ARNALDO C ASTELLUCCI MD , DD DDSS
ENDODONTICS Volume 1
Foreword
JOHN D. W EST EST, DDS, MSD
IL TRIDENTE EDIZIONI ODONTOIATRICHE
H S I L G N N E T I O W D I E N E
ENDODONTICS
This Book is dedicated in memory of my loving Mother and Father.
In scientic questions, opinions and views of any kind should not be transmitted from one man to another, from one textbook to another, or from one generation to another, unless they are based upon actual ndings. Opinion cannot be substituted for scientic evidence.
Balint Orban, M.D., J.A.D.A., 1930
IL TRIDENTE EDIZIONI ODONTOIATRICHE
DTP & Cover Sheet: Photolitograph: Printed by:
- Florence, Italy - Florence, Italy
Arti Grache - Signa, Italy - 2004, June
Previous italian edition copyrighted 1993
ISBN 88-89411-00-7
FIRST EDITION
Copyright © 2004 by
Edizioni Odontoiatriche Il Tridente S.r.l.
All right reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permission may be sought directly from Edizioni Odontoiatriche Il Tridente S.r.l. in Florence, Italy: phone +39 055 500 1312, fax +39 055 500 0232, e-mail:
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Edizioni Odontoiatriche Il Tridente S.r.l. Viale dei Mille 60 50131 Florence, Italy
E NDODONTICS
Edited by
ARNALDO C ASTELLUCCI, MD, DDS Visiting Professor of Clinical Endodontics, University of Florence Dental School, Italy President, Warm Gutta-Percha Study Club Founder and Director, Micro-Endodontic Training Center, Florence, Italy
Foreword by
JOHN D. W EST, DDS, MSD Associate Professor, Department of Endodontics, University of Washington School of Dentistry, Seattle, Washington Clinical Instructor, Department of Endodontics,Boston University, Henry Goldman School of Dental Medicine Guest Faculty, Pacic Endodontic Research Foundation Founder and Director, Center of Endodontics, Tacoma, Washington
IL TRIDENTE EDIZIONI ODONTOIATRICHE
Edizioni Odontoiatriche Il Tridente - Firenze
F OREWORD TO THE F IRST I TALIAN E DITION
October 6, 1992
Endodontics world wide has developed rapidly in the last quarter century. In the United States alone more than 3,500 dentists now limit their practices to endodontics and over 100,000 general dentists successfully treat endodontic cases. ere is nothing to prevent similar development of endodontic practice in Europe in the years ahead. is process will surely be accelerated with the Unication of Europe and the further development of the Common Market, professionally and academically, no less than commercially. It is signicant that Dr. Castellucci’s book ENDODONZIA is being published in Italian, and at this time. Italian dentistry is enjoing a renaissance no less spectacular than the intellectual, cultural, and artistic renaissance experienced in Florence in the 13th century. Nowhere in Europe presently is modern endodontics so much appreciated and nowhere does the profession reach out for more information about this vital eld. is comprehensive work covers the depth and breadth of endodontics admirably. With great skill and love for the material, Dr. Castellucci has delivered a text that is both interesting and informative. He has organized his book from the early history of endodontics to the restoration of endodontically treated teeth. In between no detail is omitted in describing the methods of treatment necessary for clinical success. e careful reader will nd everything here for the proper management of endodontic problems and for the mastery of endodontic technique. e book is arranged exquisitely, balancing intelligent scholarly text with outstanding visual material. It is eminently readable, making it a happy adventure in obtaining endodontic knowledge. As is well known, the most critical clinical aspects of endodontics are Cleaning and Shaping of Root Canal Systems and ree Dimensional Obturation, thereafter. e chapters devoted to these subjects are outstanding as is the chapter on the equally critical subject, Endodontic/Periodontic Relation. ey alone merit the reading of this book, but for the fortunate reader there is more, much more to be found here. I recommend Dr. Castellucci’s book wholeheartedly to any dentist (colleague) who contemplates incorporating modern endodontics into his/her practice. It is a signicant contribution to this eld!
