UNIT 3 GRP 2 Periodontics and Endodontics
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Mañalac, 2024DENT 101: Perspective in Dentistry Academic Year 2024 –2025 | 1stSemester –---------------------------------------- Instructor: Dr. Jannyl Alyanna Gonzales Date of Lecture: 11/06/2024 Transcribed by: Phoebe Mañalac Adapted from: Group Presentation UNIT 3: THE DENTAL DISCIPLINES EndodonticsDefinition●a branch of dentistry concerned with the diagnosis, treatment, and prevention of diseases of the dental pulp and the surrounding tissues. It is recognized as a speciality in dentistry. The term endodontics was derived from the Greek words - “endo” meaning inside and “odont” meaning tooth. Together, these words mean the study of the inner part of the tooth - the dental pulp - and the procedures to treat them. ●dental pulp- the soft tissue in the center of the tooth; it contains the nerve, blood and lymphatic vessels, and connective tissue. ●by preserving as much of the natural tooth structure as possible, endodontics plays a crucial role in modern dental care, helping to relieve pain, eliminate infection, and promote long-term oral health ●recognized globally as a specialty within dentistry, endodontics combines detailed knowledge of dental anatomy with advanced techniques to improve patients' comfort and quality of life Endodontists-dentists who specialize in tooth pain, disease, and infection-their practice primarily centers around root canal therapy, a procedure designed to remove diseased or infected dental pulp and replace it with filling materialHistory of EndodonticsEndodontics is a dental field focused on the morphology, physiology, and pathology of the dental pulp and surrounding tissues. Its practice encompasses the identification of normal or healthy pulp, diagnosing, preventing and treating pulp diseases and related conditions. TIMELINE OF ENDODONTICS Babylonian Times Tooth Worm Theory - said that toothaches were caused by worms gnawing inside teeth. Babylonians came up with some remedies including luring worms out with honey, inhaling henbane fumes, or using rancid oil. Around 200 B.C. A bronze wire was found in a tooth, likely used by the Romans to treat infections. 1600s Root canal infections were mainly treated by draining for pain relief. 1687 Charles Allen published the first English book on dentistry, describing tooth transplantation. 1700 Anton van Leeuwenhoek -questioned the tooth worm theory, claiming that pulp inflammationwas the cause of tooth discomfort, even if he mistakenly connected the pain relief to worm death. Although techniques like using sulfuric acid to pain continued into the 19th century, his study contributed to a decline in conviction in the notion. 1729 Pierre Fauchard–father of modern dentistry, published the book The Surgeon Dentist. He described root canalsand pulp cavitiesin this book, but he also discussed the procedure of opening teeth to clear pus and treat abscesses. He mentioned a few other tooth pain remedies that might appear absurd now, but it's important to consider them in light of the medical knowledge and practices of that period. However, Fauchard's final technique for easing discomfort has a closer connection to endodontic problems since it uses a tiny needle or pin to trepanate the tooth, or extract the pulp.1756 A German dentist's discussion of thefirst pulp caplaid the foundation for another widespread endodontic technique: Frederick the Great's dentist,Dr. Phillip Pfaff, talked about employing lead or gold foil to cover exposed pulps. This was done to keep the restoration from coming into direct contact with the exposed nerve. 1838 Edwin Maynard created the first instrument designed specifically for endodontics. He designed this endodontic instrument by modifying a watch spring. 1847 Edwin Truman introduced gutta-perchato the field of dentistry. Gutta-percha was first used in dentistry as a filling and denture base material 1867 G. A. Bowmanpopularized the use of gutta-percha as a sole root filling material First Part of the 20th CenturyEndodontics was recognized as a specialty and the concept of ‘‘endodontics’’ began to take shapeLatter Part of the 19th Century and First Part of the 20th Century -Endodontics was referred to as root canal therapy or pathodontia. -Dr. Harry B. Johnston, of Atlanta, Georgia, a well-known lecturer and clinician in the early twentieth century coined the term endodontics from the Greek word ‘‘en,’’ meaning in or within, and ‘‘odous,’’ meaning tooth: the process of working within the tooth. Gutta-percha●Withstood the "test of time," maybe more so than any other substance in dentistry, despite the fact that numerous other materials have been created and employed for the obturation of the root canal system. ●Over time, gutta-percha has been discovered to be beneficial for a wide range of applications, including the production of corks, surgical instruments, insulation for underwater cables, golf balls (gutties), and boat hull protection, to mention a few of the more well-known ones. ●Although other obturation materials will undoubtedly be created and tested in the future, gutta-percha is now the most extensively used substance on the market.
