Scope of Endodontics: Definition

Scope of Endodontics
Definition:
 Endodontic is that branch of dentistry concerned with diagnosis,
treatment, prognosis and prevention of disease and injuries of the pulp
and periapical tissues.
Objectives:
 The objective of endodontic treatment is To render the affected tooth
biologically acceptable, i.e.
1) Symptom free,
2) Functional,
3) Without diagnosable pathosis.
Basic phases of endodontic treatment:
 There are three basic phases of endodontic treatment:
1) Diagnostic phase.
2) Preparatory phase.
3) Obliteration phase.
1) Diagnostic phase:
 In which the disease to be treated is determined and the treatment plan
is developed.
2) Preparatory phase:
 In which the contents of the root canal are removed and the canal is
prepared to receive filling material.
3) Obliteration phase:
 In which the canal is filled or obliterated with an inert material to obtain
a hermatic seal as close as possible to the cemento - dentinal junction.
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 The three basic phases of endodontics are similar to :
1. Three legged stool with each leg giving support to successful
endodontics in which the phase is observed.
2. Just as the stool will topple if one of the legs is broken the success of
endodontic treatment depends one observation of all the three phases.
Indications of endodontic therapy:

1. Most of teeth that have pulpal and / or periapical pathosis are excellent
candidates for successful endodontic therapy.
2. Teeth without pulpal or periapical pathosis may need endodontic
treatment due to:
 Need of pulp space for intra - radicular post to retain suitable
restoration.
 Calcified pulp or root canals, to avoid complete calcification.
 Traumatic pulp exposure due to dental work.
 Super erupted or mesially drifted tooth when crown reduction will
result in pulp exposure.
 Traumatic injuries of the pulp due to crown and / or root fracture.
 Esthetic requirements (Bleaching).
 Tooth retained to support overlay denture.
2
Contra - indications of endodontic therapy:
 The following is a list of reasons for extracting pulpally or periapically
involved teeth:
1) Non - restorable tooth:
 Any tooth that can not be restored to be functionally and esthetically
acceptable following endodontic treatment must be removed.
2) Insufficient periodontal support:
 Unless good periodontal support is present to ensure retention of the
tooth, endodontic treatment is contra - indicated.
 If the periodontal lesion is a result of pulpal involvement, endodontic
treatment is indicated.
3) Non - strategic tooth:
 A tooth that is not in occlusion and not needed as a prosthetic abutment
may not be a candidate for endodontic therapy.
4) Vertical root fracture:
 Teeth with vertical fractures that involve the root have hopeless
prognosis, so removal of the tooth is indicated.
5) Canal not suitable for instrumentation and periapical surgery is
contra-indicated:
 Teeth with root canals that are sclerosed or severely curved making the
passage of endodontic instruments to CDJ impossible may be contra -
indicated, specially if apical surgery is also contra - indicated due to
systemic or anatomic considerations.
6) Massive resorption:
 Teeth with internal or external resorption, in which the canals can not
be debrided and filled by conventional or surgical treatment, should be
extracted.
3
Pulp related injury and pathosis:
1) Dentin exposure:
 It will lead to pulp irritation due to:
1. Exposure to air and saliva.
2. Extreme thermal changes.
3. Exposure to bacteria and their products.
 These will be mediated via exposed dentinal tubules.
2) Pulp exposure:
 It results in irreversible pulpal damage.
 The extent of damage will affect the healing ability of the injured pulp.
3) Pulpal pathosis:
 Pulpal hyperemia is a pre-inflammatory state and is not regarded as a
disease and considered reversible.
 Inflamed or degenerative pulp state will proceed to necrosis and needs
endodontic therapy.
4) Internal resorption:
 When it is detected, pulpectomy should be performed, once the pulp
tissues responsible are removed, all resorption ceases.
5) Root fracture:
 Should be suspected whenever there is a history of traumatic injury to a
tooth.
 It affects the pulp directly.
6) Periapical and other radicular pathosis:
 Periapical changes are usually an extension of untreated pulpal
pathosis.
4
Endodontic treatments:
1) Dentin protection:
 To provide: 1. Thermal and bacterial protection.
2. Chemical barrier to filling material.
3. Prevent spread of bacterial invasion.
2) Pulp protection:
 Indirect or direct pulp cappings are attempts to lessen or eliminate an
irritant and create a situation in which an injured pulp can return to a
biologically acceptable state.
3) Pulpotomy:
 It is the removal of a portion of the pulp; usually the injured or infected
coronal pulp is removed in attempt to preserve the health of the
radicular pulp.
 Pulpotomy is regarded as temporary treatment.
4) Pulpectomy and root canal therapy:
 Removal of the entire pulp.
 It is the treatment of choice for pulps with irreversible pulpal damage or
teeth with severe loss of tooth structure and needs post to support
crowns.
5) Periapical surgery:
 When it is impossible to eliminate pulpal or periapical pathosis in the
conventional manner, the root apex is exposed and the pathological
condition is treated via surgical approach.
6) Other treatments:
 Bleaching.
 Hemisectioning.
 Root amputation.
 Replantation.
 Endo - osseous implant.

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Scope of Endodontics

Indications of endodontic therapy:

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