Herbert Schilder, DDS Professor and Chairman Department of Endodontics
F OREWORD COLLEGE OF ENDODONTICS Seattle, Washington, USA © 1994-2004, University of Washington U N I V E R S I T Y
O F
WASHINGTON April19,2004
Forthesecondtimein adecade,ArnaldoCastelluccihascreatedthebestendodontictextbookinthe world. PerhapsthereasonforthisassertionisthatENDODONTICSaddressestheonewordthatbestdescribesendodontics inthisrstdecadeofthethirdmillennium.ThatwordisCHANGE.ArnaldoCastellucciaddressesthischange,teaches ushowtolearnfromthischangeandthenchallengesus,allofus,toembraceendodonticchange. Thisunprecedentedworkpresentsnewwaysofthinkingandthechangesin21 stCenturyendodontictechnologies. Castellucci’strilogyofendodonticsisapracticalandprofoundlterforthemodernendodonticcliniciantolearnwhy, when,andhowtoexperiencenewfoundclinicalartistrybasedonprovenbiologicprinciples. ENDODONTICSdifferentiatesitselfasasignicantendodonticresourceinvecriticallydistinctivedomains. First,itsauthor,ArnaldoCastellucci,isatoweringgureinthedevelopmentofadvancedendodonticsthroughout theworld,particularlyinEurope.His25-yearloveaffairwithendodonticsischaracterizedbyclinicalexcellence, sacrice, ethics, integrityand a desire toteach in a way that his students feel reverence for theirendodondic experience.Inaddition,hisstudentslearnessentialknowledgeandskills.Arnaldohasestablishedarichlegacy ofproducingthehighestqualityofeducationforhisstudents’learning.ENDODONTICSisanexpressionofhis dedicationtomakingthatdifference. Second,ENDODONTICS combinesthe artand science ofclinically relevantmodern endodontics.Fromthe evolutionaryhistorytoendodonticpretreatmentinVolumeI,cleaningandshapingand3DobturationinVolume II,andinterdisciplinaryendodonticsto restorationinVolume III,readers whobenetthe mostarethe oneswho understandtheprinciplesofthisbook.Doctorswillthenbeabletoadjusttheirtreatmentandtreatmentplanningas technologieschangeandknowledgegrows. Third,ArnaldoCastelluccihasassembledanimpressivelistofcontributors.Eachisagreatteacherandagreat thinker. TheseauthorsareacredittoArnaldo’svisionofcomprehensiveendodonticsthatteachesnotonlyendodontic principlesandtechniquesbuttherelationshipofendodonticstoestheticandrestorativedentistry. Fourth,thesheervolumeofknowledgeandthoroughnessofeverysubjectmakesENDODONTICSanunmatched one-stopendodonticreference. Finally,thersteditionofENDODONTICSwaslargelyareectionofProfessorHerbertSchilder’steachingsand words.InCastellucci’ssecondbook,Schilder’sinuencecontinuesinCastellucciStyle. Andsoitiswithlove,possibility,andan“ifIcandoit,youcandoit”contextthatArnaldoCastelluccihas writtenthismodernendodontictextbook.Ifreadfromcovertocover,thereaderlearnssuccessfulendodonticsandis challengedtowantmore.Arnaldoinvitesustomakeendodonticsplayful.Andthenendodonticswillbefun. Everyprofessional,atsometimeintheircareer,feelstheneedtodomorethanwhatisrequiredofthem.They want toexcel.Theywanttomastertheircraftandhavethatmasteryimpacttheirlivesthroughperformanceand fulllmentatthehighestlevelpossibleintheireld.ENDODONTICSisthatinvitation…itistheinvitationtogo beyondourself.
