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Book Details
Abstract
ENDODONTICS: PRINCIPLES AND PRACTICE, 4th Edition is an essential scientific and clinical building block for understanding the etiology and treatment of teeth with pulpal and periapical diseases. You'll easily understand and learn procedures through step-by-step explanations accompanied by full-color illustrations.
- Comprehensive coverage of normal structures, disease, diagnosis and treatment planning, periodontic endodontic interrelationship, trauma, local anesthesia, root canal instruments, access preparations, cleaning and shaping, obturation, temporization, retreatment, endodontic surgery, endodontic outcomes, internal bealching, vital pulp therapy, geriatric endodontics, vertical fractures, and more gives you a complete understanding of modern endodontics!
- Distinguished experts in the field of endodontics share their experience regarding each topic discussed.
- Current references incorporate evidence-based information that is relevant to your practice.
- Advice for the prevention and treatment of accidental procedural errors ensures you are prepared to safely care for your patients.
- Outlines and Learning Objectives at the beginning of each chapter provide quick reference for specific topics.
- High-quality, full-color illustrations allow you to see the procedures described.
- Newly reorganized content now simulates the order in which procedures are performed in clinical settings.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Endodontics | i | ||
| Copyright page | iv | ||
| Contributors | v | ||
| Preface | viii | ||
| Videos | x | ||
| Chapter Review Questions | x | ||
| Video Contents | xi | ||
| Table of Contents | xii | ||
| 1 The biology of dental pulp and periradicular tissues | 1 | ||
| Chapter Outline | 1 | ||
| Learning Objectives | 1 | ||
| Development of the Dental Pulp | 1 | ||
| Early Development of Pulp | 1 | ||
| Root Formation | 3 | ||
| Formation of Lateral Canals and Apical Foramen | 4 | ||
| Lateral Canals | 4 | ||
| Apical Foramen | 5 | ||
| Formation of the Periodontium | 5 | ||
| Anatomic Regions and Their Clinical Importance | 5 | ||
| Pulp Function | 6 | ||
| Induction | 6 | ||
| Formation | 6 | ||
| Nutrition | 7 | ||
| Defense | 7 | ||
| Sensation | 8 | ||
| Morphology | 8 | ||
| Cells of the Dental Pulp | 8 | ||
| Odontoblasts | 8 | ||
| Stem Cells (Preodontoblasts) | 8 | ||
| Fibroblasts | 9 | ||
| Cells of the Immune System | 10 | ||
| Extracellular Components21 | 11 | ||
| Fibers | 11 | ||
| Noncollagenous Matrix22 | 11 | ||
| Calcifications | 11 | ||
| Blood Vessels | 11 | ||
| Afferent Blood Vessels (Arterioles) | 12 | ||
| Efferent Blood Vessels | 12 | ||
| Lymphatics26,27 | 12 | ||
| Vascular Physiology | 12 | ||
| Vascular Changes During Inflammation30 | 13 | ||
| Innervation | 14 | ||
| Neuroanatomy | 15 | ||
| Pulpal and Dentinal Nerves | 15 | ||
| Developmental Aspects of Pulp Innervation | 16 | ||
| Pathways of Transmission from Pulp to Central Nervous System | 16 | ||
| Theories of Dentin Hypersensitivity | 16 | ||
| Age Changes in the Dental Pulp and Dentin | 17 | ||
| Repair and Regeneration | 17 | ||
| Periradicular Tissues | 17 | ||
| Cementum | 17 | ||
| Cementoenamel Junction | 18 | ||
| Periodontal Ligament | 18 | ||
| Alveolar Bone | 19 | ||
| References | 20 | ||
| 2 Protecting the pulp and promoting tooth maturation | 21 | ||
| Chapter Outline | 21 | ||
| Learning Objectives | 21 | ||
| Definitions | 21 | ||
| Pulp Protection | 21 | ||
| Vital Pulp Therapy | 21 | ||
| Regeneration, Revascularization, and Revitalization | 22 | ||
| Iatrogenic Effects on the Dental Pulp | 22 | ||
| Local Anesthesia | 22 | ||
| Cavity/Crown Preparation | 23 | ||
| Heat | 23 | ||
| Cavity Depth/Remaining Dentin Thickness | 24 | ||
| Cavity Drying and Cleansing12 | 24 | ||
| Etching Dentin/Smear Layer Removal27-29 | 25 | ||
| Other Restorative Procedures | 25 | ||
| Postrestorative Hypersensitivity36,37 | 25 | ||
| Dental Materials | 26 | ||
| Microleakage42-44 | 26 | ||
| Cytotoxicity | 26 | ||
| Depth of Preparation | 26 | ||
| Desiccation by Hygroscopy50 | 26 | ||
| Specific Materials | 26 | ||
| Zinc Oxide–Eugenol18,51-53 | 26 | ||
| Restorative Resins58-60 | 26 | ||
| Glass Ionomer Cements | 27 | ||
| Amalgam | 27 | ||
| Orthodontic Tooth Movement | 27 | ||
| Vital Tooth Bleaching | 27 | ||
| Protecting the Pulp From the Effect of Materials | 27 | ||
| Cavity Varnishes, Liners, and Bases | 27 | ||
| Vital Pulp Therapies | 27 | ||
| Indirect Pulp Capping | 28 | ||
| Direct Pulp Capping | 28 | ||
| Pulpotomy | 28 | ||
| The Open Apex94,95 | 28 | ||
| Diagnosis and Case Assessment96 | 28 | ||
| Treatment Planning | 30 | ||
| Apexogenesis97-102 | 30 | ||
| Technique | 31 | ||
| Apexification101,111 | 32 | ||
| Technique | 33 | ||
| Restoration After Apexification112,117 | 33 | ||
| Success or Failure of Apexification | 33 | ||
| Tissue Engineering and Regenerative Endodontics | 33 | ||
| Technique | 34 | ||
| References | 35 | ||
| 3 Endodontic microbiology | 37 | ||
| Chapter Outline | 37 | ||
| Learning Objectives | 37 | ||
| Microbial Causation of Apical Periodontitis | 37 | ||
| Routes of Root Canal Infection | 37 | ||
| Dentinal Tubules | 37 | ||
| Direct Pulp Exposure | 38 | ||
| Periodontal Disease | 38 | ||
| Anachoresis | 39 | ||
| Microbiota of Endodontic Infections | 39 | ||
| Primary Intraradicular Infection | 39 | ||
| Gram-Negative Bacteria | 39 | ||
| Gram-Positive Bacteria | 39 | ||
| As-Yet-Uncultivated Bacterial Phylotypes | 39 | ||
| Complexity of Endodontic Polymicrobial Infections | 41 | ||
| Other Microorganisms in Endodontic Infections | 41 | ||
| Symptomatic Infections | 41 | ||
| Ecology of the Endodontic Microbiota | 41 | ||
| Oxygen Tension and Redox Potential | 41 | ||
| Available Nutrients | 41 | ||
| Bacterial Interactions | 42 | ||
| Apical Periodontitis as a Biofilm-Related Disease | 42 | ||
