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Part 1 book “Textbook of endodontics” has contents: Introduction and scope of endodontics, pulp and periradicular tissue, pathologies of pulp and periapex, endodontic microbiology, rationale of endodontic treatment, diagnostic procedures,… and other contents.
Textbook of ENDODONTICS Textbook of ENDODONTICS THIRD EDITION Nisha Garg MDS (Conservative Dentistry and Endodontics) Ex-Resident, Postgraduate Institute of Medical Education and Research Chandigarh, India Ex-Resident, Government Dental College Patiala, Punjab, India Presently Reader Department of Conservative Dentistry and Endodontics Sri Sukhmani Dental College and Hospital Dera Bassi, Punjab, India Amit Garg MDS (Oral and Maxillofacial Surgery) Ex-Resident, Government Dental College Postgraduate Institute of Medical Sciences Rohtak, Haryana, India Consultant Oral and Maxillofacial Surgeon Faridabad, Haryana, India Foreword Anil Chandra ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • London Philadelphia Panama đ Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +507-301-0496 Fax: +507-301-0499 Email: cservice@jphmedical.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Medical Inc The Bourse 111, South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: + 267-519-9789 Email: joe.rusko@jaypeebrothers.com Jaypee Brothers Medical Publishers (P) Ltd Shorakhute, Kathmandu Nepal Phone: +00977-9841528578 Email: jaypee.nepal@gmail.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2014, Jaypee Brothers Medical Publishers All rights reserved No part of this book may be reproduced in any form or by any means without the prior permission of the publisher Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended for educational purposes only While every effort is made to ensure accuracy of information, the publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work If not specifically stated, all figures and tables are courtesy of the authors Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device Textbook of Endodontics First Edition: 2007 Second Edition: 2010 Third Edition: 2014 ISBN: 978-93-5090-952-2 Printed at Dedicated to Prisha and Vedaant Contributors Amit Garg Consultant Oral and Maxillofacial Surgeon Faridabad, Haryana, India Navjot Singh Khurana Sandhya Kapoor Punia Senior Lecturer Department of Conservative Dentistry and Endodontics Darshan Dental College Udaipur, Rajasthan, India Amita Lecturer Department of Conservative Dentistry and Endodontics Government Dental College Patiala, Punjab, India Associate Professor Faculty of Dentistry Jamia Millia Islamia New Delhi, India Anil Dhingra Professor Faculty of Dental Sciences Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India Nisha Garg Senior Lecturer Department of Conservative Dentistry and Endodontics National Dental College Dera Bassi, Punjab, India Reader Department of Conservative Dentistry and Endodontics BRS Dental College and Hospital Panchkula, Haryana, India Professor and Head Department of Conservative Dentistry and Endodontics DJ Institute of Dental Sciences and Research Modinagar, Uttar Pradesh, India Bobbin Gill Consultant Endodontist Chandigarh, India Jaidev Dhillon Professor and Head Department of Conservative Dentistry and Endodontics BRS Dental College and Hospital Panchkula, Haryana, India JS Mann Associate Professor Department of Conservative Dentistry and Endodontics Government Dental College Patiala, Punjab, India Manoj Hans Reader Department of Conservative Dentistry and Endodontics Vyas Dental College and Hospital Jodhpur, Rajasthan, India Monia Sharma Reader Department of Periodontics DAV Dental College Yamuna Nagar, Haryana, India Neelam Mittal Reader Department of Conservative Dentistry and Endodontics Sri Sukhmani Dental College and Hospital Dera Bassi, Punjab, India Poonam Bogra Senior Professor Department of Conservative Dentistry and Endodontics DAV Dental College Yamuna Nagar, Haryana, India RS Kang Associate Professor Department of Conservative Dentistry and Endodontics Government Dental College Patiala, Punjab, India Ruchi Vashisht Reader Department of Conservative Dentistry and Endodontics National Dental College Dera Bassi, Punjab, India Sachin Passi Principal and Head Department of Conservative Dentistry and Endodontics Sri Sukhmani Dental College and Hospital Dera Bassi, Punjab, India Sanjay Miglani Shinam Kapila Pasricha Suresh K Saini Reader Department of Prosthodontics BRS Dental College and Hospital Panchkula, Haryana, India Vikas Punia Senior Lecturer Department of Prosthodontics Darshan Dental College Udaipur, Rajasthan, India Yoshitsugu Terauchi DDD PhD Lecturer, Tokyo Medical and Dental University Japan Foreword It gives me immense pleasure to introduce you to the third edition of the Textbook of Endodontics Past several years have witnessed the publication of many new textbooks on the subject of