JohnD.West,DDS,MSD AfliateAssociateProfessor UniversityofWashingtonSchoolofEndodontics ClinicalInstructor BostonUniversityHenryM.GoldmanSchoolofDentalMedicine
VIII
P REFACE AND ACKNOWLEDGEMENTS
In the eleven years that have passed since the publication of the rst edition in I talian 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 simplied the most complex part of the root canal treatment, namely the shaping. Their use in fact makes root canal preparation more rapid, more efcient, 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 lling have been afrmed or introduced in the past decade namely, the Thermal 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, immature apices, pulp exposures and that can also be used in surgery for retrograde lling, 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 innite number of uses in the endodontic eld, namely removal of posts and screws, the removal of calcications, old lling material in the pulp chamber, the nishing of the access cavity, the exposure of the mesio palatine canal of the mesio buccal root of the upper rst 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 due 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 difculty that is present in the st raight part of the root canal, even if in the most apical third, is easily seen and resolved thanks to the magnication 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 lling 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 lling 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 rst edition I felt the need to update it, making available to students and clinicians the necessary information. Furthermore, driven
IX
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 aknowledgement 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 Endodontic Instruments, Shaping and Cleaning and Nickel Titanium To Prof. Giuseppe Cantatore from Rome, Italy, coauthor of the chapters on Endodontic Instruments, Nickel Titanium and the Thermal 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 Thermal System To Prof. Vito Antonio Malagnino and to Dr. Paola Passariello from Rome, I taly, 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. Ian 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, Wahsington, for the touching words he has seen t 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.
X
C ONTRIBUTORS R ICCARDO BECCIANI, MD, DDS Visiting Professor of Restorative Dentistry, Univeristy of Siena Dental School, Siena, Italy.
ELIO BERUTTI, MD, DDS Professor and Chairman of Endodontics, Univeristy of Turin Dental School, Turin, Italy; Past President of the Italian Society of Endodontics.
UZIEL S. BLUMENKRANZ, DDS Private Practice limited to Endodontics, Washington, Washington DC, USA; Past President of the Venezuelan Endodontic Society.
STEPHEN L. BUCHANAN, DDS, FACD, FICD Founder, Dental Education Laboratories; Adjunct Clinical Pr ofessor, Department of Endodontics, University of the Pacific School of Dentistry, San Francisco, California, USA; Diplomate, American Board of Endodontics.
GIUSEPPE C ANTATORE, MD, DDS Associate Professor, Department of Endodontics, University of Verona Dental School, Verona, Italy; Private Practice limited to Endodontics, Rome, Italy.
G ARY B. C ARR , DDS, MSD Founder and Director, Pacific Endodontic Research Foundation, San Diego, Califor nia, USA; Lecturer, University of California at Los Angeles; Consultant in Endodontics, VA Medical Center Long Beach, California; Diplomate, American Board of Endodontics.
ARNALDO C ASTELLUCCI, MD, DDS Visiting Professor of Clinical Endodontics, University of Florence Dental School, Flor ence, Italy; President, Warm Gutta-Percha Study Club; Founder and Director, Micro-Endodontic Training Center, Florence. Past President of the Italian Society of Endodontics; Past Pr esident of the International Federation of Endodontic Associations; Editor of the “Italian Journal of Endodontics” and of “The Endodontic Informer”.
KIRK A. COURY , DDS, MS Private Practice Limited to Endodontics, Amarilli, Texas, USA; Diplomate, American Board of Endodontics.
P AOLO FERRARI, DDS L.M.D. University of Geneva; Private Practice, Parma and Piacenza, Italy.
G ARY D. GLASSMAN, DDS, FRCD(C) Fellow and Examiner for the Royal College of Dentist of Canada; Fellow of the Academy of Dentistry International; Fellow of the Academy of Dental-Facial Aesthetics; Endodontic Editor for Oral Health; Past President of the Gorge Hare Endodontic Study Club.
W. BEN JOHNSON, DDS Clinical Professor Louisiana State University School of Dentistry, New Orleans, Louisiana; Clinical Associate Professor Baylor College of Dentistry, Dallas, Texas; Fellow of the Pierre Fauchard Academy; Fellow International College of Dentists; Private Practice limited to Endodontics, Tulsa, Oklahoma, USA.
R ONALD R. LEMON, DMD Professor and Chair man, Department of Endodontics, LSUHSC School of Dentistry, New Orleans, Louisiana, USA; Diplomate, American Board of Endodontics.
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M ARIO LENDINI, DDS Private Practice, Turin, Italy.
V ITO ANTONIO M ALAGNINO Professor and Chair man of Endodontics, Univeristy of Chieti Dental School “G. D’Annunzio”, Chieti, Italy; Past President of the Italian Society of Endodontics; Past President of the Italian Society of Restorative Dentistry, S.I.D.O.C.; Editor of the Italian Journal of Endodontics; Co-Editor of the Italian Jour nal of Restorative Dentistry; Honorary Member of the French Society of Endodontics.
