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Preface and acknowledgements
Contents
 

ENDODONTICS - Vol. 1

CASTELLUCCI A.

Pages 354 - color illustrations

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Preface and acknowledgements

In the eleven years that have passed since the publication of the first edition in Italian of my book Endodontics, there has been a real explosion in new technology, new instruments and new materials, necessitating the need for revision and updating. The new rotary instruments in Nichel Titanium are widely and universally accepted, and have simplified the most complex part of the root canal treatment, namely the shaping. Their use in fact makes root canal preparation more rapid, more efficient, with results that are certainly more predictable. Consequently there is reduced stress for both patient and clinician and ultimately one can obtain a preparation that is extremely conservative having the advantage of maintaining the strength of the endodontically treated tooth and therefore increasing its longevity.

Apart from the gutta-percha vertical compaction technique described by Prof. Schilder, well known and widely used around the world, other techniques of heated filling have been affirmed or introduced in the past decade namely, the Thermafil Technique presented by Dr. Ben Johnson and the Continuous Wave Technique described by Dr. Stephen Buchanan.

A new canal obturation material has recently become available as a substitute for gutta-percha: this material is resinous with all the physical characteristics of gutta-percha (thermoplastic, soluble in chloroform) but also guarantees adhesion to the dentinal wall and therefore an even better seal.

Prof. Mamoud Torabinejad, from the Loma Linda University in California, has studied and validated a biocompatible and above all hydrophilic material for the treatment of perforations, imature apices, pulp exposures and that can also be used in surgery for retrograde filling, has literally changed the approach of operators confronted with the above clinical situations enabling large numbers of teeth to be saved, which would have otherwise been condemned to extraction or a certainly long treatment time, with a more uncertain prognosis.

Ultrasonics currently are not used exclusively for oral hygiene procedures on our patients, but have an infinite number of uses in the endodontic field, namely removal of posts and screws, the removal of calcifications, old filling material in the pulp chamber, the finishing of the access cavity, the exposure of the mesio palatine canal of the mesio buccal root of the upper first molar, the removal of fractured instruments and silver cones, as well as retrograde cavity preparation in the endodontic surgery.

But the greatest revolution that has occurred in the last decade has certainly been the widespread use of the operatory microscope. This is essentially clue to people like Gary Carr of San Diego California. Today in the specialist endodontic schools of North America and in many other parts of the world, endodontics is taught and carried out using the microscope. The canal has ceased to be "a black hole" in which one works aided by tactile sensitivity and that which one can "see" only by attentive examination of a radiograph. Currently, whatever difficulty that is present in the straight part of the root canal, even if in the most apical third, is easily seen and resolved thanks to the magnification and coaxial illumination that an operatory microscope guarantees.

The operating microscope has radicallly transformed Surgical Endodontics into a microsurgical procedure. All the surgical phases can be carried out with the use of the microscope: the incision, the root end preparation and filling as well as the suturing. This has dramatically increased the predictability of the results, improved the prognosis, raised the quality of success and by no means last, reduced the operator's stress.

In surgical endodontics the microscope enables careful examination of the accuracy of ones incision, preparation, retrograde filling and suturing, with an increase in predictability of results, and a better prognosis and higher percentage of success.

For all these reasons after eleven years since the publication of the first edition I felt the need to update it, making available to students and clinitians the necessary information. Furthermore, driven by the success which the preceeding edition also had abroad, the work is published in English with the contribution of many colleagues and friends that offered to help me with this by no means easy task.

Concerning this I would like to express my acknowledgement to the numerous Italian and foreign contributors, who with their contribution have given prestige to this work.

Therefore my thanks to:

To Dr. Mario Lendini from Turin, Italy, author of the chapter on Digital Radiography To Dr. Uziel Blumenkranz from Washington, Washington DC, coauthor of the chapter on Periapical Pathology and in particular on the section about The Cracked Tooth Syndrome To Dr. Kirk A. Coury from Amarillo, Texas coauthor of the chapter on Anaesthesia

To Dr. Stefano Patroni from Piacenza and to Dr. Paolo Ferrari from Parma, Italy, authors of the chapter on Pretreatment

To Prof. Elio Berutti from Turin, Italy, coauthor of the chapters on Endoclontic Instruments, Shaping and Cleaning and Nickel Titanium

