Table Of Content

Essential Endodontology Essential Endodontology Prevention and Treatment of Apical Periodontitis Third Edition Edited by Dag Ørstavik cand. odont. & dr. odont. Professor Emeritus Department of Endodontics Institute of Clinical Dentistry University of Oslo Oslo, Norway This edition first published 2020 © 2020 John Wiley & Sons Ltd Edition History Blackwell Munksgaard Ltd (2e, 2008), Blackwell Science Ltd (1e 1998) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Dag Ørstavik to be identified as the author of the editorial material in this work has been asserted in accordance with law. 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Title: Essential endodontology : prevention and treatment of apical periodontitis / edited by Dag Orstavik. Description: 3rd edition. | Hoboken, NJ : Wiley-Blackwell, 2020. | Includes bibliographical references and index. Identifiers: LCCN 2019026638 (print) | ISBN 9781119271956 (hardback) | ISBN 9781119271970 (adobe pdf) | ISBN 9781119271994 (epub) Subjects: MESH: Periapical Periodontitis–prevention & control | Periapical Periodontitis–therapy | Endodontics Classification: LCC RK450.P4 (print) | LCC RK450.P4 (ebook) | NLM WU 242 | DDC 617.6/32–dc23 LC record available at https://lccn.loc.gov/2019026638 LC ebook record available at https://lccn.loc.gov/2019026639 Cover Design: Wiley Cover Image: © Dag Ørstavik Set in 10/12pt Warnock by SPi Global, Pondicherry, India 10 9 8 7 6 5 4 3 2 1 v Contents Foreword ix List of Contributors xi About the Companion Website xiii 1 Apical Periodontitis: Microbial Infection and Host Responses 1 Dag Ørstavik 1.1 Introduction 1 1.2 Terminology 1 1.3 Pulp Infection and Periapical Inflammation 3 1.4 Biological and Clinical Significance of Apical Periodontitis 4 1.5 Concluding Remarks 7 References 8 2 Dentin‐Pulp and Periodontal Anatomy and Physiology 11 Leo Tjäderhane and Susanna Paju 2.1 Introduction 11 2.2 Dentin 11 2.3 Pulp Tissue and its Homeostasis 22 2.4 Pulp Inflammation 27 2.5 Pulp Nociception and Hypersensitivity 32 2.6 Age‐related Changes in Dentin‐pulp Complex 34 2.7 The Periodontium 39 2.8 The Periodontal Ligament (PDL) 39 2.9 Cementum 44 2.10 Alveolar Bone 46 References 49 3 Etiology and Pathogenesis of Pulpitis and Apical Periodontitis 59 Ashraf F. Fouad and Asma A. Khan 3.1 Introduction 59 3.2 Etiology of Pulpitis and Apical Periodontitis 60 3.3 Inflammation Versus Infection of the Pulp and Periapical Tissues 61 3.4 The Dental Pulp 62 vi Contents 3.5 T he Periapical Tissues 70 3.6 C oncluding Remarks 79 References 80 4 Microbiology of Apical Periodontitis 91 José F. Siqueira Jr and Isabela N. Rôças 4.1 I ntroduction 91 4.2 M icrobial Causation of Apical Periodontitis 91 4.3 E ndodontic Biofilms and the Community‐as‐Pathogen Concept 95 4.4 M echanisms of Bacterial Pathogenicity 102 4.5 M icrobial Ecology and the Root Canal Ecosystem 105 4.6 T ypes of Endodontic Infections 110 4.7 I dentification of Endodontic Bacteria 111 4.8 E ndodontic Biofilm Community Profiles 115 4.9 M icrobiota in the Apical Root Canal 116 4.10 Symptomatic Infections 117 4.11 P ersistent/Secondary Endodontic Infections 120 4.12 Extraradicular Infections 123 4.13 O ther Microorganisms in Endodontic Infections 125 References 127 5 Epidemiology, Treatment Outcome, and Risk Factors for Apical Periodontitis 143 Lise‐Lotte Kirkevang and Michael Vaeth 5.1 I ntroduction 143 5.2 G eneral Aspects of Epidemiology 144 5.3 E lements of an Epidemiologic Study 155 5.4 E valuation of Epidemiologic Data 157 5.5 F actors and Conditions Associated with Treatment Outcome 160 References 169 6 Radiology of Apical Periodontitis 179 Shanon Patel and Conor Durack 6.1 I ntroduction 179 6.2 N ormal Apical Periodontium 180 6.3 R adiographic Appearance of Apical Periodontitis 190 6.4 Healing Characteristics 194 6.5 Conventional Radiography for Assessment of Apical Periodontitis 195 6.6 Advanced Radiographic Techniques for Endodontic Diagnosis 195 6.7 Differential Diagnosis 197 6.8 CBCT for Assessment of AP 202 6.9 Concluding Remarks 204 References 204 7 Clinical Manifestations and Diagnosis 211 Asgeir Sigurdsson 7.1 I ntroduction 211 7.2 P ulpal Diagnostic Terms 212 7.3 S ymptomatology of Pulpal Disease 213 Contents vii 7.4 Clinical Findings 216 7.5 Diagnostic Testing 217 7.6 Formulation of a Pulpal Diagnosis 223 7.7 Periapical Diagnosis 225 7.8 Symptomatology of Periapical Disease 226 7.9 Formulation of a Periapical Diagnosis 230 7.10 Future of Pulpal and Periapical Diagnosis 231 References 231 8 Biological Basis for Endodontic Repair and Regeneration 237 Kerstin M. Galler 8.1 Principles of Regeneration and Repair 237 8.2 Vital Pulp Therapy 238 8.3 Cell Types Involved in Pulp Healing 239 8.4 The Role of Inflammation 242 8.5 Signaling Molecules in Dentine 243 8.6 Tissue Engineering Approaches to Dental Pulp Regeneration 245 References 248 9 Prevention: Treatment of the Exposed Dentine Pulp Complex 253 Lars Bjørndal 9.1 Diagnostic Challenges of Deep Caries and Traumatic Pulp Exposure 253 9.2 Discerning Pulpal Diagnosis 254 9.3 The Pulp Biology Associated with Pulp Capping 257 9.4 Criteria for Assessing Success of Vital Pulp Therapies 259 9.5 Indirect Pulp