling) of the decontaminated canals. Filling of the cleaned and decontaminated canals is done with an inert filling such as gutta-percha and typically a eugenol-based cement. Epoxy resin is employed to bind gutta-percha in some root canal procedures. Endodontics includes both primary and secondary endodontic treatments as well as periradicular surgery which is generally used for teeth that still have potential for salvage.
1.Diagnostic and preparation
To cure the infection and save the tooth, the dentist drills into the pulp chamber and removes the infected pulp and then drills the nerve out of the root canal with long needle-shaped hand instruments known as files (H files and K files).
2.Opening in the crown
The endodontist makes an opening through the enamel and dentin tissues of the tooth, usually using a dental drill fitted with a dental burr.
3.Removal of pulp tissue
a)Procedures for shaping
The step back technique, also known as telescopic or serial root canal preparation, is divided in two phases: in the first, the working length is established and then the apical part of the canal is delicately shaped since a size 25 K-file reaches the working length; in the second, the remaining canal is prepared with manual or rotating instrumentation
The crown down is a procedure in which the dentist prepares the canal beginning from the coronal part after exploring the patency of the whole canal with the master apical file.
There is a "hybrid" procedure combining "step back" and "crown down": after the canal's patency check, the coronal third is prepared with hand or Gates Glidden drills, then the working length is determined and finally the apical portion is shaped using step back techniques.
b)Operative techniques for instruments
There are two slightly different anti-curvature techniques. In the balanced forces technique, the dentist inserts his file into the canal and rotates clockwise a quarter of a turn, engaging dentin, then rotates counter-clockwise half/three quarter of a revolution, applying pressure in apical direction, shearing off tissue previously meshed.
The root canal is flushed with an irrigant. The following substances may be used as root canal irrigants during the root canal procedure:
- less than 5% sodium hypochlorite (NaOCl)
- 6% sodium hypochlorite with surface modifiers for better flow into nooks and crannies
- 2% chlorhexidine gluconate
- 0.2% chlorhexidine gluconate plus 0.2% cetrimide
- 17% ethylenediaminetetraacetic acid (EDTA)
- Framycetin sulfate
- Mixture of citric acid, doxycycline, and polysorbate 80 (detergent) (MTAD)
5.Filling the root canal
he standard filling material is gutta-percha. The standard endodontic technique involves inserting a gutta-percha cone (a "point") into the cleaned-out root canal along with a sealing cement. Another technique uses melted or heat-softened gutta-percha which is then injected or pressed into the root canal passage(s)
A temporary filling material is applied between the visits.
Molars and premolars that have had root canal therapy should be protected with a crown that covers the cusps of the tooth.
Endodontic retreatment describes a dental root canal procedure that is carried out on a tooth that has previously had root canal treatment. For this reason it is also called "repeat root canal treatment"