To Prof. Giuseppe Cantatore from Rome, Italy, coauthor of the chapters on Endoclontic Instruments, Nickel Titanium and the Thermafil System

To Dr. Michael Scianamblo from San Francisco, California, author of the chapter on The Technique of Precocious Coronal Enlargement

To Dr. Clifford J. Ruddle from Santa Barbara, California, author of the chapter on The Protaper System and the chapter on Retreatment

To Dr. Stephen L. Buchanan from Santa Barbara, California, author of the chapter on The GT System and The Continuous Wave Condensation

To Dr. Richard E. Mounce from Portland, Oregon, author of the chapter on The K3 System To Dr. John T. McSpadden from Lookout Mountain, Georgia, coauthor of the chapter on The Quantec System

To Dr. Gary D. Glassman and Kenneth Serota from Toronto, Canada, coauthor of the chapter on The Quantec System

To Dr. W. Ben Johnson from Tulsa, Oklahoma, coauthor of the chapter on The Thermafil System To Prof. Vito Antonio Malagnino and to Dr. Paola Passariello from Rome, Italy, coauthors of the chapter on the Microseal System

To Dr.Ronal R. Lemon from New Orleans, Louisiana, coauthor of the chapter on Bleaching To Dr. Gary B. Carr from San Diego, California, coauthor of the chapter on Microscopes To Dr. John J. Stropko from Scottsdale, Arizona, author of the chapter on Endodontic Microsurgery To Dr. Riccardo Becciani from Florence, Italy, author of the chapter on the Testoration of the Endodontically Treated Teeth

My thanks go to Dr. lan Watson from Toronto, Canada and to Dr. John Theunissen from Massa, Italy, for their valuable help with the English translation of this work.

Furthermore I would like to express profound gratitude to my friend John D. West from Tacoma, Washington, for the touching words he has seen fit to use in the preface of this work.

Finally I would like to dedicate this book to he, whom I owe everything to, and who has literally changed the course of my life, from whom I learned everything which I am now proud to teach. That is my esteemed Teacher, Prof. Herbert Schilder.

Arnaldo Castellucci

Contents

Volume I

CHAPTER 1 - A BRIEF HISTORY OF ENDODONTICS
ARNALDO CASTELLUCCI

Bibliography


CHAPTER 2 - EMBRYOLOGY
ARNALDO CASTELLUCCI

Crown formation

Root formation

Single- and multiple-root formation

The formation of lateral canals

Exposed dentin and enamel pearls

Function and fate of dental lamina

Bibliography


CHAPTER 3 - DEFINITION, SCOPE, AND INDICATIONS FOR ENDODONTIC THERAPY
ARNALDO CASTELLUCCI

Basic phases of endodontic therapy

Indications and contraindications

True contraindications
False contraindications
True indications
Strategic endodontics

Bibliography


CHAPTER 4 - DIAGNOSIS IN ENDODONTICS
ARNALDO CASTELLUCCI

Subjective information

Medical history
Dental history

Objective information

Examination
Percussion
Palpation
Radiographic examination
Thermal tests
Electric pulp test
Cavity test
Anesthesia test
Transillumination
Bite test

Bibliography


CHAPTER 5 - ENDODONTIC RADIOGRAPHY
ARNALDO CASTELLUCCI

Basic principles of radiology

Principles of x-ray formation

The quality of the radiograph

Factors controlling the x-ray beam

Kilovoltage
Exposure time
Milliamperage
Filter
Collimator
Target-object distance

Basic principles of image formation

Image sharpness
Image magnification
Image distortion

Intraoral radiographic techniques

Bisecting angle technique
Paralleling technique

Spatial localization: buccal object rule

Radiographic orientation

Endoral radiographic examinations

A) Preoperative or diagnostic radiographs

Upper incisors
Upper canine
Upper premolars
Upper molars
Lower incisors
Lower canine
Lower premolars
Lower molars

B) Intraoperative radiographs

Upper incisors and canines
Upper premolars
Upper molars
Lower incisors and canines
Lower premolars
Lower molars

Common causes of errors

1) Light radiographs
2) Dark radiographs
3) Radiographs with poor contrast
4) Dark stains
5) Light stains
6) Yellow or brown stains
7) Blurry radiographs
8) Radiographs with partial images

