
Current Therapy in Endodontics
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Figure 1.1 Extraoral examination includes a visual assessment of facial asymmetry Figure 1.2 The presence of a sinus tract must be noted in the examination report Figure 1.3 A gutta-percha point is placed through the opening of the sinus tract until resistance is felt. A radiograph is obtained to identify the path of the sinus tract Figure 1.4 Percussion testing is best performed by tapping a tooth using the back end of a mirror handle. The tapping force should be consistent when testing multiple teeth Figure 1.5 The Tooth Slooth is used to test for biting sensitivity in a given tooth Figure 1.6 The Vitality Scanner 2006 from Kerr is a common electrical pulp testing device used in endodontic diagnosis. Figure 1.7 Endo Ice has an effective working temperature to make it an ideal refrigerant for thermal testing Figure 1.8 Placing the pellet on the cervical third of the tooth ensures an accurate patient response Figure 1.9 Even though endodontic treatment on tooth #14 is incomplete, the pulpal diagnosis would still be previously treated Figure 1.10 After the restoration is removed, inspection of the underlying tooth surfaces reveal an incomplete fracture of the mesiobuccal cusp, extending mesiodistally and buccolingually along a buccal groove Figure 1.11 A crack is seen advancing in the mesiodistal direction. A, With the restoration in place. B, With the restoration removed Figure 1.12 A coronal and axial slice from a conebeam volume reveals a crack that has extended apically and formed two separate segments. This is known as a split tooth Figure 1.13 This is a more obvious example of a vertical root fracture. In most cases, identifying a vertical root fracture can be challenging without the aid of advanced imaging modalities Figure 2.1 A digital image is viewable instantly on a large computer monitor. With available image enhancement tools, patients can more easily visualize important findings, such as caries or a periapical radiolucency Figure 2.2 The Dexis Platinum Sensor features a beveled corner design to enhance patient comfort. The attached wire connects to a computer via USB to yield high-resolution images instantly. Figure 2.3 ScanX from Air Techniques is an example of a photo-stimulable phosphor system. A, The scanning units come in various sizes to handle larger tasks. B, The imaging plates come in various sizes similar to a wet film. Figure 2.4 A, Periapical lucency is seen associated with the right maxillary central incisor. B, A cone-beam computed tomography scan of the area depicts a well-defined circular low-density area palatal to the root of the tooth. An overread from an oral and maxillofacial radiologist confirms a diagnosis of nasopalatine duct cyst Figure 2.5 A and B, The Veraviewepocs 3De (J. Morita Manufacturing Corp., Kyoto, Japan) cone-beam computed tomography machine has a footprint similar to that of a panoramic machine Figure 2.6 One Volume Viewer (J. Morita Manufacturing Corp., Kyoto, Japan) is a versatile viewing program designed to give the clinician maximum functionality in an easy and intuitive interface Figure 2.7 A, A panoramic scout image is used to define the region of interest for 3D imaging: Axial plane (red box), sagittal plane (blue box), and coronal plane (green box). B, An isotropic (symmetrical) voxel provides a highly accurate image that is free of distortion. Figure 2.8 A comparison of a periapical (PA) radiograph (A) and a proximal slice from a cone-beam computed tomography scan of the same area (B) highlights the advantages of 3D imaging in endodontic diagnosis. The proximal slice shows a transported and perforated root canal treatment that is not evident in the PA radiograph Figure 2.9 A, Right maxillary central incisor exhibits an apparent resorptive lesion at midroot level. B, An axial slice from a cone-beam computed tomography scan provides the necessary information on the type of resorption (internal or external) and the prognosis of the tooth Figure 2.10 A, Posteroanterior radiograph of the mandibular right second molar depicts a normal presentation of bone. B, A sagittal slice of a cone-beam computed tomography scan of the same area depicts a well-defined low-density finding in the periapical region of the tooth Figure 2.11 A, A panoramic radiograph fails to show a radiopaque finding apical to the area of the maxillary right bicuspids. Sagittal (B) and coronal (C) slices from a cone-beam computed tomography scan of the same area depict the high-density mass clearly. An overread provided by an oral and maxillofacial radiologist identified the high-density mass as idiopathic osteosclerosis Figure 2.12 A, Scatter artifact is seen as light and dark lines extending radially from metallic sources. B and C, Beam hardening artifacts from cone-beam computed tomography imaging can resemble bone loss or root fracture Figure 3.1 Motion for rotary instruments. A, Brushing technique. File is moved laterally so as to avoid threading. This motion is most effective with stiffer instruments with a positive rake angle, like ProTaper. B, Up-and-down motion. In this a rotary file is moved in an up-and-down motion with a very light touch so as to dissipate the forces until desired working length is reached or resistance is met. C, Taking file in the canal till it meets resistance. Gentle apical pressure is used till the file meets resistance and then withdrawn. The instrument is inserted again with a similar motion, e.g., RaCe files Figure 3.2 Creating a glide path Figure 3.3 Examples of motors. A, First-generation motor without torque control. B, Newest-generation motor with built-in apex locator and torque control Figure 3.4 Crown-down approach. Arrows indicate corresponding cutting area Figure 3.5 Recommended steps for hybrid technique Figure 3.6 Rake angles Figure 3.7 Variable helical angle Figure 3.8 Pitch refers to the number of flutes per unit length Figure 3.9 Cross-section of different rotary instruments. A, K-File RaCe. B, ProFile, GT, LightSpeed. C, Hero 642. D, K3. E, ProTaper, Flexmaster. F, ProTaper F3 Figure 3.10 LightSpeed LSX. A, Safe-failure design. B, Absence of flute. C, Front view Figure 3.11 Hero Shapers rotary files Figure 3.12 Cross section of a Quantec file Figure 3.13 Quantec Files. Top, LX noncutting (gold handles). Bottom, SC safe cutting (silver handles) Figure 3.14 K3 file design Figure 3.15 RaCe design characteristics Figure 3.16 Safety memo disc (SMD) showing how petals are used Figure 3.17 Mtwo file characteristics Figure...
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