| Persistent and Secondary Endodontic Infections | 43 | ||
| Bacteria at the Root Canal–Filling Stage | 43 | ||
| Microbiota in Root Canal–Treated Teeth | 43 | ||
| Extraradicular Infections | 44 | ||
| References | 45 | ||
| 4 Pulp and periapical pathosis | 48 | ||
| Chapter Outline | 48 | ||
| Learning Objectives | 48 | ||
| Irritants | 48 | ||
| Mechanical Irritants | 48 | ||
| Chemical Irritants | 49 | ||
| Microbial Irritants | 50 | ||
| Pulpal Pathosis | 51 | ||
| Inflammatory Process | 52 | ||
| Immunologic Responses | 52 | ||
| Lesion Progression | 53 | ||
| Classification of Pulpal Diseases | 53 | ||
| Normal Pulp | 53 | ||
| Reversible Pulpitis | 53 | ||
| Symptoms | 53 | ||
| Treatment | 54 | ||
| Irreversible Pulpitis | 54 | ||
| Symptoms | 54 | ||
| Tests and Treatment | 54 | ||
| Hyperplastic Pulpitis | 55 | ||
| Hard Tissue Changes Caused by Pulpal Inflammation | 55 | ||
| Pulp Calcification | 55 | ||
| Internal (Intracanal) Resorption | 55 | ||
| Pulpal Necrosis | 56 | ||
| Symptoms | 56 | ||
| Tests and Treatment | 56 | ||
| Previously Initiated Root Canal Therapy | 56 | ||
| Periapical Pathosis | 56 | ||
| Nonspecific Mediators of Periapical Lesions | 56 | ||
| Specific Mediators of Periapical Lesions | 57 | ||
| Lesion Progression | 58 | ||
| Classification of Periapical Lesions | 58 | ||
| Normal Periapical Tissues | 58 | ||
| Symptomatic Apical Periodontitis | 58 | ||
| Etiology | 58 | ||
| Signs and Symptoms | 58 | ||
| 5 Diagnosis, treatment planning, and systemic considerations | 68 | ||
| Chapter Outline | 68 | ||
| Learning Objectives | 68 | ||
| Diagnosis | 69 | ||
| Chief Complaint | 69 | ||
| Health History | 70 | ||
| Health and Medical History | 70 | ||
| Antibiotic Prophylaxis | 71 | ||
| Dental History | 71 | ||
| History of the Present Complaint | 71 | ||
| The Pain Referral Phenomenon | 72 | ||
| Nonodontogenic Pain | 73 | ||
| Objective Examination | 73 | ||
| Extraoral Examination | 74 | ||
| Intraoral Examination | 74 | ||
| Soft Tissue | 74 | ||
| Dentition | 74 | ||
| Clinical Tests | 75 | ||
| Control Teeth | 75 | ||
| Percussion and Palpation of Supporting Tissues | 76 | ||
| Pulp Vitality Tests | 76 | ||
| Selecting the Appropriate Pulp Test | 76 | ||
| Cold Tests | 76 | ||
| Heat Tests | 77 | ||
| Electrical Pulp Testing | 77 | ||
| Significance of Thermal Tests | 78 | ||
| Blood Flow Determination | 78 | ||
| Periodontal Examination | 78 | ||
| Probing | 79 | ||
| Mobility | 79 | ||
| Radiographic Examination | 79 | ||
| Periapical Lesions | 79 | ||
| Pulpal Lesions | 80 | ||
| Additional Diagnostic Procedures | 81 | ||
| Caries Removal | 81 | ||
| Selective Anesthesia | 81 | ||
| Bite Test | 81 | ||
| Transillumination | 81 | ||
| Reaching a Diagnosis | 81 | ||
| The Difficult Diagnosis | 82 | ||
| Treatment Planning | 83 | ||
| Restorability | 83 | ||
| Specific Treatments | 83 | ||
| Pulpitis | 83 | ||
| Normal or Reversible Pulpitis | 83 | ||
| Irreversible Pulpitis | 83 | ||
| Necrosis | 83 | ||
| Periapical Diagnosis | 83 | ||
| Normal | 83 | ||
| Symptomatic Apical Periodontitis | 83 | ||
| Asymptomatic Apical Periodontitis | 83 | ||
| Acute Apical Abscess | 83 | ||
| Chronic Apical Abscess | 83 | ||
| Condensing Osteitis | 83 | ||
| Extraction as an Alternative to Endodontic Therapy | 84 | ||
| Treatment Planning Considerations | 84 | ||
| Diagnosis | 84 | ||
| Endodontic-Periodontal Status | 84 | ||
| Resorption | 84 | ||
| Radiographs | 85 | ||
| Procedural Difficulties | 85 | ||
| Health and Medical History | 85 | ||
| Physical Limitations | 85 | ||
| Restorative Considerations | 85 | ||
| Anatomy | 85 | ||
| Pulp Chamber | 85 | ||
| Canal Calcification (Calcific Metamorphosis) | 85 | ||
| Root Curvature | 85 | ||
| Number of Canals | 85 | ||
| Root Length | 86 | ||
| Tooth Location | 86 | ||
| Degree of Apical Closure | 86 | ||
| Unusual Anatomy | 86 | ||
| Systemic Considerations | 86 | ||
| Systemic Diseases that May Influence Endodontic Pathosis or Its Treatment | 88 | ||
| Diabetes Mellitus | 88 | ||
| Hypertension | 89 | ||
| Risk for Osteoradionecrosis or Osteonecrosis of the Jaw | 89 | ||
| Viral Infections | 90 | ||
| HIV/AIDS | 90 | ||
| Herpes Viruses | 90 | ||
| Sickle Cell Anemia | 90 | ||
| Smoking | 90 | ||
| Genetic Predisposition | 90 | ||
| Endodontic Disease May Initiate or Contribute to Systemic Diseases | 90 | ||
| Acute Endodontic Infections | 91 | ||
| Chronic Endodontic Infections | 91 | ||
| References | 92 | ||
| 6 Interaction between the general dentist and the endodontist | 95 | ||
| Chapter Outline | 95 | ||
| Learning Objectives | 95 | ||
| Specialty Qualifications in the United States | 95 | ||
| Endodontic Practice Figures in the United States | 96 | ||
| Communication between Endodontists and General Dentists | 96 | ||
| Standards of Endodontic Care and Case Documentation | 96 | ||
| Identification and Classification of Cases | 97 | ||
| The AAE Case Selection System | 97 | ||
| I. Referral Before Treatment | 97 | ||
| Complex Medical and Behavioral Issues | 97 | ||
| Emotional and Physical Limitations | 97 | ||
| Complex Diagnosis | 97 | ||
| Radiographic Difficulties | 100 | ||
| Position of a Tooth in the Arch | 100 | ||
| Local Anesthesia Difficulties | 100 | ||
| Rubber Dam Isolation | 100 | ||
| Morphologic Difficulties | 100 | ||
| Pulp Chamber and Root Canal Calcification | 100 | ||
| Difficult Access and Anatomy of the Tooth Involved | 100 | ||
| Existing Restorations | 101 | ||
| Cases with Root Resorption | 101 | ||
| Endodontic Periodontal Lesion | 101 | ||
| Traumatic Injuries, Retreatments, and Surgeries | 101 | ||
| II. Referral During Treatment | 104 | ||
| Flare-ups | 104 | ||
| Procedural Accidents | 104 | ||
| III. Referral After Treatment | 104 | ||
| Pain | 104 | ||
| Pathosis | 104 | ||
| Sinus Tract | 105 | ||
| What is Expected of a General Practitioner | 105 | ||
| What is Expected of an Endodontist | 105 | ||
| References | 105 | ||