Protection of the patient, dentist, and auxiliary personnel

Bibliography


CHAPTER 6 - DIGITAL RADIOGRAPHY SYSTEMS (DRS)
MARIO LENDINI

Origins and technological evolution

Features of the DRS image

Reading and processing of DRS images
Quality of DRS images
Hardware
Acquisition Sensors
Software

Execution and processing time

Supplied dosage

Adaptation and repetitiveness

Filing

Large formats

Bibliography


CHAPTER 7 - PULPAL PATHOLOGY
ARNALDO CASTELLUCCI

The reparative capacity of pulp tissue

Pulpal diseases

Clinical classification
Healthy pulp
Hyperemia

Clinical symptoms
Diagnosis
Therapy

Pulpitis

Symptomatology
Diagnosis
Pulp tests
Radiographic examination
Therapy

Necrosis

Symptomatology
Radiographic examination
Pulp tests
Therapy

Vital pulp therapy

Pulp capping with MTA
Operative sequence for pulp capping

Bibliography


CHAPTER 8 - PERIAPICAL DISEASE
ARNALDO CASTELLUCCI, UZIEL BLUMENKRANZ

The reparative capacity of periapical tissues

Classification of the lesionsof encloclontic origin

Chronic apical periodontitis

Granuloma and cyst
Granuloma

Cysts

Reactivation of chronic apical periodontitis
Acute apical periodontitis
Acute alveolar abscess

The Cracked-Tooth Syndrome

Introduction
Definition

Cracked tooth syndrome

Etiology
Symptoms
Clinical findings
Diagnosis
Classification
Treatment
Class I
Class II
Class III
Class IV

Conclusion

Bibliography


CHAPTER 9 - USE OF ANESTHESIA IN ENDODONTICS
ARNALDO CASTELLUCCI, KIRK A. COLIRY

Topical anesthesia

Local infiltration

Regional anesthesia or nerve blocks

Inferior alveolar nerve block

Indirect technique
Direct technique

Mental nerve block
Nasopalatine nerve block
Anterior palatine nerve block

Supplemental anesthetic techniques

Anesthetic solutions and inflammation
Lingual infiltration
Intraseptal injection
Intraligamental infiltration
Intrapulpal infiltration

Intraosseous anesthesia

The intraosseous technique

Step 1: anesthetize the attached gingiva
Step 2: Cortical plate perforation
Step 3: Injecting into the cancellous bone

Dosage reccomendations
Duration of anesthesia
Considerations for intraosseous anesthesia

Anatomical considerations

Patient considerations
Other considerations

Bibliography


CHAPTER 10 - TOOTH ISOLATION: THE RUBBER DAM
ARNALDO CASTELLUCCI

Instruments

1) Rubber dam
2) Rubber dam punches
3) Rubber dam clamps
4) Rubber dam clamp forceps
5) Rubber clam frame
6) Lubricant
7) Rubber dam napkins
8) Dental floss
9) Assistant

Positioning of the dam

Bibliography


CHAPTER 11 - ACCESS CAVITY AND ENDODONTIC ANATOMY
ARNALDO CASTELLUCCI

Requirements of the access cavity

Rules for the preparation of an adequate access cavity

General principles for the preparation of the access cavity

Penetration phase
Enlargement phase
Finishing and flaring phase

Upper central incisor

Upper lateral incisor

Upper canine

Upper first premolar

Upper second premolar

Upper first molar

Upper second molar

Upper third molar

Lower central incisor

Lower lateral incisor

Lower canine

Lower first premolar

Lower second premolar

Lower first molar

Lower second molar

Lower third molar

The access cavity in prosthetically prepared teeth

The access cavity through prosthetic crowns

Common errors in the preparation of the access cavity

Errors related to inadequate preparation
Errors related to over-aggressive preparation

Bibliography

CHAPTER 12 - TREATMENT: PREPARATION TECHNIQUES FOR ENDODONTIC THERAPHY
STEFANO PATRONI, PAOLO FERRARI

Introduction

Pretreatment

Modern indications forendodontic pre-treatment

Classification

Periodontal pretreatment

Gingivectomy-gingivoplasty
The apically repositioned flap

Prosthetic restorative pretreatment

Hollow posts

Conservative restorative pretreatment

Reconstruction of the fourth wall
Copper and orthodontic bands
Amalgam anchored with posts or amalgam pins

Pre-endodontic composite

Orthodontic pretreatment

Bibliography