Capping and Stepwise Excavation 259 9.6 Pulp Capping of the Uninflamed Pulp (Class I) 261 9.7 Pulp Capping of the Cariously Involved Pulp (Class II) 261 9.8 Partial Pulpotomy 261 9.9 Pulpotomy 262 9.10 Treatment Details for Pulp‐preserving Techniques 263 9.11 The Available Evidence for Relative Merit of Treatment Procedures for Vital Pulps 264 9.12 Future Perspectives of More Advanced Biological Approaches 270 References 270 10 Vital Pulp Extirpation 275 John Whitworth 10.1 Introduction 275 10.2 Pulpectomy – Definition and Rationale 275 10.3 The Challenge of Effective Local Anesthesia 277 10.4 Principles of Effective Pulpectomy 278 10.5 Canal Shaping 283 10.6 Canal Irrigation and Medication 294 10.7 Preserving the Aseptic Environment: Root Canal Filling and Coronal Restoration 299 10.8 Concluding Remarks 304 References 304 viii Contents 11 Endodontic Treatment of Apical Periodontitis 313 Dag Ørstavik 11.1 Introduction 313 11.2 A natomic Location of the Microbes 314 11.3 B acteriological Status During Treatment 316 11.4 I nfection Control During Treatment 318 11.5 R oot Filling Phase 323 11.6 C linical Issues During Diagnosis and Treatment of Primary Apical Periodontitis 326 11.7 T reatment of Persistent or Recurrent Apical Periodontitis 327 11.8 T reatment of Immature Permanent Teeth with Apical Periodontitis 328 11.9 M onitoring Healing, Prognostication 329 11.10 C oncluding Remarks 330 R eferences 331 12 Surgical Endodontics 345 Frank C. Setzer and Bekir Karabucak 12.1 Introduction, Including History 345 12.2 S urgical Endodontic Procedures 346 12.3 Indications 346 12.4 Contraindications 348 12.5 G eneral Preparations for Surgery 348 12.6 Anesthesia 349 12.7 Surgical Anatomy 351 12.8 C linical Steps in Root‐end Surgery 354 12.9 Perforation Repair 363 12.10 R eplantation 363 12.11 R oot Amputation, Hemisection 364 12.12 G uided Tissue Regeneration 366 12.13 R etreatment of Failed Surgical Cases 367 12.14 M odes of Healing 368 12.15 O utcome of Surgical Endodontics 368 References 372 Index 387 ix Foreword Two infections affect the survival of teeth: to promote ever better approaches to its those of the gingival/periodontal and pulpal/ diagnosis, prevention, and therapy. apical periodontal tissues. The pain and loss One might ask if there is still a need for of function that come with severe forms of textbooks of this kind. Any student or prac- either disease may also severely impair the titioner can access the most advanced, novel quality of life in affected individuals. techniques and methods, as well as scientific Infections of the pulp and periapical tissues publications, directly on social media or belong to the domain of endodontology. from public databases. However, one may While other conditions and diseases form argue that there is an even greater need for important part of the discipline, treatment of the more advanced, basic text today than teeth with pulpitis or apical periodontitis by before. The figure illustrates the explosion root fillings or apical surgery constitute by in the number of publications related to far the most important part. endodontics in recent years. In the decade Essential Endodontology seeks to integrate leading up to the second edition in 2008, the basic, biological, and microbiological knowl- number of new endodontic publications edge of apical periodontitis with diagnostic was up by 38 per cent from the decade and treatment practices. The emphasis of the before. In the next 10 years, the increase was book remains the same as before. It focuses 125 per cent, totaling 14,685 publications. on the biology and clinical features of endo- It is clear that the total scientific contribu- dontology’s most important disease in order tions to the discipline now far outnumbers 16000 14685 12000 8000 6525 4454 4712 4040 4000 0 1968–1977 1978–1987 1988–1997 1998–2007 2008–2017 Figure: The number of publications listed in PubMed (US National Library of Medicine, National Institutes of Health) with the search term “endodontics” during the past five decades. x Foreword what any researcher, scientist, or clinician can The 2008 edition was hardly a year out in possibly read or absorb. It is also impossible print before the co‐editor of both previous for a novice in the field to navigate in an area editions, Thomas R. Pitt Ford, passed away. where the quality of available information His contributions to the previous two editions will be highly variable. Thus, a compressed were a sine qua non for their completion, and basis of knowledge provided by experts in his professional and personal qualities were their fields is essential as a starting point for sorely missed in the preparation of this third further studies, and provides a backbone of edition. I hope that the reader will find the knowledge and insights. The target audience spirit from the previous editions prevailing for the book remains postgraduate students, in the present, and recognize the focus on teachers, and researchers focusing on endo- quality and depth that was Tom Pitt Ford’s dontology. Essential Endodontology will also hallmark. serve as a supplement for undergraduate students of endodontics. Dag Ørstavik