| 7 Endodontic-periodontic interrelationship | 106 | ||
| Chapter Outline | 106 | ||
| Learning Objectives | 106 | ||
| Pathways of Communication between the Dental Pulp and the Periodontium | 107 | ||
| Apical Foramen | 107 | ||
| Lateral Canals | 108 | ||
| Dentinal Tubules | 108 | ||
| Effect of Pulpal Diseases and Endodontic Procedures on the Periodontium | 110 | ||
| Etiology | 110 | ||
| Pathogenesis | 111 | ||
| Effect | 111 | ||
| Effect of Periodontal Disease and Procedures on the Pulp | 113 | ||
| Etiology | 113 | ||
| Pathogenesis | 113 | ||
| Effect | 114 | ||
| Clinical and Radiographic Tests for Diagnosis of Endodontic-Periodontic Lesions | 115 | ||
| Subjective Signs and Symptoms | 115 | ||
| Visual Examination | 115 | ||
| Radiographic Examination | 115 | ||
| Clinical Tests | 115 | ||
| Vitality Tests | 115 | ||
| Palpation and Percussion | 116 | ||
| Probing | 116 | ||
| Classification and Differential Diagnosis of Endodontic- Periodontic Lesions | 116 | ||
| Primary Periodontal Defects of Pulpal (Endodontic) Origin | 116 | ||
| Treatment and Prognosis | 116 | ||
| Primary Periodontal Defects of Periodontic Origin | 116 | ||
| Treatment and Prognosis | 117 | ||
| Primary Periodontal Defects of Endodontic-Periodontic Origin (True Combined Lesions) | 117 | ||
| Treatment and Prognosis | 118 | ||
| Secondary Endodontic-Periodontic Defects | 118 | ||
| References | 119 | ||
| 8 Longitudinal tooth fractures | 121 | ||
| Chapter Outline | 121 | ||
| Learning Objectives | 121 | ||
| Incidence | 121 | ||
| Categories | 121 | ||
| Craze Lines | 122 | ||
| Fractured Cusp | 123 | ||
| Incidence | 123 | ||
| Pathogenesis | 123 | ||
| Clinical Features | 123 | ||
| Etiologies | 124 | ||
| Diagnosis | 125 | ||
| Subjective Findings | 125 | ||
| Objective Tests | 125 | ||
| Radiographic Findings | 125 | ||
| Other Findings | 125 | ||
| Treatment | 125 | ||
| Prognosis | 125 | ||
| Prevention | 125 | ||
| Cracked Tooth | 125 | ||
| Incidence | 126 | ||
| Pathogenesis | 126 | ||
| Clinical Features | 126 | ||
| Etiologies | 126 | ||
| Diagnosis | 127 | ||
| Subjective Findings | 127 | ||
| Objective Tests | 127 | ||
| Radiographic Findings | 127 | ||
| Other Findings | 127 | ||
| Treatment | 128 | ||
| Further Examination | 129 | ||
| Restoration | 129 | ||
| Prognosis | 130 | ||
| Prevention | 130 | ||
| Split Tooth | 130 | ||
| Incidence | 131 | ||
| Pathogenesis | 131 | ||
| Clinical Features | 131 | ||
| Etiologies | 131 | ||
| Diagnosis | 132 | ||
| Subjective Findings | 132 | ||
| Objective Findings | 132 | ||
| Radiographic Findings | 132 | ||
| Other Findings | 132 | ||
| Treatment | 132 | ||
| Prognosis | 133 | ||
| Prevention | 133 | ||
| Vertical Root Fracture | 133 | ||
| Incidence | 133 | ||
| Pathogenesis | 133 | ||
| Clinical Features | 133 | ||
| Etiologies | 134 | ||
| Diagnosis | 135 | ||
| Subjective Findings | 135 | ||
| Objective Tests | 135 | ||
| Radiographic Findings | 135 | ||
| Dental History | 136 | ||
| Other Findings | 136 | ||
| Fracture Characteristics | 137 | ||
| Treatment | 138 | ||
| Prognosis | 138 | ||
| Prevention | 138 | ||
| References | 138 | ||
| 9 Local anesthesia | 142 | ||
| Chapter Outline | 142 | ||
| Learning Objectives | 142 | ||
| Factors Affecting Endodontic Anesthesia | 142 | ||
| Apprehension and Anxiety | 142 | ||
| Fatigue | 143 | ||
| Tissue Inflammation | 143 | ||
| Previous Unsuccessful Anesthesia | 143 | ||
| Initial Management | 143 | ||
| Psychological Approach | 143 | ||
| Topics Related to Injection Pain | 143 | ||
| Obtaining the Patient’s Confidence | 143 | ||
| Topical Anesthetic | 143 | ||
| Solution Warming | 143 | ||
| Needle Insertion | 143 | ||
| Small-Gauge Needles | 143 | ||
| Slow Injection | 143 | ||
| Two-Stage Injection | 144 | ||
| Gender Differences in Pain | 144 | ||
| When to Anesthetize | 144 | ||
| Adjunctive Pharmacologic Therapy | 144 | ||
| Conventional Pulpal Anesthesia for Restorative Dentistry | 144 | ||
| Mandibular Anesthesia for Restorative Dentistry | 145 | ||
| Lidocaine with Epinephrine and Vasoconstrictors | 145 | ||
| Anesthetic Factors Associated with the Inferior Alveolar Nerve Block | 145 | ||
| Lip Numbness | 146 | ||
| Soft Tissue Anesthesia | 146 | ||
| Onset of Pulpal Anesthesia | 146 | ||
| Duration | 146 | ||
| Success | 146 | ||
| Alternative Attempts to Increase Anesthetic Success | 146 | ||
| Increasing the Volume | 146 | ||
| Increasing the Epinephrine Concentration | 146 | ||
| Alternative Solutions | 146 | ||
| 2% Mepivacaine with 1 : 20,000 Levonordefrin, 4% Prilocaine with 1 : 200,000 Epinephrine, and Plain Solutions (3% Mepivacaine and 4% Prilocaine) | 146 | ||
| 4% Articaine with Epinephrine for Inferior Alveolar Nerve Blocks | 146 | ||
| Long-Acting Agents | 146 | ||
| Buffered Lidocaine | 146 | ||
| Alternative Injections and Locations | 146 | ||
| Gow-Gates and Vizarani-Akinosi Techniques | 146 | ||
| Incisive Nerve Block/Infiltration at the Mental Foramen | 146 | ||
| Lidocaine Infiltration Injections | 146 | ||
| Articaine Infiltration Injections | 147 | ||
| Evaluating Mechanisms of Failure with the Inferior Alveolar Nerve Block | 147 | ||
| Accuracy of Needle Placement | 147 | ||
| Needle Deflection and Needle Bevel | 147 | ||
| Accessory Innervation | 147 | ||
| Cross-Innervation | 147 | ||
| Red Hair | 147 | ||
| Methods to Increase Success of the Inferior Alveolar Nerve Block | 147 | ||
| Infiltrations of Articaine After an Inferior Alveolar Nerve Block | 147 | ||
| Intraosseous Anesthesia After an Inferior Alveolar Nerve Block | 147 | ||
| Periodontal Ligament Anesthesia After an Inferior Alveolar Nerve Block | 147 | ||
| Injection Speed and Success | 147 | ||
| Pain and Inflammation | 147 | ||
| Maxillary Anesthesia for Restorative Dentistry | 147 | ||
| Anesthesia-Related Factors | 147 | ||
| Lip/Cheek Numbness or Dead Feeling of the Teeth | 148 | ||
| Success | 148 | ||
| Onset of Pulpal Anesthesia | 148 | ||
