Clinical endodontics: a textbook

273 Pages·2009·12.08 MB·English

by  Tronstad

ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
Clinical Endodontics
A Textbook
3rd edition
Leif Tronstad, LDS, DMD, MS, PhD
ProfessorEmeritus
UniversityofOslo
FacultyofDentistry
Oslo,Norway
572illustrations
Thieme
Stuttgart·NewYork
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
LibraryofCongressCataloging-in-PublicationData Important note: Medicine is an ever-changing science
undergoing continual development. Researchand clinical
Tronstad,Leif. experience are continually expanding our knowledge, in
Clinicalendodontics:atextbook/LeifTronstad.—3rdrev.ed. particular our knowledge of proper treatment and drug
p.;cm. therapy.Insofarasthisbookmentionsanydosageorappli-
Includesbibliographicalreferencesandindex. cation,readersmayrestassuredthattheauthors,editors,
ISBN978-3-13-768103-8(alk.paper) andpublishershavemadeeveryefforttoensurethatsuch
1.Endodontics-Textbooks.I. Title. referencesareinaccordancewiththestateofknowledge
[DNLM:1.DentalPulpDiseases–therapy. atthetimeofproductionofthebook.
2.Endodontics–methods.WU230T854c2008] Nevertheless, this does not involve, imply, or express
RK351.T762008 anyguaranteeorresponsibilityonthepartofthepublish-
617.6’342–dc22 ersinrespecttoanydosageinstructionsandformsofap-
plicationsstatedinthebook.Everyuserisrequestedto
examinecarefullythemanufacturers’leafletsaccompany-
ing each drug and to check, if necessary in consultation
withaphysicianorspecialist,whetherthedosagesched-
ulesmentionedthereinorthecontraindicationsstatedby
themanufacturersdifferfromthestatementsmadeinthe
presentbook.Suchexaminationisparticularlyimportant
withdrugsthatareeitherrarelyusedorhavebeennewly
released on the market. Every dosage schedule or every
formofapplicationusedisentirelyattheuser’sownrisk
and responsibility. The authors and publishers request
everyusertoreporttothepublishersanydiscrepanciesor
inaccuraciesnoticed.Iferrorsinthisworkarefoundafter
publication,erratawillbepostedatwww.thieme.comon
theproductdescriptionpage.
Someoftheproductnames,patents,andregisteredde-
signsreferredtointhisbookareinfactregisteredtrade-
marksorproprietarynameseventhoughspecificreference
tothisfactisnotalwaysmadeinthetext.Therefore,the
appearanceofanamewithoutdesignationasproprietary
isnottobeconstruedasarepresentationbythepublisher
thatitisinthepublicdomain.
(cid:2)2009GeorgThiemeVerlag, Thisbook,includingallpartsthereof,islegallyprotected
R(cid:3)digerstrasse14,70469Stuttgart,Germany bycopyright.Anyuse, exploitation,orcommercialization
http://www.thieme.de outside the narrow limits set by copyright legislation,
ThiemeNewYork,333SeventhAvenue, without the publisher’s consent, is illegal and liable to
NewYork,NY10001,USA prosecution.Thisappliesinparticulartophotostatrepro-
http://www.thieme.com duction, copying, mimeographing, preparation of micro-
films,andelectronicdataprocessingandstorage.
Coverdesign:ThiemePublishingGroup
TypesettingbySommerDruck,Feuchtwangen
PrintedinGermanybyGraphischesCentrumCunoGmbH,
Calbe(Saale)
ISBN 978-3-13-768103-8 123456
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
To
Anne-Grethe
andtoNora,Greger,Ulrik,Andrea,Kristin,
andKarl-Henrik
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
VI
Preface to the Third Edition
ThescopeofthethirdeditionofClinicalEndodontics treatment are discussed, and main endodontic
isasbeforetobeasimple,yetcomprehensivetext- techniques are described. The format of the pre-
bookinendodonticsthatservesasanintroductory viouseditionshasbeenkept,andnewrelevantin-
textfordentalstudentsandasasuitablerefresher formationhasbeenaddedtothetext.Thelistsof
source for general practitioners, postdoctoral stu- references following each chapter have been up-
dents,andendodontists.Withthisconceptinmind, dated.Iagainextendmythankstofriendsandcol-
ClinicalEndodonticssummarizesthebiologyofthe leagueswhohavecontributedillustrationalmate-
endodontium and the apical periodontium and rialtothebook.
