Treatment Plan in endodontics

8/9/2019 Treatment Plan in endodontics

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TREATMENT PLAN

REPORT BY

DR.AMITHBABU.C.B


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WHAT IS TREATMENT PLAN?

Treatment plan is the blue print for case

management

After diagnosis & prognosis, treatment isplanned

Includes all procedures required for the

establishment &maintenance of oral health


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Unforeseen developments may necessitate

modification of treatment plan

Except for emergencies, no treatment to bestarted unless treatment plan has been

established


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VITAL CASE

Best managed by a biologically basedBest managed by a biologically based

approach.approach.

IncreasedIncreased intrapulpalintrapulpal pressurepressure PulpotomyPulpotomy oror pulpectomypulpectomy have a high degreehave a high degree

of predictability in alleviating pain.of predictability in alleviating pain.

SimplySimply debridingdebriding the pulp chamber is alsothe pulp chamber is alsohighly predictable method ofhighly predictable method of providinprovidin painpain

relief.relief.


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When a canal has been entered the clinicianWhen a canal has been entered the clinician

should completely all the tissue.should completely all the tissue. Partial instrumentation may result inPartial instrumentation may result in

increased post operative pain.increased post operative pain.

Teeth should be closed with a temporaryTeeth should be closed with a temporaryfilling at the conclusion of the visitfilling at the conclusion of the visit


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PULPAL INFLAMATIONPULPAL INFLAMATION

Majority of the tooth withMajority of the tooth with pulpalpulpal inflammationinflammation

are free from symptoms.are free from symptoms.

Duration of pain is used as a yardstick forDuration of pain is used as a yardstick for

determining whether there is sensitive dentine ordetermining whether there is sensitive dentine or

an irreversiblean irreversible pulpalpulpal inflammation.inflammation.

If a cold test results in pain in a few seconds theIf a cold test results in pain in a few seconds the

cause is considered to be sensitive dentine.cause is considered to be sensitive dentine.

Lingering pain is considered as indication ofLingering pain is considered as indication of

irreversibleirreversible pulpitispulpitis ..


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HYPERSENSITIVE TEETHHYPERSENSITIVE TEETH

Sensitive to temperature changes usually cold

Duration of pain is few seconds

Exposed dentine ,lekage under restoration ,orpreparation with out water coolant may

cause symptoms.

In most cases root canal therapy is notindicated.


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PULPAL INFLAMMATION AND PAINPULPAL INFLAMMATION AND PAIN

Unless pulp is exposed pulpal diagnosis is

based on clinical findings.

Caries must be removed and in the teeth withsymptoms of pulpal pain old fillings should be

removed.

It is therefore essential to remove fillings in

symptomatic tooth.


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In most cases the removal of infection and the

placement of a temporary filling will make the

symptoms subside.

Still in severe cases were there is constant

pain , endodontic treatment is indicated.


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IRREVERSIBLE PULPITITSIRREVERSIBLE PULPITITS

Emergency management for painfulEmergency management for painful

,irreversible,irreversible pulpitispulpitis involves initiating rootinvolves initiating root

canal treatment to alleviate pain.canal treatment to alleviate pain.

Complete removal of the pulp and totalComplete removal of the pulp and total

cleaning and shaping of the root canal systemcleaning and shaping of the root canal system

are the emergency treatment .are the emergency treatment .

In multi rooted toothIn multi rooted tooth pulpotomypulpotomy has beenhas been

advocated for emergency irreversibleadvocated for emergency irreversible pulpitispulpitis..


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NOTENOTE

It is impossible to detect clinically the apicalIt is impossible to detect clinically the apical

extend of the inflamed pulp and provideextend of the inflamed pulp and provide

predictable pain relief ,its is important topredictable pain relief ,its is important to

clean and shape root canal systems to theclean and shape root canal systems to the

fullest extent possible.fullest extent possible. File should not be introduced into the canalsFile should not be introduced into the canals

unless aunless a pulpectomypulpectomy is anticipated.is anticipated.

Pain symptoms can persist or worsen ifPain symptoms can persist or worsen ifinflamed pulp remains in the root canal.inflamed pulp remains in the root canal.


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Complete removal of the pulp is the bestComplete removal of the pulp is the best

treatment of irreversibletreatment of irreversible pulpitispulpitis


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NONVITAL CASENONVITAL CASE

Its a microbiologic challenge to the clinicianIts a microbiologic challenge to the clinician

A tooth has had a non vital pulp for sometimeA tooth has had a non vital pulp for sometimemay suddenly become acutely painful.may suddenly become acutely painful.

The treatment in such cases isThe treatment in such cases is isis simplysimplyopening the tooth and changing the bacterialopening the tooth and changing the bacterialflora environment.flora environment.

The therapeutic goals in such cases are toThe therapeutic goals in such cases are toreduce the bacterial content in the root canalreduce the bacterial content in the root canalsystem and changing bacterial flora.system and changing bacterial flora.


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To promote decompression of theTo promote decompression of the periperi radicularradicular

tissues by instrumentation and irrigation of thetissues by instrumentation and irrigation of the

canal.canal.

Calcium hydroxide should be placed temporarily toCalcium hydroxide should be placed temporarily to

seal the canal with a cotton pellet in the pulpseal the canal with a cotton pellet in the pulp

chamber.chamber. Endodontic treatment should be completed soon toEndodontic treatment should be completed soon to

prevent continued bacterial penetration to the canal.prevent continued bacterial penetration to the canal.

