PubMed · 4532772
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G A Fonseca. [Pulp conservation].. https://pubmed.ncbi.nlm.nih.gov/4532772/
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There is a need in clinical dentistry for improved diagnostic methods for an accurate evaluation of pulp tissue pathosis. The purpose of this investigation was to attempt to image extracted human teeth with the aim of establishing the possible future application of magnetic resonance imaging in the diagnosis of pulpal pathosis. The results of this pilot study demonstrate that, in the in vitro setting, the outline of the tooth and pulp chamber can be imaged with a high degree of accuracy, and detailed images of the periodontal membrane and gross pulpal anatomy can be obtained. There were obvious differences in the signals given off by different locations within these teeth, and the images of the dental pulp tissue were detailed enough to suggest the possible correlation with histology. The high (9.4 T) field strengths used in this study demonstrate the in vitro application of this technology and the future possibilities for diagnosis of periodontal and odontogenic problems are significant.
Patients are sometimes referred for treatment to dentists who limit their practices to endodontics. A survey of consecutive referrals to seven such dentists was undertaken. The most common reasons for such referrals were (i) for the retreatment of a tooth with a previous root filling, (ii) because the referring dentist was unable to control pain and/or swelling, or (iii) because the referring dentist was unable to diagnose the endodontic problem. Only 60 (12.8%) of the 469 reasons reviewed were in teeth that were symptomless, uncomplicated and untouched by the referring dentist.
In essence, endodontics as a clinical discipline is concerned with the prevention and treatment of pulpal and periapical infection. In recent research the infective process has been investigated as well as the mechanisms by which the pulp and periodontium deal with microbial insults. With regard to the pulp, findings on the hemodynamics of pulpitis suggest that the inflammatory response in this tissue is much less influenced by the special anatomic environment of the tooth than was previously believed. Pulpal diseases are being underdiagnosed, mostly because of inadequate examination methods. Laser Doppler flowmetry which gives a vascular rather than a nervous response may gain importance in pulpal diagnostics in the future. It is established that apical periodontitis with bone resorption cannot develop in the absence of bacteria in the root canal system. Root canal infection is characterized by a wide variety of combinations of relatively few anaerobic bacteria, and bacterial synergism plays an important role in maintaining the infection. Microbial invasion of an apical granuloma may take place. Non-oral and environmental organisms like Pseudomonas aeruginosa are frequently isolated from treatment-resistant cases. Success of endodontic treatment depends on the reduction or elimination of the infecting bacteria. This may predictably be obtained after a thorough chemo-mechanical instrumentation and disinfection of the root canal with calcium hydroxide. The standardized technique which entails the preparation of a cylindrical apical box with removal of significant amounts of dentin near the root apex predictably gives a clean canal. This technique has provided excellent clinical and radiographic results in well documented follow-up studies.