dealswiththeetiologyandpathogenesisofendo-
donticdiseases.Examinationmethods,diagnoses, Oslo,Summer2008 LeifTronstad
treatmentprinciples,andprognosisofendodontic
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
VII
Table of Contents
1 TheEndodontium .................... 1 ProvocationTests ................... 78
Structure ............................... 1 AnesthesiaTest ..................... 78
TheDentin .......................... 1 OpticalTests ....................... 79
TheDentalPulp...................... 5 RadiographicExamination................ 79
ReactionPatterns ........................ 9 TentativeDiagnosis ..................... 79
Pulpitis ............................. 9 ClinicalDiagnosis ....................... 81
PathogenesisofPulpitis ............... 11 FurtherReading ........................ 82
SystemicInfluences .................. 24
PulpNecrosis........................ 25 5 TreatmentofTeethwithVitalPulp ..... 84
RepairinthePulp .................... 26 EndodonticAspectsofRestorativeProcedures 84
FurtherReading ......................... 29 CavityandCrownPreparation ......... 84
CavityCleansingandDrying .......... 85
2 TheApicalPeriodontium .............. 31 ImpressionMethods ................. 85
Structure ............................... 31 PulpProtection ..................... 86
ReactionPatterns ........................ 32 MarginalLeakage ................... 87
ApicalPeriodontitis .................. 32 PulpCapping ........................... 88
EtiologyofApicalPeriodontitis ......... 32 Indications ......................... 88
PathogenesisofApicalPeriodontitis ..... 41 WoundDressingandTissueReactions .. 89
RadiographicAppearanceandDifferential PulpalSeal ......................... 90
Diagnosis ........................... 54 Follow-upExaminationandPrognosis .. 91
FurtherReading ......................... 62 CappingoftheInflamedPulp ......... 93
Pulpotony ............................. 94
3 EndodonticSymptomatology .......... 65 Indications ......................... 94
PulpalPain.............................. 65 WoundDressingandTissueReactions .. 96
DentalHypersensitivity ............... 65 ClinicalConsiderations............... 96
SymptomaticPulpitis ................. 66 Follow-upExaminationsandPrognosis . 96
PeriapicalPain........................... 68 Pulpectomy ............................ 96
SymptomaticApicalPeriodontitis....... 68 Indications ......................... 97
OralandPerioralPainofEndodonticInterest . 69 TreatmentPrinciples ................ 97
PeriodontalDiseases.................. 69 ClinicalConsiderations............... 101
InfectionofCystsandSalivaryGlands ... 70 Follow-upExaminationsandPrognosis . 102
Sinusitis ............................ 70 FurtherReading ........................ 102
TemporomandibularJointDysfunction
Syndrome........................... 71 6 TreatmentofNonvitalTeeth .......... 104
TrigeminalNeuritis................... 72 ConservativeEndodonticTreatment........ 105
ChronicNeurogenicPain .............. 73 Indications ......................... 105
Referredpain ........................ 74 TreatmentPrinciples ................ 105
FurtherReading ......................... 74 ClinicalConsiderations............... 112
Follow-upExaminationsandPrognosis . 114
4 EndodonticExaminationandDiagnosis .. 76 ApicalPeriodontitisRefractoryto
History ................................. 76 EndodonticTreatment ................... 116
ClinicalExamination ..................... 76 SystemicAntibioticTreatment ........ 117
PercussionandPalpationTests ......... 76 SurgicalTreatment .................. 118
SensitivityTests...................... 77 Prognosis .......................... 119
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
VIII TableofContents
TreatmentofImmatureNonvitalTeeth ..... 120 MaterialswithAssumedTherapeutic
Apexification ....................... 120 Effect ..............................173
Follow-upExaminationsandPrognosis . 121 RetrogradeFillingMaterials............175
EndodonticTreatmentofRoot-Fractured FurtherReading .........................177
Teeth ................................. 123
EndodonticTreatmentofEndo–PerioLesions 125 11 EndodonticTechniques............... 178
Surgical–EndodonticTreatment ........... 127 PreparationforTreatment ................ 179
Indications ......................... 127 AccessCavity ....................... 179
Asepsis ............................ 132 RubberDam........................ 181
FlapDesignandSurgicalAccess ....... 133 RootCanalInstrumentation .............. 183
MicrobiologicalandMicroscopic Step-BackPreparation ............... 184
Examination ....................... 134 ApicalBoxPreparation ............... 185
ResorptionLacunaeandPerforation CrownDownPreparation............. 187
Defects ............................ 134 InstrumentationofCurvedRootCanals . 188
Apicoectomy ....................... 137 RootCanalObturationwithSilverPoints .... 189
IntentionalReplantation ............. 137 RootCanalObturationwithGutta-Percha
Aftercare .......................... 138 Points ................................. 190
Follow-upExaminationandPrognosis .. 138 TheDippingTechnique............... 190
FurtherReading ........................ 139 ThermoplasticizedGutta-Percha
Techniques......................... 191
7 EndodonticEmergencyTreatment ..... 141 LateralCondensationTechnique ....... 194
