Apicoectomy (retrograde/nonconventional endo)
INTRODUCTION TO ENDODONTICS
OBJECTIVES
 To know the importance and significance of endodontic therapy.
 To know the different ways of assessing success and failure in
endodontic treatment.
 To recognize the importance of patient recall.
 To know how endodontic therapy has evolved into what it is today.
 To define each principle in Endo therapy and give an overview of its
significance in endodontic treatment.
II. DEFINITION OF ENDODONTICS
 The branch of dentistry concerned with the: morphology, physiology
and pathology of the human dental pulp and periradicular tissues.
 Its study and practice encompass the basic and clinical sciences
including the biology of the normal pulp and the etiology, diagnosis,
prevention and treatment of diseases and injuries of the pulp and
associated periradicular conditions.
III. SCOPE OF ENDODONTICS
Endodontics includes, but is not limited to:
 Differential diagnosis
To differentiate one disease from another disease.
 Treatment of oral pains of pulpal and/or periapical origin (orthograde
/conventional RCT)
Iba ang sign and symptoms ng pulpal and periapical origin.
sometimes, pareho sila.
 Vital pulp therapy
Pulp capping – calcium hydroxide to protect the pulp. Ex, DYCAL,
PULP DENT, HIDREX, PERACAL-C, LIMELIGHT
Direct Pulp Capping na expose yung pulp or pulp horn, before you place the
calcium hydroxide you have to clean the canal with the use of anesthetic
solution. Then, apply light pressure to stop the bleeding. Add calcium
hydroxide and dental material to protect the calcium hydroxide and the pulp.
If possible, permanent filling, 3 to 6 months observation. After observing,
take an xray to know if there is the growth of the secondary.
Indirect Pulp Capping a thin layer of dentin still covers and protect the pulp
and you have to place calcium hydroxide on top of it. 0.5mm thick ang
ilalagay, then add another layer of dental material para hindi madidisolve
yung calcium hydroxide. After the placement, you can now place your
permanent filling material. For example,resin or amalgam.
Pulpotomy is the surgical removal of the coronal portion of a vital pulp
through incision. Clean with anesthetic solution. Remove the infected portion.
Apply light pressure to stop bleeding. If bleeding stops, that’s the time to
place dycal. Disadvantage: it will not respond to your electric pulp tester
because it is being covered with metal. Pulpotomy is more successful in
children Pulpotomy is more successful in posterior
 Nonsurgical treatment of root canal systems with or without
periradicular.
 Pathosis of pulpal origin selective surgical removal of pathological
tissues resulting from pulpal pathosis.
Example is cyst. Tatanggalin.
 Intentional replantation and replantation of avulsed teeth.
 Surgical removal of tooth structure:
Root-end resection - removal of the root tip
Bicuspidization - a surgical procedure performed to separate the mesial and
distal roots of molars with its crown portion, where both segments are then
retained individually.
Hemisection - a specialized dental procedure where half ofan injured natural
tooth is removed. A hemisection can only be performedon molars, which are
the larger, flatter teeth at the rear of the mouth.
 Bleaching of discolored dentin and enamel.
 Tetreatment of teeth.
 Treatment procedures related to coronal restorations.
IV. OBJECTIVES OF ENDODONTICS
 To be able to retain a tooth inside the oral cavity which may otherwise
require extraction.
 Relief of pain, if present.
You can give analgesic. If there is abscess, you can give antibiotic.
 Removal of pulp from root(s) of tooth.
Mandibular central and lateral incisors: 1 root but 2 root canals.
 Disinfection of root and surrounding bone by cleaning and shaping of
the root canal walls.
Cleaning and shaping – mechanical procedures.
 Complete filling of root canals (obturation).
 Placement of final restoration (if not restorable,extract).
 Main contraindication: non-restorable tooth.
3rd molar is not indicated in RCT due to inability of the clinician to do
procedures because of the minimal opening of the oral cavity of the patient.
V. HISTORY OF ENDODONTICS
 Dr. Grossman published an excellent history of endodontics in the July
1976 issue of JADA.
- Journal of the American Dental Association.
A. PRE-SCIENCE: 2ND / 3RD CENTURY B.C. TO 1826
 1776 to 1826.
 Skull dating from the second or third century B.C. found in the Negev
Desert in Israel had bronze wire in one of its teeth.
 Abscesses treated with leeches.
 Pulps being cauterized with red hot cauteries.
 Entire root canals filled with gold foil
B. AGE OF DISCOVERY: 1826 TO 1876
 Dr. Angelo Sargenti
o Endodontist who practices any form of power-driven root canal
preparation.
o First to introduce single visit endodontics.
o Single visit root canal therapy can be traced through the literature
for at least 100 years.
 Establishment and of the science of dentistry.
 Publication of a dental journal.
 Formation of proper dental schools.
 Discovery of anesthesia.
 Gutta percha points were created to fill root canals
 Barbed broaches became available for cleaning and enlarging canals.
 Medications were created for treating pulpal infections and cements
were discovered to fill them
C. THE DARK AGE: 1876 TO 1926
 Discovery of the X-ray.
 Charles Edmund Kells: used radiographs for diagnosis and during root
canal treatment.
 Advancement of general anesthesia to local anaesthesia.
 Wholesale extraction of teeth and very little endodontics was practiced.
 Hardly any innovation took place.
 "Focal Infection" theory
- states that bacteria from an inflamed part could migrate and
metastasize to other parts of the body.
D. THE RENAISSANCE: 1926 TO 1976
 Golden period of endodontics.
 Better anesthesia and radiographs.
 Host of root canal medicaments appeared on the scene.
 The focal infection theory started dying out.
 First textbook "Root Canal Therapy" by Dr. Grossman.
 Root canal instruments got standardized and became available more
readily.
 Establishment of the American Association of
 Endodontics and the American Board of Endodontics.
 Establishment of numerous dental schools worldwide.
 Teaching the science of endodontics as a dental specialty.
 Establishment of a number of journals solely devoted to this specialty.
 Huge number of research projects for post graduate curriculum.
 A variety of techniques became established as the norm.
 Vertical condensation by Dr. Herb Schilder.
 Lateral condensation.
 Softened gutta-percha.
 Thermoplastic gutta-percha

