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Rationale of Endodontics

The document discusses the rationale behind endodontic therapy, emphasizing the importance of addressing endodontic diseases caused by injuries to the tooth that lead to irreversible changes in the pulp and surrounding tissues. It outlines the process of endodontic treatment, including debridement and obturation, to eliminate infection and promote healing. The document also references theories of infection spread and inflammation responses relevant to endodontic practices.

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Parvathy Nair
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5 views26 pages

Rationale of Endodontics

The document discusses the rationale behind endodontic therapy, emphasizing the importance of addressing endodontic diseases caused by injuries to the tooth that lead to irreversible changes in the pulp and surrounding tissues. It outlines the process of endodontic treatment, including debridement and obturation, to eliminate infection and promote healing. The document also references theories of infection spread and inflammation responses relevant to endodontic practices.

Uploaded by

Parvathy Nair
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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RATIONALE OF

SUBMITTED BY
LAKSHMY S
ENDODONTICS
CONTENTS
• INTRODUCTION
• PATHOGENESIS OF ENDODONTIC DISEASE
• THEORIES OF SPREAD OF INFECTION
• PORTALS FOR ENTRY OFMICROORGANISMS
• INFLAMMATION
• FISH ZONES OF REACTION TO INFECTION
• KRONFELD’S MOUNTAIN PASS THEORY
• RATIONALE OF ENDODONTIC THERAPY
• CONCLUSION
• REFERENCE
INTRODUCTION
• The word “Rationale” means fundamental reason or logical basis.
• The word “Endodontics” : endo-inside , odont- teeth
• Definition of Endodontics - branch of dentistry that is concerned with
the morphology, physiology and pathology of the human dental pulp
and peri radicular tissues.
PATHOGENESIS OF ENDODONTIC DISEASE
• Endodontic pathology is mainly caused by injury to the tooth which can be
physical, chemical or bacterial.

• Such injury can result in reversible or irreversible changes in the pulp and
peri radicular tissues.

• The resultant changes depend on the intensity, duration, pathogenicity of


the stimulus, and the host defense mechanism.

• The changes that occur are mediated by a series of inflammatory and


immunological reactions. All these reactions take place to eliminate the
irritant and repair any damage.
• However, certain conditions are beyond the reparative ability of the
body and need to be treated endodontically to aid the survival of tooth.

• Rationale of endodontic therapy is complete debridement of root canal


system followed by three-dimensional obturation.
THEORIES OF SPREAD OF INFECTION

• FOCUS OF INFECTION: it refers to a circumscribed area of


tissue, which is infected with exogenous pathogenic
microorganisms and is usually located near a mucous or cutaneous
surface.

• FOCAL INFECTION: it is localized or general infection caused


by the dissemination of microorganisms or toxic products from
focus of infection.
PORTALS FOR ENTRY OF
MICROORGANISMS
• Dental caries
• Open dentinal tubules
• Accessory and lateral canals which connect pulp and periodontium
• Through defective restorations which marginal leakage
• Anachoresis (microorganisms are transported in blood to an area of
inflammation where they establish an infection).
INFLAMMATION
• Inflammation is defined as a local physiological response of living tissue to an
irritant or injury.
• Objective of inflammation is to eliminate the irritant and repair damage to the
tissues.
• Inflammation can result from:
i. Physical agents like cold, heat, mechanical trauma or radiation.
ii. Chemical agents like organic and inorganic poisons
iii. Infective agents like bacteria, viruses and their toxins
iv. Immunological agents like antigen-antibody cell mediated responses.
• SIGNS OF INFLAMMATION:
Roman writer Celsius gave four cardinal signs of inflammation (Celsius Tetrad):
1. Rubor (redness)
2. Tumor (swelling due to filtration of macromolecules and fluids in affected area)
3. Calor, i.e., Heat (due to vasodilatation and blood inflow in affected area)
4. Dolor (pain due to effect of cytotoxic agents on nerve endings)
Virchow later added the fifth sign function lasea (loss of function due to changes
in affected tissue)

o TYPES OF INFLAMMATION:
- Acute inflammation (dominated by polymorphonuclear neutrophils and
macrophages)
- Chronic inflammation (dominated by lymphocytes, macrophages and plasma
cells)
• TISSUES CHANGES FOLLOWING INFLAMMATION
Two types of tissue changes are seen following inflammation:
a) Degenerative changes in the pulp can be
-Fibrous
-Resorptive
-Calcific
-Suppuration
b) Proliferative changes
• Irritants are mild and act as stimulants or both irritant and
stimulant, for example, Calcium hydroxide.
• In center of the inflamed area, the irritant may be strong enough
to produce degeneration or destruction, whereas at the periphery,
irritant may be mild enough to stimulate proliferation.
• Principal cells of proliferation or repair are the fibroblasts.
FISH ZONES OF REACTION TO INFECTIONS
• In 1939, Dr, W E Fish recognised four zones of reaction formed in
response to bacteria
• According to Fish, the microbes are confined by
polymorphonuclear neutrophil leukocytes to a zone of infection.
• Four zone of reaction are:
a) Zone of infection
b) Zone of contamination
c) Zone of irritation
d) Zone of stimulation
1. Zone of necrosis:
• Infection is present In the center of the lesion
• Microorganisms are found in this zone
• Characterized by polymorphonuclear leukocytes