Mañalac, 2024Scope of Practice of Endodontics1.Endodontic Diagnosis ●Endodontic diagnosis involves a thorough examination comprising both subjective and objective components. The integration of these evaluations allows endodontists to establish an accurate diagnosis and develop an appropriate treatment plan. 1.The subjective componententails assessing the patient's reported symptoms, including detailed accounts of pain location, intensity, and duration. 2.The objective componentinvolves a systematic review of the patient’s medical and dental histories, analysis of radiographic imaging, comprehensive clinical examination, and the administration of pulp vitality tests. ●Based on the diagnostic findings, there are four potential conclusions. Each of these diagnostic conclusions is critical in determining the most effective course of treatment: 1.Normal Pulp: absence of subjective or objective symptoms, with the tooth responding normally to sensory stimuli and a healthy layer of dentin protecting the pulp. 2.Irreversible Pulpitis: bacteria are present within the pulp, endodontic treatment or extraction are necessary. 3.Reversible Pulpitis: decay approaches the pulp but has not yet penetrated it, the dentist may opt to place a sedative material and monitor the tooth for potential self-repair. 4.Necrotic or Nonvital: the tooth fails to respond to sensory stimuli. Tests in Endodontic Diagnosisa.Pulp Test - A diagnostic procedure utilized by dentists to assess the vitality of a tooth's pulp. During this testing, a control tooth—selected from the opposite quadrant and of the same type—is employed to provide a baseline for comparison. This allows the dentist to evaluate the sensitivity of the infected tooth relative to the healthy control tooth, thereby facilitating a more accurate diagnosis of pulp health and determining the appropriate course of treatment. b.Diagnostic Test - A diagnostic test in endodontics is utilized to assess the health and vitality of a tooth's pulp and surrounding tissues, guiding treatment decisions. There are 5 types of diagnostic testing: 1.Percussion Test:involves tapping on the incisal or occlusal surface of the tooth with a mouth mirror handle to evaluate if the inflammatory process has extended into the periapical tissues. 2.Palpation Test: consists of applying firm pressure to the mucosa above the root apex, similarly indicating the presence of inflammation. 3.Cold and Heat Tests: assess pulp sensitivity by applying ice, dry ice, or heated materials to the tooth surface to gauge the pulp's response to temperature changes. 4.Electric Pulp Test: uses a small electrical stimulus, delivered through a conductive medium like toothpaste, to evaluate the vitality of the pulp. Collectively, these diagnostic tests provide critical information for determining the appropriate course of treatment. c.Radiographic use in Endodontics - Radiographic imaging is essential in endodontics, necessitating a minimum of four radiographs throughout the procedural process: 1.Periapical Radiograph: obtained during the diagnostic stage 2.Working Length Radiograph: taken to determine the length of the canal, which is best assessed with the file remaining in the tooth 3.Final Instrumentation Radiograph: follows, capturing the tooth with the final size of file in all involved canals. 4.Completion Radiograph: exposed to document the filled canal, which has been temporized with an intermediate restorative material. This systematic approach to radiographic assessment ensures accurate diagnosis and effective treatment planning in endodontic procedures. 2.Root Canal Culture -In endodontic practice, culture tests are utilized todetect and identify bacterial presence within root canals, as well as to confirm their sterility prior to obturation. -The primary objective of endodontic treatment is to eradicate bacterial contamination from the root canal system to prevent the formation of periapical lesions. The most common culture test used is theanaerobic culture tests. Although they have demonstrated high effectiveness in identifying bacterial presence, their application necessitates specialized equipment and precise methodologies. 3.Conditions I.Radicular Cyst -Also known as a periapical cyst-An odontogenic cyst frequently associated with permanent dentition, particularly affecting the maxillary central incisors and mandibular first molars. -Its development is a result of bacterial infection and subsequent pulpal necrosis, which induce an inflammatory response that activates the epithelial cell rests of Malassez within the periodontal ligament region of the affected tooth. II.Fractured or Avulsed Tooth -Fractures vary in severity, from those affecting only the enamel, which may cause sharp edges but no symptoms, to those exposing dentin, leading to sensitivity and needing restorative care. -If the fracture exposes the pulp or if the tooth is mobile, urgent treatmentis necessary, often involving a root canal. Root and alveolar fractures, while not immediately visible, require stabilization through bonding. Tooth avulsion, particularly of permanent teeth, demands immediate action—replacing the tooth in its socket or preserving it in saline or milk before seeking urgent care. Quick stabilization can lead to successful retention, though avulsed teeth typically need root canal therapy due to pulp necrosis. For cases involving contamination or delayed treatment, antibiotics and tetanus status checks are essential.
Mañalac, 2024Procedures in Endodontics1.Pulpotomy ●involves the removal of the diseased coronal portion of the tooth pulp while preserving the healthy pulp tissue within the root ●primarily performed in pediatric dentistry, especially for treating extensive cavities or decay in primary (baby) molars, earning it the informal name of a pediatric root canal. ●Following the removal of the infected pulp, a medicated dressing is applied to sustain the vitality and function of the remaining pulp tissue. The approach leverages the robust blood supply in primary teeth, making pulpotomies an effective temporary solution until natural exfoliation occurs. ●Although predominantly used for primary teeth, pulpotomies can occasionally benefit permanent teeth in specific cases. In contrast, traditional adult root canal treatments involve the complete removal of the pulpfrom both the crown and roots. ●The pulpotomy is often indicated for vital primary teeth, deep carious lesions, and emergency interventions to preserve tooth vitality. 