Rationale in

Endodontics
 The word “Rationale” means fundamental reason or
logical basis.
 The rationale for Endodontic Therapy is based on the
belief that a natural tooth functions more efficiently &
comfortably than a bridge, partial denture or a metal
implant.
 Endodontic therapy (non-surgical or surgical) is a
debridement procedure that disrupts and removes the
microbial eco-system. It is important that clinicians
understand the close relation-ship between the presence
of microorganisms and endodontic disease process to
develop an effective rationale for the treatment
Portals of Exit

Caries

Extension to periradicular
region through
2
(1) apical foramen
3 (2) periodontium through
furcation
(3) lateral canals

1
Role of micro organisms in pulpal &
periapical diseases
 Study done by Kakehashi et al (1965)
demonstrated that bacteria were cause of the
pulpal and periradicular disease.
 Pulps of rats exposed to normal oral microbial
flora showed pulpal necrosis & periapical
lesions formation, however no pathologic
changes were seen in exposed pulps of germ
free rats. This study reveals the importance of
bacteria in the development of apical
periodontitis.
 Response of pulpal & periapical
tissue to irritant.
 The host responds to microbial invasion by non
specific inflammatory response and specific
immunologic response.
 Response depending on intensity
Sclerosis
Mild to moderate Reparative dentin
Noxious Reversible inflammation
Stimuli
Irreversible changes
Severe Necrosis
Peri radicular pathology

• A clear concept & knowledge of fundamentals of

inflammation is necessary in understanding the
diseases of the pulp and their extension to periradicular
 Fish’s zones in well established
granuloma
 According to concept of Fish, periapical lesion
is not an infection by itself but the reaction of
body to infection in the canal.

Zone of stimulation
Zone of
Zone of contamination
irritation
Zone of necrosis
 Zone of necrosis (zone of infection). The infection is
present in the center of inflammation. The dominant
cells are poly morphonuclear neutrophils, other cells
present in the pus fluid are dead cells and destructive
components released from phagocytes.

Zone of stimulation
Zone of
Zone of contamination
irritation
Zone of necrosis
 Zone of contamination (exudative inflammatory
zone). Round cell infiltration is observed in this zone.
There is no microorganism but cellular destruction is
present and there is increase in osteoclastic activity
thus bone cells undergo autolysis. Polymorphonuclear
leukocytes and macrophages are also seen.

Zone of stimulation
Zone of
Zone of contamination
irritation
Zone of necrosis
 Zone of irritation (granulomatous zone /
proliferative / inflammatory zone). This zone has
histiocytes as the predominant cell in addition to
osteoclasts. Toxicity is reduced because distance from
canal foramina to zone of irritation is increased.
Lymphocytes, plasma cells, macrophages, eosinophils
are present in small number. Cell derived mediators of
inflammation like antibodies from plasma cells,
histamine and seratonin are also seen in this zone.
Zone of stimulation
Zone of
Zone of contamination
irritation
Zone of necrosis
 Zone of stimulation (Zone of endodontic capsulation),
this zone is characterized by fibroblasts and osteoblasts.
The toxicity is mild enough to be a stimulant. As a result of
stimulation collagen fibers are laid down by fibroblasts
which act as a wall of defense around the zone of irritation
and as a scaffolding on which the osteoblasts build new
bone which is irregular in fashion.

Zone of stimulation
Zone of
Zone of contamination
irritation
Zone of necrosis
 Basis for non surgical endodontic
therapy
 Kronfeld’s mountain pass concept
 Kronfeld pointed out that granuloma is not an
environment in which bacteria survive but they
are destroyed here.

Zone 1

Mountain pass

Zone 2

Zone-3 elimination of the invaders by

endodontic therapy results in healing.
  Zone 1: compares bacteria
in the root canals with
invaders entrenched behind
high inaccessible
mountains, the foramina
serving as a mountain pass.
Zone 1

Mountain pass
 Zone 2: the tissue of the
granuloma represents a
Zone 2 mobilized army defending
the plains (periapex) from
invaders. If only invaders
enter the plain through the
mountain pass, they are
destroyed by the defenders
(PMNcells).
 Zone 3: only complete
elimination of the
invaders from the
mountain entrenchment
will eliminate the need
for a defense force in
the plains. Once this is
accomplished the local
destruction created by
the battle is repaired.
 The objective of non-surgical endodontic
therapy for teeth with periapical pathology is
the elimination of the irritant from the canal &
subsequent fluid impervious obturation. Once
this occurs, defending army of leukocytes
withdraw, the local destruction created by
battle is repaired (granulation tissue).
 BASIC PHASES OF
ENDODONTIC THEARPY

Obturatio
n
Cleaning
&shaping

Access
 Access preparation
Rationale: to create smooth straight – line path to
canal system & to the apex
 Cleaning & shaping of root canal system
Rationale: remove all pulp tissue, bacteria &
endotoxins from root canal system.
 Obturation
Rationale: to eliminate all avenues of leakage from
the oral cavity or periradicular tissue to root canal
system & to seal within the system any irritant that
cannot be fully removed during canal shaping &
cleaning procedures