2. Zone of contamination:
• Characterized by round cell infiltration.
• Cellular destruction from the toxins discharged from central zone
is observed
• Bone cells are dead and might undergo autolysis which results in
empty appearance of lacunae.
3.Zone of irritation:
oIt is characterized by macrophages, histocytes and osteoclasts
oFound away from central lesion
oSmall round cells, normal bone cells can be seen.
oDegradation of collagen framework by phagocytic cells and
macrophages, while osteoclasts attacking the bone tissue is found.

4.Zone of stimulation:
oCharacterized by fibroblasts and osteoblasts
oAt the periphery, toxin is mild enough to be a stimulant
•Response to this stimulation, collagen fibers get laid down by
fibroblasts, which acts both as a wall of defense around the zone of
irritation and as a scaffolding on which the osteoblasts built new
bone.

 According to his concept, periapical lesion is not an infection by


itself but the reaction of body to infection in the canal.

 Fish theorized that “removal of the nidus of infection would lead


to resolution of the infection.
KRONFELD’S MOUNTAIN PASS THEORY
o Kronfeld gave mountain pass concept in 1939 to understand the
close relationship between pulp and periodontium.
o Kronfeld explained that the granuloma does not provide a
favorable environment for the survival of the bacteria.
o He explained tissue reaction under 3 zones:
 Zone A
 Zone B
 Zone C
A)Zone A:
Kronfeld compared the bacteria in the infected root canal with the army
of enemies embedded behind “high and inaccessible mountains.” the
apical foramen serves as mountain passes.

B)Zone B:
• Army tries to descend through mountain pass to invade into plains (peri
radicular tissue) beyond mountain pass.
• Another army in plains take care of the invaders. By forming trenches
and reinforcement in form of acute and chronic inflammatory cells it
tries to block advances of enemies.
• These defenders are white blood cells and other cells of granulomatous
tissue. This corresponds to the accumulation of white blood cells near
root apex.
C)Zone C:
o Only complete elimination of the invaders from their mountainous
entrenchment will eliminate the need of a defense forces in the
‘plains”.
o Once this is accomplished, the defending army of leukocyte
withdraws, the local destruction created by the battle is repaired
(granulation tissue) and the environment results to normal.
o This analogy explains the rationale for the disappearance of
granulation tissue after extraction of an infected tooth or appropriate
root canal therapy.
o The complete elimination of pathologic irritants from the canal
followed by the three dimensional fluid impervious obturation will
result in complete healing of periapical area.
RATIONALE OF ENDODONTIC THERAPY
• Rationale of endodontic therapy relies on the fact that non-vital
pulp being avascular has no defense mechanisms.

• Breakdown products from damaged tissue diffuses into


surrounding tissue leading to periapical irritation.

• Endodontic therapy seals the root canal system 3-dimensionally


and prevents percolation of toxic byproducts into periapex.
• Endodontic therapy includes:
 Nonsurgical endodontic treatment
 Surgical endodontic treatment

o Nonsurgical endodontic treatment includes three phases:


1. Access preparation: create a straight line path for canal orifice and
apex.
2. Shaping and cleaning: for complete elimination of vital or necrotic
pulp tissue, microorganisms, and their by-products.
3. Obturation: to have a three-dimensional well-fitted root canal with
fluid tight seal so as to prevent percolation and microleakage of
periapical exudate into root canal space and to prevent infection by
completely obliterating the apical foramen and other portals of
communication.
• Rationale of surgical endodontic treatment: rationale of surgical
endodontics is to remove the diseased tissue present in the canal
and around the apex, and retro fill the root canal space with
biologically inert material so as to achieve a fluid tight seal.
CONCLUSION
• When the root canal has been treated, the reservoir of bacteria or
noxious products gets eliminated; when the root canal is cleaned
and obturated, the destroyed periapical bone will undergo repair.

• The ultimate goal of endodontic treatment is either to prevent the


development of endodontic lesions or in cases where it is present,
to create adequate conditions for tissue healing.
REFERENCES
• Grossman’s endodontic textbook -12th edition
• Ingle’s textbook -6th edition
• Weine’s endodontic therapy- 5th edition
• Textbook of Endodontics, Nisha Garg- 4th edition

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