2.Pulpectomy ●referred to asroot canal therapy●performed when tooth damage extends beyond the crown and affects the root●Unlike a pulpotomy, which only removes pulp from the crown, a pulpectomy involves the complete removal of pulp from both the crown and root. ●This procedure is essential for saving and restoring a severely decayed or infected tooth. By removing all affected pulp tissue, the treatment eliminates infectionand prevents further damage, allowing the tooth to be preserved and restored. 3.Root Canal Treatment ●Root canal treatment is a fundamental aspect of endodontic procedures, aimed at saving teeth that might otherwise be lost to infection or decay. This detailed procedure involves removing the infected or inflamed pulp from inside the tooth, thoroughly cleaning and disinfecting the canal system, and sealing the space to prevent future infection. ●By preserving the natural tooth, it supports oral health and function, helping to avoid more invasive options like extractions or implants. ●One significant advantage of a root canal is that it preserves the tooth and the surrounding bone area. This helps maintain the profile of the bone because, if the tooth is extracted, the bone that holds it would have nothing to support, leading to bone collapse and resorption. However, a notable disadvantage is that since the tooth is no longer vital, it becomes fragile and susceptible to fractures due to the lack of nutrients. ➢Widening of the root canal- During the root canal procedure, dentists may need to widen the canal to effectively clean out the infection. This is a crucial step that ensures all infected tissue is removedand the space is adequately prepared for filling. ➢Endodontic filing - Endodontic filing is an essential part of the procedure, involving the mechanical cleaning and irrigation of the root canal system.The primary goal is to remove debris from the canal walls and flush it out. This process can be done using various types of files, whether rotary or hand-operated, made from materials such as stainless steel or nickel-titanium. The history of endodontics saw notable advancements starting in the mid-18th century, with rapid progress in the 19th century as dentists and scientists worldwide developed methods to preserve teeth by either saving or removing the pulp tissue. Initially, stainless-steel hand files were used to clear pulp and debris from the canal system. ➢Root canal filling- The final step in a root canal procedure is root canal filling. The once-infected chamber is filled with a new root filler, with gutta-perchabeing the most commonly used material. These root-canal-filling materials are designed to effectively eliminate bacteriain periapical lesions, create a dense seal in the apical regions, and facilitate healing. An adhesive is applied to seal the area, protecting the new root filling from bacteria and saliva. 4.Root Canal Retreatment -When a previously treated tooth has not been properly sealed, leading to entrapment of bacteria, this can result in periapical lesions, indicating the need for a retreatment. -Endodontic retreatment is required when a tooth does not heal properly or if pain persists, suggesting that an infection was not fully eliminated or has returned. During this procedure, the endodontist reopens the tooth, removes the existing root canal filling, and meticulously cleans the canals. Using magnification and illumination, the specialist inspects for hidden or unusual canals that require attention. Once the treatment is complete, the canals are refilled and sealed, followed by placing a temporary fillingto allow the tooth to heal and function properly over the long term. 5.Apicoectomy -A surgical procedure performed when a standard root canal treatment failsto eliminate aninfection at the root's apex. This procedure is necessary when a radicular cyst does not shrink even after a root canal has been performed, requiring the cyst to be surgically removed. -During this microsurgery, the endodontist removes the root tip along with any surrounding infected tissue. The root canal end is then sealed with a small filling, and stitches are applied to promote healing. -This procedure is considered only after other treatments have proven unsuccessful, offering a crucial option for saving a tooth that might otherwise need extraction. By addressing the area beyond the root tip, an apicoectomy supports the continued healthof the tooth and surrounding tissues. 6.Pulpal debridement -Also called nerve debridement-It is a clinical procedure aimed at providing temporary pain relief in cases of abscesses or pulp infections.
Mañalac, 2024-Dental pulp: situated centrally within the tooth and comprises blood vessels, nerve fibers, and connective tissue. -Pathological conditions such as carious lesions or traumatic injury to the pulp can result in significant inflammation and associated pain, necessitating prompt intervention. -This procedure involves creating an opening in the affected tooth to facilitate the removal of necrotic or infected pulp tissue, thereby reducing intrapulpal pressure and mitigating discomfort. -Pulpal debridement is considered a temporary measure, providing symptomatic relief until definitive treatment, such asroot canal therapyor extraction, can be performed. The excision of the compromised tissue effectively decreases inflammation and palliates pain. 7.Hemisection -It also known as root amputationor premolarization of molars-It involves the division of a tooth along its longitudinal axis to remove one of its roots and the associated part of the crown. -This is often performed on mandibular molars or maxillary first premolars when the affected structures cannot be preserved through standard endodontic or periapical surgery. -Before the surgical procedure, endodontic treatment is performed on the remaining root and crown. Prompt restorative treatmentfollowing the procedure is essential to prevent fractures in the remaining crown. Education and Training PathwaysHow to become an Endodontist in the Philippines 1.Pass the Qualifying Examination at your chosen dentistry school ●To gain admission to their chosen dentistry school, students must successfully pass the qualifying exam required by the university. Depending on the institution, further assessments such as interviews or dexterity exams to assess the applicant’s manual skills and ability to adhere to instructions may be held. 2.Enroll and Complete the Pre-dentistry Course ●In the Philippines, a Pre-dentistry course curriculum is a two-year requirementthat prepares students for advanced dental education by providing a strong foundation in health sciences and primary health care. Students are required to complete general subjects, including Mathematics, Humanities, and Social Sciences, alongsidespecialized courses in human health sciences, such as genetics, physiology, human anatomy, and primary health care. 3.Finish the Dental Medicine Proper Program ●This is a four-year coursethat introduces students to dental science subjects and provides knowledge of oral health. Students who meet the General Weighted Average (GWA) requirement from their Pre-dentistry courses can proceed directly to the Dental Medicine Proper. Throughout this program, students will study medical and dental sciences, with a particular emphasis on clinical, hospital, and community dentistry as they enter their third year. At this stage, students will begin performing procedures on actual patientswith the supervision of a clinical supervisor. 