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39-529: Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the etiology , diagnosis, prevention, and treatment of diseases and injuries of the dental pulp along with associated periradicular conditions. In clinical terms, endodontics involves either preserving part, or all of the dental pulp in health, or removing all of the pulp in irreversible disease. This includes teeth with irreversibly inflamed and infected pulpal tissue. Not only does endodontics involve treatment when

78-399: A Cochrane review in 2015 found no evidence to determine whether there is a difference in the outcome of a procedure done by magnification devices or a conventional procedure done with no magnification. The American Association of Endodontists strongly encourages its members to pursue the use of an oral microscope to ensure the highest level of excellence. The use of a CBCT is also becoming

117-461: A cabbage preparation, every day, and based upon the positive outcomes, he inferred that it prevented scurvy, even though he did not know precisely why. It took about another two hundred years to discover the precise etiology; the lack of vitamin C in a sailor's diet. The following are examples of intrinsic factors: An etiological myth, or origin myth, is a myth intended to explain the origins of cult practices, natural phenomena, proper names and

156-501: A delayed pedicle skin graft, where the skin from the arm would be attached to the nose for many months to create the reconstruction, first printed in the 1597 book De Curtorum Chirurgia per Insitionem . The Italian method was rediscovered in 1800 by German surgeon Carl Ferdinand von Graefe . Major advancements in modern plastic surgery are mostly attributed to Harold Gillies , who pioneered facial reconstruction during World War I using pedicled tube flaps on patients like Walter Yeo , and

195-468: A dental pulp is present, but also includes preserving teeth which have failed to respond to non-surgical endodontic treatment, or for teeth that have developed new lesions, e.g., when root canal re-treatment is required, or periradicular surgery . Endodontic treatment is one of the most common procedures. If the dental pulp (containing nerves , arterioles , venules , lymphatic tissue , and fibrous tissue) becomes diseased or injured, endodontic treatment

234-441: A flap is to maintain blood flow to tissue to maintain survival, and understanding the anatomy in flap design is key to a successful flap surgery. Flaps may include skin in their construction. Skin is important for many reasons, but namely its role in thermoregulation , immune function , and blood supply aid in flap survival. The skin can be divided into three main layers: the epidermis , dermis , and subcutaneous tissue . Blood

273-460: A previous root canal treatment fails, and re-root canal treatment is not possible. This may be as a result of anatomical features, such as root dilaceration, which can compromise the completion of cleaning and obturating the root canal system. Procedural errors, including ledges or perforations, may also be indications for an apicectomy. Local anaesthetic is utilised to achieve anaesthesia as well as haemostasis for improved visualisation. A flap in

312-423: A root and its overlying portion of the crown are separated from the rest of the tooth and optionally removed, is another (non-periradicular) endodontic surgery. Microsurgical endodontics , the use of magnification devices such as microscopes, and dental loupes, has been widely accepted among endodontists and practitioners; its use is believed to increase accuracy and visualization in the operating field . However,

351-482: A sacrifice, the Greeks offered the bones wrapped in fat to the gods while keeping the meat for themselves. In Ovid 's Pyramus and Thisbe , the origin of the color of mulberries is explained, as the white berries become stained red from the blood gushing forth from their double suicide. Flap (surgery) Flap surgery is a technique in plastic and reconstructive surgery where tissue with an intact blood supply

390-473: A single artery and can include skin, soft tissue, and bone. Adjacent angiosomes are connected by narrower choke vessels, and multiple angiosomes can be supplied by a single artery. Knowledge of these supply arteries and their associated angiosomes is useful in planning the location, size, and shape of a flap. Flaps can be fundamentally classified by their mechanism of movement, the types of tissues present, or by their blood supply. The surgeon generally chooses

429-411: A year to complete. Following flap surgery, the biggest risk in recovery is flap death. Flap failure is an uncommon occurrence but does happen. The reported flap failure rate in free flaps is less than 5%. The most commonly cause is by venous insufficiency consisting of 54% of all causes. Venous insufficiency is commonly caused by a venous thrombus within the first 2 days following surgery. After

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468-483: Is a myth that has arisen, been told over time or written to explain the origins of various social or natural phenomena. For example, Virgil 's Aeneid is a national myth written to explain and glorify the origins of the Roman Empire . In theology , many religions have creation myths explaining the origins of the world or its relationship to believers. In medicine, the etiology of an illness or condition refers to

507-568: Is a technique essential to plastic and reconstructive surgery . A flap is defined as tissue that can be moved to another site and has its own blood supply . This is in comparison to a skin graft which does not have its own blood supply and relies on vascularization from the recipient site. Flaps have many uses in wound healing and are used when wounds are large, complex, or need tissue and bulk for successful closure. Flaps can contain many different combination of layers of tissue, from skin to bone (see § Classification ). The main goal of

