422 rds clinical endodontic procedures course director dr ebtissam al-madi

422 RDSClinical Endodontic Procedures

Course DirectorDr Ebtissam Al-Madi

Endodontics

That branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues.

2Introduction to Clinical EndodonticsE. Al-Madi

Its study and practice encompass the basic and clinical sciences including

biology of the normal pulp, the etiology,

diagnosis, prevention, and treatment of diseases and

injuries of the pulp and associated periradicular

tissues.

3Introduction to Clinical EndodonticsE. Al-Madi

Skills to acquire in 433 RDS

• Develop a systematic approach to diagnosis of endodontic pain by organizing clinical findings, symptoms and pain history.

4Introduction to Clinical EndodonticsE. Al-Madi

• Clinically record the status of the pulpal and periapical tissue through clinical and radiographic examinations.

5Introduction to Clinical EndodonticsE. Al-Madi

• Utilize endodontic tests to determine pulp vitality.

6Introduction to Clinical EndodonticsE. Al-Madi

• Establish a differential diagnosis of odontogenic and non-odontogenic pain.

7Introduction to Clinical EndodonticsE. Al-Madi

• Establish a differential diagnosis between endodontic and periodontal disease.

8Introduction to Clinical EndodonticsE. Al-Madi

• Be familiar with major pulpal and periapical pathology and their sign and symptoms.

9Introduction to Clinical EndodonticsE. Al-Madi

• Plan and deliver routine non-surgical endodontic treatment to patients with pulpal and periapical disease.

10Introduction to Clinical EndodonticsE. Al-Madi

• Select or differentiate cases for treatment or referral based on knowledge, experience and ability.

E. Al-Madi Introduction to Clinical Endodontics 11

• Determine the prognosis of the treated tooth

E. Al-Madi Introduction to Clinical Endodontics 12

• Recognize the need for endodontic surgery in appropriate cases.

13Introduction to Clinical EndodonticsE. Al-Madi

• Identify the need for adjunctive procedures subsequent to endodontic therapy.

E. Al-Madi Introduction to Clinical Endodontics 14

• Plan and refer case for appropriate restoration.

E. Al-Madi Introduction to Clinical Endodontics 15

• Recall treated patients, and be aware of the value of post-operative follow-up (recall), and continuing prognosis.

E. Al-Madi Introduction to Clinical Endodontics 16

• Diagnose, evaluate and perform retreatment on suitable cases.

17Introduction to Clinical EndodonticsE. Al-Madi

• Be exposed to trauma cases, emergency cases, endo-perio cases, bleaching and preventive therapy cases.

E. Al-Madi Introduction to Clinical Endodontics 18

• Exposure to new endodontic technologies; such as apex locators, rotary instrumentation, innovations in irrigation, and contemporary obturation techniques.

19Introduction to Clinical EndodonticsE. Al-Madi

Previously in 322 RDS

Theory-322• Case Selection, Indication &

Contraindication to Endodontic therapy

• Endodontic Instruments and Isolation • Endodontic Access Opening • Root Canal Preparation • Root Canal Filling materials and

Obturation • Endodontic Radiography and Local

Anesthesia

21Introduction to Clinical EndodonticsE. Al-Madi

Theory-322• Intracanal Medication• Endodontic Mishaps• Histology and Physiology of

the Pulp • Microbiology and Immunology• Pulp Reaction to Caries and

Dental Procedures• Pulpal Diseases• Periradicular Disease

22Introduction to Clinical EndodonticsE. Al-Madi

Practical- 322

• Minimum 3 anterior roots • Minimum 2 premolar roots

(including two-canal premolar)• Minimum 4 molar teeth

23Introduction to Clinical EndodonticsE. Al-Madi

422 RDS Clinical Endodontic Procedures Overview

Theoretical components

1. Clinical Diagnostic Procedure2. Preparation for Clinical

Endodontic Therapy 3. Clinical Endodontics4. Endodontic Re-treatment 5. Restoration of Endodontically

treated teeth 6. Endodontic Emergency

Treatment

25Introduction to Clinical EndodonticsE. Al-Madi

7. Traumatic Dental Injuries 8. Endodontic-Periodontal

Relation 9. Prognosis of Root Canal

Therapy 10.Endodontic Surgery 11.Discoloration and

Bleaching 12.New Trends in

Endodontics

26Introduction to Clinical EndodonticsE. Al-Madi

Clinical Requirements

A minimum of:• Two (2) single rooted teeth:

