ENDODONTIE

SEF LUCRARI DR. ANCA MELIAN

 ENDODONTIE
Endo: “inauntru”
Odont: “dinte” (limba greaca)

Definitie
Endodontia este o ramura clinica a stomatologiei
asociata preventiei, diagnosticării şi
tratamentului bolilor pulpei dentare şi a
sechelelor acestora
 Scopul endodontiei
1. Terapia pulpei vii: coafaje pulpare (indirect sau direct), pulpotomia
2. Diagnosticul pozitiv si diferential al durerii orale
3. Tratamentul endodontic in cazul canalelor radiculare infectate cu
sau fara patologie periradiculara de origine pulpara (pulpectomie,
tartament mecanochimic)
4. Chirurgia endodontica in cazul patologiei datorate bolii pulpare
• Rezectia apicala
• Hemisectia
• Amputatia radiculara
5. Replantarea in cazul dintilor avulsionati
6. Implante endodontice
7. Retratamente endodontice dintilor tratati anterior
8. Albirea dintilor devitali
9. Restaurari coronare a dintilor devitali cu ajutorul pivotilor
intraradiculari
 ISTORIC
http://www.jendodon.com/article/S0099-2399%2887%2980204-2/abstract
• Sec II-III i.H.
• Chinezii : „vierme alb” : arsenic
• Grecii si romanii:
– ac inrosit
– ulei fierbinte
– opium
– Hyoscyamus niger (Maselarita).
• secolul-I : drenaj
• secolul VI : se descrie anatomia spatiului pulpar

• Pierre Fauchard (1678-1761) – fondatorul stomatologiei moderne

“Le chirurgien dentiste” : descrierea pulpei dentare, indepartarea ei din
spatiul endodontic (1746)
• Lazare Rivere (1725): ulei de cuisoare ca sedativ
• Louis I. Grossman (1902-1988): parintele endodontiei
 Louis Grossman, 86, Professor and Expert On Dental Therapy
By ERIC PACE, Published: March 26, 1988 , New York Times
http://www.nytimes.com/1988/03/26/obituaries/louis-grossman-86-
professor-and-expert-on-dental-therapy.html

• Dr. Louis I. Grossman, a longtime professor of dentistry at the University

of Pennsylvania and an authority on root canal therapy, died Thursday at
Pennswood Village, a retirement home in Newtown, Pa. He was 86 years
old.
• Dr. Grossman was known as the father of endodontics, a branch of
dentistry that deals largely with dental pulp, the sensitive, soft tissue that
fills the central cavity of teeth.
• The portion of that cavity that is inside the root of a tooth is called the
root canal. Root canal therapy entails removing infected pulp from the
root canal and replacing it with an inert material.
• Dr. Leif Tronstad, chairman of the university's department of endodontics
and holder of an endowed professorship named after Dr. Grossman, said
yesterday: ''The major contribution that he made was to make this type
of treatment acceptable. Before this, teeth were commonly extracted. It
is not many years since half the American population at the age of 50
had dentures.'' Author of 1940 Textbook
 dr. Louis I. Grossman
• Dr. Louis I. Grossman was born in a Ukrainian village near Odessa on December 16, 1901,
and was brought to the United States by his family as a boy. He grew up in Philadelphia and
completed his high school education at South Philadelphia High School in 1919. He earned a
doctorate in dental surgery at the University of Pennsylvania in 1923 and a doctorate in
medical dentistry (Dr. Med Dent) at the University of Rostock in Germany in 1928.

• On December 21, 1928, he married Emma May MacIntyre and they had two children, a
daughter Clara Ruth Grossman in 1939 and a son Richard Alan Grossman in 1943. Dr.
Grossman began his teaching career as an Instructor in Operative Dentistry at the University
of Pennsylvania in 1927, in addition to being appointed as a Fellow in Research at the
American Dental Association.

• In 1941 he was an Associate in Oral Medicine; he became Assistant Professor of Oral

Medicine in 1947, Associate Professor of Oral Medicine in 1950, and Professor in 1954. His
achievements and honors were extensive in many sectors of dentistry with a prime focus in
endodontics. He was an honorary member of the Association of Licentiates in Dental Surgery
and University of Dentists of Belgium; Montreal Endodontia Society; Vancouver Endodontic
Study Club, Brazilian Dental Association; Dental Association of Medellin (Colombia); and the
Japanese Endodontic Association. He received an honorary Doctor of Science (ScD) from the
University of Pennsylvania.
 dr. Louis I. Grossman
• His major publication and crowning achievement was his textbook Root Canal Therapy published in 1940 (now
known as Endodontic Practice) with multiple editions appearing worldwide. Subsequently translated into eight
languages, the book has served as a benchmark for the development of modern endodontic philosophy and
practice. Dr. Grossman also authored Dental Formulas and Aids to Dental Practice, first published in 1952, and the
Handbook of Dental Practice published in 1948.

