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Egor Koshelev
Egor Koshelev

Indication Of Root Canal Treatment Pdf [UPDATED] Download


Dental infections, while relatively straightforward regarding diagnosis and access, can be challenging to manage acutely. Dental abscesses or periapical infections typically arise secondary to dental caries (tooth rot related to poor dental hygiene), trauma, or failed dental root canal treatment. Left untreated these infections can be not only extremely painful but also pose a significant risk of descending into the deep neck space or ascending to intracranial sinuses. Identifying, treating and educating patients about a dental abscess will not only grant symptomatic relief but can also prevent dangerous complications. This activity explains when this condition should be considered on differential diagnosis, articulates how to properly evaluate for this condition, and highlights the role of the interprofessional team in caring for patients with this condition.




Indication Of Root Canal Treatment Pdf Download


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Dental infections, while relatively straightforward regarding diagnosis and access, can be challenging to manage acutely. Dental abscesses or periapical infections typically arise secondary to dental caries (tooth rot related to poor dental hygiene), trauma, or failed dental root canal treatment. Left untreated these infections can be not only extremely painful but also pose a significant risk of descending into the deep neck space or ascending to intracranial sinuses. Identifying, treating and educating patients about a dental abscess will not only grant symptomatic relief but can also prevent dangerous complications.[1][2]


Dental caries, dental trauma, and poor dental hygiene are the most frequent causes of a dental abscess. Break down in the protective enamel of teeth allows for oropharyngeal bacteria to enter the tooth cavity (pulp cavity) causing a local infection. As this infection within the pulp cavity grows within the limited space of the tooth, it compresses the inner dentine walls causing severe pain. This infection then tracks down through the root canal and inferiorly into the mandible or superiorly into the maxilla depending on the location of the infected tooth. Another cause that predisposes individuals to a dental abscess is a partially erupted tooth, most commonly a wisdom tooth, where bacteria get trapped between the crown and soft tissues causing inflammation. Other causes include genetic causes such as amelogenesis imperfect that predispose individuals to weakened enamel, more susceptible to wear. Mechanical causes tooth grinding breaks down tooth enamel. Medical conditions like Sjogren syndrome the cause dry mouth which accelerates oropharyngeal microbial growth. Chemical irritants such as smoke from methamphetamine, immunosuppression arising from chemotherapy, or chronic immunosuppressive medical conditions such as HIV/AIDs can predispose individuals to dental caries.[3][4]


The anatomy of the tooth consists of the crown of the tooth which is connected to the root of the tooth which extends into the gum and jaw. The outer most covering of the tooth, the enamel overlays the softer dentine. The nerves and vasculature tunnel through the tooth root canal to the innermost hollow area of the tooth called the pulp canal which houses nerves and vasculature that supply the tooth.


Surgical management of a dental abscess can include root canal or tooth extraction. If there is a periapical dental abscess, it may require incision and drainage. Incision and drainage can be performed in the emergency department or the clinic but must be followed up by a dentist.


A root canal is a procedure performed by dentists where the crown of the tooth is removed, revealing the infected tooth roots. These passages are opened with surgical tools and cleaned with a solution. The tooth root is then filled, and the tooth crown is replaced. Complications include breaking surgical tools off inside of tooth root canal, cracked tooth, or incomplete evacuation of bacteria. These complications may require repeat root canal of tooth extraction.


Objective. The purpose of this study was to evaluate the success and failure of root canal treatment performed in areas of previous irradiation and to examine any cases of osteoradionecrosis associated with such treatment.


Study design. A retrospective analysis was done on 22 teeth that had root canal treatment after radiation therapy. Strict radiographic and clinical criteria were used to determine success and failure.


Conclusions. Our study showed that root canal treatment in previously irradiated patients may be successful. In addition, treatment approaches, as well as the criteria for success and failure, should be the same for irradiated patients as for those who have not received radiation treatment.


Many factors, such as cost, number of adjunctive procedures, esthetic and biologic considerations, compromised ability to restore a tooth, anatomic factors, tooth color and tooth thickness, patient preference, and other systemic factors, affect the choice of treatment [2-4]. RCT is an appropriate and cost-effective intervention to extend the life of a tooth with a diseased pulp. The RCT procedures always involves cavity preparation followed by disinfection of endodontic space [5], as well as a proper root canal filling technique [6]. Orthograde re-treatment is also cost-effective; however, unless clinically indicated, the benefits of additional apical surgery do not justify the additional cost [4, 7]. Based on an American Dental Association survey in the United States, initial (not lifetime) costs were compared for a simple extraction, extraction then an Implant Supported Crown (ISC), and extraction followed by a three-unit Fixed Partial Dentures (FPD) with a high noble FPD restoration. They concluded that a slight difference in the cost but a time factor is different [2, 8].


