1. Introduction to endodontics, pathohistological and clinical classification of pulpal diseases, indication and contraindication of endodontic treatment
4.Year - Dental Medicine

2. Pulp normality The CLINICALLY NORMAL PULP vital to testing procedures
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!!!

3. Dental pulp - healthy

4. Dental pulp - inflamed, infected
Acute pulpitis

5. Dental pulp
DP : dental pulp OB : odontoblast D : dentin PD : predentin TF : Tom's fiber

6. The response of the pulp
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

7. Histopathologic classification of pulpal diseases
A. Regresive changes
B. Inflammatory changes
Pulpal hyperemy
Acute pulpitis
Chronic pulpitis
C. Necrosis of the pulp
D. Gangraena of the pulp
Acute pulpitis
serose partial
total
purulent partial
Chronic pulpitis
clausa
a tergo
granulomatosa interna
aperta ulcerosa
aperta hypertrophica

8. A. Regresive changes vacuolar degeneration of odontoblasts
hyalinic degeneration of the pulp
lipidic degeneration of the pulp
reticular atrophy
pathological calcification

9. 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

10. A. Regresive changes: Hyalinic degeneration of the pulp
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

11. Regresive changes: Lipidic degeneration of the pulp Reticular atrophy
We can find it in pulp with chronic inflammation
It is break - down of metabolism, and the result is
the lipids in cells
RETICULAR ATROPHY:
It is regresive change present in pulp of old people
Lost odontoblasts and pulpal cells are compensated by tissue

12. A. Regresive changes: Pathological calcification
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 denticuls
Sometimes they are small microscopic, sometimes biggist and they can fill pulp chamber or root canal, or obliterate it totally.

13. 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
4. DEATH OF THE PULP:
pulp with lost vitality, necrotic, gangrenous

14. Symptoms typical for reversible process
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

15. Symptoms typical for irreversible process
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

16. Right diagnosis How do the right diagnosis? 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

17. Reversible or irreversible pulpal disease?
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.

18. Reversible or irreversible pulpal disease?
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

19. Reversible or irreversible pulpal disease?
B. INFLAMMATORY CHANGES:
Hyperemy
Acute pulpitis acute serous partial pulpitis
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- acute serous total pulpitis
- acute purulent partial pulpitis
- acute purulent total pulpitis
Chronic pulpitis
C. NECROSIS
D. GANGRAENA
reversible
irreversible
Endodontic

20. Endodontic treatment 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.

21. 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?

22. Indications for endodontic therapy
Presence of irreversible pulpal disease
Prophylactic pulpal therapy which may be needed prior to other treatment procedures (restorative dentistry, prosthodontics & periodontics)

23. Contraindications for endodontic therapy
The objections are listed according to:
status of the patient
dental reasons
local reasons
Status of the patient:
Age - past middle life
Health of the patient - DM, leukemia, terminal cancer, radiation
necrosis, tuberculosis, syphilis ...
Too many treated pulpless teeth

24. Contraindications for endodontic therapy
Dental reasons:
Pulpless teeth are not salvageable if there are associated periapical and periodontal lesions
Local reasons:
the periapical lesion is an apical cyst
the tooth is badly broken down by caries
the involved tooth is badly fractured
the involved tooth has a mechanical root perforation
the involved tooth has perforating internal or external root resorption
the involved tooth is wholly or partially luxated

25. Contraindications for endodontic therapy
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

26. Thank you
for attention !