| Duration of Pulpal Anesthesia | 148 | ||
| Alternative Anesthetic Solutions | 148 | ||
| Plain Solutions of Mepivacaine and Prilocaine | 148 | ||
| 4% Prilocaine with 1 : 200,000 Epinephrine, 2% Mepivacaine with 1 : 20,000 Levonordefrin, and 4% Articaine with 1 : 100,000 Epinephrine | 148 | ||
| Bupivacaine with Epinephrine | 148 | ||
| Increasing the Duration of Pulpal Anesthesia | 148 | ||
| Increasing the Volume of Solution | 148 | ||
| Increasing the Epinephrine Concentration | 148 | ||
| Repeating an Infiltration after 30 Minutes | 148 | ||
| Alternative Injection Techniques | 148 | ||
| Pain, Inflammation, and Anxiety | 148 | ||
| Supplemental Anesthesia for Restorative Dentistry in the Mandible and Maxilla | 148 | ||
| Indications | 148 | ||
| Infiltration | 149 | ||
| Additional Infiltration of Lidocaine in the Maxilla | 149 | ||
| Infiltration of Articaine in the Mandible | 149 | ||
| Intraosseous Anesthesia | 149 | ||
| Technique for the Stabident System | 150 | ||
| Perforator “Breakage” | 151 | ||
| Injection Discomfort | 151 | ||
| Selection of Perforation Site | 151 | ||
| Anesthetic Agents | 151 | ||
| Onset of Anesthesia | 151 | ||
| Success | 151 | ||
| Failure | 151 | ||
| Duration | 151 | ||
| Postoperative Pain and Problems | 151 | ||
| Systemic Effects | 151 | ||
| Medical Contraindications | 151 | ||
| Precautions | 151 | ||
| Periodontal Ligament Injection | 151 | ||
| Technique | 151 | ||
| Mechanism of Action | 152 | ||
| Injection Discomfort in Asymptomatic Patients | 152 | ||
| Onset of Anesthesia | 152 | ||
| Success in Asymptomatic Teeth | 152 | ||
| Duration in Asymptomatic Teeth | 154 | ||
| Postoperative Discomfort in Asymptomatic Teeth | 154 | ||
| Selective Anesthesia | 154 | ||
| Systemic Effects | 154 | ||
| Other Factors | 154 | ||
| Damage to the Periodontium | 154 | ||
| Damage to the Pulp | 154 | ||
| Damage to Primary Teeth | 154 | ||
| Precautions | 154 | ||
| Anesthesia Difficulties in Endodontics | 154 | ||
| Success of the Inferior Alveolar Nerve Block with Symptomatic Irreversible Pulpitis | 155 | ||
| Success of Maxillary Molar Infiltration with Irreversible Pulpitis | 155 | ||
| Asymptomatic Irreversible Pulpitis versus Symptomatic Irreversible Pulpitis | 155 | ||
| Supplemental Techniques for Mandibular Teeth in Endodontics | 155 | ||
| Supplemental Buccal Infiltration of Articaine | 155 | ||
| Supplemental Intraosseous Injections | 155 | ||
| Supplemental Periodontal Ligament Injections | 155 | ||
| Supplemental Intrapulpal Injection | 156 | ||
| Indications | 156 | ||
| Advantages and Disadvantages | 156 | ||
| Mechanism of Action | 156 | ||
| Technique | 156 | ||
| Anesthetic Management of Pulpal or Periapical Pathoses | 156 | ||
| Symptomatic Irreversible Pulpitis | 156 | ||
| General Considerations | 157 | ||
| Mandibular Posterior Teeth | 157 | ||
| Mandibular Anterior Teeth | 157 | ||
| Maxillary Posterior Teeth | 157 | ||
| Maxillary Anterior Teeth | 157 | ||
| Symptomatic Pulp Necrosis | 157 | ||
| Asymptomatic Pulp Necrosis | 157 | ||
| Anesthesia for Surgical Procedures | 158 | ||
| Incision for Drainage | 158 | ||
| Periapical Surgery | 158 | ||
| References | 158 | ||
| 10 Endodontic emergencies and therapeutics | 162 | ||
| Chapter Outline | 162 | ||
| Learning Objectives | 162 | ||
| Diagnosis and Treatment Planning | 162 | ||
| Incidence of Exacerbations | 163 | ||
| The Initial Patient Contact | 163 | ||
| Patient Management | 163 | ||
| Profound Anesthesia | 163 | ||
| Categories of Emergencies | 163 | ||
| Pretreatment Emergency | 163 | ||
| Management of Irreversible Pulpitis | 164 | ||
| Interappointment Emergencies | 164 | ||
| Causes of Flare-Up | 164 | ||
| Biology of the Necrotic (Nonvital) Exacerbation | 165 | ||
| Postobturation Emergencies | 165 | ||
| Predisposing Factors | 165 | ||
| Genetics | 165 | ||
| Gender | 165 | ||
| Anxiety | 165 | ||
| Microbiology of Flare-Ups | 165 | ||
| Sources of Microbes in the Canal Space | 166 | ||
| Intracanal Disinfectants | 166 | ||
| Signs and Symptoms of Infection | 166 | ||
| Microbial Resistance | 167 | ||
| Therapy | 167 | ||
| Canal Debridement and Disinfection | 167 | ||
| Drainage | 167 | ||
| Pharmacotherapy for Flare-Ups | 168 | ||
| Antimicrobial Drugs | 168 | ||
| Analgesics | 169 | ||
| Opioids, Acetaminophen, and Nonsteroidal Antiinflammatory Drugs | 169 | ||
| Corticosteroid Drugs | 169 | ||
| References | 170 | ||
| 11 Management of traumatic dental injuries | 172 | ||
| Chapter Outline | 172 | ||
| Learning Objectives | 172 | ||
| Examination and Diagnosis | 173 | ||
| Stage of Root Development and Dental Trauma | 173 | ||
| History | 173 | ||
| Chief Complaint | 173 | ||
| History of Present Illness | 173 | ||
| Medical History | 174 | ||
| Clinical Examination | 174 | ||
| Soft Tissues | 174 | ||
| Facial Skeleton | 174 | ||
| Teeth and Supporting Tissues | 174 | ||
| Mobility | 174 | ||
| Displacement | 175 | ||
| Periodontal Damage | 175 | ||
| Pulpal Injury | 175 | ||
| Radiographic Examination | 175 | ||
| Injuries to the Hard Dental Tissues and the Pulp | 177 | ||
| Enamel Fractures | 177 | ||
| Uncomplicated Crown Fractures | 177 | ||
| 12 Endodontic radiography | 198 | ||
| Chapter Outline | 198 | ||
| Learning Objectives | 198 | ||
| Importance of Radiography in Endodontics | 199 | ||
| Digital Radiography | 199 | ||
| Diagnosis | 199 | ||
| Identifying Pathosis | 199 | ||
| Determining Root and Pulpal Anatomy | 199 | ||
| Characterizing Normal Structures | 199 | ||
| Treatment | 199 | ||
| Determining Working Lengths | 199 | ||
| Moving Superimposed Structures | 199 | ||
| Locating Canals | 199 | ||
| Differentiating Canals and Periodontal Ligament Spaces | 199 | ||
| Evaluating Obturation | 199 | ||
| Follow-up Evaluation (Recall) | 200 | ||
| Identifying New Pathosis | 200 | ||
| Evaluating Healing | 200 | ||
| Special Applications | 200 | ||
| Cone-Image Shift | 200 | ||
