Definition and scope of endodontics, indications d

Introduction and Scope of Endodontics

Endo is a Greek word for “Inside” and Odont is Greek word for “Tooth”. Endodontic treatment treats inside of the tooth.
Definition: American association of endodontic define (endodontics) as:Branch of dentistry concerned with the morphology, physiology, and pathology of human dental pulp and periradicular tissues.

Objectives of Endodontic Treatment

The basic objective of endodontic treatment is total debridement of the pulp space and development of an impermeable fluid tight seal at the apex. OBTURATION, the multi dimensional sealing of the entire root canal system is one of the important step in endodontic procedure.
Other objectives include:
Relief of pain = symptom free
To render the affected tooth biologically acceptable and functioning without a diagnosable pathosis
Removal of pulp from root(s) of tooth
Disinfections of root and surrounding bone
Root canal treatment is an attempt to retain a tooth which may otherwise require extraction.
Scope of endodontics include the followings:
Differential diagnosis and treatment of oral pains of pulp and / or periapical origion.
Vital pulp therapy such as pulptomy.
Root canal therapy such as pulpectomy, non surgical treatment of root canal system with or without periapical pathosis of pulpal origin and the obturation of these root canal systems
Selective surgical removal of pathological tissues resulting from pulpal pathosis.
Replantation of avulsed tooth.
Surgical removal of tooth structure as in hemisection, and root amputation.
Endodontic implants
Bleaching of discolored teeth.
Retreatment of teeth previously treated endodontically.
Treatment procedure related to coronal restoration by means of post and core involving root canal space.
Basic phases of endodontic therapy:
Diagnosis phase: in which the cause of disease is identified and the treatment plan is pepared.
Preparatory phase: in which, by cleaning and shaping of the canal space, the root canal contents are removed and the canal is shaped to receive root filling.
Obturation phase: in which the root canal is filled three dimensionally to ensure tight seal.

Indications of endodontic therapy:
Every tooth, from central incisor to third molar, is a potential candidate for treatment. The concept of retaining every possible tooth, and even the healthy roots of periodontally involved teeth, is based on the even distribution of the forces of mastication.
The final success of any extensive restorative procedure depends on the root-surface area attached through the periodontal ligaments to the alveolar bone.
To carry this concept one step further, recognized today is the importance of retaining even endodontically treated roots, over which may be constructed a full denture, the so-called overdenture. On some occasions, attachments may be added to these roots to provide additional retention for the denture above. At
other times, the treated roots are merely left in place on the assumption that the alveolar process will be retained around roots, and there will not be the usual
ridge resorption so commonly seen under full or even partial dentures.


However, some of the indications may include:
1-Teeth with pulpal and /or priapical pathosis. e.g acute or chronic pulpitis, periapical granuloma,….etc.
2-Teeth with no pulpal or periapical pathosis may need endodontic treatment due to:
a-The need for post and core construction to rebuild the missing coronal portion of the tooth
b-Traumatic pulp exposure due to dental work or accidental fracture.
c-Internal or external resorption.
d-Over erupted and mesially drifted teeth when crown reduction may cause pulp exposure.
e-Teeth retained in the mouth to support overlay denture
f-Esthetic requirement.

Intentional Endodontics:

Occasionally, intentional endodontics of teeth with perfectly vital pulps may be necessary. Examples of situations requiring intentional endodontics include
hypererupted teeth or drifted teeth that must be reduced so drastically that the pulp is certain to be involved. On other occasions, a pulp is intentionally removed and the canal filled so that a post and core may be placed for increased crown retention. In these cases, the endodontic treatment may be completed
before tooth reduction is started. Over and above these quite obvious indications for intentional endodontics, it has been recommended that pulpectomy and root canal filling be done for vital teeth badly discolored by tetracycline ingestion.
Following root canal therapy, internal bleaching may be carried out.

Some factors that may affect the indications of root canal treatment:

1. Social factors: such as:
-Lack of time (patient, doctor)
-Economic constraints
-Restless patient (Down syndrome, Parkinsonism)
-Lack of interest from the patient
-Poor hygiene
-Patient prefers other solution (denture, fixed bridge)
2. Age of the patient.
3. General health status of the patient( e.g. systemic diseases, pregnancy)


Contraindications of endodontic therapy:
In theory( there are no contraindication of endodontic therapy) Especially if the tooth is periodontally sound or can be cured. and the apical foramen or foramenae can be sealed. However, an advanced and untreatable periodontal diseases and vertical root fracture are absolute contraindication of endodontic therapy.

There are some CONTENDED contraindication for root canal therapy:

1-Teeth with large periapical lesion.
2-Teeth with root resorption.
3- Non restorable teeth which can not properly function after endodontic treatment.
4-Non strategic teeth which can not serve in occlusion or as abutments after endodontic treatment.e.g. wisdom teeth
5- Teeth with root canals not suitable for instrumentation and /or periapical surgery such as calcified or severely curved canals.
6- Patients with systemic conditions contraindicates surgical endodontics.
7- Deep root caries
9- Presence of broken instrument.
10- Presence of calcification
11- Anatomical difficulties: e.g. presence of severe dilacerated root or pulp stones
12- Difficulty of treatment: Presence of silver cone within the canal.Presence of ceramic crown covering the crown (to overcome these problems surgical intervention is indicated or removal of the old root canal filling)
13- size of the lesion :
Pulp pathosis→periapical lesion(abcess →granuloma →cyst)(The smaller the lesion, the more is the prognosis)

Considerations prior to endodontic therapyA B

Although it is true that root canal treatment can be performed on virtually any tooth in the mouth, there are some important considerations that must be evaluated prior to recommending root canal treatment:
1. Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis?
2. Is the tooth salvageable, or is it so badly damaged it cannot be restored?
3. Is the entire dentition so completely broken down it would be virtually impossible to restore?
4. Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement?
5. Is the tooth so severely involved periodontally that it would be lost soon for this reason?
6. Is the practitioner capable of performing the needed endodontic procedures?