• He was a chairman of the American Board of Endodontics, was a charter member of the American Association of
Endodontists (AAE) and served as its President from 1948 to 1949. He was a Fellow of the American Association
for the Advancement of Science. Dr. Grossman passed away at the age of 86 in 1988. The University of
Pennsylvania has honored Dr. Grossman with an endowed Professorship, usually given to the department
chairperson.

• The AAE has honored him with the Louis I. Grossman Award that recognizes an author for cumulative publication
of significant research studies that have made an extraordinary contribution to endodontology. This award is given
at the AAE meeting when warranted. A study club was formed in Philadelphia in the honor of Dr. Louis I. Grossman
for his unyielding dedication and commitment towards facilitating the recognition of endodontics as a specialty in
the field of dentistry. The purpose of the Louis I. Grossman Study Club was to provide an opportunity to the
endodontists as well as other interested dentists to meet, share ideas, and expand and update our knowledge in
the field of endodontics and dental medicine.

• Dr. Louis I. Grossman was the founder of the first Root Canal Study Club. It was established in 1939 in
Philadelphia, Pennsylvania, at a time when the Focal Infection Theory threatened the future of endodontics. The
purpose of the Root Canal Study Club as stated in the original letter compiled by Dr. Grossman was “to study
problems connected with root canal therapy and to present clinics so as to help others in practicing this important
phase of dentistry more adequately.” Endodontists from as far away as Massachusetts chose Philadelphia as the
hub for scientific and educational learning in the field of endodontics.
• http://www.rootcanalcentre.com/…/GROSSMANS-Endodontic-Pract…
“We need to treat the patient as a whole, not the mouth as a hole"
Dr. Louis I. Grossman – The Visionary Father of Modern Endodontics.

Dr. Louis I. Grossman was the founder of the

first Root Canal Study Club
 ISTORICUL ENDODONTIEI
dr. Louis I. Grossman: 4 ere a cate 50 de ani
Prestiinta 1776-1826

Perioada descoperirilor 1826-1876

Perioada intunecata 1876-1926

Renasterea 1926-1976

Era inovatoare 1977-prezent

Prestiinta : 1776-1826
• cataplasme
• lipitori
• instrumente inrosite
Perioada descoperirilor 1826-1876
• Anestezia: 1884: infiltratiile de cocaina 4%
(procaina dupa 20 ani)
• Gutaperca
• Instrumente pentru extirpare si debridare
(nu si pentru obturare radiculara).
Perioada intunecata 1876-1926
• 1911: William Hunter: boala de focar
• Extractia – optiunea de tratament in cazul
infectiilor pulpare, desi se cunosteau
radiografia (1895) si anestezia
 Renasterea 1926-1976
perioada de aur a endodontiei

• Este recunoscuta endodontia ca stiinta medicala

• Sunt imbunatatite metodele Rx si anestezice
• Teoria bolii de focar reevaluata
• Infiintarea AAE 1943: Asociatia Americana de
Endodontie
 Era inovatoare 1977-prezent
Progres foarte rapid in domeniu
Viziune mai clara, tehnici mai precise in prepararile
biomecanice, obturatii mai bune

↓
Endodontie mai simpla, mai usoara, mai
rapida, cu rezultate mai predictibile
Vizita unica _ concept unanim acceptat
 Informarea pacientului
• Cine poate realiza un tratament endodontic ?
• Cine este specialist in endodontie ?
• Ce este endodontia ?
• Cum poate sa fie afectata integritatea pulpei dentare?
• De ce simt durere ?
• Cand poti sa afirmi ca pulpa este infectata ?
• De ce am nevoie de tratament endodontic ?
• Care sunt alternativele unui tratament de canal ?
• Care sunt riscurile si complicatiile unui tratament de canal ?
• Cate vizite sunt necesare pentru un tratament de canal ?
• De ce am simtit durere dupa tratament endodontic ?
• Voi avea un dinte mort dupa o terapie de canal ?
• Dintele tratat endodontic are nevoie de ingrijiri speciale sau vreun alt tratament
suplimentar ?
• Poate fi tratat endodontic orice dinte ?
“The modern concept of root canal treatment”
P Carrotte

• Root canal treatment is normally prescribed to treat an infection,

and as with all surgical procedures an aseptic technique is essential
throughout.
• As research has shown that success is only achieved when all
microorganisms are removed from the entire root canal system, the
anatomy of this system must be understood for each tooth.
• Modern endodontic practice is concerned not with the old cliché of
cleaning, shaping and filling, but with shaping first, to open the
canals wide, so that cleaning can be effectively carried out prior to
three-dimensional filling.
Department of Restorative
Dentistry
Endodontic Unit
Endodontic treatment conserves teeth that will
otherwise have to be extracted. It is concerned with
the etiology, diagnosis, prevention and treatment of
diseases and injuries to the pulp and associated
peri-radicular conditions.

