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Essential Endodontology
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Table of Contents

Foreword ix List of Contributors xi About the Companion Website xiii 1 Apical Periodontitis: Microbial Infection and Host Responses 1 Dag Orstavik 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 Tjaderhane 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 3.5 The Periapical Tissues 70 3.6 Concluding Remarks 79 References 80 4 Microbiology of Apical Periodontitis 91 Jose F. Siqueira Jr and Isabela N. Rocas 4.1 Introduction 91 4.2 Microbial Causation of Apical Periodontitis 91 4.3 Endodontic Biofilms and the Community?as?Pathogen Concept 95 4.4 Mechanisms of Bacterial Pathogenicity 102 4.5 Microbial Ecology and the Root Canal Ecosystem 105 4.6 Types of Endodontic Infections 110 4.7 Identification of Endodontic Bacteria 111 4.8 Endodontic Biofilm Community Profiles 115 4.9 Microbiota in the Apical Root Canal 116 4.10 Symptomatic Infections 117 4.11 Persistent/ Secondary Endodontic Infections 120 4.12 Extraradicular Infections 123 4.13 Other 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 Introduction 143 5.2 General Aspects of Epidemiology 144 5.3 Elements of an Epidemiologic Study 155 5.4 Evaluation of Epidemiologic Data 157 5.5 Factors and Conditions Associated with Treatment Outcome 160 References 169 6 Radiology of Apical Periodontitis 179 Shanon Patel and Conor Durack 6.1 Introduction 179 6.2 Normal Apical Periodontium 180 6.3 Radiographic 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 Introduction 211 7.2 Pulpal Diagnostic Terms 212 7.3 Symptomatology of Pulpal Disease 213 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 Bjorndal 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 11 Endodontic Treatment of Apical Periodontitis 313 Dag Orstavik 11.1 Introduction 313 11.2 Anatomic Location of the Microbes 314 11.3 Bacteriological Status During Treatment 316 11.4 Infection Control During Treatment 318 11.5 Root Filling Phase 323 11.6 Clinical Issues During Diagnosis and Treatment of Primary Apical Periodontitis 326 11.7 Treatment of Persistent or Recurrent Apical Periodontitis 327 11.8 Treatment of Immature Permanent Teeth with Apical Periodontitis 328 11.9 Monitoring Healing, Prognostication 329 11.10 Concluding Remarks 330 References 331 12 Surgical Endodontics 345 Frank C. Setzer and Bekir Karabucak 12.1 Introduction, Including History 345 12.2 Surgical Endodontic Procedures 346 12.3 Indications 346 12.4 Contraindications 348 12.5 General Preparations for Surgery 348 12.6 Anesthesia 349 12.7 Surgical Anatomy 351 12.8 Clinical Steps in Root?end Surgery 354 12.9 Perforation Repair 363 12.10 Replantation 363 12.11 Root Amputation, Hemisection 364 12.12 Guided Tissue Regeneration 366 12.13 Retreatment of Failed Surgical Cases 367 12.14 Modes of Healing 368 12.15 Outcome of Surgical Endodontics 368 References 372 Index 387

About the Author

Dag Orstavik is Professor Emeritus of Endodontology at the Institute of Clinical Dentistry, University of Oslo, Oslo, Norway. From 2004 until 2017, he was Head of the Department of Endodontology and responsible for the undergraduate and specialty training programs in endodontics at the Dental Faculty.

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