| Working Radiographs | 200 | ||
| Radiographic Sequence | 200 | ||
| Diagnostic Radiographs | 201 | ||
| Number | 201 | ||
| Angulation | 201 | ||
| Working Radiographs | 201 | ||
| Working Length | 201 | ||
| Master Cone | 201 | ||
| Other Considerations | 201 | ||
| Obturation | 202 | ||
| Follow-up Evaluation (Recall) | 202 | ||
| Exposure Considerations | 202 | ||
| Cone-Image Shift | 202 | ||
| Principles | 202 | ||
| Image Shift | 202 | ||
| Superimposed Structures | 202 | ||
| Faciolingual Determination | 203 | ||
| SLOB Rule | 203 | ||
| Indications and Advantages | 204 | ||
| Separation and Identification of Superimposed Canals | 204 | ||
| Movement and Identification of Superimposed Structures | 204 | ||
| Determination of Working Length | 204 | ||
| Determination of Curvatures | 204 | ||
| Determination of Faciolingual Locations | 204 | ||
| Identification of Undiscovered Canals | 204 | ||
| Location of “Calcified” Canals | 204 | ||
| Disadvantages | 206 | ||
| Decreased Clarity | 206 | ||
| Superimposition of Structures | 207 | ||
| Endodontic Radiographic Anatomy | 209 | ||
| Interpretation | 209 | ||
| Limitations | 209 | ||
| Differential Diagnosis | 209 | ||
| Endodontic Pathosis | 209 | ||
| 13 Endodontic instruments | 218 | ||
| Chapter Outline | 218 | ||
| Learning Objectives | 218 | ||
| Instruments for Different Procedures | 218 | ||
| Examination and Diagnosis Kit | 218 | ||
| Routine Endodontic Procedure Kit | 219 | ||
| Emergency Kit | 219 | ||
| Instruments for Bleaching | 220 | ||
| Intracanal Preparation Instruments | 220 | ||
| Physical Properties | 220 | ||
| Instrument Fabrication | 220 | ||
| Physical Characteristics | 221 | ||
| Instrument Design and Standardization | 222 | ||
| Color Coding | 222 | ||
| Dimensions | 222 | ||
| Length | 222 | ||
| Taper | 223 | ||
| Tip Design | 223 | ||
| Hand-Operated Instruments | 223 | ||
| Mechanically Operated Instruments | 224 | ||
| Rotary | 224 | ||
| Reciprocating | 225 | ||
| Vibratory | 225 | ||
| Lasers | 225 | ||
| Avoidance of Instrument Separation | 225 | ||
| Intracanal Obturation Instruments | 225 | ||
| Lateral Compaction | 226 | ||
| Warm Vertical Compaction | 227 | ||
| Disinfection and Sterilization | 228 | ||
| References | 228 | ||
| 14 Internal anatomy | 230 | ||
| Chapter Outline | 230 | ||
| Learning Objectives | 230 | ||
| Methods of Determining Pulp Anatomy | 230 | ||
| Textbook Knowledge | 230 | ||
| Radiographic Evidence | 232 | ||
| Exploration | 232 | ||
| General Considerations | 232 | ||
| Root and Canal Anatomy | 233 | ||
| Identification of Canals and Roots | 233 | ||
| Alterations in Internal Anatomy | 234 | ||
| Age | 234 | ||
| Irritants | 234 | ||
| Calcifications | 234 | ||
| Internal Resorption | 235 | ||
| Components of the Pulp System | 235 | ||
| Pulp Horns | 235 | ||
| Pulp Chamber | 236 | ||
| Root Canals | 236 | ||
| Accessory Canals | 236 | ||
| Apical Region | 237 | ||
| Development | 237 | ||
| Apical Foramen | 237 | ||
| Variations in Anatomy | 237 | ||
| Apical Constriction | 237 | ||
| Variations of Root and Pulp Anatomy | 238 | ||
| Dens Invaginatus (Dens in Dente) | 239 | ||
| Dens Evaginatus | 239 | ||
| High Pulp Horns | 239 | ||
| Lingual Groove | 239 | ||
| Dilaceration | 239 | ||
| Other Variations | 239 | ||
| References | 242 | ||
| 15 Isolation, endodontic access, and length determination | 244 | ||
| Chapter Outline | 244 | ||
| Learning Objectives | 244 | ||
| Isolation | 244 | ||
| Rubber Dam Application | 244 | ||
| Rubber Dam Retainers | 245 | ||
| Types | 245 | ||
| Universal Clamp Designs | 245 | ||
| Additional Designs | 246 | ||
| Preparation for Rubber Dam Placement | 247 | ||
| Isolation of Teeth with Inadequate Coronal Structure | 247 | ||
| Ligation | 247 | ||
| Deep-Reaching Clamps | 247 | ||
| Bonding | 248 | ||
| Clamping of the Gingiva | 248 | ||
| Replacement of Coronal Structure | 248 | ||
| Temporary Restorations | 248 | ||
| Coronal Buildups | 248 | ||
| Band Placement | 248 | ||
| Provisional Crowns | 248 | ||
| Corrective Surgery | 248 | ||
| Gingivectomy | 248 | ||
| Crown Lengthening | 249 | ||
| Orthodontic Extrusion | 249 | ||
| Rubber Dam Placement | 249 | ||
| Placement as a Unit | 249 | ||
| Placement of a Clamp, Followed by the Dam and Then the Frame | 249 | ||
| Placement of the Rubber Dam and Frame and Then the Clamp | 249 | ||
| Rubber Dam Leakage | 249 | ||
| Disinfection of the Operating Field | 249 | ||
| Access Openings | 249 | ||
| General Principles | 250 | ||
| Canal Morphologies | 250 | ||
| General Considerations | 250 | ||
| Access Openings and Canal Location* | 253 | ||
| Maxillary Central and Lateral Incisors | 253 | ||
| Maxillary Canines | 255 | ||
| Maxillary Premolars | 256 | ||
| Maxillary Molars | 256 | ||
| Mandibular Central and Lateral Incisors | 258 | ||
| Mandibular Canines | 261 | ||
| Mandibular Premolars | 261 | ||
| Mandibular Molars | 261 | ||
| Errors in Access | 267 | ||
| Inadequate Preparation | 267 | ||
| Excessive Removal of Tooth Structure | 267 | ||
| Length Determination | 267 | ||
| Radiographic Evaluation | 267 | ||
| Electronic Apex Locators | 270 | ||
| References | 271 | ||
| 16 Cleaning and shaping | 273 | ||
| Chapter Outline | 273 | ||
| Learning Objectives | 273 | ||
| Principles of Cleaning | 274 | ||
| Principles of Shaping | 274 | ||
| Apical Canal Preparation | 274 | ||
| Termination of Cleaning and Shaping | 274 | ||
| Degree of Apical Enlargement | 277 | ||
| Elimination of Etiology | 278 | ||
| Apical Patency | 278 | ||
| Pretreatment Evaluation | 278 | ||
| Principles of Cleaning and Shaping Techniques | 278 | ||
| Smear Layer Management | 279 | ||
| Irrigants | 280 | ||
| Sodium Hypochlorite | 280 | ||
| EDTA | 280 | ||
| Chlorhexidine | 281 | ||
| MTAD | 281 | ||
| QMix | 281 | ||
| Ultrasonics | 281 | ||
| Lubricants | 281 | ||
| Preparation Errors | 281 | ||
| Preparation Techniques | 283 | ||
| Working Length Determination | 283 | ||
