Introduction and Scope of Endodontics

ENDODONTICS Greek word Endo – Inside Odont – Tooth Endodontic treatment treats inside of the tooth.

DEFINITION: ENDODONTICS is defined as the branch of dentistry that deals with the diagnosis, prevention and treatment of diseases of the dental pulp and the tissues at the root apex..

AIM: Maintain vitality of the pulp. Preserve and restore the tooth with damaged and necrotic pulp. Preserve and restore the teeth which has failed to the previous endodontic therapy, to allow the tooth to remain functional in the dental arch. Elimination of of microorganisms from the root canal system and the prevention of reinfection.

OBJECTIVE: The objective of the endodontic therapy is restoration of the treated tooth to its proper form and function in the masticatory apparatus,in a healthy state.

Thus we can say that the primary goal of endodontic therapy, Is to create an environment within the root canal system which allows the healing and continued maintenance of the health of the periradicular tissue.

HISTORY OF ENDODONTICS: Practiced as early as 2nd and 3rd century BC . History of endodontics begins in 17th century & since then many advances,developments & research work has been proceeded continuously. 1725-Lazare Rivere Use of clove oil as sedative 1746 – P. Fauchard( father of modern dentistry) Removal of pulp tissue

1838 – Edwards Maynard 1st Root canal instrument 1847 – Truman Gutta-percha as a filling material 1867 – Bowman Gutta-percha for obturating root canal 1920 – Herman Calcium hydroxide 1936 – Walker Sodium Hypochlorite

1957 – Nygaard Ostby EDTA 1958 – Ingle and Levine Standardization of Instruments 1993 – Torabinejad MTA

EVOLUTION OF ENDODONTICS Dr Grossman,the pioneer of endodontics divided the evolution of endodontics in four eras from 1776-1976

Pre science(1776 to1826) In this era ,endodontic therapy mainly consisted of crude modalities like abscesses were being treted with leeches & pulps were being cauterized using hot cauteria. Age of discovery(1826 to 1876) In this era , development of anesthesia,guttapercha & barbed broaches, also medications for treating pulpal infections & the cements &pastes were discovered to fill them.

-improvement in anesthesia & radiographs Dark age(1876 to 1926) Inspite of introduction of X-rays & general anesthesia, extractions was choice of treatment than endodontics in most of damaged teeth as the theory of focal infection was main concern at that time. The renaissance(1926 to 1976) In this era,endodontics was established as science & therapy,forming its golden era -improvement in anesthesia & radiographs -the theory of focal infection was also fading out,resulting in more of endodontics being practiced. -And in 1943-because of growing interest in endodontics,the AAE( the American Association of Endodontics )was formed.

Innovation era- It is the period from 1977 onwards -Tremendous advancements in endodontics introduced better vision,techniques of biomechanical preparations,obturation are being developed resulting in the simpler,easier & faster endodontics with more of the successful results. -Concept of single visit endodontics globally accepted in contrast to multiple visits.

Modern endodontics Great improvement in the field of endodontics Researches & papers presented regarding the advances,modifications & change in attitude regarding endodontic therapy Extensive studies have been done on microbial flora of pulp and periapical tissue. The biological changes,role of innate & acquired immunological factors are being investigated in dental pulp after it gets infected,healing of periapical tissue after RC Therapy is also being investigated.

Various ways to reduce the levels of microbial infection viz, chemical,mechanical & their combination have led to development of newer antimicrobial agents & techniques of biomechanical preparation for optimal cleaning & shaping of root canals. To increase the efficiency of root canal instrumentation, engine driven rotary instruments & Nickel Titanium multitapered instruments with different cutting tips- better,easier & efficient cleaning & shaping of the root canals

Advent of Endomicroscope opened the great opportunities for an endodontist -used from access opening till the obturation of root canals - makes images magnified & illuminated Introduction of newer obturation systems- system B, Touch & heat etc made it possible to fill the canal three dimensionally Materials like MTA(Mineral Trioxide Aggregate)- repair material apexification,perforation repair to be done under moist field.

SCOPE OF ENDODONTICS Vital pulp therapy Diagnosis and DD of oral pain RCT of teeth with or without preiradicular pathology of pulpal origin Surgical management of periapical lesion resulting from pulpal pathosis Management of avulsed teeth(replantation)

Endodontic Implants Root end resections, Hemisection, Root resections Retreatment of teeth previously treated endodontically Bleaching of discolored teeth Coronal restorations of teeth using Post and cores

WHO IS AN ENDODONTIST ?

An endodontist is an dentist who undergoes a special training in diagnosing and treating the problems associated with inside of the tooth.

HOW DOES PULP BECOMES DAMAGED?

Tooth Decay Gum diseases Trauma to tooth

WHY DOES IT PAIN ?

When pulp becomes infected,it causes Incresed blood flow and cellular activity. Pressure can not be releived. Pain

HOW CAN WE TELL IF PULP IS INFECTED?

When pulp gets inflamed, Tooth ache on hot and cold Spontaneous pain Pain on biting or on lying down Drainage,swelling,& abcess on the root end

NEED AND PROCEDURE OF ROOT CANAL THERAPY Trauma/decay of tooth Inlamation of pulp Infection – may spread around the tissues causing destruction of bone and supporting tissue Loss of tooth

Hence RCT is done to save the damaged pulp and restore the tooth into full fuction by, Access opening & Working length determination Through cleaning and shaping of root canal system

Then filling it with Gutta-percha(rubber like)material to prevent recontamination of the tooth Tooth is permanently restored with crown with or without post

NUMBER OF VISITS SINGLE VS MULTIPLE

CONCLUSION As dentists became increasingly aware that natural teeth function more efficiently than any replacement,they found it worth additional effort to retain pulpally involved teeth. In practice of dentistry the role of endodontics has greatly broadened in scope in past 40 years.although many factors are responsible,the most important reason behind this growth is extremely high predictability of endodontic success

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