Introduction to Endodontics

History scope, basic principles and advancement

For undergraduates

ByAhmed Shteiwi

Main source of this lecture

What is Endodontics ?

Root Canal Treatment (RCT)

• Is removal of vital or necrotic pulp tissue from pulp chamber and root canal by cleaning and shaping process

• Then the chamber and canal cavities must be blocked by suitable sealing materials to not become a shelter of pathogens “hermetic seal”

Periapical x-ray film showing endodontically treated upper molar

Why RCT ?• Pulp injury ..• Prosthetic treatment ..

Next lectures..

History

• 1687 the aim of Endodontics has been to relieve pain, maintain exposed pulp, and preserve teeth. Often, these attempts were successful.

Fauchard (1678-1761), considered the founder of modern dentistry, who in his textbook “Le chirurgien dentiste” precisely described the dental pulp 3 and dispelled the legend of the “tooth worm,” which had been considered the cause of caries and toothaches since the time of the Assyrians.

• 1725, Lazare Riviere introduced the use of oil of cloves for its sedative properties.

• 1746, Pierre Fauchard described the removal of pulp tissue.

• 1820, Leonard Koecker cauterized exposed pulp with a heated instrument and protected it with lead foil.

• 1836, Shearjashub Spoone recommended arsenic trioxide for pulp devitalization.

1838, Edwin Maynard of Washington, D.C. introduced the first root canal instrument, which he created by filing a watch spring

• In 1847, Edwin Truman introduced gutta-percha as a filling material.

• 1860, A FINE AND RARE BEECHWOOD GUTTA-PERCHA GOLF BALL MARKING MACHINE OWNED BY WILLIE PARK

• In 1850, W.W. Codman confirmed that the aim of pulp capping, which had already been proposed by Koecker in 1821, was to form a dentin bridge.

• In 1864, S.C. Barnum of New York prepared a thin rubber leaf to isolate the tooth in the course of filling.

• Together with G.A. Bowman, he introduced the rubber dam clamp forceps in 1873.

Recent rubber dam clamp forceps

• In 1867, Bowman used gutta-percha cones as the sole material for obturating root canals.

• 1867, Magitot suggested the use of an electric current to test pulp vitality.

• In 1885, Lepkoski substituted formalin for arsenic to “dry” the non-vital pulp stumps left in the root canals after excision of the coronal pulp to prevent their decomposition.

• At the end of the 17th century, prosthetic restorations, including the Richmond or Davis crown, became increasingly popular. Since they required the use of canal posts, they created an ever greater need for endodontic therapy.

• In 1891, the German dentist Otto Walkhoff introduced the use of camphorated chlorophenol as a medication to sterilize root canals.

Intra-canal medication

• In 1895, and more precisely in the evening of November 8 in his laboratory in the Bavarian city of Wurzburg, the scientist Konrad Wilhelm von Roentgen accidentally discovered a new form of energy that had the ability to penetrate solid material. Because of their unknown nature, he decided to call these rays “X”.

• A few weeks later Otto Walkhoff, a dentist in Brunswick, Germany, took the first dental radiograph, making a contribution to dentistry that almost equaled Roentgen’s to medicine.

• Roentgen’s discovery of the X-ray has been ranked in importance with the discovery and development of anesthesia by Horace Wells and William Morton, both dentists, and the discovery of microorganisms and their role in disease by the likes of Pasteur and Lister.

• In 1900, Price described periapical radiolucencies as “blind abscesses” and advised the use of radiography for establishing the diagnosis of pulpless teeth.

• In 1908, Dr. Meyer L. Rhein, a physician and dentist in New York, introduced a technique for determining canal length and level of obturation.

About the same time, G.V. Black suggested a measurement control to determine the length of the canal and the size of the apical foramen, so that overfilling could be prevented.

• In 1904, Frank Billings directed the attention of dentistry and medicine to the apparent relationship between oral sepsis and bacterial endocarditis.

• 1909, Mayrhofer published a work linking the nature of pulpal infection with specific microorganisms. The results indicated that streptococ-ci were present in about 96% of the cases studied.

• A wrong believe that the pulpless teeth can cause dangerous infection to the whole body because it has a septic foci introduced by William Hunter, an English physician and pathologist , and there is no benefit from treating pulpless teeth , this believe make the dentists to extract any pulpless teeth

• This cause a stop in developing of root canal treatment for 40 years !

• Coolidge, Johnson, Reihn, Callahan, Grove, Prinz, and others. Mainly because of their efforts, the principle of preserving the pulpless tooth survived, they improve their current procedures by using aseptic techniques, bacteriological and histological methods, and X-rays for diagnostic purposes.

• It was not until the late 1940s or early 1950s that the cumulative laboratory research and clinical evidence was sufficient to confirm that the devitalized tooth did not play a role in the causation of systemic disease. Thus the theory of focal infection fell and faith was restored in endodontic treatment.

NowadaysA quick tour ..

Diagnosis

• cone beam computed tomography “CBCT”

Electronic Apex Locator

Endodontic Microscope

Rotary systems

• Irrigating ultrasonic device

• Obturation of root canals by hot injectable gutta -percha

Mineral trioxide aggregate

• Mineral trioxide aggregate used for open apex closure or for sealing of different perforation sites

Biodentin sealer

References• A Brief History of Endodontics : CASTELLUCCI ,ARNALDO ,Endodontics v2 : IL TRIDENTE

EDIZIONI ODONTOIATRICHE 2005

• Italo Medeiros Faraco Junior, Roberto HOLLAND : Histomorphological Response of Dogs’ Dental Pulp Capped with White Mineral Trioxide Aggregate : Braz Dent J (2004) 15(2): 104-108

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www.christies.com/lotfinder/lot/a-fine-and-rare-beechwood-gutta-percha-golf-5557844-details.aspx

• http://www.cornehl-watches.com/en/services/making-of-clocks-and-watches/collection.html• http://fphoto.photoshelter.com/image/I0000zX74rFlpDwM• http://surreyhills.dental/services/root-canal-treatment/• http://dentallecnotes.blogspot.com/2011/08/note-on-rubber-dam-isolationwith.html• https://www.meyersmedmal.com/failure-to-use-dental-dam-malpractice/

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