| Hand Instrumentation | 284 | ||
| Watch Winding | 284 | ||
| Reaming | 284 | ||
| Filing | 284 | ||
| Circumferential Filing | 284 | ||
| Standardized Preparation | 284 | ||
| Step-Back Technique | 284 | ||
| Step-Down Technique | 284 | ||
| Passive Step-Back Technique | 286 | ||
| Anticurvature Filing | 286 | ||
| Balanced Force Technique | 287 | ||
| Recapitulation | 288 | ||
| Shaping Modifications | 288 | ||
| Engine-Driven Instruments | 288 | ||
| Gates-Glidden Drills | 288 | ||
| Nickel-Titanium Rotary Instruments | 288 | ||
| Criteria for Evaluating Cleaning and Shaping | 291 | ||
| Intracanal Medicaments | 293 | ||
| Calcium Hydroxide | 294 | ||
| Phenols and Aldehydes | 294 | ||
| Corticosteroids | 294 | ||
| Chlorhexidine | 294 | ||
| Temporary Restorations* | 294 | ||
| Objectives of Temporization | 295 | ||
| Routine Access Cavities | 295 | ||
| Techniques of Placement | 296 | ||
| Extensive Coronal Breakdown | 296 | ||
| Provisional Post Crowns | 296 | ||
| Long-Term Temporary Restorations | 297 | ||
| References | 297 | ||
| 17 Preparation for restoration | 301 | ||
| Chapter Outline | 301 | ||
| Learning Objectives | 301 | ||
| Risks to Survival of Root-Filled Teeth | 301 | ||
| Structural and Esthetic Considerations | 302 | ||
| Structural Changes in Dentin | 302 | ||
| Loss of Tooth Structure | 302 | ||
| Biomechanical Factors | 302 | ||
| Esthetic Factors | 303 | ||
| Requirements for an Adequate Restoration | 303 | ||
| Coronal Seal | 303 | ||
| Restoration Timing | 303 | ||
| Restoration Design | 303 | ||
| Principles and Concepts | 303 | ||
| Planning the Definitive Restoration | 304 | ||
| Anterior Teeth | 304 | ||
| Posterior Teeth | 304 | ||
| Direct Restorations | 304 | ||
| Indirect Restorations | 305 | ||
| Preparation of Tooth and Canal Space for Post and Core | 305 | ||
| Coronal Tooth Preparation | 305 | ||
| Post Selection | 305 | ||
| Post Space Preparation | 310 | ||
| Removal of Gutta-Percha | 310 | ||
| Finishing the Post Space | 312 | ||
| Ferrule | 312 | ||
| Post Type, Retention, and Core Systems | 312 | ||
| Anterior Teeth | 312 | ||
| Posterior Teeth | 312 | ||
| Pins | 313 | ||
| Restoring Access Through an Existing Restoration | 313 | ||
| References | 314 | ||
| 18 Obturation | 316 | ||
| Chapter Outline | 316 | ||
| Learning Objectives | 316 | ||
| Objectives of “Obturation” | 316 | ||
| Potential Causes of Failure | 317 | ||
| Apical Seal | 317 | ||
| Leaving Debris in the RCS | 317 | ||
| Coronal Seal | 317 | ||
| Irritants from the Oral Cavity | 317 | ||
| Restoration | 317 | ||
| Lateral Seal | 317 | ||
| Length of Obturation | 317 | ||
| Overextension (Overfill) | 317 | ||
| Obturating Materials | 317 | ||
| Lack of Apical Seal Secondary to Overextension | 317 | ||
| Obturation Short of the Apical Construction (Underfill) | 318 | ||
| Lateral Canals | 318 | ||
| Vertical Root Fractures | 319 | ||
| Timing of Obturation | 319 | ||
| Patient’s Symptoms | 319 | ||
| Pulp and Periapical Status | 319 | ||
| Vital Pulp | 319 | ||
| Necrotic Pulp | 319 | ||
| Degree of Difficulty | 319 | ||
| Culture Results | 319 | ||
| Number of Appointments | 319 | ||
| Core Obturating Materials | 320 | ||
| Solid Materials | 320 | ||
| Gutta-Percha | 320 | ||
| Composition | 320 | ||
| Shapes | 320 | ||
| Advantages | 320 | ||
| Sealability | 320 | ||
| Methods of Obturation | 320 | ||
| Resin | 321 | ||
| Silver Points | 321 | ||
| Pastes (Semisolids) | 321 | ||
| Types | 321 | ||
| Zinc Oxide–Eugenol (ZnOE) | 321 | ||
| Plastics | 321 | ||
| Techniques of Placement | 321 | ||
| Advantages and Disadvantages of Pastes | 322 | ||
| Sealers | 322 | ||
| Desirable Properties | 322 | ||
| Types | 323 | ||
| ZnOE-Based Sealers | 323 | ||
| Grossman’s Formulation | 323 | ||
| Epoxy Resin | 323 | ||
| Other Plastics | 323 | ||
| Calcium Hydroxide | 323 | ||
| Glass Ionomer | 324 | ||
| Ceramic-Based Sealer | 324 | ||
| Others | 324 | ||
| Mixing | 324 | ||
| Placement | 324 | ||
| Obturation Techniques with Gutta-Percha | 324 | ||
| Selection of Technique | 324 | ||
| Lateral Compaction | 324 | ||
| Indications | 324 | ||
| Advantages | 325 | ||
| Disadvantages | 325 | ||
| Technique of Lateral Compaction | 325 | ||
| Spreader or Plugger Selection | 325 | ||
| Master Cone Selection | 325 | ||
| Fitting the MC | 326 | ||
| Steps in Obturation | 326 | ||
| Ultrasonic Compaction | 329 | ||
| Finishing Procedure | 329 | ||
| Correcting Obturation Problems | 329 | ||
| Solvent-Softened Custom Cones | 330 | ||
| Indications | 330 | ||
| Technique | 330 | ||
| Vertical Compaction | 330 | ||
| Indications | 331 | ||
| Advantages and Disadvantages | 331 | ||
| Technique | 331 | ||
| Other Warm Vertical Approaches | 331 | ||
| Sectional Obturation | 332 | ||
| Thermoplasticized Injection | 333 | ||
| Solvent | 333 | ||
| Carrier-Based Systems | 333 | ||
| Newer Techniques and Materials | 334 | ||
| Evaluation of Obturation | 335 | ||
| Symptoms | 335 | ||
| Radiographic Criteria | 335 | ||
| Restoration | 336 | ||
| The Future | 336 | ||
| References | 336 | ||
| 19 Procedural accidents | 338 | ||
| Chapter Outline | 338 | ||
| Learning Objectives | 338 | ||
| Perforations during Access Preparation | 338 | ||
| Causes | 338 | ||
| Prevention | 340 | ||
| Clinical Examination | 340 | ||
| Operative Procedures | 340 | ||
| Recognition and Treatment | 340 | ||
| Lateral Root Perforation | 342 | ||
| Furcation Perforation | 342 | ||
| Nonsurgical Treatment | 342 | ||
| Surgical Treatment | 342 | ||
| Prognosis | 342 | ||
| Accidents during Cleaning and Shaping | 343 | ||
| Ledge Formation | 343 | ||
| Prevention of a Ledge | 343 | ||
| Preoperative Evaluation | 343 | ||
| Curvatures | 343 | ||
| Length | 343 | ||
| Initial Size | 345 | ||
| Technical Procedures | 345 | ||
| Management of a Ledge | 345 | ||
| 20 Retreatment | 355 | ||
| Chapter Outline | 355 | ||
| Learning Objectives | 355 | ||
| Treatment Options | 355 | ||