Scope of practice:
Endodontic treatment using microscopy
Management of pulpal and periapical diseases
Non-vital pulp therapy / conventional root canal
treatment
Vital pulp therapy
Surgical endodontic treatment
Management of endodontic complications and
mishap
Management of trauma to the tooth
Non-vital bleaching
Restoration of endodontically treated teeth
 All preclinical exercises are performed on a manikin in clinically simulated environments.
The following are examples of “My first root canal treatment” by fourth year dental students.
 http://www.dent.unimelb.edu.au/dsweb/future_students/postgrad/endo_teach.html
Innovation in endodontic teaching at the Melbourne Dental School
• Instrumentation using rotary nickel-titanium (NiTi) vs traditional stainless steel (SS) files
• Teeth are composed of three hard tissues, enamel, dentine and cementum. Housed within the tooth is a loose innervated connective tissue, called
the dental pulp, which occupies the root canal system of the tooth.
• The pulp may become exposed to a variety of noxious stimuli in the form of either constant irritants or specific events, which may lead to
inflammation of the pulp or interfere with its blood supply. Should the pulp not cope with these noxious stimuli, it will become necrotic (degenerate
due to the lack of a blood supply) and eventually the root canal system will also become infected.

• It has been well established that bacteria in the infected root canal system can then cause an inflammatory response around the apex of the tooth,
referred to as apical periodontitis. Endodontic (root canal) treatment aims at curing such disease.

• The objective of root canal treatment is to completely seal a thoroughly cleaned and disinfected root canal system. A thorough debridement of the
root canal system is an essential step toward this goal. The process of debridement includes mechanical instrumentation in conjunction with
chemical irrigation. This combined technique will usually eliminate most of the bacterial contaminants of the canal, as well as the necrotic debris and
contaminated dentine.

• The process of cleaning and shaping the canal is not an easy goal to achieve, especially in curved canals which most of the root canals are.
Historically, SS files have been used to instrument the canals. These files are naturally stiff. They tend to straighten curved canals, in addition, more
serious complications, such as the development of ledges, apical zipping, and perforations have been reported in publications. To negotiate around
the curves with these instruments, operators need certain skills which only come with a long period of training and practice. Inexperienced operators
usually find it very difficult to achieve a good result with these instruments.

• One of the most significant advances that has alleviated these shortfalls is the NiTi file. These files are ideally suited for root canal treatment as they
are “super-elastic”.

• With motor-driven rotary NiTi files, the canal preparation results are more consistent and less time consuming. Operator and patient fatigue are
reduced as a result. Furthermore, it has been reported that even inexperienced operators, such as undergraduate dental students with minimal or no
training are able to instrument canals effectively when rotary NiTi files have been utilised. In other words rotary NiTi canal preparation is technically
less sensitive than the stainless steel counterpart.

• With generous support from VDW, Dentsply and Gunz, A/Prof Parashos and Dr Sathorn have adopted rotary Ni-Ti technology as a major
instrumentation technique in undergraduate and postgraduate Endodontic programme.

• All preclinical exercises are performed on a manikin in clinically simulated environments.

 Bibliografie
http://dental-library.com/category/endodontics/
1. Grossman L.I. 1902-1988
2. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974; 18: 269-296.
3. Hess JC. Enseignement d’odontologie conservatrice. Clinique endodontique.vol 3.1985. Edit
Maloine-Paris
4. Seltzer S. Endodontology: Biologic considerations in Endodontic Procedures, 1988, 2nd edn.; 439-
470, Philadelphia, PA, USA:Lea&Febiger
5. Pitt Ford TR. Harty’s Endodontics in Clinical Practice, 5th edition, 2003.
6. Castellucci Arnaldo. Endodontics vol 1,2. 2005
7. Ørstavik D, Pitt Ford TR. Essential Endodontology: Prevention and Treatment of Apical
Periodontitis, 2nd Edition , 2007
8. Nisha Garg, Amit Garg. Textbook of Endodontics 3rd Edition, 2014
9. Torabinejad M. Endodontics: Principles and Practice, 5th Edition
10. Simon S, Pertot WJ. La reprise du traitement Endodontique, Quintessence Int, 2007
11. Gafar M, Iliescu A. Endodontie clinica si practica, 2007
12. Melian Anca &al „Principii si decizii terapeutice in Endodontie” ,Ed.PIM, Iasi, 2008
13. Vataman Maria. Răspunsul pulpei dentare la acţiunea unor factori agresivi. Editura Panfilius,
2003
14. Cherlea V. Tratamentul endodontic, 2008