📖 Endodontics
ENDODONTICS INTRACANAL MEDICAMENTS IN ROOT CANAL TREATMENT
EndodonticsCalcium Hydroxide in Endodontics
EndodonticsThe Ca(OH)2, has been used by endodontists throughout the world since Hermann introduced it to dentistry in 1920.
It is a highly alkaline substance with a pH of approximately 12.5.
Calcium hydroxide has antibacterial properties and has the ability to induce repair and stimulate hard-tissue formation. The
bactericidal effects is conferred by its highly alkaline pH. The release of hydroxyl ions in an aqueous environment is related to the
antimicrobial property.
Hydroxyl ions are highly oxidizing free radicals that destroy bacteria by :
· Damaging the cytoplasmic membrane
· Protein denaturation
· Damaging bacterial DNA
The vehicle used to mix Ca(OH)2 and the manner in which it is dispensed has a significant role to play in achieving maximum
antibacterial effects as an intracanal medicament in endodontics.
In general, aqueous viscous or oily vehicles are used. The aqueous or water-soluble vehicles have high degree of solubility and
need multiple dressings to achieve desired results.
On the other hand, viscous vehicles like glycerine, polyethylene glycol, and propylene glycol promote slow solubility and hence
longer dressing intervals. The other medicaments combined with Ca(OH)2 include CMCP and 0.12% chlorhexidine.
Endodontics Root Canal Anatomy -MDS Lecture
EndodonticsAPPLICATIONS 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 .