Definition & Indication of endodontic therapy
The basic knowledge about the need and importance of endodontics has to be possessed by a student to begin with treating such cases and this section covers the basics for endodontic management.
1. What are the three basic steps of endodontic treatment?
• The diagnostic phase, in which the cause of the disease is identified and the treatment is plan is prepared. • The preparatory phase in which the root canal contents are removed by cleaning and shaping the root canal to receive a three dimensional filling. • The obturation phase, in which the canal is filled with an inert material to ensure a tight seal.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 25
2. Which are the true contraindications for endodontic treatment?
The true contraindications for endodontic treatment are advanced periodontal disease, inadequate crown- root ratio, caries of the root and bifurcation caries, vertical root fracture and internal resorption with perforation.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 27,28
3. Which is the most important instrument in the diagnostic tray for a patient coming for the first visit?
During diagnosis and treatment planning, ‘The periodontal probe’ is the most important instrument in the diagnostic tray since that has lost too much periodontal support is not a candidate for root canal therapy. Though the pulp may be vital, endodontic treatment cannot be proceeded. Both straight and bifurcation probes have to be present in the tray.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 27
4. How does pregnancy affect RCT?
Endodontic treatment can be done in the second or third trimester. Performing in the first trimester is not advised since the patient cannot receive any radiation and it is the time during which the highest percentage of abortions occurs. A case of hot pulpitis in the first trimester should be temporized with medications. There are no contraindications for the third trimester as long as the patient can sit on the chair for an extended period of time.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 39,40
5. How is endodontics defined?
Endodontics is the specialty of dentistry concerned with diagnosis and treatment of diseases and injury to the pulp and the periapical tissue.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 24
6. Why is it not so important to remove the broken instrument from a canal?
When there is a broken instrument in the root canal, if it is possible to negotiate the apical portion of the canal beyond the fragment and remove the infected contents and seal the apical foramen, the instrument can be left. If the instrument blocks the accessibility to the apical portions, then endodontic surgery is indicated.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 30
7. How are the untreated lateral canals leading to a lateral endodontic lesion treated?
Surgically treating a lateral endodontic lesion due to the presence of untreated lateral canals is contraindicated since it would leave numerous unsealed portals of exit. The proper treatment plan in such cases consists of removing the old obturation material and a three dimensional filling of the root canal system so that all the portals of exit are sealed.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 35
8. What are the points to be remembered while treating an elderly patient with RCT?
The elderly patients can be treated as any other patient but it is to be remembered that the root canals are thinner due to the deposition of secondary dentin that makes probing difficult. Also the healing is slightly slower when compared to the younger patients.
Ref: Endodontics,Arnaldo Castelluci, IL Tridente, vol 1; 39