JOHN T. MCSPADDEN, DDS International lecturer and researcher, Lookout Mountain, Georgia, USA.
R ICHARD E. MOUNCE, DDS Private Practice limited to Endodontics, Portland, Oregon, USA.
P AOLA P ASSARIELLO Visiting Professor of Endodontics, Univeristy of Chieti Dental Scool “G. D’Annunzio”, Chieti, Italy; Private Practice limited to Endodontics, Rome, Italy.
STEFANO P ATRONI, MD, DDS L.M.D. University of Geneva, Private Practice, Piacenza, Italy.
CLIFFORD J. R UDDLE, DDS, FACD, FICD Assistant Professor, Deparment of Graduate Endodontics, Loma Linda University, Loma linda, California, USA; Adjunct Assistant Professor, Department of Endodontics University of the Pacific School of Dentistry, San Francisco, California; Consultant Department of Graduate Endodontics Long Beach Veterans Medical Center, Long Beach, California, USA.
MICHAEL J. SCIANAMBLO, DDS Associate Professor at the University of California, School of Dentistry, San Francisco; Fellow of the Harvard School of Dental Medicine, USA.
KENNETH S. SEROTA, DDS, MMSC Fellow of the Academy of Dentistry International; Fellow of the Pierre Fauchard Academy; Founder of ROOTS – www.rxroots.com; Program Coordinator, Continuing Education Department, University of Toronto Faculty of Dentistry, Toronto, Canada.
JOHN J. STROPKO, DDS Private Practice of Endodontics, Scottsdale, Arizona, USA; Visiting Clinical Instructor, Pacific Endodontic Research Foundation, San Diego, California; Adjunct Assistant Professor Graduate Endodontics Goldman School of Dental Medicine, Boston, Massachusetts; Assistant Professor Graduate Clinical Endodontics Loma Linda University School of Dentistry, Loma Linda, California; Instructor and Co-Founder Clinical Endodontic Seminars, Scottsdale, Arizona.
XII
C ONTENTS V OLUME I CHAPTER 1
A BRIEF HISTORY OF ENDODONTICS
by Arnaldo Castellucci
CHAPTER 2
EMBRIOLOGY
by Arnaldo Castellucci
CHAPTER 3
DEFINITION, SCOPE AND INDICATIONS FOR ENDODONTIC THERAPY
by Arnaldo Castellucci
CHAPTER 4
DIAGNOSIS
ENDODONTICS
by Arnaldo Castellucci
CHAPTER 5
ADIOGRAPHY ENDODONTIC R
by Arnaldo Castellucci
CHAPTER 6
ADIOGRAPHY S YSTEMS (DRS) DIGITAL R
by Mario Lendini
CHAPTER 7
PULPAL P ATHOLOGY
by Arnaldo Castellucci
CHAPTER 8
PERIAPICAL DISEASE
by Arnaldo Castellucci and Uziel Blumenkranz
CHAPTER 9
THE USE
CHAPTER 10
TOOTH
CHAPTER 11
ACCESS C AVITY AND ENDODONTIC ANATOMY
by Arnaldo Castellucci
CHAPTER 12
PRETREATMENT: PREPARATION TECHNIQUES
by Stefano Patroni and Paolo Ferrari
IN
OF
ANESTHESIA
ISOLATION:
IN
ENDODONTICS
by Arnaldo Castellucci and Kirk A. Coury
THE R UBBER D AM
by Arnaldo Castellucci
FOR ENDODONTIC
THERAPY
V OLUME II CHAPTER 13
ENDODONTIC INSTRUMENTS
CHAPTER 14
CLEANING AND SHAPING
CHAPTER 15
SCHILDER ’S TECHNIQUE
CHAPTER 16
A CONTEMPORARY APPROACH TO CLEANING AND SHAPING THE R OOT C ANAL S YSTEM EMPHASIZING “E ARLY CORONAL ENLARGEMENT”
by Michael Scianamblo
CHAPTER 17
CURVED C ANALS
by Arnaldo Castellucci
THE
by Elio Berutti and Giuseppe Cantatore
R OOT C ANAL S YSTEM
FOR SHAPING THE
R OOT C ANAL S YSTEM
by Arnaldo Castellucci and Elio Berutti by Arnaldo CastelluccI
X III
CHAPTER 18
R OTARY INSTRUMENTS
CHAPTER 19
THE PROT APER TECHNIQUE
by Clifford Ruddle
CHAPTER 20
THE PREDEFINED ENDODONTIC PREPARATION. CONCEPTS, INSTRUMENTS, AND TECHNIQUES FOR THE GREATER T APER S YSTEM
by Stephen L. Buchanan
CHAPTER 21
THE K3 R OTARY NICKEL TITANIUM INSTRUMENTS S YSTEM
