بســم الله الرحمــن الرحيـــم

1. بســم الله الرحمــن الرحيـــم Endodontic Case presentation t Prepared By:ABDULLAH AL - QEDRAH.SSC-Endo.(R1).

2. 1st Case

3. Personal data: Age:50yrs. Sex : Male. Nationality: Saudi. Date started: 21/Feb/2010 Date finished: 07/Mar/2010 Chief complaint: - Severe pain → cold. + percussion. History of complaint: - Trauma??? → 1 yr ago.

4. Medical History Dental History - D.M. controlled Rees (1994) the dentist is often the first professional to encounter pt with uncontrolled DM. Use morning appts, confirm breakfast; avoid excessive epi. in LA. Goerig: Diabetics have slower healing of PARL. Goldman (1987): Reasons for poor wound healing & infection are hyperglycemia leading to impaired phagocytosis, chemotaxis, adherance and killing of bacteria. - Multiple fillings, RCTs., - Exo. w/o complications . Intra-Oral Examination Extra-Oral Examination - Soft Tissues: - WNL. EXCEPT periodontal ??? - Hard Tissues: - Splinting by ortho. wire and composite of lower anterior teeth. - WNL

5. Clinical Evaluation # 31

6. Diagnosis Pulpal :- Irreversible Pulpitis. Periapical :- Acute Apical Periodontitis . Periodontal:- generalized Gingivitis with localized periodontitis ( lower ant.). Prognosis Good. Treatment plan 1- Non-Surgical Root Canal Therapy of # 31 & 32. ( Ca(OH)2internal ). 2- Composite Restoration of the access cavity. 3- Exo. teeth # 41 & 42 after consult. with Periodontist→ implant. 4- O.H. Instruction.

7. ANATOMY OF LOWER CENTRAL INCISOR: Vertucci (1984): 70-75% 1 canal and 18-22% 2 canals. Benjamin & Dowson (1974): the incidence of 2 canals in mandibular incisors is 41%, generally merging in the apical area. This value is higher than Vertucci's study (= 18-22%). Rankine & Henry (1965), in lower anterior teeth with long crowns and roots usually had 1 canal, thus, short blunt crowns usually had 2 canal (only 13% with separated foramena). Rankine & Henry (1965), access and instrument ( curving file) must be modified to negotiate L canal. Mauger, Schindler & Walker (1998): Determine the prevalence of two canals and an isthmus in mandibular incisors. An isthmus was present in 20% of the teeth at the 1mm level, 30% at 2mm, and 55% at 3mm.

8. Measurement # 31 - Mauger, Schindler & Walker (1998): The width measurements indicate that a final apical prep size should > #35 file to debride most mand. incisors. - Miyashita (1997) evaluated 1,085 mand. incisors and recommended #40 MAF.

9. Andreasen’s Classification of dental trauma: (1981 & 1990):1- Fracture:

10. Andreasen’s Classification of dental trauma: (1981 & 1990):2- Luxation:

11. Prognosis of luxated permanent teeth for developing necrosis: Andreasen 1985, Concusion → 3% become necrotic. Subluxation → 6%. Extrusion → 26%. Lateral luxation → 58%. Intrusion → 85%. In general, teeth with complete root development have poorer prognosis for pulp vitality (necrosis usually seen in 3 weeks) than teeth with incomplete root development (which showed 34% pulpal healing). Dumsha 1982, after observing 52 teeth after extrusive luxation from 4 week to 1.5 yrs → 98% showed necrosis which > than andreasen studies ( may because this study had an older patients → complete apical closure. Also, the severity of these injury are probably greater than those in andreasen study ). So, teeth with fully developed apices that are forcefully separated from their blood supply are likely to necrose.

12. Ca(OH)2 Properties: - Bystrom & Sundqvist (1981; 1985): Ca(OH)2 is antimicrobial. - Sjogren (1991): Ca(OH)2 applied for 7 days eliminated bacteria in canal systems . - McCormick (1983) Osteoclastic cells (osteoclasts & PMNs) prefer acidity. The high pH of Ca(OH)2 antagonizes their action. - Nerwich & Messer (1993): Evaluated dentinal pH after Ca(OH)2 dressing. Inner dentin pH rapidly increases by OH diffusion (peaks 1 day), but takes 2-3 weeks to peak in outer dentin.

13. Initial Obturation

14. Obturation

15. 2nd Case

16. Patient personal data Age:56 years. Sex:Male. Nationality :- Saudi. Date started: 24/Jan/2010. Date finished: 14/Feb/2010. Chief Complaint - I want to replace my anterior teeth & my dr. referred me to u. History of Chief Complaint - Failed old FPD (from 13 to 23 with missing 12, 11, 21, 22.) due to recurrent caries. - Prosthodontist referred the Pt for RCT of T # 23 & 24. ( Elective for P/C. ).

17. Medical History Dental History - Multiple fillings, RCTs., - Exo. w/o complications. - Crowns and bridges. Past :- - W.N.L Current :- - W.N.L Extra-Oral Examination Intra-Oral Examination - WNL - Soft Tissues: - WNL. EXCEPT Gingivitis ??? - Hard Tissues: - Attrition & erosion related to some upper teeth.

18. Clinical Evaluation # 24

19. Diagnosis Pulpal :- Normal Pulp. Periapical :- Normal. Periodontal:- Generalized gingivitis. Prognosis - Good. Treatment plan 1- Non-Surgical Root Canal Therapy. 2- Cl I Composite Filling then crown. 3- O.H. Instruction & scalling then prophylaxis.

20. ANATOMY OF Upper 1st premolar : - Carns & Skidmore (1973): → 85% max 1st premolars have 2 canals. → Max first premolars showed five different morphologic categories of combinations of roots, canals, and foramina: - 2,2,2 (57%); - 1,2,2 (15%); - 1,2,1 (13%); - 1,1,1 (9%); and - 3,3,3 (6%). → Remember to look for wider M-D width at CEJ as a predictor of a 3 canal premolar. - Vertucci 1984, 1st Premolar : → 62% Type IV (2 canals), → 18% Type II (2-1 canals), → 69% have 2 canals at apex. - Bellizzi (1985): 90% have 2 canals.

21. Measurement # 24

22. Initial Obturation Obturation