Overall, 85.5% showed two separated roots, 12.1% a single root, 2.6% three roots or radix. 87.7% showed three root canals, 12.1% two root canals, 2.6% four root canals, and 1.6% a single root canal. 10% showed a single foramen, 75.3% two foramina, 13.6% three foramina and 1% showed four foramina.19.5% showed C-shaped anatomical variation, 51.4% in male patients, 48.6% in female patients. According to Fan classification: C1 13.6% in cervical third, C2 10% in the middle third, C3 17.3% in middle third, 15.5% in apical third, and C4 12.7% in the apical third. Root canals number in these samples were 5.4% a single canal, 21.6% two canals, 70.3% three canals, and 2.7% four canals. The root showed 46% with one foramen, 46% two foramina, and 8% three foramina. Radicular grooves 83.3% were found in the lingual area and 16.2% towards the buccal area.


The most prevalent anatomic presentation of the evaluated sample was a mandibular second molars with two roots, three root canals, and two apical foramina. Their variation was C-shaped root canals and Radix Paramolaris.


Knowledge of the morphology of the root canal system is essential for the correct diagnosis of anatomical variation before starting the endodontic therapy [1]. Mandibular second molars usually have two roots with three root canals, two in the mesial root and one in the distal root; however, these teeth can present severe anatomical variations, such as the presence of three canals in the mesial root, two canals in the distal root, or supernumerary roots [2].


A C-shaped configuration is within the anatomical variants that can be found on second molars, this was first described in 1979, by Cooke and Cox [3] as a consequence of an alteration in root development due to the lack of fusion of the Hertwig's root epithelial sheath of the vestibular or lingual side [4]. The C-shaped anatomical configuration can be as a single ribbon or an isthmus connecting individual root canals [5, 6]. Some studies reported C-shaped root canal prevalence between 2.7% to 8%, more frequent in the Asian population or white race. This variation seems to be associated with their ethnic [4, 6]. Seo and Park observed that these root canals have a high possibility of splitting into two or three canals in the apical third, so this particular canal anatomy is not predictable based only on the shape of the pulp chamber [7].


CBCT evaluations have made it possible to carry out studies of mandibular second molars in populations such as China, Indian, Korea, Brazilian, Portuguese and Israeli, allowing them to know the characteristics of anatomical variations, and the percentage of appearance of the population studied. The present study aimed to determine the anatomical variations of the root canal system of mandibular second molars using cone-beam computed tomography (CBCT).


A convenience sample of 190 mandibular second molars from a total of 967 CBCTs of the period above mentioned, corresponding to 161 Venezuelan patients were selected according to the following criteria: the presence of CBCT images of mandibular second molars with complete root formation, absence of previous root canal treatment, and absence of root resorption or periapical pathosis. CBCT mandibular full arches, with the presence of both second molars, were taken as two samples.


Two endodontists independently evaluated the images twice, with a week interval between the assessments. If there were disagreements between them, a radiologist with endodontic experience was asked to perform a third evaluation and then reach a final consensus. All the evaluators were calibrated by analyzing 20 random cases of mandibular molars based on the same criteria and variants. The Cohens Kappa was used to analyze the presence of anatomical variation and variation type (qualitative variable), and the intraclass correlation coefficient (ICC) was used to analyze the roots and root canals number (quantitative variable), according to Brea et al. methods [12].


One hundred ninety mandibular second molars (100%) were evaluated; 42.6% were male patients and 57.4% female patients. In regards of tooth position, 51.6% were mandibular left second molars and 48.4% mandibular right second molars. Their root numbers showed two separated roots in 85.3% cases (Fig. 1), single-rooted in 12.1% cases (Fig. 2), and three roots or radix Paramolaris in 2.6% cases (Fig. 3). 87.7% mandibular second molars showed three root canals, 12.1% two root canals, 2.6% four root canals, and 1.6% a single root canal. 10% cases showed a single foramen, 75.3% two foramina, 13.6% three foramina and only 1% showed four foramina (Table 1).


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