EmergencyTreatmentofVitalTeeth ....... 141 StandardizedEndodonticTechnique.... 195
TeethwithSymptomaticPulpitis ...... 141 Two-StepandOtherTechniques ....... 197
CrownFractures .................... 142 RootCanalObturationwithAdhesive
DentalHypersensitivity .............. 142 Technique ............................. 199
TraumaticOcclusion ................. 143 RootCanalObturationwithPastes ......... 200
EmergencyTreatmentofNonvitalTeeth .... 143 RegenerativeEndodontics ................ 201
SymptomaticApicalPeriodontitis...... 143 FurtherReading ........................ 201
FurtherReading ........................ 145
12 DentalMorphologyandTreatment
8 EndodonticAspectsofRootResorption . 146 Guidelines ......................... 203
InternalRootResorption ................. 149 MaxillaryCentralIncisor ................. 203
CervicalRootResorption ................. 150 TreatmentGuidelines ................ 203
ExternalInflammatoryRootResorption..... 152 MaxillaryLateralIncisor ................. 204
ReplacementResorption ................. 155 TreatmentGuidelines ................ 204
FurtherReading ........................ 156 MaxillaryCanine........................ 205
TreatmentGuidelines ................ 205
9 EndodonticInstruments.............. 158 MaxillaryFirstPremolar ................. 205
RootCanalInstrumentation .............. 158 TreatmentGuidelines ................ 206
HandInstruments ................... 158 MaxillarySecondPremolar ............... 206
Engine-DrivenInstruments ........... 161 TreatmentGuidelines ................ 206
RootCanalObturation ................... 163 MaxillaryMolars........................ 207
HandInstruments ................... 163 MaxillaryFirstMolar ................ 207
Gutta-PerchaGuns .................. 163 MaxillarySecondMolar .............. 207
SurgicalInstruments .................... 164 MesiobuccalRootofMaxillaryMolars .. 207
FurtherReading ........................ 166 DistobuccalRootofMaxillaryMolars ... 208
PalatalRootofMaxillaryMolars ....... 208
10 EndodonticMaterials ................ 167 TreatmentGuidelines ................ 208
TemporaryFillingMaterials............... 167 MaxillaryThirdMolar ............... 209
RootCanalFillingMaterials............... 168 MandibularIncisors ..................... 209
CoreMaterials ...................... 168 TreatmentGuidelines ................ 210
RootCanalSealers................... 171 MandibularCanine ...................... 210
ThiemeVerlag Sommer-Druck Tronstad WN013628/01/03 16.7.2008
HerrSchabert Feuchtwangen ClinicalEndodontics TN768103 Titelei
TableofContents IX
TreatmentGuidelines ................ 210 RootFilledTeethwithNormalApical
MandibularFirstPremolar................ 211 Periodontium ...................... 231
TreatmentGuidelines ................ 211 Retreatment ........................... 232
MandibularSecondPremolars ............ 212 Treatment-ResistantCases............ 232
TreatmentGuidelines ................ 212 SurgicalRetreatment ................ 233
MandibularMolars...................... 212 FurtherReading ........................ 234
MandibularFirstMolar .............. 212
MandibularSecondMolar ............ 213 15 BleachingofDiscoloredTeeth ......... 236
MesialRootofMandibularMolars ..... 213 DiscolorationofTeeth ................... 236
DistalRootofMandibularMolars ...... 213 VitalTeeth ......................... 236
TreatmentGuidelines ................ 213 NonvitalTeeth ...................... 237
MandibularThirdMolar.............. 214 BleachingofEndodonticallyTreatedTeeth .. 238
FurtherReading ........................ 214 PreparationforBleaching............. 238
BleachingAgents.................... 239
13 EndodonticComplications ............ 215 BleachingProcedures ................ 239
IncompleteAnalgesia .................... 215 RestorationoftheBleachedTooth...... 240
AccessCavity........................... 215 BleachingofVitalTeeth .................. 240
PerforationsfromthePulpChamber ....... 216 BleachingofTeethwithEnamelDefects. 240
RootPerforations ....................... 217 BleachingofTeethwithDentin
ApicalPerforations .................. 217 Discolorations ...................... 240
LateralPerforations.................. 220 FurtherReading ........................ 241
PostPerforations .................... 221
ObliteratedRootCanal ................... 222 16 RestorationofEndodonticallyTreated
FractureofanInstrument ................ 223 Teeth ............................. 242
AdverseReactionstoMedicaments ........ 226 StrengtheningofEndodonticallyTreated
LocalTissueIrritation ................ 226 Teeth ................................. 242
NeurotoxicReactions ................ 226 IntracoronalRestorations............. 242
AllergicReactions ................... 227 CoronalRestorations................. 244
OverfillingoftheRootCanal .............. 227 RetentionofProstheticAppliancesin
VerticalRootFractures................... 228 EndodonticallyTreatedTeeth ............. 244
FurtherReading ........................ 229 PreparationofRootCanalPostSpace ... 246
CementationofRootCanalPosts....... 246
14 EndodonticRetreatment ............. 230 FurtherReading ........................ 246
IndicationsforRetreatment............... 230
RootFilledTeethwithApical 17 PrognosisofEndodonticTreatment .... 247
Periodontitis ....................... 230 FurtherReading ........................ 249