endodontics by well-known scholars and scientists Several critically important paradigm shifts have occurred in dentistry, particularly in the field of endodontics in the past decades, a shift towards the comprehensive approach in the endodontic practice today It is of foremost importance to put this work into the context of the continuum of endodontic literature Endodontics has become so important in the last several decades that books which condense all the techniques and treatment options are certainly looked-for Written by the two leading authorities on this important aspect of dentistry, Drs Nisha Garg and Amit Garg have accumulated a tremendous amount of knowledge to summarize this important information into easy-to-read chapters This compact yet comprehensive work clearly portrays their efforts The authors have invested extensive time and effort to freshly describe the existing literature and have added interesting chapters like Endodontic Failures and Retreatment, Tooth Hypersensitivity, and Tooth Infractions I am sure the new edition of the book will be equally appreciated by the undergraduate and postgraduate students as well as the researchers I am delighted and honored to introduce and recommend the book, which will effectively bridge the gap between the scientific esoteric and practitioner’s daily need for relevant knowledge, and will become one of the most significant steps in understanding the subject of endodontics. Anil Chandra Professor Department of Conservative Dentistry and Endodontics King George’s Medical University Lucknow, Uttar Pradesh, India Preface to the Third Edition In presenting the third edition of the Textbook of Endodontics, we would like to express our appreciation in the kindly manner in which the earlier editions were accepted by dental students and professionals across the country The scope of the third edition of this book is as earlier to be simple yet comprehensive Textbook of Endodontics that serves as an introductory for dental students and a refresher source for general practitioners The book attempts to incorporate most recent advances in endodontics while at the same time not losing the sight of basics, therefore, making the study of endodontics easier and interesting In an attempt to improve the book further, many eminent personalities were invited to edit, write and modify the important chapters in form of text and photographs We would especially thank Dr Jaidev Dhillon, Dr Anil Dhingra, Dr Neelam Mittal, Dr Poonam Bogra, Dr Sachin Passi, and Dr Manoj Hans for providing us clinical case-photographs and radiographs for better understanding of the subject We are indebted to Dr Poonam Bogra for writing an important chapter Biofilm in Endodontics for the book and editing chapters, Access Cavity Preparation, Cleaning and Shaping of Root Canal System, Irrigation and Intracanal Medicaments We fall lack of words to thank Dr Sri Rekha for critically evaluating the chapter; Working Length Determination, Endodontic Instruments and Management of Traumatic Injuries We are thankful to Dr Sanjay Miglani for modifying chapter Internal Anatomy, Dr Navjot Singh Khurana for editing chapter Management of Traumatic Injuries, Dr Monia Sharma for Endodontic Periodontal Lesions, Dr Ruchi Vashisht for Obturation of Root Canal System and Surgical Endodontics, Dr Shinam Pasricha for Tooth Infractions and Tooth Resorption, Drs Amita and Suresh Saini for Postendodontic Restorations, Dr Bobbin for Flare-ups, Drs Sandhya Kapoor Punia and Vikas Punia for editing Geriatric Endodontics and Tissue Engineering We are specially thankful to Yoshitsugu Terauchi for sharing his new device for removal of the fractured instrument We are thankful to Dr RS Kang and Dr JS Mann for their constant support, motivation and encouragement We are also thankful to Dr Arundeep Singh, Dr Rahul Jain and Dr Gaurav Aggarwal for providing photographs and radiographs for the book Also thankful to Dr Shaweta for helping us in sorting out the MCQs for the book We offer our humble gratitude and sincere thanks to Mr Avtar Singh (Chairman), and Mr Daman Jeet Singh, Sri Sukhmani Dental College (SSDC), Dera Bassi, Punjab, India, for providing healthy and encouraging environment for our work We would like to express our thanks to staff of Department of Conservative Dentistry and Endodontics, Sri Sukhmani Dental College, Dera Bassi, Punjab, India, Dr Sachin Passi, Dr Rajnish Kumar and Dr Rahul Jain for their ‘ready to help’ attitude, constant guidance and positive criticism which helped in improvement of the book It is hoped that all these modifications will be appreciated and render the book still more valuable basis for endodontic practice We are thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (DirectorPublishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coordinator), Mr Manoj Pahuja (Senior Graphic Designer), Mr Binay Kumar (Proofreader), Mr