Essential Endodontology
Prevention and Treatment of Apical Periodontitis
3. Edition January 2020
408 Pages, Hardcover
Practical Approach Book
Further versions
The authoritative reference that continues to present a systematic analysis of the scientific basis of endodontology
The third edition of Essential Endodontology: Prevention and Treatment of Apical Periodontitis has been revised and updated to include the most recent developments in the field, maintaining its position as the major scientific treatise of apical periodontitis. Making an often-complex subject more digestible, the book explores the scientific basis of endodontology, adopting a systematic analysis of the available clinical and laboratory evidence.
Promoting apical periodontitis as a disease entity, the comprehensive third edition focuses on its biology and clinical features, enabling the reader to have a better understanding of its diagnosis, prevention and treatment. In addition to thorough updates and full colour illustrations throughout, a new chapter on regenerative endodontics has been added to this edition.
* Written with a focus on the scientific basis of endodontology
* Includes a new chapter on regenerative endodontics
* Presents the most current information and major developments in this fast-moving field
* Provides helpful learning outcomes in each chapter
* Contains full colour illustrations, enriching the text
* Features contributions from a noted panel of international experts, including new contributors from across the globe
Regarded as a vital companion to the pursuit of excellence in postgraduate and specialist education, Essential Endodontology is an indispensable and accessible resource for practicing endodontists, postgraduate students of endodontology and those seeking professional certification in endodontology.
List of Contributors xi
About the Companion Website xiii
1 Apical Periodontitis: Microbial Infection and Host Responses 1
Dag Ørstavik
1.1 Introduction 1
1.2 Terminology 1
1.3 Pulp Infection and Periapical Inflammation 3
1.4 Biological and Clinical Significance of Apical Periodontitis 4
1.5 Concluding Remarks 7
References 8
2 Dentin-Pulp and Periodontal Anatomy and Physiology 11
Leo Tjaderhane and Susanna Paju
2.1 Introduction 11
2.2 Dentin 11
2.3 Pulp Tissue and its Homeostasis 22
2.4 Pulp Inflammation 27
2.5 Pulp Nociception and Hypersensitivity 32
2.6 Age-related Changes in Dentin-pulp Complex 34
2.7 The Periodontium 39
2.8 The Periodontal Ligament (PDL) 39
2.9 Cementum 44
2.10 Alveolar Bone 46
References 49
3 Etiology and Pathogenesis of Pulpitis and Apical Periodontitis 59
Ashraf F. Fouad and Asma A. Khan
3.1 Introduction 59
3.2 Etiology of Pulpitis and Apical Periodontitis 60
3.3 Inflammation Versus Infection of the Pulp and Periapical Tissues 61
3.4 The Dental Pulp 62
3.5 The Periapical Tissues 70
3.6 Concluding Remarks 79
References 80
4 Microbiology of Apical Periodontitis 91
José F. Siqueira Jr and Isabela N. Rôças
4.1 Introduction 91
4.2 Microbial Causation of Apical Periodontitis 91
4.3 Endodontic Biofilms and the Community-as-Pathogen Concept 95
4.4 Mechanisms of Bacterial Pathogenicity 102
4.5 Microbial Ecology and the Root Canal Ecosystem 105
4.6 Types of Endodontic Infections 110
4.7 Identification of Endodontic Bacteria 111
4.8 Endodontic Biofilm Community Profiles 115
4.9 Microbiota in the Apical Root Canal 116
4.10 Symptomatic Infections 117
4.11 Persistent/ Secondary Endodontic Infections 120
4.12 Extraradicular Infections 123
4.13 Other Microorganisms in Endodontic Infections 125
References 127
5 Epidemiology, Treatment Outcome, and Risk Factors for Apical Periodontitis 143
Lise-Lotte Kirkevang and Michael Vaeth
5.1 Introduction 143
5.2 General Aspects of Epidemiology 144