D. THE INNOVATION ERA: 1977 TO PRESENT

 The single visit endodontic therapy globally accepted by all schools of
thought.
 Improved visibility is now available with the advent of the endodontic
microscope.
 Newer, better and more reliable apex locators.
- Root canals will appear when the clinician is ready to see it.
Meaning, clinicians should know the anatomy and the
characteristics of the root canal.
The greatest development in Endodontic knowledge is the
discovery of the variations and
ramifications of the root canal system.
 As technology in dentistry advances, we
approach our treatment techniques in different
manners.
 We continue to strive for perfection while
speeding up chair-time and reducing
overheadcosts.
 The fundamentals of endodontics remain the same.

VI. ENDONOMICS
 Understanding how endodontics can and should be the most productive
part of your practice.

VII. BASIC PRINCIPLES

1. Chain of asepsis.
2. Correct diagnosis and treatment planning.
3. Atraumatic handling of tissues.
4. Cleaning of the canal debridement and removal of biofilm sticking on
the canal walls
- Mechanical cleaning with constant agitation Ultrasonics cavitation
with NaOCI irrigation.
- Electro-chemically activated fluid with ozonated water or NaOCI
for irrigation.
- Photo-activated disinfection with methylene blue or Toluodine
blue.
Sodium hypochlorite – irrigant in endo. 1:5 (1:9 sa libro) – 5 is
water.
5. Shaping of the Canal
6. Complete Obturation
7. Restoration
8. Recall

VIII. RATIONALE OF ENDODONTICS

 Saving the natural teeth to health.
 Restore efficient mastication.
 Control pain and swelling.
 Speech and phonation.
 Preserve occlusion.
 Aesthetics

IX. BASIC CONCEPT OF ROOT CANAL THERAPY

 The average complete denture patient has a more complex health history
than ever before.

X. CLINICAL EXAMINATION
 If bacteria and by-product of pulpal inflammation has been reduced to a
non-critical level of infection, it will effect a cure allowing resolution
and repair of damaged periradicular tissue.
 The extent of damage depends on the virulence number of
microorganisms and the resistance of the host.

XI. CONCLUSION
 To appreciate Endodontics, all of the scope, history, rationale and
principles must be fully understood.