by Richard E. Mounce
CHAPTER 22
THE QUANTEC R OTARY NITI INSTRUMENTATION S YSTEM
by John McSpadden, Gary Glassman and Kenneth S. Serota
CHAPTER 23
OBTURATION OF THE R OOT C ANAL S YSTEM: BIOLOGICAL PRINCIPLES, M ATERIALS AND TECHNIQUES
by Arnaldo Castellucci
CHAPTER 24
THE SCHILDER TECHNIQUE ARM GUTTA-PERCHA W
CHAPTER 25
AVE THE CONTINUOUS W
CHAPTER 26
THE THERMAFIL S YSTEM
by Giuseppe Cantatore and W. Ben Johnson
CHAPTER 27
THE MICROSEAL TECHNIQUE
by Vito Antonio Malagnino and Paola Passariello
CHAPTER 28
ENDODONTIC-PERIODONTIC INTERRELATIONSHIP
by Arnaldo Castellucci
CHAPTER 29
THE TREATMENT
by Arnaldo Castellucci
CHAPTER 30
R OOT R ESORPTIONS
by Arnaldo Castellucci
CHPATER 31
BLEACHING ENDODONTICALLY TREATED TEETH
by Arnaldo Castellucci and Ronald Lemon
CHAPTER 32
THE USE OF THE SURGICAL OPERATIVE MICROSCOPE IN ENDODONTICS
by Gary B. Carr and Arnaldo Castellucci
CHAPTER 33
MICRO-ENDODONTIC NONSURGICAL R ETREATMENT
by Clifford J. Ruddle
CHAPTER 34
MICRO-SURGICAL ENDODONTICS
by John J. Stropko
CHAPTER 35
R ESTORATION
by Riccardo Becciani
IN
NICKEL-TITANIUM
OF
OF
V ERTICAL COMPACTION
by Elio Berutti and Giuseppe Cantatore
OF
CONDENSATION
by Arnaldo Castellucci
by Stephen L. Buchanan
V OLUME III
OF
TEETH WITH IMMATURE APICES
OF THE
ENDODONTICALLY TREATED TEETH
XIV
C URRICULUM V ITAE
Dr. Castellucci graduated in Medicine at the University of Florence in 1973 and he specialized in Dentistry at the same University in 1977. From 1978 to 1980 he attended the Continuing Education Courses on Endodontics at Boston University School of Graduate Dentistry and in 1980 he spent four months in the Endodontic Department of Prof. Herbert Schilder. Since then, he has a limited practice on Endodontics. Active Member of the Italian Endodontic Society S.I.E. since 1981, in 1982 he was elected in the Board of Directors of the Society where he worked as Scientic Advisor, Secretary Treasurer, Vice President and lately as President in 1993-95. Active Member of the European Society of Endodontology E.S.E., he was the Secretary in 198183. He is Active Member of the American Association of Endodontists A.A.E. since 1985. He is Active Member of the Italian Society of Restorative Dentistry S.I.D.O.C. since 1992. He has been the President of the International Federation of Endodontic Associations I.F.E.A. in 1990-92. From 1983 to 2000 he has been Professor of Endodontics at the University of Siena Dental School. Now is Visiting Professor of Endodontics at the University of Florence Dental School. He translated into Italian the text on “Clinical and Surgical Endodontics. Concepts in Practice”, by Frank, Glick, Simon and Abou-Rass. He is the Editor of “The Italian Endodontic Journal” and of “The Endodontic Informer”. He is also the Founder and President of the “Warm Gutta-Percha Study Club”. He published articles on Endodontics in the most prestigious Endodontic Journals. He is the author of the text “Endodonzia”, which now is available in the English language. He is Founder and President of the Micro-Endodontic Training Center in Florence, where he teaches and gives hands-on courses on nonsurgical and surgical Endodontics. International lecturer, he gave presentations at National and International Congresses in Brasil, Canada, Colombia, England, France, Germany, Israel, Lebanon, Mexico, Monaco, Russia, Spain, Switzerland, United States, Venezuela.
