What’s the Basis for Successful Endodontic Treatment

Root canal shaping is one of the most important steps in canal treatment. It is essential to determine the efficacy of all subsequent procedures, including chemical disinfection and root canal obturation are the basis for successful endodontic endo motor treatment, aiming to debride the root canal, to remove contaminated dentin, and to create an ideal canal shape for three-dimensional filling .

The main objective of a clinician is to mechanically and chemically cleanse the root canal system thoroughly, making it free of microorganisms and their substrates.

The root with a graceful tapering canal and a single apical foramen has long been established as an exception rather than the rule. Bifurcating canals, multiple foramina, fins, deltas, loops, cul-de-sacs, intercanal links, C-shaped canals, and accessory canals have most commonly been faced by the investigators in most teeth .

The instrumentation of the apical matrix to a large size leads to more anatomical irregularities and increases irrigant exchange in the apical third. Apical enlargement during canal cleaning and shaping procedures increases the likelihood of achieving maximum elimination of bacteria from root canal system , though a major part of the canal remains uncleaned even after thorough cleaning and shaping .

Until recently, most investigations have involved counting the number of canals and foramina and categorizing how the canals join or split. Majority of studies have tried to evaluate the shape of the canal systems( root canal treatment equipment ) and its clinical implications than to evaluate the actual preoperative size of the canal .

However, it is recommended not to widen the root canal to a larger extent to avoid unnecessary weakening of the root and increased risk of fracture. Regarding modern concepts, the final canal allows adequate irrigation and close adaptation of the filling material during obturation . Working width (WW) is relatively new concept, which involves perceiving a root canal in both perpendicular (working length) and horizontal (WW) dimensions. Thus, endodontic ―working width‖ has always remained unforgotten dimension during root canal procedure without solid scientific evidence; however, it is still not clear ―how large is enough.

What’s the Diagnosis of Endodontics Depends On

November 4, 2016 (Newswire) –Diagnosis, treatment planning and clinical outcome assessment in endodontics depend to a large extent on radiographic examinations. Conventional periapical radiographs, either captured on conventional x-ray film( dental x ray machine portable ) or digital are used for the management of endodontic problems provide limited information because of the combination of their two dimensional nature, geometric distortion, anatomical noise, and temporal perspective.

Useful information such as the presence, location and extent of periradicular lesions, the anatomy of root-canals( root canal treatment equipment ) and the proximity of adjacent anatomical structures provided by periapical radiographs are exposed during endodontic treatment procedures . Inspite of widespread use periapical images, either captured on x-ray film or digital sensors, provide limited information .

The most important limitation of periapical radiographs is that they do not always accurately reflect the anatomy being assessed because of the complexity of the maxillofacial skeleton . In endodontic practice, radiographs are recorded using the paralleling technique / long-cone or right-angle technique, instead of the bisecting angle technique, as it produces more geometrically accurate images.

For accurate reproduction of anatomy in the paralleling technique, the radiographic film or RVG sensor should be placed parallel to the long axis of the tooth, and the x-ray beam should be directed perpendicular both to the image receptor and the tooth being assessed. The lack of long-axis orientation results in geometric distortion of the radiographic image.

Another important principle in endodontic radiology is to display the structures of diagnostic interest onto a background as homogeneous as possible . However, the anatomical structures surrounding the tooth may superimpose and cause difficulty in interpreting periapical radiographs.Various studies have demonstrated the difficulty of radiographically visualizing the periapical lesions confined to the cancellous bone, as the denser overlying cortical plate masks the area of interest.

Anatomical noise also accounts for some underestimation of the size of periapical lesion on radiographic images .Anatomical noise is dependent on several factors such as non-optimal irradiation geometry, overlying anatomy,the thickness of the cancellous bone and cortical plate, and the relationship of the root apices to the cortical plate.

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A Brief Introduction of the Generation of Dental Apex Locator

The development of the electronic apex locator (EAL) has helped make the assessment of

working length more accurate and predictable, particularly useful when the apical portion of

the canal system is obscured by certain anatomic structures:Impacted teeth, tori ,zygomatic

arch, excessive bone density, overlapping roots and shallow palatal vault.
The objective of working length determination is to establish the length (distance from the

apex) at which canal preparation and subsequent obturation are to be terminated. Methods

for determining working length are radiographs , electronic apex locators, tactile sense,

mathematics method, apical periodontal sensitivity, paper points, microscopic magnification

and average tooth length.

 

Root canals are surrounded by dentine and cementum that are insulators to electric current.

At the apical foramen there is a small hole in which conductive materials within the canal are

electrically connected to the periodontal ligament that is a conductor of electric current. The

resistive material of the canal (dentine, tissue, fluid) with a particular resistivity forms a

resistor, the value of which depends on the length, cross-sectional area and the resistivity of

the materials .

 

The first generation: Resistance between the periodontium and the oral mucous membrane in humans was

constant at 6.5 K Ohm, regardless of the age of the patients or the shape and type of teeth.

Contents of the canal (vital pulp tester vs. necrotic pulp) also had no effect upon the resistance.

First-generation apex location devices measure the opposition to the flow of direct current

or resistance. The resistance was measured between the two electrodes to determine

location within a canal. Pain was often felt with this type of apex locator.
Second-generation apex locatorsmeasure the opposition to the flow of alternating current or

impedance.This generation contains 2 types of apex locator: low frequency and high

frequency apex locator. Low frequency AL is based on the assumption that the impedance

between the oral mucous membrane and the depth of the gingival sulcus closely resembles

the impedance between the canal terminus and the oral mucous membrane.

 

The 3rd generation apex locator has been called “frequency dependent” apex locators. This

type was supplied by 2 frequencies to measure the impedance in the canal. There are 2

types of the 3rd generation ALs: impedance difference type and impedance ratio type.

Impedance difference AL measures the impedance value at two different frequencies and

calculates the difference between the two values (Yamashita, 1990) while impedance ratio

type measured the position of the file from the ratio between these two impedances.

 

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