Endodontics
Course Review
Enoch Ng, DDS 2014
Apical Healing
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Clinically healed
o
No tenderness to percussion or palpation, no sinus tracts, no swelling
o
Normal mobility, properly restored
o
Radiographically healed
Normal PDL and lamina dura, absence of resorption and radiolucency
o
Histologically healed
No inflammation, restoration of PDL fibers, cementum and osseous repair, no resorption
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Clinical Failure
o
Any symptoms
Evaluating outcomes
o
Peak healing time at 1 years
Radiographic healing at 1 year is good sign
o
Pre-operative apical periodontitis – may take up to 4 years to completely heal
o
Recall periods case specific, but all should be monitored 3-12 months postop
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Clinically
o
Patient’s symptoms
o
Clinical exam
Percussion, palpation, mobility
Perio probings, sinus tract
o
Evaluating restoration
Proper cuspal coverage
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Radiographically
o
Periapical and CBCT radiography
o
Pre and post-op lesion size
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Histologically
o
25% of radiographically normal teeth are histologically inflamed
o
100% of teeth with radiographic apical radiolucency are histologically inflamed
Factors Affecting Healing
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Multi-rooted teeth lower healing rates than single rooted teeth
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Vital pulp > necrotic pulp
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Larger lesions have lower healing
o
<5mm = 87%, >10mm = 73%
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Presence of lesion gives 13% less healing
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Preparation technique – adequate debridement and irrigation, flared preparation > stepback
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Multivisit RCT with Ca(OH)
2
= 10% increased healing
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Cavit temporary >3.5mm thick, good for 3 weeks only
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Significant microleakage after >3days exposure to artificial saliva
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Exposed GP root filling recontaminated by saliva in less than 30 days
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For long term healing, quality of coronal seal > quality of obturation
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History of radiation – 91% healing with RCT, no cases of osteoradionecrosis
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Diabetes significantly decreases healing of RCT with a lesion
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Smokers have lower healing rates
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Age/gender do not affect outcomes