X V
C ONTRIBUTORS Volume I
UZIEL BLUMENKRANZ, DDS Private Practice limited to Endodontics, Washington, Washington DC, USA Past President of the Venezuelan Endodontic Society.
ARNALDO C ASTELLUCCI, MD, DDS Visiting Professor of Clinical Endodontics, University of Florence Dental School, Italy; President, Warm Gutta-Percha Study Club; Founder and Director, Micro-Endodontic Training Center, Florence, Italy
KIRK A. COURY , DDS, MS Diplomate, American Board of Endodontics
P AOLO FERRARI, DDS L.M.D. University of Geneva, Switzerland Private Practice, Parma and Piacenza, Italy.
M ARIO LENDINI, DDS Practice limited to Endodontics, Turin, Italy
STEFANO P ATRONI, DDS L.M.D. University of Geneva, Switzerland Private Practice, Piacenza, Italy.
XVI
C ONTENT S Volume I
CHAPTER 1
A BRIEF HISTORY OF ENDODONTICS ..................................................................................
2
ASTELLUCCI A RNALDO C
Bibliography..........................................................................................................................
CHAPTER 2
EMBRYOLOGY ........................................................................................................................
5 6
ASTELLUCCI A RNALDO C
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 ...............................
6 14 16 17 20 21 23 24
A RNALDO C ASTELLUCCI
Basic phases of endodontic therapy.................................................................................... Indications and contraindications........................................................................................ True contraindications..................................................................................................... False contraindications .................................................................................................... True indications ............................................................................................................... Strategic endodontics....................................................................................................... Bibliography..........................................................................................................................
CHAPTER 4
DIAGNOSIS IN ENDODONTICS ...............................................................................................
25 26 27 29 39 40 43 44
A RNALDO C ASTELLUCCI
Subjective information.......................................................................................................... Medical history................................................................................................................. Dental history................................................................................................................... Objective information........................................................................................................... Examination ..................................................................................................................... Percussion ........................................................................................................................
44 44 44 46 46 47
XVII
Palpation .......................................................................................................................... Radiographic examination............................................................................................... Thermal tests.................................................................................................................... Electric pulp test .............................................................................................................. Cavity test......................................................................................................................... Anesthesia test ................................................................................................................. Transillumination ............................................................................................................. Bite test............................................................................................................................. Bibliography..........................................................................................................................
CHAPTER 5
ENDODONTIC R ADIOGRAPHY ...............................................................................................
47 48 56 59 62 62 64 64 65 66
ASTELLUCCI A RNALDO C
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 magnication ........................................................................................................ 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 ....................................................................................................
67 67 68 69 69 71 71 72 72 74 74 74 79 79 80 80 83 85 93 94 94 95 97 98 99 100 101 102 103 104 104 104 105 106 106 106 110
XVIII
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 R ADIOGRAPHY S YSTEMS (DRS) ..........................................................................
110 110 111 111 111 112 112 112 115 118
120
ARIO L ENDINI M
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
ULPAL P ATHOLOGY ............................................................................................................. P
120 123 124 127 127 127 128 129 130 131 132 133 134 136
A RNALDO C ASTELLUCCI
The reparative capacity of pulp tissue ................................................................................ Pulpal diseases...................................................................................................................... Clinical classication........................................................................................................ Healthy pulp .................................................................................................................... Hyperemia........................................................................................................................ Clinical symptoms....................................................................................................... Diagnosis..................................................................................................................... Therapy ....................................................................................................................... Pulpitis.............................................................................................................................. Symptomatology ......................................................................................................... Diagnosis..................................................................................................................... Pulp tests..................................................................................................................... Radiographic examination.......................................................................................... Therapy ....................................................................................................................... Necrosis............................................................................................................................ Symptomatology ......................................................................................................... Radiographic examination.......................................................................................... Pulp tests.....................................................................................................................