4.Pass the Board Exam ●Graduates of the Dental Medicine Proper Program must successfully pass the Dental Licensure Exam, which is conducted and supervised by the Professional Regulatory Commission (PRC). This exam is divided into two phases: a written and a practical phase. Upon successful completion of both phases, the dentist will be issued a dental practice license. 5.Enroll and Finish the Master of Science in Dentistry Major in Endodontics Program ●The Master of Science in Dentistry (MScD) with a Major in Endodonticsis a three-year specialization programthat focuses on treating dental issues affecting the root of the tooth and the interior structures of the teeth. Materials and Equipment in EndodonticsEndodontic instrumentsare specialized tools crafted specifically for root canal treatments, integral to endodontic procedures. These instruments are designed to carefully extract infected or damaged tissue from the apical portion of the tooth’s pulp chamber while thoroughly cleaning the canal walls. A clear understanding of the different types of endodontic instruments is essential for ensuring effective treatment. a.Categories of Endodontic Instruments Endodontic instrumentation can be generally divided into three primary categories, each serving unique functions during various stages of root canal preparation and treatment: I.Handheld Endodontic Instruments Traditional endodontic tools such as files, reamers, pluggers, and spreaders. Handheld instruments have evolved significantly with the development of new materials technology. They are commonly made from stainless steel and nickel-titanium (NiTi), offering a balance between strength and flexibility. 1.Files and Reamers ●Files, particularlyK-files andH-files, serve ascutting instruments used for cleaning and shaping the root canal. K-filesare particularly effective in navigating curved canals due to their flexibility. They are available in multiple ISO-standard sizes, measured in millimeters, and are designed to clear debris from within the canal. ●Reamers are utilized to remove dentinand widen the canal laterally, preparing it for the insertion of filling materials. 2.Pluggers and Spreaders ●Pluggers are employed to compact gutta-percha, a widely used material in root canal fillings. Spreaders aid in the lateral compaction of these filling materials, ensuring asecure and precise fit within the tooth. II.Rotary Endodontic Instruments Rotary instruments represent a modern advancement to endodontic practice, providing enhanced speed and efficiency. Typically crafted fromnickel-titanium (NiTi) alloys, these instruments are valued for their flexibility and durability, which reduces the risk of root fracture. 1.EndoSequence ●Employs files made from Shape Memory Alloys (SMA), which demonstrate superelasticity at body temperature, enabling efficient navigation through complex canal systems. 2.ProTaper Next ●Another widely used system, this incorporates a unique file design that facilitates thorough cleaning and shaping, even in curved root structures. These instruments have been proven effective in minimizing the risk of canal transportation while improving shaping efficiency.III.Ultrasonic Endodontic Instruments Ultrasonic endodontic instruments rely on high-frequency vibrationsto effectively dislodge debris, making them especially valuable in root canal retreatmentswhere
Mañalac, 2024conventional techniques may fall short. These ultrasonic tools come in various tip designs and modes of action, providing clinicians with a range of options tailored to the patient’s specific dental anatomy and condition. b.Basic Instrumentation in Endodontics I.Basic Instrument Pack 1.Front-surface mouth mirror: This provides an undistorted view, enhancing visibility deep within the pulp chamber. 2.Endodontic explorer: A double-ended, extra-long, sharp instrument designed to help in the location of canal entrances and for detecting fractures. 3.Long spoon excavator: This is required to remove pulpal contents and any present soft caries. 4.Locking tweezers: These are ideal for handling paper points, gutta-percha points, cotton wool pellets and root canal instruments. 5.Briault and Periodontal probes: Both are essential for the initial assessment of the tooth, helping to evaluate caries and the localized periodontal conditions. 6.Flat plastic instrument and an Amalgam plugger: These are needed for the placement of an inter-appointment restoration. 7.Millimeter ruler or other measuring device: These should be accessible for measuring purposes. 8.Surgical hemostat: This may be used to position X-ray films during radiography throughout treatment. II.Rubber Dam It is a prerequisite that the tooth being treated must be isolated—this is achieved effectively and efficiently with the use of a rubber dam. 1.Rubber Dam Punch-A punch is utilized to create the necessary numbers of holes depending on the teeth requiring isolation. Typically, single-tooth isolation is sufficient for endodontic treatment. 2.Rubber Dam Clamp-There are various designs of rubber dam clamp to accommodate every possible situation. However, there are no standardized regulationsgoverning their manufacture. Clamps serve two primary functions: 1.to anchor the rubber dam to the tooth 2.to retract the gingivae -In endodontics, the main requirement is the anchorage provided by the clamp. 3.Clamp Forceps-The forceps are employed to place, adjust and remove the rubber dam clamp. Some forceps may need adjustment to their working ends prior to initial use. 4.Rubber Dam Frame-The corners of the rubber dam are held apart by a frame, which is stretched over the patient’s mouth to avoid obstructing the operator’s visionand to ensure the patient’s comfort. c.Instruments for Access Cavity Preparation I.Burs 1.Friction Grip Burs-Friction grip tapered or cylindrical fissure burs, ISO 010 or ISO 012, are used in theinitial stagesof access preparation to establish the appropriate outline form. For penetrating ceramic or composite materials, diamond-coated burs are required. 