NSRCT mandibular molars Flashcards
What are the stages required to reach an endodontic diagnosis?
Since diagnosis is the first step in the care and management of any patient in endodontics, a systematic approach is necessary in order to provide proper treatment to manage the patient’s complaint. The following stages are required to make an endodontic diagnosis (Berman & Rotstein 2015):
• Listening to the patient’s presenting complaint and asking him about the symptoms and history of that complaint.
• Taking appropriate medical and dental histories.
• Examining the patient extra‐orally as well as
intra‐orally.
• Performing and interpreting objective clinical and
radiographic tests.
• Correlating the objective findings with the subjective information.
How is an odontogenic sinus tract formed, and what are the possible causes?
The major causative role of microbes in the pathogenesis of pulp and periapical diseases has been established (Kakehashi, Stanley & Fitzgerald 1965). Periapical diseases of endodontic origin are generated by an inflammatory reaction to pulpal necrosis and infection to prevent the spread of infection into periapical tissues.This reaction might result in a chronic inflammatory environment at the apical area which induces bone resorption. If the reaction is sustained, a sinus tract might form and drain intra‐orally through the buccal or lingual/ palatal cortices; occasionally the sinus tract might drain extra‐orally into the skin (Ørstavik & Pitt Ford 2008). Cutaneous draining sinus can be caused by many diseases, such as suppurative apical periodontitis, osteomyelitis, an infected cyst, salivary gland infection, congenital anomalies, deep mycotic infection, foreign‐body reaction, malignancy, and granulomatous disorders (Johnson, Remeikis & Van Cura 1999).
How do you manage a cutaneous sinus tract of odontogenic origin?
A cutaneous sinus tract of odontogenic origin is often treated improperly because of its relatively infrequent occurrence. Adequately performed non‐ surgical root canal treatment (NSRCT) is often an effective approach to manage a cutaneous sinus tract of endodontic origin.The success of NSRCT depends mainly on the eradication of microbes from the root canal system by effective chemomechanical debridement. Canal shaping is performed to facili- tate effective irrigation, disinfection, and obturation. Irrigants are used to flush out debris, dissolve organic and inorganic tissues, and eradicate microbes and their toxins. In infected teeth with chronic apical abscess, all debridement procedures followed by a quality obturation of the root canal should be performed close to the radiographic apex in order to regain healthy periapical tissues (Chugal, Clive & Spångberg 2003). Although the presence of apical periodontitis reduces the success rate of NSRCT, the treatment prognosis would be favorable when it is effectively performed under optimal conditions. It has been shown that cases with cutaneous sinus tracts of odontogenic origin ade- quately heal once the offending tooth is endodonti- cally treated, and complete healing with a visible scar might occur on the skin area of the sinus tract (Soares et al. 2007). Delayed diagnosis or inad- equate treatment of pulpal diseases might lead to unwanted complications such as sinus tract forma- tion.Therefore, adequate debridement of the root canal system is essential to achieve healing of periapical inflammation and resolution of the draining sinus.
Why is “postoperative evaluation” imperative after endodontic treatment?
Regular recall is essential to evaluate treatment success, side effects, and the patient’s overall progress, as well as to identify any necessary intervention that has been overlooked. It also allows the clinician to address any issues or complications following treatment.
How do you determine the success of non‐surgical root canal treatment?
Treatment outcome is evaluated by using clinical and radiographic measures. Clinical success criteria include normal mobility and function along with absence of signs and symptoms of infection including discomfort, pain, tenderness to percus- sion, swelling, sinus tract, periodontal pocket, sinusitis, and paresthesia. On the other hand, radiographic success criteria include normal periodontal ligament space, absence of furcal or apical radiolucency, and absence of bone and/or root resorption (Torabinejad & White 2015). Based on recall studies, endodontically treated teeth demonstrate significant successful outcome rates if the treatment is appropriately chosen and rendered (Setzer and Kim 2014)
