Endodontics: All You Need to Know

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1 Endodontics: All You Need to Know Saju George, DMD Contemporary Endodontics Princeton NJ September 2015

2 Process - Endodontics Medicaments endodontics Irrigation Cleaning

3 Ideal requirements Intra canal medicaments Antibacterial in nature Decrease inflamation of periapical tissues Neutralize tissue debris Should act as second line of defence against leakage of temporary filling Dry persistently wet canals.

4 Classification Setting materials liners, subliners, root canal sealers Non- setting materials Root canal medicaments

5 Actions As an intracanal medicament for antibacterial effect To induce root end closure To dry persistently wet canals As a dressing in resorption and avulsion cases As a tissue solvent & for pre-treatment

6 Introduction In the absence of bacteria, there will be no pulpal or periapical inflamatory reaction and damaged tissues can heal Moller

7 Actions -Antibacterial Why do we use as an intra canal dressing?

8 Actions -Antibacterial Why do we use as an intra canal dressing?

9 Introduction Bacteria play a decisive role in the development of apical periodontitis Kakehashi Presence of an empty canal between appointments can lead to increase in the bacteria Trom & Sundquvist

10 History Herman 1930 Used calyxl as a pulp capping agent Sciaky & Pisanti Calcific bridge was mineralised 1960 by calcium from systemic circulation

11 History Kaiser 1964 Frank 1966 Treated non-vital teeth with open apices Procedure that produced root end closure Stenier & Van hassel Root end closure was histologically similar to cementum

12 Classification- Non setting Material Vehicle Pulpdent Methyl cellulose Hypocal Methyl cellulose Reogan Methyl cellulose Analar Ca(OH)2 Water

13 Actions - Pre-treatment Pre-treatment with calcium hydroxide enhances the tissue dissolving effect of NaOCL Hasselgren et al

14 Actions -Pre treatment 30 min pre-treatment, 90min dissolution time with NaOCL 24Hrs/ 7 days pre-treatment,60 min dissolution time(0.5 NaOCL) had the ability to completely disintegrate necrotic tissue Hasselgren et al

15 Actions - Dissolution Tissue dissolution Does calcium hydroxide have any tissue dissolving effects,and if so,how potent is it in comparison with sodium hypochlorite?

16 Comparison - Dissolution Vs Sodium hypochlorite Sodium hypochlorite 30% decrease in weight in 1Hr 15%tissue loss in 15 minutes Same weight for next 30 mins 1/2 tissue loss in 1 Hr 50% decrease in weight in 20 Hrs All tissue gone in 2 Hrs 97 % loss in 1 week

17 Actions- Dissolution Tissue dissolving ability- Does oxygen matter? Anaerobic conditions did not affect solvent action NaOCL decreased tissue size in first 1-2 hours with no effect on tissue texture was slower to affect size

18 Actions - Antibacterial Antibacterial effect of calcium hydroxide ph of calcium hydroxide Action on bacterial lippopolysaccharidde Diffusion of calcium hydroxide in tooth & tissue role of the hydroxyl ions Time as a factor for maximum effect

19 Actions - Antibacterial Time effect on antibacterial action 10 min application of Ca(OH)2 was ineffective 7 day application efficiently eliminated bacteria sjogren et al 13/14 strains that survive were anaerobic bacteria Enterococcus faecalis did not survive Ca(OH)2 treatment for a week.sjogren et al

20 Actions - Antibacterial Effective against a wide variety of bacteria Compared with phenolic compounds, they are as effective but less toxic Compared with potassium iodide, there were fewer culture reversals

21 Actions - Anti bacteial < 1 Minute 1-3 minutes Strep. sanguis Strep. Mutans S. salivarius S. morbillorum S. milleri Lacto bacillus casei S. milis Actinomyces isralii S. intermedius 3-6 minutes Campylobacter fetus Arachnia propionica Caphocytophaga ochracea Eubacterium alactolyticum Bifidobacterium dentium >6 minutes Wolinella recta Enterococcus faecalis Actinobacillus Actinomycetemcomitans Bystrom, 1986

22 Actions - Anti bacterial Lipopolysaccharide may have a significant effect on host tissues and residual LPS in root canals may affect endodontic treatment Safavi Nichols

23 Actions - Anti bacterial effect on bacterial lippopolysaccharidde ( LPS) LPS is implicated in osteoclast mediated bone resorption LPS is shed from cell wall during growth and cell lysis LPS may exert significant changes on host tissue due to sensitivity of monocytes and immune cells to it

24 Actions - Antibacterial Increased ph destroys bacteria Has a non specific effect within confines of canal Gordon-1985 Most organisms are destroyed at ph 9.5 but survive to ph 11 or greater Hugo-1971 detoxifys LPS

25 Actions - Anti bacterial detoxifys LPS by removing esterified fatty acids and altering its chemical conformation Safavi Nichols

26 Actions - Ph ph zones with Ca(OH)2

27 Placement - Conventional in the chamber and files rotated in counter clockwise manner With lentulo spirals

28 Water Vs Glycerin Placement Partially water soluble for antibacterial effect Agreeable taste Non poisonous properties Does not evaporate from mix Humectant nature

29 Conclusions It should be used in re-treatment cases In necrotic teeth with or without lesions in bone In partially vital teeth It does not have to be used in Vital cases

30 Conclusions seems to be the one that comes close to satisfying the requirements for an ideal medicament,with a good margin of safety during use.

31 Questions??

Histological Periapical Repair after Obturation of Infected Root Canals in Dogs

JOURNAL OF ENDODONTICS Printed in U.S.A. Copyright 1999 by The American Association of Endodontists VOL. 25, No. 5, MAY 1999 Histological Periapical Repair after Obturation of Infected Root Canals in Dogs