2.Round Burs-Round burs, normal and extra-long (ISO 010, 014 and 018), are used in a contra-angle handpiece to lift the roof off the pulp chamber and remove overhanging dentine. The longer and smaller sizes of burs may be used to remove dentine when opening calcified canals. 3.Safe-ended Burs-After initial access to the pulp space, a safe-ended or non-cutting tip, tapered diamond, or tungsten-carbide bur can be used to remove the entire roof of the pulp chamber. The non-cutting tip helps prevent gouging of the pulpal floor. 4.Gates-Glidden Burs -The Gates-Glidden bur has a slender shank with a cutting bulb and a pilot-tip. It is designed to fracture near the hub if it breaks, rather than between the shank and the cutting bulb d.Instruments for Root Canal Preparation I.Hand instruments These are categorized based on their usage and according to the classification established by the International Organization for Standardization (ISO). These standards define the terminology, dimensions, physical properties, measuring systems and quality control of endodontic instruments and materials. Endodontic hand instruments, such as files, reamers, and barbed broaches are standardized concerning size, color coding, and physical properties. 1.Barbed broaches-Barbed broaches are primarily used for the removal of pulp tissue from wide root canals and for extracting cotton wool dressings from the pulp chamber. 2.Reamers-Reamers are manufactured by twisting a tapered stainless steel blank, resulting in an instrument with sharp cutting edges along the spiral. They are employed with a half-turn twist and pull action, effectively shaving the canal wall and removing dentine chips from the root canal. 3.Files-There are various types of root canal file, predominantly constructed from stainless steel. Files are mainly used with a filing or rasping action, involving little to no rotation of the instrument within the root canal. Common types of files include: ➢K-files: Similar to reamers, these are made by twisting a triangular or square blank, but into a tighter series of spirals, producing 0.9 to 1.9 cutting edges per millimeter in length. They can function in both reaming and a push-and-pull filing motion. ➢K-flex File: Developed to improve on the original K-file design. It has a rhomboid-shaped cross-section. A drawback of the K-Flex file is that it tends to lose its cutting efficiency more quickly than K-files. ➢Flexofile: The alloy used in Flexofile manufacture influences its cutting efficiency and fracture resistance. This file has a non-cutting
Mañalac, 2024(Batt) tip and a triangular cross-section, resulting in sharper cutting flutes and increased capacity for debris removal. ➢Hedstrom File: Produced through a milling process from a steel blank of round cross-section, Hedstrom files feature elevated cutting edges, creating a tapering effect that forms a series of intersecting cones. 4.Power-assisted root canal instruments-Numerous power-assisted root canal instruments have been developed over the years to expedite root canal preparation quicker and reduce operator fatigue. ➢Reciprocating handpieces: These handpieces impart a mechanical action to the root canal instrument to cut dentine. An early example is the Giromatic, a mechanized handpiece that converts continuous rotation of the driveshaft into an alternating quarter-turn movement of the file. 5.Rotary NiTi instruments -The introduction of instruments made for nickel-titanium (NiTi) has led to a dominance of new rotary root canal instrument systems in the endodontic market, many of which combine rotary and hand NiTi files. ➢Variable Taper: The variable taper concept maximizes the cutting efficiency by minimizing the contact area between the surface of the instrument and the canal wall. ➢Flute Design: The cross-sectional shape of the flutes influences cutting efficiency and the ability to remove debris. ➢Rake Angle: The rake or cutting angle of most conventional instruments is negative so the cutting blade scrapes rather than cuts the dentine, and this is inefficient. ➢Helical Flute Angle: This angle describes how the cutting flutes spiral around the instrument’s shaft. If there are too few spirals, dentine debris can quickly accumulate, leading to clogging of the instrument. ➢Core Diameter/Flute Depth: The core strength and flexibility of an instrument is dependent on its core cross-sectional diameter; a larger core diameter results in a more robust and rigid instrument. ➢Non-cutting Tip: A non-cutting, safe-ended or Batt tip aids in guiding the instrument. E.Schools of Thought and Treatment Approaches a.Endodontics, the branch of dentistry that deals with the dental pulp and tissues surrounding the roots of a tooth, which utilizes several treatment philosophies and approaches, each with its unique focus and application. Philosophy/ Approach Description Indications Conservative Approach Focuses on preserving as much of the natural tooth structure as possible Direct pulp capping, pulpotomy, partial pulpectomy Traditional Root Canal Treatment Removal of infected or inflamed pulp, cleaning and shaping the root canal system, filling with a biocompatible material Irreversible pulpitis, necrosis Surgical Endodontics (Apicoectomy) Surgical removal of the root tip and surrounding infected tissue, placement of a filling to seat the root end Failed root canal treatment, persistent infection Regenerative Endodontics Innovative method that involves the replacement of damaged tooth structures, including dentin and root structures, and cells of the pulp-dentin complex Immature teeth with necrotic pulp Microsurgical Techniques Use of advanced technologies like dental operating microscopes, ultrasonic instruments, and biocompatible materials, ideal for complex cases requiring high accuracy Complex cases requiring precision Non-Surgical Root Canal Treatment Reopening the tooth, removing filling materials, cleaning the canals, and refilling them Failed previous root canal treatment Philosophy/ Approach Advantages Limitations Conservative Approach Minimally invasive, maintains tooth integrity Limited to cases with minimal pulp damage Traditional Root Canal Treatment Well-established, high success rate Can be time-consuming, requires multiple visits