Professional Documents
Culture Documents
ØPeriodontal
considerations
ØRestorative
considerations
ØEndodontic
considerations
ØSurgical considerations
2
ERIODONTAL CONSIDERATIONS
•Periodontal probing
•Mobility assessment
•Radiographic assessment
•Endodontic treatment should
not be planned for teeth with
poor periodontal prognosis
( e . g . mobility III )
3
ESTORATIVE CONSIDERATIONS
RESTORATIVE
6
TREATMENT PLANNING
Scope of endodontics
§Vital pulp therapy
§Pulpectomy or RCT
§Endodontic surgery
§Retreatment
§Hemisection or root
amputation
§Bleaching
§Apexification or
apexogenesis 7
TREATMENT PLANNING
vTreatment or extraction?
vWhat kind of treatment ?
§Endodontic
§Periodontal
§Restorative
vWho will be the operator?
vSingle-visit or multi-visit?
vCost
vPrognosis
8
EPARATION FOR TREATMENT
ØInfection control
§Universal precautions(operatory
preparation)
§Instrument sterilization
§Tooth isolation
ØPatient preparation
§Informed consent
§Pain control
9
ECTION CONTROL GUIDE LINES
oLocal anesthesia
oDivitalization
13
Local Anesthesia (LA)
•When to anesthetize
ØLA should be given at each appointment
•Three misconceptions
§Necrotic teeth may be instrumented without LA
(vital tissue
may exists periapically)
§Patient’s sense aids the clinician to determine
working length
§LA is unnecessary during obturation phase
(obturation
pressure and extrusion of sealer may produce pain)
14
MERGENCY TREATMENT
Pretreatment emergency
•Irreversible pulpitis without acute apical
periodontitis
•Irreversible pulpitis with acute apical
periodontitis
•Pulp necrosis with acute apical periodontitis
Principles:
•Complete pulp removal
•Total cleaning and shaping (C/S) of
the
root canal system
•Pulpectomy is the best to achieve
pain
relief
16
Irreversible pulpitis without AAP
•Without swelling
•With localized swelling
•With diffuse swelling
19
Without Swelling
Principle :
debridement and drainage
Three ways to resolve swelling and
infection
§Drainage through the root canal
§Drainage by incising a fluctuant
swelling (incision and drainage,
I &D )
§Antibiotic treatment
21
Localized Swelling
23
Diffuse Swelling
•Possible to turn into a medical emergency
and life-threatening condition
•Principles
§Thorough C/S of the canals
§Apical patency achieved whenever
possible
§Tooth left open
§I&D in the absence of drainage through
the canals with a rubber dam drain
inserted or sutured (2~3 days)
§Referral to oral surgeons
24
Antibiotic Therapy
§Indicated for patients with
•Diffuse swelling regardless of the
establish of drainage
•Spreading infections or systemic
signs
§Penicillin (1st choice) or
clindamycin or
erythromycin + Metronidazole
25
Endo-Perio Interrelationship
Pain 27
Endo-Perio Interrelationship
Radiolucenc 28
Endo-Perio Interrelationship
Pocket 29
Treatment Sequence
30
Treatment Sequence
31
Treatment Sequence
32
SUMMARY
qPulpal status always dictates treatment of
periapical disease .
qDrainage of abscess should be performed before
endodontic
treatment .
qEndodontic treatment should be done first
prior to
periodontic treatment .
qApical healing regardless of marginal
periodontitis .
Ma rginal healing influenced by pulpal
infections .
qThe objectives of treatment are : 33
THANK
YOU 34