[MUSIC] I'm Doctor Karabucak, Associated Professor at the University of Pennsylvania, department of Endodontics. I will be reviewing and highlighting the scope of Endodontics and treatment modalities within Endodontics specialty. Endodontics is a branch of dentistry recognized by the American Dental Association and has been playing an important role in providing dental care as a specialty since 1964. Our specialty focuses on the human dental pulp, surrounding periradicular tissues, and bone structure. It's study and practice encompass the basic and clinical sciences investigating the etiology, diagnosis, prevention and treatment of diseases, or injuries of the pulp and associate tissues such as periodontal tissues and bone supporting roots. Human dental pulp is a connective tissue containing blood vessels And nerves, uniquely situated within the rigid, mineralized tooth structures like dentin, and cementum. Highly vascularized pulpar tissue differentiates from periodontal tissues, as soon as it enters into root canal. Dental pulp resides within the tooth and extends from the top of the canal space to the tip of the root. Normal, healthy pulp plays an essential role in tooth and root development during childhood It maintains vascular tone and regulates dentin formation and the position which stimulates tooth eruption through the jaw bone to take it's place within the dental arch. In case of a disease or an injury, if dental pulp looses it's vitality root development cannot take place and surrounding structures will be prone to infections. During natural and healthy development of the teeth, pulpal tissues continue to maintain vascular tone and support inflammatory responses by modifying new dentin formation to support and repair tooth structures. Due to tooth decay or trauma, the pulp may become inflamed or infected. This injury to the pulp may trigger discomfort or pain increasing with temperature change within the oral environment and with mastication. In these situations the role of endodontists is to assess the health of the pulp and to treat accordingly. Extra attention should be made to preserve healthy pulp tissue to prevent further extensive treatment. If the level of inflammation is reversible, health of pulp can be preserved and because of inflammation such as dental decay, should be removed and the tooth is restored to protect and promote health of the pulp. However, if the inflammation and infection is advanced, root canal treatments should be initiated, and the diseased pulp and infected tissues should be removed. In cases of advanced dental infections, drainage should be established to reduce localized pressure more importantly to prevent pooling to spread into facial spaces. The goal of root canal treatment is to remove the cause of infection, clean and disinfect canal systems, fill canal systems to maintain clean and disinfected. Even though in general treatment is done in one visit, in some cases it may require multiple visits. The entire treatment must be preformed aseptically to reach best outcomes. During the treatment different instruments and irrigation solutions are used to shape and disinfect canals. A bio-compatible material is used to fill and seal these canal systems. At different stages of the treatment, or in some cases throughout the treatment, an endodontic operating microscope is used to facilitate visualization of canals and to make sure that all canals are located and treated adequately. It is important to point out that upon completion of root canal treatment, access should be sealed and the tooth should be restored permanently. A permanent restoration will prevent recontamination of canal systems, also will protect remaining tooth structures against chewing forces. Root canal treated tooth can last a lifetime. But in some cases, root canal treated tooth does not heal properly when root canal system becomes really infected or because of its complex root anatomy. Endodontic retreatment may become necessary to save the tooth. Retreatment can be either accomplished by reentering the canal system through a crown portion of the tooth or by accessing diseased root ends directly. Treatment options should be evaluated for each individual tooth and discussed with the patient to reach the best expected outcome. If the treatment decision is non-surgical, new access opening through a crown is made, and all canal system is clean, disinfected, and sealed. As you see with this case that previously untreated canal was located during re-treatment, under microscope. Post-operative radiograph shows that all canals were disinfected and filled to promote healing of peridicular tissues. However, if the treatment decision is to access infected root ends directly, a surgical flap or a osteotomy around root tip are made to expose disease areas. This process allows root canal systems to be cleaned and sealed apically. The procedure is preformed with local anesthesia, and in most cases it is more conservative compared to previous treatment options we discussed. It preserves well fitted restorations and helps to clean anatomical complexities more efficiently. As you see with this case, that granuloma was removed from the apical areas of a lower molar an untreated canal was located. All canals were cleaned and sealed. Lastly endodontic care doesn't end at the completion of endodontic treatment, but continues with periodic evaluations. Periodic evaluations will make sure that the health of teeth structures and surrounding tissues continue. And oral health is maintained. Thank you for your attention.
