This chapters describes the structure of dentin, its chemical and physical properties, and some of its mechanical properties. This topic is clinically significant because the permeability of dentin regulates the rate of inward diffusion of irritants that initiate the pulpal inflammation and the outward diffusion of dentinal fluids that contain immunoglobulines.
Caries is a disease of multifactorial nature, involving the interaction of an acidogenic (acid-producing) and aciduric (acid-tolerating) microbiota on a susceptible tooth surface in a conducive enviroment, influenced by frequent intake of rapidly fermentable carbohydrates. The caries lesion develops as a result of desmineralization of enamel or cementum, and later of dentin, by acids produced by plaque bacteria as they matabolize dietary carbohydrates.
The shaping and cleaning of the root canal constitutes one of the most important phases of endodontic therapy. Instrumentation of the canal reduces the microbial content of the root canal to a great extent. However, the root canal anatomy provides areas in which bacteria can persist and thrive.
The initial step for shaping and cleaning the root canal is proper access to the chamber that leads to straight-line penetration of the root canal orifices. The next step is exploration of the root canal, extirpation of the remaining pulp tissue or gross debridement of the necrotic tissue, and verification of the working length.
The International Association for the Study of Pain has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This text will review both sensory and emotional aspects of pain and their relationship to endodontic practice.
Endodontic emergencies are a challenging part of clinical practice. The clinician must have an understanding of inflammatory and infectious processes, pain mechanisms, local anesthesia, the use of therapeutics, and patient management. This chapter will focus on emergencies occurring prior to, during, and after treatment.
Prior to discussing pain-preventive strategies, it is essential to understand basic pulp biology and the pulp’s response to caries and other irritants. Pulpal disease and concomitant pain is caused by caries, trauma, or as a result of restorative procedures.
The final pulpal and periapical diagnosis is based on a synthesis of information collected from the patient’s history of the chief complaint, dental and medical histories, radiographs, sensibility, and clinical tests. The process is challenging since no single test can be considered definitive.
The tooth, its pulp, and its supporting structures must be viewed as a biological unit. Because the vitality of the tooth depends on its ability to function, and not on the viability of the pulp, the health of these structures is of prime importance. The interrelations among these structures influence each other during function and disease.
Unfortunately, the need for revision of previous nonsurgical (and surgical) root canal procedures is quite common in today’s practice of endodontics. The number of these cases can be largely reduced, however, if adherence to the principles of technical excellence provided in this book is a priority during the initial treatment.
Before a meaningful discussion of the diagnostic interpretation of radiographs can begin, the technical quality of the image must first be assessed. A poorly made radiographic image will not contribute as much to the process of diagnosis as a well made one, but this self-evident concept is missed by many clinicians.
Procedural errors during endodontic therapy occur not only with students and beginners, but also with skilled and experienced clinicians in spite of taking all possible precautions. Such iatrogenic complications can be prevented by adhering to the fundamental biological and mechanical guidelines of endodontics.
Current endodontic therapy aims to maintain the health of the pulp in cases of inflammation, but a much-desired objective is the regeneration of a healthy pulp–dentin complex. The management of immature permanent teeth with open apices and pulpal necrosis is a significant challenge.
Trauma of the oral and maxillofacial region occurs frequently and comprises 5% of all injuries for which people seek dental treatment. Among all facial injuries, dental injuries are the most common, of which crown fractures and luxations occur most frequently.