546-490: Is an imprecise process. In the past, the etiology of a common sailor's disease, scurvy , was long unknown. When large, ocean-going ships were built, sailors began to put to sea for long periods of time, and often lacked fresh fruit and vegetables. Without knowing the precise cause, Captain James Cook suspected scurvy was caused by the lack of vegetables in the diet. Based on his suspicion, he forced his crew to eat sauerkraut ,

585-441: Is delivered to make the procedure pain free. The tooth to be treated is then isolated using a rubber dam, which prevents saliva entering the tooth during treatment and protects the airway from the fine files and strong chemicals used. The root canal treatment procedure is often carried out over single or multiple appointments. Root canal treatment involves: Instrument fractures are common procedural mishaps in root canal treatment. It

624-417: Is essential to prevent instrument fractures. The success of removing a broken instrument depends on the location, direction and type of instrument. A sodium hypochlorite accident can result in long-term functional and aesthetic complications. Extrusion of sodium hypochlorite irrigating solution during a root canal procedure can cause a severe inflammatory reaction and tissue damage. Treatment is provided based on

663-558: Is flap death, where the flap loses blood supply. The loss of blood can be due to many reasons, but is commonly due to tension on the vascular supply and insufficient blood flow to the end segments of the flap. This can sometimes be fixed with another surgery or using additional methods of healing in the reconstructive ladder. As with healing of any wound, healing of a flap maintains the same process of wound healing. There are four stages to wound healing: hemostasis , inflammation , proliferation , and remodeling , all of which can take up to

702-407: Is important in flap surgery, because flaps are cut off from other blood vessels when it is raised and removed from its surrounding native tissue. The remaining blood supply must then keep the tissue alive until additional blood supply can be formed through angiogenesis . The angiosome is a concept first coined by Ian Taylor in 1987. It is a three-dimensional region of tissue that is supplied by

741-403: Is lifted from a donor site and moved to a recipient site. Flaps are distinct from grafts , which do not have an intact blood supply and relies on the growth of new blood vessels. Flaps are done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, or to rebuild more complex anatomic structures like breasts or jaws. Flap surgery

780-531: Is mainly supplied to the skin by two networks of blood vessels. The deep network lies between the dermis and the subcutaneous tissue, while the shallow network lies within the papillary layer of the dermis. The epidermis is supplied by diffusion from this shallow network and both networks are supplied by collaterals , and by perforating arteries that bring blood from deeper layers either between muscles (septocutaneous perforators) or through muscles (musculocutaneous perforators). This robust and redundant blood supply

819-510: Is recognized as one of the thirteen registered dental specialties. In addition to a dental degree, endodontists have an additional three years of postgraduate University training in the area of endodontics to be recognized and registered by the Dental Board of Australia. A general dentist is permitted to perform endodontic treatment, but must be competent in the skills required for the treatment and refer complex cases for specialist management. In

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858-410: Is required to save the tooth. Root canal treatment is a dental procedure used to treat infected tooth pulp which would be otherwise extracted. The pulp is the soft tissue core of the tooth which contains nerves, blood supply and connective tissue necessary for tooth health. This is usually caused when bacteria enter the pulp through a deep cavity or failed filling. Root canal treatment is required when

897-458: Is the study of causation or origination. The word is derived from the Greek word αἰτιολογία ( aitiología ), meaning "giving a reason for" (from αἰτία ( aitía )  'cause' and -λογία ( -logía )  'study of'). More completely, etiology is the study of the causes, origins, or reasons behind the way that things are, or the way they function, or it can refer to

936-505: The Aeneid (published c.  17 BC ), Virgil claims the descent of Augustus Caesar 's Julian clan from the hero Aeneas through his son Ascanius , also called Iulus. The story of Prometheus ' sacrifice trick at Mecone in Hesiod 's Theogony relates how Prometheus tricked Zeus into choosing the bones and fat of the first sacrificial animal rather than the meat to justify why, after

975-640: The United States after finishing a dental degree , a dentist must undergo 2–3 additional years of postgraduate training to become an endodontist. American Dental Association (ADA) accredited programs are a minimum of two years in length. Following successful completion of this training, the dentist becomes eligible to sit for the American Board Of Endodontology examination. Successful completion of board certification results in Diplomate status in

1014-643: The American Board of Endodontics. Although general dentists can perform endodontic treatment, there are several things which set endodontists apart. Endodontists use microscopes during treatment to better treat the small internal anatomy of teeth without taking away too much tooth structure, or causing iatrogenic damage. Also, endodontists use CBCT (3D imaging) to assess case difficulty and for diagnosis and treatment planning of endodontic cases. Etiology Etiology ( / ˌ iː t i ˈ ɒ l ə dʒ i / ; alternatively spelled aetiology or ætiology )

1053-514: The causes themselves. The word is commonly used in medicine (pertaining to causes of disease or illness) and in philosophy , but also in physics , biology , psychology , political science , geography , cosmology , spatial analysis and theology in reference to the causes or origins of various phenomena . In the past, when many physical phenomena were not well understood or when histories were not recorded, myths often arose to provide etiologies. Thus, an etiological myth, or origin myth ,

