📖 Endodontics
Hemisection
EndodonticsHemisection is the sectioning of a diseased tooth (usually a mandibular molar) into two parts and removing the diseased root and its connected crown part.
Hemisection is also called as “root amputation” or “root sectioning”.
Hemisection is usually suggested in Mandibular Molars which have undergone failed Root canal treatment cases where we can see Furcation involvement making it difficult to clean using traditional Root canal therapy.
The other reason can be due to procedural Errors by the Dentist is treating infected teeth such as Perforations etc.
Indications:
Multirooted tooth – Vertical Bone loss involving one root only
Furcation involvement with bone loss / infection from Buccal to Lingual aspect
Root Exposure due to dehiscence
Root Resorption in one root of a multirooted tooth
Unfavorable proximity of roots of adjacent teeth, preventing patient from maintaining adequate hygiene.
Vertical fracture of the tooth (one root), in cases where the vertical fracture is restricted to only one root while the other root is not affected, hemisection is preferred to save the tooth.
Contraindications :
Complicated Root anatomy making it difficult to Section one root without damaging the adjacent root. Fusion of Roots, Curved Roots etc.
Retained Root having calcified or inoperable canals
Adjacent teeth are strong enough for fabricating a bridge
CRACKED TOOTH SYNDROME
Endodontics
Prevalence
Molars of older individuals most frequently present with cracked tooth syndrome. Most cases occur in teeth with class I restorations (39%) or in those that are unrestored (25%), but with an opposing plunger cusp occluding centrically against a marginal ridge. Mandibular molars are most commonly affected , followed by maxillary molars and maxillary premolars.
Symptoms
The patient usually complains of mild to excruciating pain at the initiation or
release of biting pressure. Such teeth may be sensitive for years because of an
incomplete fracture of enamel and dentin that produces only mild pain.
Eventually, this pain becomes severe when the fracture involves the pulp chamber
also. The pulp in these teeth may become necrotic.
Clinical features
Close examination of the crown of the tooth may disclose an enamel crack, which
may be better visualized by using the following methods:
Fiber optic light: this is used to transilluminate a fracture
line. Most cracks run mesiodistally and are rarely detected radiographically
when they are incomplete.
Dye: Alternatively, staining the fractute with a dye, such as
methylene blue, is a valuable aid to detect a fracture.
Tooth slooth: this is a small pyramid shaped plastic bite
block, with a small concavity at the apex of the pyramid to accommodate the
tooth cusp. This small indentation is placed over the cusp, and the patient is
asked to bite down. Thus, the occlusal force is directed to one cusp at a time,
exerting the desired pressure on the questionable cusp.
APPLICATIONS OF LASERS IN ENDODONTICS
EndodonticsTraditional vitality assessment methods such as heat, cold, and electric pulp testers assess neural vitality and often cause false-positive errors. As the histological assessment of pulpal status is not feasible clinically, a tool to assess the vascular flow of the pulp would be very useful.
Laser Doppler flowmetry (LDF) is an accurate method to assess the blood flow in a microvascular system
II. PULP CAPPING AND PULPOTOMY
Pulp capping and pulpotomy constitute a more conservative form of pulp therapy in comparison to pulpectomy. Although the outcome of pulp capping procedure is variable ranging from 44 to 97%, the procedure is recommended when the exposure is 1.0 mm or less and especially when the patient is young. Pulpotomy is recommended in immature permanent teeth, where pulpectomy is not advised.
The most commonly used agents for both the procedures are calcium hydroxide and MTA (mineral trioxide aggregate). The use of a laser in these procedures leads to a potentially bloodless field as the laser has the ability to coagulate and seal small blood vessels. The laser-tissue interactions make the treated wound surface sterile and also improve the prognosis of the procedure.
III. DISINFECTION OF ROOT CANALS
The ability of bacterial pathogens to persist after shaping and cleaning is one of the main reasons for endodontic failures. This is attributed to the complex nature of the root canal system, the presence of a smear layer, and the fact that large areas (over 35%) of the canal surface area remain unchanged following instrumentation with various Ni-Ti techniques.
IV. OBTURATION
Thermoplasticized gutta-percha obturation systems are one of the most efficient methods is achieving a fluid-impervious seal. Softening of the gutta-percha has been attempted with various lasers. These include argon, CO , Nd:YAG, and Er:YAG.
V.APICAL SURGERY
Apical surgery including apical resection is indicated when the previously performed root canal therapy fails and nonsurgical means are inadequate to ensure the complete removal of the pathological process.
The potential for using lasers is on the basis of the following observations:
• Ability of lasers to coagulate and seal small blood vessels, thereby enabling a bloodless surgical field
• Sterilization of the surgical site
• Potential of lasers (Er:YAG) to cut hard dental tissues without causing elaborate thermal damage to the adjoining tissues .
Endodontics Root Canal Anatomy -MDS Lecture
Endodontics