In case of a fluctuant swelling incision and drainageIn case of a fluctuant swelling incision and drainage

should be performed in conjunction with canalshould be performed in conjunction with canalinstrumentationinstrumentation


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RETREATMENT CASESRETREATMENT CASES

Endodontic retreatment may include nonsurgicalEndodontic retreatment may include nonsurgical

retreatment alone, surgicalretreatment alone, surgical endodonticsendodontics alone, oralone, or

both, i.e. nonsurgical followed by surgicalboth, i.e. nonsurgical followed by surgical

retreatment.retreatment.

The primary indication for nonsurgical retreatment isThe primary indication for nonsurgical retreatment is

failure of the initial endodontic therapy.failure of the initial endodontic therapy.

Secondary indications include clinically successful,Secondary indications include clinically successful,contaminated RCT; and technically inadequate RCT,contaminated RCT; and technically inadequate RCT,

when planned to receive a new coronal restoration.when planned to receive a new coronal restoration.


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The decision to retreat is often based on anThe decision to retreat is often based on anassumption that endodontic failure has occurred.assumption that endodontic failure has occurred.Thus, we need to have some understanding ofThus, we need to have some understanding ofreasons we categorize a case as a "failure".reasons we categorize a case as a "failure".

This is not as straightforward as it may seem,This is not as straightforward as it may seem,since the decision to call something a failure issince the decision to call something a failure isvery subjective and varies with the diagnostician.very subjective and varies with the diagnostician.In fact, several studies done in the 1960s showedIn fact, several studies done in the 1960s showedhuge variations in nonsurgical endodontic successhuge variations in nonsurgical endodontic successratesrates -- 5353--95%!95%!


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Seltzer's quote sums up the problem:Seltzer's quote sums up the problem:

There is no agreement on the definition ofThere is no agreement on the definition of

success or failure of endodontic treatment insuccess or failure of endodontic treatment in

as much as there is no agreement on criteria.as much as there is no agreement on criteria.Sam Seltzer, 1963.Sam Seltzer, 1963.


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CRITERIACRITERIA


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A retreatment plan should be developed afterA retreatment plan should be developed after

the clinician has determined the cause ofthe clinician has determined the cause of

failure and weighed other factors that mayfailure and weighed other factors that may

affect the prognosis.affect the prognosis.

Retreatment cases may require surgicalRetreatment cases may require surgical

endodonticsendodontics in combination with non surgicalin combination with non surgical

retreatment.retreatment.


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IMMATURE TEETHIMMATURE TEETH

Primary immature permanent teeth may have

pulpal pathosis caused by caries and trauma

,preserving these young teeth is essential.

Depending on the nature of the tooth

pulpotomy or pulpectomy need to be

performed to save the tooth.


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ENDODONTIC AND PERIODONTICENDODONTIC AND PERIODONTIC

CONSIDERATIONSCONSIDERATIONS

The relationship between theThe relationship between the pulpalpulpal and theand the

periodontal tissue complex begins during theperiodontal tissue complex begins during the

embryonic stage of development.embryonic stage of development.

The richly vascularised dental papillae and theThe richly vascularised dental papillae and the

surroundings, future periodontal tissue havesurroundings, future periodontal tissue have

shared circulations.shared circulations.


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Accessory canals contain connective tissue andAccessory canals contain connective tissue and

blood vessels that connect the circulatory systemblood vessels that connect the circulatory system

of the pulp with that of theof the pulp with that of the periodontiumperiodontium..

Patent accessory canals are a potential pathwayPatent accessory canals are a potential pathway

for the spread of microorganisms and their toxicfor the spread of microorganisms and their toxic

byproducts, as well as other irritants, from thebyproducts, as well as other irritants, from thepulp to the PDL and vice versa, resulting in anpulp to the PDL and vice versa, resulting in an

inflammatory process in the involved tissues.inflammatory process in the involved tissues.


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When the pulp becomes infected, it elicits anWhen the pulp becomes infected, it elicits aninflammatory response of the PDL at the apicalinflammatory response of the PDL at the apicalforamen or adjacent to openings of lateral andforamen or adjacent to openings of lateral and

accessory canals (accessory canals (Seltzer et al, 1967Seltzer et al, 1967).).

Inflammatory byproducts ofInflammatory byproducts of pulpalpulpal origin mayorigin maypermeate through the apex, lateral or accessorypermeate through the apex, lateral or accessory

canals, and dentinal tubules to trigger ancanals, and dentinal tubules to trigger aninflammatory vascular response in theinflammatory vascular response in theperiodontiumperiodontium..


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ENDODONTIC SURGERYENDODONTIC SURGERY

It may be performed as an initial treatment orIt may be performed as an initial treatment or

as a treatment procedure.as a treatment procedure.

Consideration should be given to prevent theConsideration should be given to prevent therecurrence of the problem.recurrence of the problem.


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SINGLE VISIT VERSUS MULTIVISITSINGLE VISIT VERSUS MULTIVISIT

TREATMENTTREATMENT

Debate is going about the merits of a single

visit or multivisit approach to endodontic

treatment.

An extensive body of research has sought to

determine relative success rates, pain

associated with each approach, and its

relationship to pulp vitality and the presenceof periapical oseitis


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REFERENCESREFERENCES

PATHWAYS OF THE PULP-STEPHEN COHEN

INGLE-ENDODONTICS

GROSSMAN-11 EDITION

WWW.WIKIPEDIA.COM


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Treatment Plan in endodontics

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