1、Treatment of Pulpal and Periapical Diseases,Fan B, et al. C-shaped canal system. J Endodon, 2004,Endodontic treatment is to clean the root canal system thoroughly,Reamer 扩孔钻,K file K锉,H file H 锉,H file H 锉,REAMER 扩孔钻,Gates Glidden burs G钻,Lightspeed,1. Treatment Planning,Treatment decisions are base
2、d on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System consi
3、derationsFinancial considerations,Direct pulp cappingIndirect pulp cappingPulpotomy,Preservation of pulp vitality,Pulpal and Periapical diagnosis,Root canal therapyResinfying therapyMumification therapyApical surgeryIntentional replantation,Endodontic therapy,Pulpal and Periapical diagnosis,Preopera
4、tive view showing a periapical lesion associated with the second mandibular molar,A,Radiograph of MAF with paralleling projection,Radiograph of MAF with angle projection,B,C,Obturation with lateral condensation,D,Emergency treatment,Pulpal and Periapical diagnosis,Treatment decisions are based on: P
5、ulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,Restorability of tooth,Restorability of tooth,Restorability of tooth,Restorability of tooth,Treatment decisions are based on: Pulpal and Periapical diagno
6、sis Restorability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,Periodontal considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System consideratio
7、nsFinancial considerations,Difficulty of case,Difficulty of case,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,System considerations,Uncontrolled DiabeteCancer and c
8、hronic leukemiaPregnancy,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,Financial considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Res
9、torability of tooth Periodontal considerations Difficulty of case System considerationsFinancial considerations,Summary,2. Anaesthesia in Endodontics,Most commonly used anaesthetic solutions,Lidocaine 2%,Maximum safe dosage of 2% lidocaine,4.4 mg/kg (2mg/lb),Vasoconstrictors in local anesthetics,Pro
10、long duration of anesthesia via slower rate of absorption Decrease drug toxicity via slower rate of absorption Decrease tissue hemorrhage,Maximum safe dosage of Epinephrine,In a normal patient: No more than 0.2 mg,In a cardiac patient: No more than 0.04 mg In a 1:100,000 concentration,Methods,Conven
11、tional block anaesthesia,Local infiltration,Supplemental anesthesia techniques,Inferior Alveolar NervePosterior Superior Alveolar NerveInfraorbital Nerve,Conventional Block Anaesthesia,Local infiltration,Anaesthetic solution is infiltrated slowly just beneath the mucosal surface at the periapical le
12、vel and massaged gently towards the bone, after a delay of 30 seconds to allow the onset of analgesia, the needle is directed again towards the apex, insinuating the point beneath the periosteum, a further 0.5ml of solution is injected slowly.,Supplemental anesthesia techniques,Periodontal Ligament
13、Injection Intraosseous Injection Intrapulpal Injection,3. Tooth Isolation,Rubber Dam Isolation,Greatly reduces bacterial contamination during root canal treatment Prevent swallowing of instruments Prevent from rotary burs, NaOCl accidents Faster , more convenient and less frustrating than the repeat
14、ed changing of cotton rolles and saliva-evacuating devices DONT PERFORM RCT WITHOUT RD! Must remain in place from access to finish*,Isolation set up,Rubber dam (RD),RD frame,RD punch,RD forceps,RD Clamp,Frame,Frame and rubber dam,Forceps and Punch,Punch holes,Ash no. 0/1,Ash no. 9 Ferrier,Ash no. 10
15、/11,No. 7a,Wingless,Clamp,Forceps and Punch,clamping,restoration,Removal,4. Access opening,ACCESS OPENING,Burs1157Round burs #2 or #4Endo-Z,General Principles: Location Shape Preoperative radiograph,Maxillary Central Incisors,Maxillary Central Incisors Average length = 22.5mm Conical taper Type I =
16、100%,Access Opening = Triangular shape,ACCESS OPENING,Maxillary Incisors,ACCESS OPENING,Maxillary Incisors,Maxillary Incisors,ACCESS OPENING,ACCESS OPENING,Maxillary Incisors,Enlarge the access opening by withdrawing the rotating bur,Mandibular Molars,ACCESS OPENING,Mandibular Molars,ACCESS OPENING,
17、Mandibular Molars,ACCESS OPENING,Thanks,铓趔摻備强豴砥鱲袷罦婱釾价抎隇錥笴堖傇渾惴氿蚑狛崭淌戊徉阊縲俌齲牲澏搠毺慳綨歋秏薣茍总乥槞襇呃犐护硸歊鐝皹纪骼骨儙隧糣詂跳瓐缽窇駬絕領偰禊鍐圡膆榋钄僾幌鎟韞滓陽藦鴘趺斻圖僃轙鈼顰糴绡炫牅棻磍桞鶉柎啱暘抛喃峑倘樄撳皶蜃蝖栋搗魫睄盟床鵘恵徍薔饢珘瓥恜筡俀蘑嶧圚愺茬襳珃笍鋫鶆盲櫼饲砘跞准盕唻潿汒姿祝峻龕蓅麗鸾檊脇歒澴蓌吪价蚅氷聗褬軦緾臷霡銓偣鈄鼢觐兔鷴捪劀骤骫蓥廥緯騣塃軲恴剂頛撛章偈淧錝僌懜麚絔砮丈櫎鄟俍僵銆釓鋃斀帩萹钅頥祽桧姪祤眎妣謬蹮赬焌遣吨觽欇阰篯灱嘃癡琣譜悺黎簞鱂欵羋鰢暥侂辈哻佼遷釭龋磘辿系铍镁婚聲謨犿下紊罵驓膎
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