Endodontics for Dental Hygienists
Bruce Y. Cha, DMD
University of New Haven

Course Objectives

1. Become familiar with the scientific foundation and value of the endodontic treatment in dental practice
2. Become familiar with identifying clinical signs and symptoms of endodontic origin and making proper diagnosis
3. Become familiar with the terms and procedures of endodontic treatment
4. Become familiar with endodontic follow up and evaluation of endodontic treatment
4. Become familiar with communicating with patients and dental professionals on the subject of diagnosis and treatment of endodontic diseases.

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Myths About Root Canal Treatment

Myth #1—Root canal treatment is painful.
Truth—Root canal treatment doesn't cause pain, it relieves it.

Myth #2—Root canal treatment causes illness.
Truth—Root canal treatment is a safe and effective procedure.  

Myth #3—A good alternative to root canal treatment is extraction (pulling the tooth).
Truth—Saving your natural teeth, if possible, is the very best option.

Outcome of Endodontic Treatment

94% success in 44,613 patients over 2 years observation period     -Lazarski et al 2001
97% retained in 1,462,936 patients over 8 years observation period   -Salehrabi & Rotstein 2004

Single Tooth Implants vs Non Surgical RCT
There is no difference in long-term prognosis between single tooth implants and restored root canal treated teeth.
-Iqbal and Kim  J Endodon 2008:34:519-29

Biologic Basis of Endodontics

• Pulp and Periapical Pathogenesis

• Polymicrobial Anaerobic Infection

• Immune Response with Osteoclastic Activity

Diagnostic Procedures in Endodontics

    History Taking: Chief Complaint
    Medical History
    Past Dental History
    Clinical Examination
    Radiographic Examination

    Endodontic Diagnosis

   Pulpal Diagnosis: Thermal Sensitivity (Cold and Hot), EPT  
        Normal, Reversible, Irreversible, Necrotic (Symptomatic or Asymptomatic)
              (A-Delta Fiber vs. C-fiber)      

    Periapical Diagnosis: Percussion, Palpation, Swelling, Periapical Radiolucency
    Symptomatic or Asymptomatic Apical Periodontitis
    Acute Apical Abscess
    Chronic Apical Abscess  (Sinus Tract or Fistula)  

    Cracked Tooth
    Referred Pain
    Resorption

Endodontic Treatment Planning: Difficulty Assessment (Minimal, Moderate, High)

1.       Patient Considerations

a.      Medical History
b.      Anesthesia
c.      Patient Disposition
d.      Ability to Open Mouth
e.      Gag Reflex

2.       Diagnostic and Treatment Considerations

a.      Diagnosis
b.      Radiographic Difficulties
c.      Position in the Arch
d.      Tooth Isolation
e.      Morphologic Aberration of Crown
f.       Canal and Root Morphology
g.      Radiographic Appearance of Canal (s)
h.      Resorption

3.       Additional Considerations

a.      Trauma History
b.      Endodontic Treatment History
c.      Emergency Situation
c.      Periodontal – Endodontic Combined Lesion

Role of Endodontist in Dental Practice as an Expert in Delivery of Specialty Endodntic Treatment

Scope of Endodontics

1.       Vital Pulp Therapy

a.      Indirect Pulp Capping

b.      Direct Pulp Capping

c.       Pulpotomy

2.       Nonsurgical Endodontics

a.      Primary Teeth

b.      Permanent Teeth

c.      Apexification

d.      Perforation Repair

e.      Retreatment

3.       Surgical Endodontics

a.      Incision and Drainage/Trephination

b.      Periradicular Curettage

c.      Root Resection (Apicoectomy)

d.      Root-end Filling (Retrofilling)/Root Repair

e.      Biopsy

f.       Hemisection

g.      Root Amputation

h.      Intentional Replantation (Extraction/Replantation)

i.       Surgical Removal of the Apical Segment of a Fractured Root

4.       Management of Traumatic Dental Injuries

a.      Enamel Fracture (Uncomplicated Crown Fracture)

b.      Crown Fracture Without Pulp Exposure (Uncomplicated Crown Fracture)

c.      Crown Fracture with Pulp Exposure (Complicated Crown Fractue)

d.      Crown-Root Fracture

e.      Root Fracture

f.       Luxation

g.      Avulsion (Exarticulation)

h.      Alveolar Fracture involving Teeth

5.       Intracoronal Bleaching

6.       Restoration of Endodontically Treated Teeth

7.       Post/Post and Core Removal

Nonsurgical Endodontic Treatment Procedure

• Informed Consent
• Anesthesia
• Asepsis
• Rubber Dam Isolation
• Working Length Determination
• Cleaning and Shaping
• Intracanal Medicament: Calcium Hydroxide with pH=12
• Obturation of Root Canal Space: Entomb Surviving Microorganisms, Prevent Influx of Apical Tissue Fluid, Barrier to the Coronal Leakage
• Temporization
• Post Op Instruction:
• Post Endodontic Coronal Restoration with Full Coverage Crown or Onlay for Posterior Teeth, Post retains core which supports the crown
  85% of failed endodontically treated teeth did not have crown restorations after RCT in 1.4 million patients. - Salehrabi and Rotstein 2004
• Evaluation of the Endodontic Treatment
  Is the root canal filling reaching within 1 mm of the radiographic apex?
  Is the root canal filling dense without void?
  Is the coronal restoration intact?
  Is there a PA radiolucency? Was there a PA radiolucency? Is it new? Is it worse compared to the PA radiolucency of the past?

Post Op Evaluation

• Success or Failure?

• Healed, Tendency to Heal, Not-Healed, Regression

• Sinus Tract (Fistula)

Restoration of Endodontically Treated Teeth

• Coronal Leakage
• Vertical Root Fracture

Frequently Asked Questions   (www.aae.org)

Who performs endodontic treatment?
What is an "endodontist"?
Why is there a need for endodontic treatment?
What are the signs of needing endodontic treatment?
How does endodontic treatment save the tooth?
Will I feel pain during or after the procedure?
How much will the procedure cost?
Will the tooth need any special care or additional treatment?
What causes an endodontically treated tooth to need additional treatment?
What is endodontic surgery?

Assessment Questions

Dinomite Day at Peabody

CT Mission of Mercy  (CTMOM): To help those who are in need

Bruce Y. Cha, D.M.D.
Diplomate, American Board of Endodontics
60 Washington Avenue, Suite 202
Hamden, Connecticut 06518
Tel:          (203) 281-6574
FAX:        (203) 281-4029
E-mail:     cha@rootcanaldrs.com
Website: www.rootcanaldrs.com