Surgical Endodontics (Apicoectomy) Directly addresses periapical pathology Invasive, potential for postoperative complications Regenerative Endodontics Promotes natural healing, potential for continued root development, particularly in immature teeth with necrotic pulp Requires specific conditions, not suitable for all cases Microsurgical Techniques Enhanced precision, improved surgical outcomes Required specialized equipment and training Non-Surgical Root Canal Treatment Addresses issues without additional surgery, non-invasive alternative Can be challenging, risk of further complications F.Challenges in Practice a.Complexity of Root Canal Morphology -Extra details within the procedure such as additional canals, curvatures, lateral canals and other anatomical variations can complicate the process of cleaning and shaping. Missed canals can lead to infection and treatment failure. b.Perforations and other Iatrogenic Errors -Presence of perforations or unwanted openings in the tooth structure contribute to a dentists’ struggle. They can occur during cleaning, shaping or locating canals and are capable of significantly impacting the likelihood of complications. c.Instrument Fracture -There are extra risks in endodontics posed by breakage of the instruments to be used. The fracturing of rotary or hand instruments in narrow, curved, or calcified canals can block access to the apex, complicating the treatment and possibly compromising the outcome. d.Pain Management
Mañalac, 2024-Achieving profound anesthesia in teeth with acute pulpitis can prove challenging. It is thus recommended that supplemental anesthesia techniques such as intraosseous, intraligamentary or intra-pulpal injections, be used. A successful treatment paired with patient comfort follows effective pain management. e.Accessibility and Costs of Equipment -Modern technologies may prove costly, making accessibility of these instruments an issue. The dentists’ treatment plan might be hindered with the lack of machines such as cone-beam computed tomography (CBCT) and ultrasonic instruments that improve accuracy and efficiency in diagnosis and treatment in endodontics. G.Current Trends and Innovations a.Endodontic Regeneration ●This technique is aimed at revitalizing infected teeth by promoting natural tissue growth within the root canal. This method begins with disinfecting the infected tooth using a combination of minocycline, ciprofloxacin, and metronidazole. After disinfection, a mineral trioxide aggregate is placed to encourage cell growth in the canal space. Endodontic regeneration fosters the reestablishment of living tissue within the tooth. This approach is particularly effective in younger, underdeveloped teeth with larger apices, though recent research suggests it can also benefit mature teeth. b.Cone beam computed tomography (CBCT) ●A diagnostic tool that offers endodontists enhanced accuracy compared to traditional two-dimensional radiographs. Studies have shown that CBCT in dental injuries, has proven to be more reliable than intraoral radiographs, particularly in identifying complex conditions such as extrusive luxations, horizontal root fractures, cortical plate fractures, and lateral luxations. CBCT offers distinct advantages in assessing more intricate details when determining root canal working length. In one case report, CBCT was used with a surgical guide to successfully remove excess extruded material from a previous root canal without damaging the sinus membrane, demonstrating CBCT’s precision in surgical planning. c.Augmented reality combined with a 3D dynamic navigation system (DNS) ●An advanced approach in surgical endodontics that allows clinicians to visualize the position of surgical instruments in real time on a computer screen, improving precision and control. Initial research indicates that this integration enhances time efficiency during procedures compared to using DNS alone. The 3D dynamic navigation system is especially useful for locating complex structures, such as intraosseous anesthetic injection sites and calcified root areas. In procedures like apicoectomies, DNS proves beneficial for both experienced and less experienced operators, as it requires less technique sensitivity than static imaging. DNS-guided surgeries typically result in smaller osteotomy sites, shorter surgical times, and greater accuracy, especially in cases with challenging tooth morphologies, ultimately helping the preparation and execution of root-end surgeries. d.Magnetic resonance imaging (MRI) ●An emerging imaging technique in endodontics that offers detailed visualization of dental structures without radiation exposure. Research shows that MRI can accurately guide cavity access preparation and is nearly as sensitive and specific as cone beam computed tomography (CBCT) in detecting vertical root fractures. Unlike CBCT, MRI excels in visualizing soft tissue lesions and detecting the spread of disease into cortical bone. Beyond dental applications, MRI can also identify intracranial lesions, optic nerve gliomas, retinoblastomas, and neuroblastomas, making it a versatile tool for broader diagnostic insight. e.Membranes and bone grafts ●These are materials in endodontic surgery that support bone regeneration and healing. Membranes act as barriers, preventing epithelial and fibroblast cells from entering a healing apicoectomy site, thus promoting bone formation. Bone grafts, available in forms such as xenografts, autografts, growth factors, allografts, and synthetic options, provide a framework for new bone growth. Autogenous bone, due to its high biocompatibility, is considered the gold standard. Collagen membranes not only aid in bone healing but also play a key role in regenerative endodontics, serving as a scaffold that encourages cell growth within the canal system. Additionally, researchers have found that using tooth material as grafts may be effective due to its similarity to bone. Together, membranes and grafts enhance bone healing and regeneration in endodontic procedures. f.Pulse Oximetry
