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Emergency treatment in endodontics By: Mohammed Turky Lecturer of endodontics – Minia University Lecturer of endodontics – South Valley University
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Emergency treatment in endodontics - Minia

Mar 13, 2022

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Page 1: Emergency treatment in endodontics - Minia

Emergency treatment in endodontics

By:

Mohammed Turky

Lecturer of endodontics – Minia University

Lecturer of endodontics – South Valley University

Page 2: Emergency treatment in endodontics - Minia

What is the meaning of emergency ?

What is the meaning of endodontic emergency ?

Goals of emergency treatment

Classification of emergency cases

Page 3: Emergency treatment in endodontics - Minia

What is the meaning of

emergency ?

A sudden and urgent condition

requiring an immediate action.

According to Dorland`s medical dictionnary

Page 4: Emergency treatment in endodontics - Minia

What is the meaning of

endodontic emergency ?

Pain and/or swelling caused by

inflammation /infection of the pulpal or

periapical tissues that require

immediate diagnosis and treatment.

Page 5: Emergency treatment in endodontics - Minia

Goals of emergency treatment

Relief of pain

Infection control

Page 6: Emergency treatment in endodontics - Minia

Walton`s classification

Page 7: Emergency treatment in endodontics - Minia

Acute pulpitis

Acute pulpitis

with acute apical

periodontitis

Acute periapical

abscess

Cellulitis

Pretreatment emergency

Page 8: Emergency treatment in endodontics - Minia

Acute pulpitis

Hot tooth

Page 9: Emergency treatment in endodontics - Minia

Diagnosis

Diffuse spontaneous pain

severe throbbing pain increased with both hot and cold

In advanced stages, pain is relieved with cold Hot tooth

No pain on percussion

Radiographically no change periapically

Page 10: Emergency treatment in endodontics - Minia

Emergency ttt.

Single visit is a matter of debate

Page 11: Emergency treatment in endodontics - Minia

Reduction of chances of bacterial growth in the canal between the visits

Intra-canal medication

Access cavity + complete cleaning & shaping

The best emergency ttt.

Page 12: Emergency treatment in endodontics - Minia

According to time& skills &

complexity

Alternatively

Pulpectomy (pulp extirpation)

Pulpotomy (even with removal of the pulp from the widest canal)

Page 13: Emergency treatment in endodontics - Minia
Page 14: Emergency treatment in endodontics - Minia

Acute pulpitis with acute apical

periodontitis

Page 15: Emergency treatment in endodontics - Minia

Diagnosis

Localized pain severe pain increased with hot and relieved with cold

+ve vitality test Severe pain on percussion

Radiographically no change periapically

Or widening of PMS

Page 16: Emergency treatment in endodontics - Minia

Emergency ttt.

Complete pulp removal in all the canals is the best

If not pulpectomy

(pulp extirpation)

Page 17: Emergency treatment in endodontics - Minia

Occlusal reduction

Page 18: Emergency treatment in endodontics - Minia

Clinical tips

Page 19: Emergency treatment in endodontics - Minia

Missed canal

2nd distal canal in lower molars

2nd canal in upper premolars

2nd canal in lower anteriors and premolars

4th canal in upper first molar

Page 20: Emergency treatment in endodontics - Minia

Acute periapical abscess

Page 21: Emergency treatment in endodontics - Minia

Diagnosis

Localized pain With or without swelling

-ve vitality test Severe pain on percussion

Radiographically

no change periapically

Or widening of PMS

Definite Rl

Page 22: Emergency treatment in endodontics - Minia

Types

Acute abscess from the first onset

``De novo``

• No pus

• No radiographic changes or just widening of PMS

Acute abscess from a chronic apical condition

``Phoneix abscess``

• pus

• definite RL

Page 23: Emergency treatment in endodontics - Minia

Emergency ttt.

Intra-canal drainage

Artifistulation

Page 24: Emergency treatment in endodontics - Minia

Intra-canal drainage

Anesthesia:

Avoid infiltration Why???

1. Pain caused by injection

2. Spread of infection

3. Ineffectiveness of such anesthesia

If necessary Nerve block

Page 25: Emergency treatment in endodontics - Minia

• Access cavity

Sharp bur in high speed………..to eliminate vibrations

Page 26: Emergency treatment in endodontics - Minia

• Intra- canal drainage

• In many cases occur immediately as soon as pulp chamber

is perforated

• Other teeth appear to be dry >>>>>>> A.C prevent drainage

Page 27: Emergency treatment in endodontics - Minia

Predictable pattern of drainage

Pus

( yellowish, whitish or greenish)+

Blood

Bloody discharge

Clear serum exudation

Page 28: Emergency treatment in endodontics - Minia
Page 29: Emergency treatment in endodontics - Minia

Instrumentation ( mechanical preparation)

Crown down technique

Complete instrumentation (2009)

Intra-canal medication (calcium hydroxide)

Rotary is preferred to reciprocation

Side vented needles or EndoVac

Page 30: Emergency treatment in endodontics - Minia

• Irrigation solution

• At the initial stages >>>>>>>>>>>> saline

• Later on, >>>>>>>>>>>>>>>>>>>>>> Naocl (0ld schools)

Page 31: Emergency treatment in endodontics - Minia
Page 32: Emergency treatment in endodontics - Minia

* Prevent persistent infection

*Prevent food impaction into the opened canals

* Prevent foreign bodies introducing into the canals

Very long initial appointment

Page 33: Emergency treatment in endodontics - Minia

Evidence- based guide

• Auslander WP: The acute apical abscess, N Y State Dent J 36:623, 1970.

• Bence R, Meyers RD, Knoff RV: Evaluation of 5,000 endodontic treatment incidents of the open tooth, Oral Surg Oral Med Oral Pathol 49:82, 1980.

• Weine FS, Healey HJ, Theiss EP: Endodontic emergency dilemma: leave tooth open or keep it closed? Oral Surg Oral Med Oral Pathol 40:531, 1975.

Page 34: Emergency treatment in endodontics - Minia

Medication

Sufficient drainage & patient afebrile

no antibiotics

Insufficient drainage & patient febrile

antibiotics

Page 35: Emergency treatment in endodontics - Minia

Artifistulation

Page 36: Emergency treatment in endodontics - Minia

Artifistulation

Page 37: Emergency treatment in endodontics - Minia
Page 38: Emergency treatment in endodontics - Minia
Page 39: Emergency treatment in endodontics - Minia

Clinical tips

Endodontic treatment can be completed in one visit after the drain is placed.

The drainage is able to dry the canal

Completing the endodontic treatment eliminates the source of the infection,

The periapical lesion heals quicker.

Page 40: Emergency treatment in endodontics - Minia

Cellulitis

Page 41: Emergency treatment in endodontics - Minia

Cellulitis