1092-418: The dental pulp is irreversibly damaged and involves both coronal and apical pulp. Root canal treatment can also be carried out on teeth with doubtful pulpal state before placing post-retained crowns and overdentures. Root canal therapy is not only performed when pain relief from an infected or inflamed pulp is required, it is also done to prevent adverse signs and symptoms from the surrounding sequelae and promote

1131-479: The development of the walking-stalk skin flap by Gilles' cousin Archibald McIndoe in 1930. Advancements continued in flap surgery. With the introduction of the operating microscope , microvascular surgery advancements allowed for the anastomosis of blood vessels. This led to the ability of free tissue transfers, and in 1958 Bernard Seidenberg transferred a part of the jejunum to the esophagus to remove

1170-409: The frequent studies to determine one or more factors that come together to cause the illness. Relatedly, when disease is widespread, epidemiological studies investigate what associated factors, such as location, sex, exposure to chemicals, and many others, make a population more or less likely to have an illness, condition, or disease, thus helping determine its etiology. Sometimes determining etiology

1209-663: The gum is designed, and then raised to allow for exposure of the periapical lesion. Bone removal ( osteotomy ) is carried out to enable access to root apex , and diseased tissue is removed at this point through curettage . The root end resection is carried out, removing 3mm apically. The canal(s) is then obturated, and the flap is sutured. There are a number of root-end filling materials available, including zinc oxide eugenol cements, and mineral trioxide aggregate . Complications that may arise include: Other non-surgical endodontic procedures include pulp capping , pulpotomy , apexification , and pulpal regeneration . Hemisection , where

Endodontics - Misplaced Pages Continue

1248-535: The healing and repair of the surrounding periradicular tissues. An example of this is if there is trauma to a front tooth which has caused it to be avulsed from the bony socket; endodontic treatment is required following re-implantation to preserve the aesthetics and function of the tooth, even though there may be no adverse symptoms of the dental pulp, or pain present at the time. Prior to root canal treatment, clinical examination and radiographic examinations are carried out to diagnose and plan treatment. Local anaesthesia

1287-473: The immediate postoperative risk, the flap will continue to heal adhering to the stages of normal wound healing and will take over 3 months for an incision to be at 80% tensile strength compared to normal tissue. Skin flaps are an essential part of a surgeon's toolbox in plastic surgery. It is part of the reconstructive ladder. The first known reports of surgical flaps originated in 600 BC in India by Sushruta where

1326-709: The least complex type that will achieve the desired effect via a concept known as the reconstructive ladder . Flaps can be classified by the content of the tissue within them. Classification based on blood supply to the flap: Anyone who is unstable for surgery should not undergo flap surgery. As with most surgeries, people who are sicker may have more difficulties with wound healing , which include individuals with comorbidities such as diabetes , smoking , immunosuppression , and vascular disease . The risks of flap surgery include infection, wound breakdown , fluid accumulation , bleeding , damage to nearby structures, and scarring . The most notable risk in this procedure

1365-486: The like. For example, the name Delphi and its associated deity, Apollon Delphinios , are explained in the Homeric Hymn which tells of how Apollo, in the shape of a dolphin ( delphis ), propelled Cretans over the seas to make them his priests. While Delphi is actually related to the word delphus ("womb"), many etiological myths are similarly based on folk etymology (the term " Amazon ", for example). In

1404-456: The severity of the injury. Tooth discolouration as a result of root canal treatment can occur if the pulpal tissue remnants are not completely removed or if a root canal sealer material containing silver is used. Periradicular surgeries involve the root surface. These include apicoectomy (removal of a root end), root resection (removal of an entire root), repair of an injured root due to perforation or resorption , removal of broken fragments of

1443-556: The standard of care. Endodontists are specialist dentists with additional training, experience and formal qualifications in endodontic treatment, apicectomies, microsurgery, and dental emergency and trauma management. Endodontics is recognized as a specialty by many national dental organizations including the Dental Board of Australia, British General Dental Council , American Dental Association , Royal College of Dentists of Canada , Indian Dental Association , and Royal Australasian College of Dental Surgeons . In Australia , endodontics

1482-405: The tilemakers' caste would reconstruct noses using regional flaps due to the practice of nose amputations as a form of legal punishment. The next description of flap surgery comes from Celsus, an ancient Roman who described the advancement of skin flaps from 25 BC to 50 AD. In the 15th century, Gaspare Tagliacozzi , an Italian surgeon, helped develop the "Italian method" for nasal reconstruction,

1521-434: The tooth or a filling material, and exploratory surgery to look for root fractures. An apicoectomy is a surgical procedure through which the apex of a root is resected, and a root-end filling is placed, preventing bacterial leakage into the root canal system from the periradicular tissues. A microsurgical technique is used to carry out apicectomy, which improves post-operative healing. An apicoectomy can be carried out when

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