Chandra Dutt (Typesetter) and staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for showing personal interest and trying to the level best to bring the book in present form Nisha Garg Amit Garg Preface to the First Edition The amount of literature available in dentistry today is vast Endodontics being no exception However, during both our graduation as well as postgraduation, we always felt the need for a book which would help us to revise and update our knowledge When we were doing undergraduation, there were no Indian authored books on endodontics We were thus motivated to frame a specialized, precise, concise, easy to read and remember yet, up-to-date Textbook of Endodontics The line diagrams are in an expressive interpretation of endodontic procedures, which are worked upon and simplified to render them more comprehensive and comparable with real photographs These illustrations (around 1200) are easy to remember and reproduce during examinations Emphasis is laid upon the language which is simple, understandable and exclusively designed for undergraduates, postgraduates, general practitioners and teachers in the field It took us more than three years to accomplish the arduous task of writing this book This thrust for knowledge led us to link everywhere, where we could Medline journals, books and more Nevertheless, a never-ending approach and internal craving of mind and soul finally resulted in publication of the book God perhaps gave us some ability and showered his light on us, guiding us for this task Till the last week before the publication of the book, we were frantically looking for loopholes, missing information and any important updates we might have missed out To the best of our knowledge, we did everything we could But for knowledge, one life is not enough The sky is the limit We await the response of this first edition, which would improve us in the next editions to come Nisha Garg Amit Garg Contents Introduction and Scope of Endodontics History of Endodontics 1; Modern Endodontics 1; Patient Education 3 Pulp and Periradicular Tissue Development of Dental Pulp 7; Histology of Dental Pulp 8; Supportive Elements 11; Innervation of Pulp 13; Anatomy of Dental Pulp 15; Pulp Chamber 15; Root Canal 15; Functions of Pulp 17; Age Changes in the Pulp 18; Pulpal Calcifications/Pulp Stones/ Denticles 18; Calcific Metamorphosis 19; Periradicular Tissue 19 Pathologies of Pulp and Periapex 22 Pulp Pathologies 22; Etiology of Pulpal Diseases 23; Progression of Pulpal Pathologies 24; Diagnostic Aids for Pulpal Pathology 25; Classification of Pulpal Pathologies 26; Barodontalgia/Aerodontalgia 27; Reversible Pulpitis/Hyperemia/ Hyperactive Pulpalgia 27; Irreversible Pulpitis 28; Chronic Pulpitis 30; Internal Resorption 32; Pulp Necrosis 32; Pulp Degeneration 34; Periradicular Pathologies 35; Periapex Pathologies 36; Etiology of Periradicular Diseases 36; Diagnosis of Periradicular Pathologies 37; Classification of Periradicular Pathologies 38; Acute Apical Periodontitis 39; Acute Apical Abscess 39; Phoenix Abscess/Recrudescent Abscess 41; Periapical Granuloma 42; Radicular Cyst/Cystic Apical Periodontitis 44; Chronic Alveolar Abscess 46; Persistent Apical Periodontitis 49; External Root Resorption 49; Diseases of Periradicular Tissue of Nonendodontic Origin 49 Endodontic Microbiology 51 Portals of Entry for Microorganisms 51; Classification of Microorganisms 53; Microbial Virulence and Pathogenicity 54; Factors Influencing the Growth and Colonization of Microorganisms 55; Microbial Ecosystem of the Root Canal 55; Types of Endodontic Infections 56; Identification of the Bacteria 57; How to Combat Microbes in the Endodontic Therapy? 59 Biofilm in Endodontics 61 Stages of Biofilm Formation 61; Types of Endodontic Biofilm 61; Ultrastructure of Biofilm 62; Microbes in Endodontic Biofilms 62; Methods to Eradicate Biofilms 63 Rationale of Endodontic Treatment Theories of Spread of Infection 65; Culprit of Endodontic Pathology 65; Portals for Entry of Microorganisms 66; Inflammation 66; Nonspecific Mediators of Periradicular Lesions 68; Antibodies (Specific Mediators of Immune Reactions) 71; Role of Immunity in Endodontics 71; Endodontic Implications (Pathogenesis of Apical Periodontitis as Explained by Fish) 71; Kronfeld’s Mountain Pass Theory 72; Rationale of Endodontic Therapy 73 65 ... Cycle 11 2; Disinfection 11 8; Antiseptics 11 9; Infection Control Checklist 12 0 11 Isolation of Teeth 12 2 Isolation with Rubber Dam 12 2; Classification of Rubber Dam Clamps 12 4 12 Pharmacology in Endodontics 13 1... Biofilm in Endodontics 61 Stages of Biofilm Formation 61; Types of Endodontic Biofilm 61; Ultrastructure of Biofilm 62; Microbes in Endodontic Biofilms 62; Methods to Eradicate Biofilms... Delhi 11 0 002, India Phone: + 91- 11- 43574357 Fax: + 91- 11- 43574 314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-20 317 08 910