Mañalac, 2024●An evolving technology in endodontics, used to measure oxygen saturation levels within dental pulp. This technique dates back to early research in 1996, where in vitro studies demonstrated its ability to detect oxygen saturation, sparking further clinical studies. ●Unlike traditional electrical pulp testing, which can produce higher readings even in necrotic teeth, pulse oximetry provides a clearer assessment by indicating reduced oxygen levels in compromised teeth. ●However, challenges remain in developing a pulse oximeter small enough for comfortable intraoral use, as well as in accommodating natural variations in oxygen saturation across different types of teeth. For example, the central incisor typically has different mean oxygen saturation levels than the lateral incisor, requiring adjustments for accurate readings across various tooth types. PeriodonticsDefinition●a specialized branch of dentistry focused on the prevention, diagnosis, and treatment of diseases affecting the periodontal structures—the tissues that surround and support the teeth ●derived from the Greek words peri ("around") and odont ("tooth"): around the tooth, periodontics centers on maintaining the health of the periodontium, which includes the gingiva (gums), alveolar bone (jaw bone), cementum (the connective tissue anchoring the tooth to the jaw bone), and the periodontal ligament ●plays a crucial role in preserving oral health, preventing tooth loss, and improving overall quality of life Periodontist-dental professionals trained specifically to diagnose and treat conditions affecting these supporting structures, including common and often progressive issues like gingivitis, an inflammation of the gums, and periodontitis, a more advanced infection involving the deeper periodontal tissues -they are skilled in performing dental implant procedures, helping patients restore function and aesthetics after tooth loss History of PeriodonticsIt is significant to understand the history of Perioodontics, as our ancestors have long dipped into the concepts, diagnosing and treating periodontal diseases way back in ancient times of well built civilizations: Sumerians, Egyptians, Hindus, Chinese, Hebrews, Mayans and Etruscans. TIMELINE OF PERIODONTICS Ancient Greece Hippocrates, also known as the father of modern medicine, believed that inflammation of the gingiva could be caused by accumulations of pituita or calculus, with gingival hemorrhage occurring in cases of persistent splenic maladus. Romans Romans have also been very conscious with their oral hygiene and in the account of Celsus (25 BC–50 AD) in his book, he discussed how to fix loose teeth by tying them together. The word "tartar" was originally employed by Celsus to refer to the tooth concretions. He explained how cautery and a lancet were used during gum surgery. Additionally, he explained how to massage the gingiva using a toothbrush. The Romans employed a number of dentifrices, including burnt pumice stone, eggshell, and stag's horn. Egypt George Ebers Papyri has numerous references to both dental and gingival maladies Ancient India Hindu mythology first mentions dentistry when Pushan receives teeth from the Ashwins, the Sun's twin sons. Charaka, a physician, and Susruta, a surgeon, discussed how to foster oral cleanliness. China The Chinese created the modern toothbrush in the 1490s, "with the bristles perpendicular to the handle”. According to Hwang –Ti (2500 BC), Oral disease-were divided into 3 types: Fong-ya or inflammatory conditions; Ya kon or disease of the soft investing tissues of the body; and Chong ya or dental caries Arabs Avicenna wrote a treatise on medicine named Canon. Included here are notes on gum bleeding, gum fissures, gum ulcers, gum separation, gum recession, gum looseness, and epulis infestation 16th Century Europe Both Pare and Albucasis described replantation, and Ambroise Pare (1510-90), one of the greatest surgeons of the 16th century, introduced the ligation of blood vessels into amputation procedures. He also accurately recorded the number of roots of different teeth and described how they attached to bone via a fibrous ligament. 17th Century Van Leeuwenhoek used his crude microscope to describe the oral microflora as "animalcules" found in scrapings from between the teeth. He has a place in scientific history that has not been challenged after three centuries. And then, even though morphologic descriptions of microorganisms have advanced significantly, the germ theory of disease was not firmly established until the groundbreaking work of Pasteur, Koch, and Lister. 18th Century It wasn’t until Pierre Fauchard’s time that dentistry was codified as a distinct discipline. Based on the understanding of his age, Pierre Fauchard established a systematic approach to dental practice, recognizing the connection between the etiology of periodontal disease and oral hygiene. 19th Century There were other names for periodontal disease, including Riggs' disease, which was named for the American dentist John Riggs and was defined as a purulent infection of the tooth periosteum. May 1914 The American Academy of Oral Prophylaxis and Periodontology, the first ever national association dedicated to identifying and treating periodontal disease, was founded under the direction of two female dentists, Gillette Hayden and Grace Rogers Spalding. 1919 Their organization was renamed the American Academy of Periodontology. 1920s The first peer-reviewed scholarly magazine devoted to periodontal disease was established. 1930 The AAP released the Journal of Periodontology in 1930. Publications devoted to periodontics were scarce in the beginning. However, it became evident that other journals were required to accommodate the demand after so many
Mañalac, 2024excellent submissions were submitted. Journal of Periodontal Research (1966), Journal of Clinical Periodontology (1974), International Journal of Periodontics and Restorative Dentistry (1981), and Periodontology 2000 (1993) are the four new publications that have been added to reflect the growing number of studies and research involving periodontics. Scope of Practice of Periodontics 1.Diagnosis and treatment of gum disease -Periodontists specialize in diagnosing and treating all stages of gum disease, which ranges from early-stage gingivitis to severe periodontitis. -This includes detecting signs of inflammation, recession, or infection in the gums and surrounding tissues and creating customized treatment plans to address and prevent disease progression. -Early intervention helps prevent the disease from advancing and affecting bone health. 2.Surgical and non-surgical therapy for periodontal disease -Periodontists can provide both surgical and non-surgical therapies or treatments tailored to the stage and severity of the periodontal disease. -Non-surgical procedures, such as scaling and root planing, aim to remove plaque from below the gum line which helps control bacteria and halt disease progression. -When necessary, surgical treatments, such as flap surgery, gum grafts, and more, are used to access infected areas, reduce pocket depth, or repair tissue damage which allows for better healing and long-term gum health. 