Canis ISSN: 2398-2942

Endodontics: basic

Contributor(s): Brook A Niemiec, MarkThompson

Introduction

  • The endodontic system is the pulp tissue (vessels, nerves, and connective tissue) that are in the root canals and pulp chambers.
  • Endodontic disease refers to inflammation (pulpitis) or necrosis (partial or complete) of the pulp tissues.
  • The goal of endodontic therapy is to maintain a vital pulp system. Failing in maintaining pulp vitality, the goal is to remove the infection from while leaving the tooth in place. Thus, endodontic therapy is comprised of two main branches: vital and non-vital pulp therapy (root canal, surgical root canal, and apexification).
  • Vital pulp therapy consists of procedures to keep vital teeth alive, which are direct and indirect pulp capping.
  • Non-vital pulp therapy results in non-vital tooth, but can be performed on a living tooth to remove pain and infection. The three main procedures are: standard root canal Endodontics: root canal therapy , surgical root canal, and apexification.
  • These therapies present a viable alternative to extraction.
    These are advanced procedures and should not be attempted without significant study and practice.

Uses

  • Vital pulp therapy Endodontics: vital pulp therapy :
    • Fresh fractures in immature (incomplete apex) tooth.
    • Crown amputation for traumatic occlusions (orthodontic or post-operative mandibulectomy).
    • Disarming aggressive patients.
    • NOT recommended for mature teeth (standard RCT is preferred).
  • Standard root canal therapy Endodontics: root canal therapy :
    • Fractured mature teeth (generally > 18 months of age).
    • Non-vital teeth (intrinsically stained Teeth: maxillary canine (intrinsically stained) Teeth: maxillary fourth premolar (intrinsically stained) ).
    • Hemi-sected teeth (from periodontal disease Periodontal disease ).
    • Luxated/avulsed teeth (following re-implantation).
  • Surgical root canal therapy:
    • Failed standard root canal therapy.
    • Root fractures.
    • Inaccessible canals (stenotic root canals, instrument fracture).

Advantages

  • Vital pulp therapy and standard root canal therapy:
    • Resolves the problem (infection, pain, trauma) while maintaining the function of the tooth.
    • Much less painful than extraction (especially with strategic teeth).
    • Less immediate complications.
  • Surgical RCT:
    • Maintains the function of a tooth.

Disadvantages

  • Very technically demanding and if not performed perfectly will fail.
  • Time intensive.
  • Expensive set-up.
  • Long-term follow-up is required.
  • High failure rate if incorrectly performed.
  • Lack of clinical signs with failure.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • VPT: very good prognosis when performed on an intact tooth, 88% if performed on a fractured tooth within 48 hours, poor if exposed greater than 48 hours
  • Standard RCT: if performed correctly, has an excellent long term prognosis. If incorrectly, very poor prognosis.
  • Surgical RCT: if performed correctly, has an excellent long term prognosis. If incorrectly, very poor prognosis.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Niemiec B A (2006) Surgical endodontic therapy of the mandibular canine tooth. J Vet Dent 23 (1), 62-66 PubMed.
  • Niemiec B A (2005) Dental radiographic interpretation. J Vet Dent 22 (1), 53-59 PubMed.
  • Niemiec B A (2005) Fundamentals of Endodontics. Vet Clin North Am Small Anim Pract 35 (4), 837-868, vi PubMed.
  • Mulligan T W, Niemiec B A (2001) Endodontic treatment of vital pulp tissue. Clin Tech Small Anim Pract 16 (3), 159-167 PubMed.
  • Niemiec B A (2001) Treatment of mandibular first molar teeth with endodontic-periodontal lesions in a dog. J Vet Dent 18 (1), 21-25 PubMed.
  • Niemiec B A, Mulligan T W (2001) Vital pulp therapy. J Vet Dent 18 (3), 154-156 PubMed.
  • Niemiec B A (2001) Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats. J Vet Dent 18 (3), 122-125 PubMed.
  • Niemiec B A (2000) Management of a complicated maxillary fourth premolar crown-root fracture in a dog. J Vet Dent 17 (3), 128-133 PubMed.

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