136 139 139 139 142 142 143 144 144 144 144 145 145 147 150 152 153 153
XIX
CHAPTER 8
Therapy ....................................................................................................................... Vital pulp therapy................................................................................................................. Pulp capping with MTA.............................................................................................. Operative sequence for pulp capping....................................................................... Bibliography..........................................................................................................................
153 153 155 156 158
P ERIAPICAL DISEASE .............................................................................................................
160
ASTELLUCCI ZIEL B LUMENKRANZ A RNALDO C , U
The reparative capacity of periapical tissues ...................................................................... Classication of the lesionsof endodontic 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 ..................................................................................................................... Denition ......................................................................................................................... Cracked tooth syndrome...................................................................................................... Etiology ............................................................................................................................ Symptoms......................................................................................................................... Clinical ndings ............................................................................................................... Diagnosis.......................................................................................................................... Classication .................................................................................................................... Treatment ......................................................................................................................... Class I ............................................................................................................................... Class II.............................................................................................................................. Class III............................................................................................................................. Class IV............................................................................................................................. Conclusion ....................................................................................................................... Bibliography..........................................................................................................................
CHAPTER 9
THE U SE OF A NESTHESIA IN ENDODONTICS .......................................................................
160 163 163 171 172 176 184 185 185 191 191 191 191 192 194 196 197 199 199 200 201 201 203 203 204 208
A RNALDO C , K ASTELLUCCI IRK A. C OURY
Topical anesthesia ................................................................................................................ Local inltration.................................................................................................................... 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 inammation ..........................................................................
208 209 210 210 210 210 212 213 213 214 214
XX
Lingual inltration............................................................................................................ Intraseptal injection ......................................................................................................... Intraligamental inltration............................................................................................... Intrapulpal inltration...................................................................................................... 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 R UBBER D AM ...............................................................................
215 215 216 218 219 219 219 220 221 222 222 222 222 223 223 224 226
ASTELLUCCI A RNALDO C
CHAPTER 11
Instruments ........................................................................................................................... 1) Rubber dam ................................................................................................................. 2) Rubber dam punches.................................................................................................. 3) Rubber dam clamps .................................................................................................... 4) Rubber dam clamp forceps ........................................................................................ 5) Rubber dam frame ...................................................................................................... 6) Lubricant...................................................................................................................... 7) Rubber dam napkins................................................................................................... 8) Dental oss.................................................................................................................. 9) Assistant ....................................................................................................................... Positioning of the dam ......................................................................................................... Bibliography..........................................................................................................................
228 228 228 228 229 230 231 231 231 231 231 243
A CCESS C AVITY AND ENDODONTIC A NATOMY ...................................................................
244
A RNALDO C ASTELLUCCI
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 aring phase............................................................................................. Upper central incisor............................................................................................................ Upper lateral incisor ............................................................................................................. Upper canine ........................................................................................................................ Upper rst premolar............................................................................................................. Upper second premolar ....................................................................................................... Upper rst molar .................................................................................................................. Upper second molar.............................................................................................................
244 249 250 250 251 252 253 257 258 259 264 266 277
XXI
CHAPTER 12
Upper third molar................................................................................................................. Lower central incisor ............................................................................................................ Lower lateral incisor ............................................................................................................. Lower canine ........................................................................................................................ Lower rst premolar ............................................................................................................. Lower second premolar ....................................................................................................... Lower rst 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..........................................................................................................................
279 280 284 285 287 289 291 299 312 315 317 319 319 325 327
P RETREATMENT: P REPARATION TECHNIQUES FOR ENDODONTIC THERAPHY ....................
330
ATRONI AOLO F ERRARI S TEFANO P , P
INDEX
Introduction .......................................................................................................................... Pretreatment.......................................................................................................................... Modern indications forendodontic pre-treatment.......................................................... Classication ......................................................................................................................... Periodontal pretreatment...................................................................................................... Gingivectomy-gingivoplasty............................................................................................ The apically repositioned ap ........................................................................................ 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..........................................................................................................................
330 331 332 332 334 334 334 335 336 339 339 339 343 344 347 351
...............................................................................................................................................
352
