To carry this concept one step further, recognized today is the importance of retaining event endodontic-cally treated roots,

over which may be constructed a full denture,the so-called overdenture. On some occasions,attachments may be added to these roots to provide additional retention for the denture above. At other times, the treated roots are merely left in place on the assumptionthat the alveolar process wil be retained around roots, and there wil not be the usual ridge resorption so commonly seen under full or oven partial dentures. Most dentists would agree that retained and restored individual tooth is better than a removable partial denture, which, in turn, is superior to a full denture. Although recent success with dental implants is impressive, the long-term outcome is not known, and functionally, the patients own tooth is superior.Treatment in every case should adhere to the standards set by the dentist for himself or herself and his or her family. Modern dentistry incorporates endodontics as an integral part of restorative and prosthetic treatment. Most any tooth with pulpal involvement, provided that it has adequate periodontal support, can be candidate for root canal treatment. Severely broken down teeth, and potential and actual abutment teeth, can be candidates for the tooth-saving procedures of endodontics. One of the greatest services rendered by the profesion is the retention of the first permanent molar (figure 1-6). In contrast, the long-range consequences of breaking the continuity of either arch are also well known ( figure 1-7). Rooth canal therapy often provides the only opportunity for saving first molars with pulp involvement.

In addition to saving molars for children, saving posterior teeth for adults is also highly desirable. Retaining a rooth-filled terminal molar, for example, means saving two teeth the molars opposite tooth as well ( figure 1- 8,A).Moreover, rooth canal treatment may save an abutment tooth of an existing fixed prosthesis. The gain is doubled if the salvaged abutment is also the terminal posterior tooth in the arch and has a viable opponent ( figure 1-8, B ). Another candidate for endodontic therapy is the adolescent who arrives in the office with a grossly damaged dentition and is faced with multiple extractions and dentures ( figure 1-9). Many of these children are mortifield by their appearance. It is gratifying to see the blossoming personality when an esthetic improvement has been achieved. The end result in these cases would not be possible without rooth canal therapy ( figure 1- 10) Intentional Endodontics Occasionally, intentional endodontics of teeth with perfectly vital pulps may be necessary. Example of situations requiring intentional endodontics include hypererupted teeth or drifted teeth that must be reduced so drastically that the pulp is certain to be involved. On other occasions, a pulp is intentionally removed and the canal filled so that a post and core may be placed for increased crown retention. In these cases, the endodontic treatment may be completed before toth reduction is started. Over and above these quite obvious indications for intentional endodontics, it has been recommended that pulpectomy and rooth canal filling be done for vital teeth badly discolored by tetracycline ingestion.

Following rooth canal therapy, internal bleaching may be carried out. Considerations Prior to Endodontic Therapy Although it is true that root canal treatment can be performed on virtually any tooth in the mouth, there are some important considerations that must be evaluated prior to recommending rooth canal treatment. Some of these were delineated by Beveridge ( personal communications, june 1971): 1. Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis? 2. Is the tooth salvageable, or is it so badly destroyed that it cannot be restored? 3. Is the entire dentition so completely broken down that it would be virtually impossible to restore? 4. Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement? 5. Is the tooth so severely involved periodentally that it would be lost soon for this reason? 6. Is the practitioner capable of performing the needed endodontic procedures? In regard to the last point, today in the United States and many other countries, endodontic specialist are available to whom paients may be refered. A decision to refer is preferable before a mishap, such as perforation of the rooth canal, occurs. If a mishap does occur during treatment, the patient must be given the option of seeing a specialist before the decision to extract the tooth is made. The well-trained dentist should have no fear of the pulpally involved tooth. If a carious exposure is noted during cavity preparation, the patient is informed of

the problem and the recommended treatment, and, if consented to, the endodontic therapy is started while the tooth is anesthetized. The prepared dentist can begin pulpectomy immediately, using sterile instruments packaged and stored for just such an emergency. Age and Health as Considerations Age need not be a determinant in endodontic therapy. Simple and complex dental procedures are routinely performed on deciduous teeth in young children and on permanent teeth in patients well into their nineties. The same holds true endodontic procedures. It should be noted, however, that complete removal of the pulp in young immature teeth should be avoided if possible. Procedures for pulp preservation are more desirable and are fully discussed in chapter 15. Health consideration must be evaluated for endodontics as it would for any other dental procedure. Most often, root canal therapy will be preferable to extraction. In severe cases of heart disease, diabetes, or radiation necrosis, for example, root canal treatment is far less traumatic than extraction. Even for terminal cases of cancer, leukemia, or Aids, endodontics is preferred over extraction. Pregnancy, particularly in the second trimester, is usually a safe time for treatment. In all of these situation, however, endodontic surgery is likely to be as traumatic as extraction. Status of the Oral Condition Pulpally involved teeth may simultaneously have periodontal lesion and be associated with other dental problems such as rampant decay, orthodontic malalignment, root resorption, and/or a history of traumatic injuries. Often the

treatment of such teeth requires a team effort of dental specialist along with the patients general dentist. The presence of periodontal lesion must be evaluated with respect to the correct diagnosis: is the lesion of periodontal or endodontic origin, or is it a combined situation? The answer to that question will determine the treatment approach and the outcome; generally, lesion s of endodontic origin will respond satisfactorily to endodontic treatment alone ( figure 1 -11), whereas those of periodontal origin will not be affected simply by endodontic procedures ( figure 1-12 ). Combined lesions- those that develop as a result of both pulpal infections and periodontal disease respond to a combined treatment approach in which endodontic intervention precedes, or is done simultaneously with, periodontal treatment ( figure 1- 13 ). Even teeth with apparently hopeless root support can be saved by endodontic treatment and root amputation ( figure 1- 14 ). Today, many pulples teeth, once condemned to extraction, are saved by root canal therapy : teeth with large periradicular lesions or apical cysts( figure 1- 15), teeth with perforations or internal or external resorption ( figure 1- 16 ), teeth badly broken down by caries or horizontal fracture ( figure 1- 17 ), pulples teeth with tortuous or apparently obstructed canals or broken instruments within, teeth with flaring open apices( figure 1- 18 ), teeth that are hopelessly discolored ( figure 1- 19 ), and even teeth that are wholly or partially luxated. All of these conditions can usually be overcome by endodontic, orthodontic,periodontic, or surgical procedures. In some cases, the prognosis may

be somewhat guarded. But in the majority of cases, the patient and dentist are pleased with the outcome, especially if the final result is an arch fully restored.

ONE- APPOINTMENT THERAPY Single appinment root canal therapy has become a common practice. When questioned, however, most dentists reply that they reserve one-appoinment treatment for vital pulp and immediate periradicular surgery cases. In 1982, only 12,8% of dentists quered thought that necrotic teeth would be successfully treated in one appointment. Endodontis have been treating patients in one- appointment visits for some time. At one time, 86% of the directors of postgraduate endodontic programs, when surveyed, reported that nonsurgical one- visit treatment was part of their programs. What are the advantages and disadvantages of single- visitendodontics? Advantages : 1. Immediate familiarity with the internal anatomy, canal shape, and contour facilitates obturation 2. No risk of bacterial leakage beyond a temporary coronal seal between appointment 3. Reduction of clinic time 4. Patient convenience no additional appointments 5. Less cost Perceived disadvantages: 1. No easy access to the apical canal if there is a flare- up

2. Clinician fatigue with extended one- appointment operating time 3. No opportunity to place an intracanal disinfectant ( other than allowing NaCl to disinfect during treatment).

What has held back one- appointment endodontics? The major consideration has been concern about post-operative pain and failure.

GOOD LUCK BABY. KEEP SMILE..