5.3 Elements of an Epidemiologic Study 155
5.4 Evaluation of Epidemiologic Data 157
5.5 Factors and Conditions Associated with Treatment Outcome 160
References 169
6 Radiology of Apical Periodontitis 179
Shanon Patel and Conor Durack
6.1 Introduction 179
6.2 Normal Apical Periodontium 180
6.3 Radiographic Appearance of Apical Periodontitis 190
6.4 Healing Characteristics 194
6.5 Conventional Radiography for Assessment of Apical Periodontitis 195
6.6 Advanced Radiographic Techniques for Endodontic Diagnosis 195
6.7 Differential Diagnosis 197
6.8 CBCT for Assessment of AP 202
6.9 Concluding Remarks 204
References 204
7 Clinical Manifestations and Diagnosis 211
Asgeir Sigurdsson
7.1 Introduction 211
7.2 Pulpal Diagnostic Terms 212
7.3 Symptomatology of Pulpal Disease 213
7.4 Clinical Findings 216
7.5 Diagnostic Testing 217
7.6 Formulation of a Pulpal Diagnosis 223
7.7 Periapical Diagnosis 225
7.8 Symptomatology of Periapical Disease 226
7.9 Formulation of a Periapical Diagnosis 230
7.10 Future of Pulpal and Periapical Diagnosis 231
References 231
8 Biological Basis for Endodontic Repair and Regeneration 237
Kerstin M. Galler
8.1 Principles of Regeneration and Repair 237
8.2 Vital Pulp Therapy 238
8.3 Cell Types Involved in Pulp Healing 239
8.4 The Role of Inflammation 242
8.5 Signaling Molecules in Dentine 243
8.6 Tissue Engineering Approaches to Dental Pulp Regeneration 245
References 248
9 Prevention: Treatment of the Exposed Dentine Pulp Complex 253
Lars Bjørndal
9.1 Diagnostic Challenges of Deep Caries and Traumatic Pulp Exposure 253
9.2 Discerning Pulpal Diagnosis 254
9.3 The Pulp Biology Associated with Pulp Capping 257
9.4 Criteria for Assessing Success of Vital Pulp Therapies 259
9.5 Indirect Pulp Capping and Stepwise Excavation 259
9.6 Pulp Capping of the Uninflamed Pulp (Class I) 261
9.7 Pulp Capping of the Cariously Involved Pulp (Class II) 261
9.8 Partial Pulpotomy 261
9.9 Pulpotomy 262
9.10 Treatment Details for Pulp-preserving Techniques 263
9.11 The Available Evidence for Relative Merit of Treatment Procedures for Vital Pulps 264
9.12 Future Perspectives of More Advanced Biological Approaches 270
References 270
10 Vital Pulp Extirpation 275
John Whitworth
10.1 Introduction 275
10.2 Pulpectomy - Definition and Rationale 275
10.3 The Challenge of Effective Local Anesthesia 277
10.4 Principles of Effective Pulpectomy 278
10.5 Canal Shaping 283
10.6 Canal Irrigation and Medication 294
10.7 Preserving the Aseptic Environment: Root Canal Filling and Coronal Restoration 299
10.8 Concluding Remarks 304
References 304
11 Endodontic Treatment of Apical Periodontitis 313
Dag Ørstavik
11.1 Introduction 313
11.2 Anatomic Location of the Microbes 314
11.3 Bacteriological Status During Treatment 316
11.4 Infection Control During Treatment 318
11.5 Root Filling Phase 323
11.6 Clinical Issues During Diagnosis and Treatment of Primary Apical Periodontitis 326
11.7 Treatment of Persistent or Recurrent Apical Periodontitis 327
11.8 Treatment of Immature Permanent Teeth with Apical Periodontitis 328
11.9 Monitoring Healing, Prognostication 329
11.10 Concluding Remarks 330
References 331
12 Surgical Endodontics 345
Frank C. Setzer and Bekir Karabucak
12.1 Introduction, Including History 345
12.2 Surgical Endodontic Procedures 346
12.3 Indications 346
12.4 Contraindications 348
12.5 General Preparations for Surgery 348
12.6 Anesthesia 349
12.7 Surgical Anatomy 351
12.8 Clinical Steps in Root-end Surgery 354
12.9 Perforation Repair 363
12.10 Replantation 363
12.11 Root Amputation, Hemisection 364
12.12 Guided Tissue Regeneration 366
12.13 Retreatment of Failed Surgical Cases 367
12.14 Modes of Healing 368
12.15 Outcome of Surgical Endodontics 368
References 372
Index 387