– U/L anterior, or U/L premolar • One (1) premolar with two canals• Three (3) molars:

– U/L 1st + 2nd molars– NO 3rd molars

• Retreatment case• Two (2) recall case:

– From your own cases, must be restored

27Introduction to Clinical EndodonticsE. Al-Madi

Required Textbook

• Principles & Practice of Endodontics– Walton & Torabinejad– 3rd ed (2002)

28Introduction to Clinical EndodonticsE. Al-Madi

Grading• Theory = 50%

– Assignments (5)– Quizzes (5)– Oral exam (10)– Midterm (10)– Final (20)

• Clinic =50%– Attendance (2)– Requirements (45)– Daily knowledge evaluation (3)

• Bonus = (+5)

29Introduction to Clinical EndodonticsE. Al-Madi

Type Grade Description

Assignments 5 1st Sem: Homework reports

Quizzes 5 1st Sem: 3 quizzes

Oral exam 10 2nd Sem:

Midterm 10 1st Sem: after 7th lect

Final 20 1st Sem:

Attendance 2 Year long- Lect & Clinic

Requirements 45 Clinical req

Daily knowledge evaluation

3 During clinic

Bonus +5 Reports and online discussions

E. Al-Madi Introduction to Clinical Endodontics 30

Clinical Requirements

Point system to include:• Difficulty of case (patient factor)• Number of canals• Curvature of the canals• Accessibility of the tooth• Retreatment case (removal of GP)• Caries control• Vital pulp therapy• Extra procedure (build-up,

gingivectomy, etc.)

31Introduction to Clinical EndodonticsE. Al-Madi

• Initial access and pulp extirpation• Completed case (all endodontically

involved teeth in pt)• Partial procedures (incomplete

pt’s)• Restoration of case• recall• Cases that are of poor quality, and

considered for retreatment will not be credited as requirements.

32Introduction to Clinical EndodonticsE. Al-Madi

Clinical Protocol (Attendance =2)

• Prompt attendance.• Clean & tidy attire & clinic.• Infection control measures.• Patient must be booked.• Working without a rubber

dam is prohibited.• Every procedure & file must

be signed before 4:30pm.

33Introduction to Clinical EndodonticsE. Al-Madi

Clinical Protocol

• You are not allowed to leave the clinical hall before 4:30 P.M.

• You must be ready for the step you are going to perform that day. (Daily Knowledge=3)

• Present cases to the course director as soon as you finish the case.

34Introduction to Clinical EndodonticsE. Al-Madi

Clinical Forms

• Start check must be signed BEFORE any procedure.

• Instructor's signature for each step.

• Sign each procedure as soon as you perform it.

• Fill in all fields of your endodontic form.

• Complete set of radiographs.

35Introduction to Clinical EndodonticsE. Al-Madi

Student's Name: File No.: Exam Date:________________

Patient's Name: Age: __________ Sex: ______________ Tooth No.: _______________

Telephone No.: (W)______________ Chief Complaint:

PAIN: CLINICAL EXAM: DIAGNOSTIC TESTS: THERAPY:None Swelling (intra/extraoral) Test Caries controlVague Pain (soft/hard/fluctuant) Tooth Vital pulp therapyPain to heat/cold Cellutitis Cold ApexificationPain to sweet/sour Sinus tract Hot Root canal therapyPain to mastication Regional lymphadenopathy EPT Root canal retreatmentSpontaneous/on stimulus Poor oral hygiene Percussion Surgical endodonticsIntermitten/continuous Perio pocket ( mm) Palpation ExtractionLocalized/diffused/radiating Mobility (I/II/III) Test Cavity Others:Severe/moderate/mild Caries Probing DepthDuration: sec./mins./hrs. Restoration (minimal/large) Faculty Signature:

Discoloration N = NormalMEDICAL ALERT: Crown fracture (class: ) AB = AbnormalRheumatic fever Tooth (canal) already opened NR = No Response Faculty Comments:Rheumatic heart disease LR = Lingered ResponseHigh blood pressure RADIOGRAPHIC EXAM: NLR = Nonlingered ResponseDrug allergy ( ) NormalHepatitis/tuberculosis Widen/thickened PDL DIAGNOSIS:Pregnancy Apical/lateral rarefaction a) PulpalOthers: Internal/external resorption Normal

Caries Reversible pulpitisREASON FOR TREATMENT: Calcification/pulp stone Irreversible pulpitisCarious exposure Root fracture (H/V) Necrosis of pulpMechanical exposure Furcation involvement Already StartedElective endo treatment Open apex b) PeriapicalTrauma Incomplete RCT NormalPerio Broken instrument Acute apical periodontitisCracked tooth Perforation Chronic apical periodontitisEndo previously initiated Others: Acute apical abscessOverdenture Chronic apical abscessOthers: Condensing osteitis

Department of Restorative Dental SciencesDIVISION OF ENDODONTICS

422 RDSClinical Endodontic Form

Result

Start Check:Date: Signature:

36 Introduction to Clinical Endodontics

E. Al-Madi

Name: Serial No.: Case No.:

Computer No.: ________________________

- No instructor's permission/sign 0 + suspension 1 2 3 4 5 6- No or improper Diagnosis -2.5 Procedures- No or improper RD isolation Failure/ -2.5 History & diagnosis- Improper patient management -2.5 Patient management/LA- Ineffective LA -2.5 IsolationACCESS Access cavity- Under-extended -1.5 Working length- Over-extended -2.5 Instrumentation- Improper location/gouging -3 Obturation- Broken bur 0 Time management

- Perforation 0 KnowledgeWL Signature- Improper size -3- Under/over ext. >2mm -3 TOTAL GRADE [Faculty]: Signature:INSTRUM. MAC Course Director's Grade:- Short -3- Apical perforation -3 FINAL GRADE [out of 10]: Signature:- Stripping perforation 0- Broken instrument 0- Flush -3 S L S L S L S L- Not flared -3OBTURATION- Short -3- Over-extended GP -3- Sealer ext. -1- Voids apically -3- Voids middle/coronal -1.5 Recall Examination- Flush -2- No intermediate RG -3 Good- No final RG -3 Poor- No final resto -5 Guarded- Treating wrong tooth 0 + suspension Surgery- No medical history 0 + suspension Likely

Comments:

Faculty's Grade:

RadiographicFindings

GUIDELINES FOR EVALUATIONProcedures

Session

Clinical

Signature

Date

Prognosis

MAF MCRoot Canal Ref. Point

Int WL WL

37 Introduction to Clinical Endodontics

E. Al-Madi

Expectations (i.e. How to ACE this course)

• Read lectures daily (weekly)

• Prepare yourself for clinic (know what you are doing + why- have all your materials ready)

• Plan ahead for clinics- use your time wisely

• Preview next week lesson

38Introduction to Clinical EndodonticsE. Al-Madi

Today’s Clinic

• Everyone will have a pt, or practice on each other:– Take a history– Fill out forms– Take radiographs– Book patient for following

week

39Introduction to Clinical EndodonticsE. Al-Madi

Today’s Assignment

• Start your log book• Review Ch. 2 + 3

– Biology of the dental pulp and periradicular tissues

– Pulp and periradicular pathosis

• Review syllabus

40Introduction to Clinical EndodonticsE. Al-Madi

Next lesson- Preview• Clinical Diagnostic

Procedure• Pulpal responses to testing

methods• Documentation of pulpal

responses and related data• Diagnostic perplexities (sinus

tract, numbness, persistent discomfort, cracked tooth syndrome, idiopathic tooth resorption, and failure cases)

• Systematic approach to endodontic diagnosis

• Diagnosis and treatment planning

• Give cases presentation showing the sequences used to determine diagnosisCH.4

41Introduction to Clinical EndodonticsE. Al-Madi