| Indications for Nonsurgical Endodontic Retreatment | 357 | ||
| Contraindications to Nonsurgical Endodontic Retreatment | 357 | ||
| Indications for Surgical Retreatment | 357 | ||
| Risks and Benefits of Retreatment | 358 | ||
| Endodontic Retreatment Procedures | 358 | ||
| Removal of Existing Restorations | 358 | ||
| Removal of Canal Obstructions | 358 | ||
| Post and Core Removal | 358 | ||
| Removal of Calcifications | 360 | ||
| Management of Ledges | 361 | ||
| Instrument Fragment Removal | 361 | ||
| Removal of Gutta-Percha | 363 | ||
| Removal of Carrier-Based Gutta-Percha Obturators | 367 | ||
| Removal of Silver Cones (Points) | 367 | ||
| Removal of Soft and Hard Pastes | 369 | ||
| Post-Treatment Complications | 371 | ||
| Repair of Perforations | 372 | ||
| Restorative Options | 372 | ||
| Follow-Up Care | 372 | ||
| Prognosis | 373 | ||
| References | 373 | ||
| 21 Endodontic surgery | 376 | ||
| Chapter Outline | 376 | ||
| Learning Objectives | 376 | ||
| Incision for Drainage | 376 | ||
| Indications | 377 | ||
| Contraindications | 377 | ||
| Procedures | 377 | ||
| Anesthesia | 377 | ||
| Incision | 377 | ||
| Drainage | 378 | ||
| Periapical Surgery | 378 | ||
| Indications | 378 | ||
| Anatomic Problems | 378 | ||
| Procedural Accidents | 379 | ||
| Irretrievable Materials in the Root Canal | 379 | ||
| Symptomatic Cases | 379 | ||
| Horizontal Apical Fracture | 379 | ||
| Biopsy | 379 | ||
| Contraindications | 379 | ||
| Anatomic Factors | 379 | ||
| Medical or Systemic Complications | 379 | ||
| Indiscriminate Use of Surgery | 379 | ||
| Unidentified Cause of Treatment Failure | 382 | ||
| Recent Advances in Endodontic Surgery | 382 | ||
| Procedures Involved in Periapical Surgery | 382 | ||
| Flap Design | 382 | ||
| Submarginal Curved Flap | 384 | ||
| Submarginal Triangular and Rectangular Flaps | 385 | ||
| Full Mucoperiosteal Flap | 385 | ||
| Incision and Reflection | 385 | ||
| Osteotomy | 386 | ||
| Periradicular Curettage | 386 | ||
| Root-End Resection | 386 | ||
| Root-End Cavity Preparation and Filling | 387 | ||
| Flap Replacement and Suturing | 387 | ||
| Postoperative Care and Instructions | 388 | ||
| Healing | 389 | ||
| Soft Tissue | 389 | ||
| Hard Tissue | 390 | ||
| Guided Tissue Regeneration | 390 | ||
| Corrective Surgery | 390 | ||
| Indications | 390 | ||
| Procedural Errors | 390 | ||
| Resorptive Perforations | 390 | ||
| Techniques | 390 | ||
| Root Amputation, Hemisection, and Bicuspidization | 391 | ||
| Techniques | 391 | ||
| Prognosis | 392 | ||
| Outcome of Endodontic Surgery | 393 | ||
| Conditions Indicating Referral | 395 | ||
| References | 396 | ||
| 22 Evaluation of endodontic outcomes | 397 | ||
| Chapter Outline | 397 | ||
| Learning Objectives | 397 | ||
| Definitions of Success and Failure | 397 | ||
| When to Evaluate | 398 | ||
| Methods for Evaluation of Endodontic Outcomes | 398 | ||
| Patient History | 398 | ||
| Clinical Examination | 398 | ||
| Radiographic Findings | 398 | ||
| Histologic Examination | 401 | ||
| Success Rates | 401 | ||
| Survival Rates | 402 | ||
| Patient-Based Outcomes | 402 | ||
| Postoperative Complications | 403 | ||
| Prognostic Indicators | 403 | ||
| Causes of Nonhealed, Failed Root Canal Treatment | 403 | ||
| Preoperative Causes | 403 | ||
| Operative Causes | 403 | ||
| Postoperative Causes | 405 | ||
| Outcomes of Treatments after Failure of Initial Nonsurgical Endodontics | 405 | ||
| Nonsurgical Retreatment | 406 | ||
| Endodontic Surgery | 407 | ||
| Single Tooth Implant | 407 | ||
| Fixed Dental Prostheses | 408 | ||
| Intentional Replantation and Autotransplantation | 408 | ||
| Extraction Without Replacement | 409 | ||
| Reasons for Extraction of Endodontically Treated Teeth | 409 | ||
| References | 409 | ||
| 23 Single implant | 412 | ||
| Chapter Outline | 412 | ||
| Learning Objectives | 412 | ||
| History of Single Implants | 412 | ||
| Diagnosis and Treatment Planning for Single Implants | 414 | ||
| Tooth Extraction and Site Preparation | 414 | ||
| Minimally Traumatic Extraction | 414 | ||
| Single Tooth Implant | 415 | ||
| Single Implants in the Esthetic Zone | 416 | ||
| Immediate Implant Surgery without Any Flaps | 416 | ||
| Surgical Technique | 416 | ||
| Single Implants in the Nonesthetic Zone | 417 | ||
| Osseous Consideration | 417 | ||
| Soft Tissue Consideration | 419 | ||
| Guided Bone Regeneration for Implant Site Development | 421 | ||
| Flap Design | 423 | ||
| Wound Closure | 423 | ||
| Dental Implant Maintenance Program | 424 | ||
| Frequency of Maintenance Appointments | 426 | ||
| References | 426 | ||
| 24 Bleaching discolored teeth | 428 | ||
| Chapter Outline | 428 | ||
| Learning Objectives | 428 | ||
| Causes of Discoloration | 428 | ||
| Acquired (Natural) Discolorations | 429 | ||
| Pulp Necrosis | 429 | ||
| Intrapulpal Hemorrhage | 429 | ||
| Calcific Metamorphosis | 429 | ||
| Age | 429 | ||
| Developmental Defects | 429 | ||
| Endemic Fluorosis | 429 | ||
| Systemic Drugs | 430 | ||
| Defects in Tooth Formation | 430 | ||
| Blood Dyscrasias and Other Factors | 431 | ||
| Inflicted (Iatrogenic) Discolorations | 431 | ||
| Endodontically Related Discolorations | 431 | ||
| Obturating Materials | 431 | ||
| Remnants of Pulpal Tissue | 431 | ||
| Intracanal Medicaments | 431 | ||
| Coronal Restorations | 431 | ||
| Metallic Restorations | 431 | ||
| Composite Restorations | 432 | ||
| Bleaching Materials | 432 | ||
| Hydrogen Peroxide | 432 | ||
| Sodium Perborate | 433 | ||
| Carbamide Peroxide | 433 | ||
| Other Agents | 434 | ||
| Internal (Nonvital) Bleaching Techniques | 435 | ||
| Thermocatalytic Technique | 435 | ||
| Walking Bleach | 435 | ||
| Final Restoration | 435 | ||
| Future Rediscoloration | 436 | ||
| When to Bleach | 437 | ||
| Complications and Safety | 437 | ||
| External Root Resorption | 437 | ||
| Coronal Fracture | 437 | ||
| Chemical Burns | 437 | ||
| Intrinsic Discolorations | 438 | ||
