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When fear of dental treatment is so extreme as to make the options commonly available to the general dentist (such as nitrous oxide, oral medication and psychosedation) inadequate, general anesthesia may be required. Protocol for treating patients under general anesthesia are presented, as well as two cases of such treatment.
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The principle of straight-line access is discussed with particular reference to endodontic access of either maxillary or mandibular molar teeth. Modifications to the traditional triangular access opening are described that will make it easier for a practitioner to locate and instrument the fourth canal system commonly found in molar teeth. The high frequency of a fourth canal in molar teeth makes it essential to anticipate and find all canals during molar endodontic therapy. Quite frequently, the general practitioner attempting molar endodontic therapy should expect to locate a second canal in the mesiobuccal root of the maxillary molar and a second canal in the distal root of a mandibular molar. The possibility of extra roots over and above the norm should also be anticipated and looked for carefully. Proper angulation and interpretation of radiographs help to identify chamber and root anatomy. A two-step access opening is advocated when making access openings on molar teeth if a coronal crack in the crown is to be seen early in treatment. A method of unroofing the pulp chamber and pre-flaring the canal orifice to facilitate the subsequent shaping of the entire root-canal system is described. Clinical and laboratory examples are pictured to illustrate modifications or errors in the standard endodontic access opening.
The authors have proved the desirability of vital subtotal extirpation of the pulp in experiments and clinically. Exposure to tricalcium phosphate transformed the terminal portion of the root pulp into osseocement biologic filling, obturated the apical opening and thus prevented the inflammation in the periodontium and protected it from pathologic exposures.
The arrest of a premolar bud was observed in an animal experiment that was designed to study the influence of endodontic treatment in dogs' temporary teeth on the eruption of their permanent successors. A chemical irritation was induced by the burst of ZOE (zinc oxide and eugenol) into the dental follicle. Moreover, a mechanical trauma on the temporary molar was promoted by the dog's biting on its cage metallic bars. The devitalization effects were studied in thick undecalcified ground sections which were subjected to microradiographic analysis, to UV light microscopy in order to detect the fluorescent indicators of calcification, and finally to methylene blue staining. The arrest of the bud development was noted in fluorescent microscopic examination. Cellular cementum was formed on the pulpal surface of the dentine, while cementum, chondroid tissue, woven bone and lamellar bone developed in the pulpal tissue. These observations advise caution during root canal therapy of temporary teeth, especially those that are exposed to mechanical trauma. Such as the upper incisors.
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A survey of all predoctoral pediatric dental programs in the United States was conducted to ascertain the contemporary teaching philosophies and techniques for pulp therapy in primary teeth. All 53 predoctoral programs responded to a two-part survey consisting of multiple choice questions regarding which pulp therapies and specific techniques were taught and which pulp therapies would be employed under certain hypothetical clinical scenarios. The results of the survey confirmed some lack of consensus on the selection and application of certain treatment modalities and techniques taught for primary tooth pulp therapy in predoctoral dental programs in the United States.
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Patients are increasingly wishing to undergo conventional endodontic treatment rather than to risk the loss of a tooth. Endodontic treatment in teeth that have been previously restored with extensive intracoronal or extracoronal restorations are often difficult to treat. The orientation of the root canals to the crown of the tooth may be lost, and this may often be compounded by the deposition of reparative dentin in the pulp chamber. The operating microscope allows better visualization of the working field, ensuring that the anatomy of the tooth is more readily inspected. This greatly enhances the clinician's ability to locate extra root canals and therefore increase the likelihood of a successful outcome. It should not be forgotten that the operating microscope also has a place in other fields of dentistry, especially restorative dentistry, and is an asset to both the specialist and the generalist.
The objective of this retrospective study was to determine the profile of primary teeth with pulpal involvement secondary to caries that required pulp therapy or extractions. Three hundred and ninety teeth were selected in 215 children (twelve years old and under) at an inner-city clinic in the United States over an eighteen-month period. An analysis of frequency distribution was done. Molar teeth were most affected by this stage of caries with morbidity increasing with age. In the under-six-year-olds, however, maxillary incisors were most affected. Extraction was the predominant treatment selected for the incisors with this degree of caries. Pulp therapy was the treatment of choice for molar teeth in the under-six-year-olds, but this trend was reversed with the number of extractions increasing in the six-to-twelve-year-old children.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.