| Tetracycline | 438 | ||
| Other Intrinsic Discolorations | 438 | ||
| Extrinsic Discolorations | 438 | ||
| Superficial Defects | 438 | ||
| Mechanism of Discoloration | 438 | ||
| Microabrasion Technique | 439 | ||
| Prognosis | 439 | ||
| Safety | 439 | ||
| When and What to Refer | 439 | ||
| References | 440 | ||
| 25 Geriatric endodontics | 441 | ||
| Chapter Outline | 441 | ||
| Learning Objectives | 441 | ||
| Biologic Considerations | 442 | ||
| Pulp Response | 442 | ||
| Changes with Age | 442 | ||
| Chronologic Versus Physiologic | 443 | ||
| Structural | 443 | ||
| Calcifications | 443 | ||
| Dimensional | 443 | ||
| Nature of Response to Injury | 443 | ||
| From Irritation | 443 | ||
| Age | 443 | ||
| Systemic Conditions | 443 | ||
| Periapical Response | 444 | ||
| Healing | 444 | ||
| Medically Compromised Patients | 444 | ||
| Diagnosis | 444 | ||
| Diagnostic Procedure | 444 | ||
| Chief Complaint | 444 | ||
| Medical History | 444 | ||
| Dental History | 444 | ||
| Subjective Findings | 445 | ||
| Objective Tests | 445 | ||
| Radiographic Findings | 445 | ||
| Differential Diagnosis | 445 | ||
| Endodontic Pathosis | 446 | ||
| Other Pathoses | 446 | ||
| Treatment Planning and Case Selection | 446 | ||
| Procedure | 446 | ||
| Prognosis | 446 | ||
| Number of Appointments | 446 | ||
| Additional Considerations | 447 | ||
| Root Canal Treatment | 447 | ||
| Treatment Considerations | 447 | ||
| Time Required | 447 | ||
| Anesthesia | 447 | ||
| Primary Injections | 447 | ||
| Supplemental Injections | 448 | ||
| Procedures | 448 | ||
| Isolation | 448 | ||
| Access Preparation | 448 | ||
| Working Length | 449 | ||
| Cleaning and Shaping | 449 | ||
| Intracanal Medicaments | 449 | ||
| Obturation | 449 | ||
| Impact of Restoration | 450 | ||
| Retreatment | 450 | ||
| Endodontic Surgery | 450 | ||
| Medical Considerations | 450 | ||
| Biologic and Anatomic Factors | 450 | ||
| Healing After Surgery | 450 | ||
| Bleaching | 450 | ||
| Internal Stains | 451 | ||
| Restorative Considerations | 451 | ||
| Overdenture Abutments | 451 | ||
| Coronal Seal | 451 | ||
| Trauma | 452 | ||
| References | 452 | ||
| Appendix Pulpal anatomy and access preparations | 455 | ||
| Maxillary Right Central Incisor | 456 | ||
| Maxillary Right Lateral Incisor | 456 | ||
| Maxillary Right Canine | 456 | ||
| Maxillary Right First Premolar | 457 | ||
| Maxillary Right Second Premolar | 458 | ||
| Maxillary Right First Molar | 459 | ||
| Maxillary Right Second Molar | 460 | ||
| Maxillary Right Second Molar | 461 | ||
| Mandibular Right Central and Lateral Incisor | 462 | ||
| Mandibular Right Canine | 462 | ||
| Mandibular Right First Premolar | 463 | ||
| Mandibular Right Second Premolar | 464 | ||
| Mandibular Right First Molar | 465 | ||
| Mandibular Right Second Molar | 466 | ||
| Mandibular Right Second Molar | 467 | ||
| Some Uncommon Variations | 467 | ||
| Appendix B | e1 | ||
| Chapter review questions | e1 | ||
| Chapter 1 | e1 | ||
| The Biology of Dental Pulp and Periradicular Tissues | e1 | ||
| Chapter review questions | e4 | ||
| Chapter 2 | e4 | ||
| Protecting the Pulp and Promoting Tooth Maturation | e4 | ||
| Chapter review questions | e7 | ||
| Chapter 3 | e7 | ||
| Endodontic Microbiology | e7 | ||
| Chapter review questions | e9 | ||
| Chapter 4 | e9 | ||
| Pulp and Periapical Pathosis | e9 | ||
| Chapter review questions | e13 | ||
| Chapter 5 | e13 | ||
| Diagnosis, Treatment Planning, and Systemic Considerations | e13 | ||
| Chapter review questions | e16 | ||
| Chapter 6 | e16 | ||
| Interaction between the General Dentist and the Endodontist | e16 | ||
| Chapter review questions | e18 | ||
| Chapter 7 | e18 | ||
| Endodontic-Periodontic Interrelationship | e18 | ||
| Chapter review questions | e20 | ||
| Chapter 8 | e20 | ||
| Longitudinal Tooth Fractures | e20 | ||
| Chapter review questions | e23 | ||
| Chapter 9 | e23 | ||
| Local Anesthesia | e23 | ||
| Chapter review questions | e27 | ||
| Chapter 10 | e27 | ||
| Endodontic Emergencies and Therapeutics | e27 | ||
| Chapter review questions | e31 | ||
| Chapter 11 | e31 | ||
| Management of Traumatic Dental Injuries | e31 | ||
| Chapter review questions | e35 | ||
| Chapter 12 | e35 | ||
| Endodontic Radiology | e35 | ||
| Chapter review questions | e38 | ||
| Chapter 13 | e38 | ||
| Endodontic Instruments | e38 | ||
| Chapter review questions | e41 | ||
| Chapter 14 | e41 | ||
| Internal Anatomy | e41 | ||
| Chapter review questions | e43 | ||
| Chapter 15 | e43 | ||
| Isolation, Endodontic Access, and Length Determination | e43 | ||
| Chapter review questions | e47 | ||
| Chapter 16 | e47 | ||
| Cleaning and Shaping | e47 | ||
| Chapter review questions | e49 | ||
| Chapter 17 | e49 | ||
| Preparation for Restoration | e49 | ||
| Chapter review questions | e51 | ||
| Chapter 18 | e51 | ||
| Obturation | e51 | ||
| Chapter review questions | e53 | ||
| Chapter 19 | e53 | ||
| Procedural Accidents | e53 | ||
| Chapter review questions | e55 | ||
| Chapter 20 | e55 | ||
| Retreatment | e55 | ||
| Chapter review questions | e57 | ||
| Chapter 21 | e57 | ||
| Endodontic Surgery | e57 | ||
| Chapter review questions | e59 | ||
| Chapter 22 | e59 | ||
| Evaluation of Endodontic Outcomes | e59 | ||
| Chapter review questions | e61 | ||
| Chapter 23 | e61 | ||
| Single Implant | e61 | ||
| Chapter review questions | e64 | ||
| Chapter 24 | e64 | ||
| Bleaching Discolored Teeth | e64 | ||
| Chapter review questions | e66 | ||
| Chapter 25 | e66 | ||
| Geriatric Endodontics | e66 | ||
| Index | 471 | ||
| A | 471 | ||
| B | 471 | ||
| C | 472 | ||
| D | 473 | ||
| E | 473 | ||
| F | 474 | ||
| G | 475 | ||
| H | 475 | ||
| I | 475 | ||
| K | 476 | ||
| L | 476 | ||
| M | 476 | ||
| N | 477 | ||
| O | 477 | ||
| P | 477 | ||
| Q | 479 | ||
| R | 479 | ||
| S | 480 | ||
| T | 481 | ||
| U | 482 | ||
| V | 482 | ||
| W | 482 | ||
| X | 482 | ||
| Z | 482 |