3.Dental implant placement -Periodontists are highly trained in the placement and maintenance of dental implants as a solution for missing teeth. This involves surgically inserting implants into the jawbone to provide a stable foundation for prosthetic teeth. 4.Regenerative therapy -Regenerative periodontal therapy focuses on rebuilding lost bone and gum tissue, specifically in cases where disease has severely damaged the periodontal support structures. -This may include bone grafts, guided tissue regeneration, or tissue-stimulating proteins that promote natural regeneration. -This does not only improve oral function and aesthetics but also stabilizes the teeth and reduces the risk of tooth loss in advanced periodontal disease cases. 5.Cosmetic periodontal procedures -Periodontists play a vital role in addressing cosmetic concerns related to gums. -These cosmetic periodontal procedures are offered to enhance the appearance of the gum line, addressing issues such as excessive gum display, gum recession, or uneven gum contours. -Procedures like gingivoplasty or gum contouring improve gum symmetry and frame the teeth attractively, leading to a more balanced and aesthetic smile. -These treatments also contribute to the patient’s overall confidence and oral health. 6.Periodontal maintenance -Periodontists provide ongoing periodontal maintenance to manage the disease and prevent recurrence, particularly in patients at high risk. This includes regular cleanings, plaque removal, and monitoring of gum health. It involves a closer inspection of gum pockets and targeted care to maintain periodontal stability and prevent relapse. Procedures in PeriodonticsA.Non-surgical Procedures 1.Scaling and Root Planing -A deep cleaning of the surfaces of the tooth roots to treat gum diseases by initially scaling below the gumline to remove plaque and bacterial toxins from the periodontal pockets. Following this, root planing is performed to smooth the tooth root, preventing future adherence of plaque or toxins. 2.Laser Treatment -Laser periodontal treatment uses a highly focused, small laser to remove inflamed gum tissue. Lasers can differentiate between healthy and diseased tissue due to the darker appearance of infected areas, allowing precise removal of infected gums. -After laser treatment, healthy gum tissue often regenerates, enhancing gum stability which helps to prevent tooth loss. -In comparison with gum flap surgery, this treatment is less painful since it is less invasive, has shorter recovery because it doesn’t require an incision, and will not impact the bite or smile. However, laser treatment may possess limitations such that it may not be utilized with highly severe cases of gum disease, and not all periodontists offer it. B.Surgical Procedures 1.Gum Flap Surgery -When non-surgical treatments aren’t enough for gum disease, gum flap surgery can help improve gum health. -This procedure involves creating a small flap in the gum tissue to access the roots and jawbone, allowing the dentist to remove plaque, tartar, and inflamed tissue. -Once cleaned, the gums are sutured back in place, and an intraoral bandage may be applied to protect the area as it heals. -Maintaining good oral hygiene and regular dental check-ups can help prevent future issues after healing. 2.Periodontal Pocket Reduction -Periodontal disease destroys supporting tissue and bone around the teeth, forming deepening pockets that allow bacteria to accumulate and advance under the gum line, which can ultimately lead to bone and tissue loss. -This is a surgical procedure to remove harmful bacteria and infected tissue lodged between the gums and teeth, especially in advanced stages of gum disease where non-surgical methods, like scaling and root planing, are insufficient. -In this procedure, the gum tissue is gently lifted to access and clean the root surfaces, removing plaque, tartar, and
Mañalac, 2024diseased tissue from the periodontal pockets. Rough bone surfaces may be smoothed to prevent future bacterial buildup. The gums are sutured to reduce pocket depth, encouraging reattachment to the bone and reducing the risk of future infection. 3.Gum Graft Surgery -A dental procedure designed to address thinning gums or gum recession. Gum grafting plays a significant role in lowering the risk of severe gum disease. It involves covering exposed tooth roots with gum tissue, which adds volume to your gum line and improves overall oral health. -This procedure not only enhances aesthetics but also reduces tooth sensitivity. Recovery typically takes one to two weeks, although it may extend longer for some individuals. 4.Crown Lengthening -Necessary if there isn’t enough of the tooth exposed to secure a crown, often due to breakage or decay that prevents proper attachment. -This procedure reduces gum tissue and reshapes bone to expose more of the tooth above the gumline. A well-fitted crown improves comfort and oral hygiene. -This is also sometimes done to correct a “gummy smile” wherein excessive gum tissue is visible when smiling. The periodontist makes incisions in the gums to pull them away from the teeth, exposing the roots and bone. -The surgeon then rinses the area with saline solution before stitching the gums back together, occasionally applying a protective bandage over the site. 5.Gingivectomy -This procedure involves removing excess gum tissue only, usually to reduce gum pockets and fibrous tissue growth, and treat gum disease. -Unlike crown lengthening, it doesn’t alter the underlying bone structure. C.Cosmetic Periodontal Procedures 1.Gingivoplasty -Primarily a cosmetic dental procedure that reshapes healthy gum tissue to improve the appearance of the gums and smile, often done to correct a “gummy smile”. -During the procedure, the gums are numbed, marked, and carefully reshaped using specialized tools to achieve a balanced look. 2.Gum Pigmentation Removal -Gingival pigmentation, or darkening of the gums, can occur due to genetics, lifestyle habits, or certain conditions, though it isn’t usually a medical concern. -People may opt for gum pigmentation removal, gum depigmentation, or “gum bleaching” to lighten their gums for cosmetic reasons. -This treatment removes the top layer of pigmented gum tissue, allowing pink, healthier-looking gums to appear. -Techniques like laser therapy, scalpel surgery, or tissue freezing can be used to achieve a more uniform gum color and enhance the overall appearance of one’s smile.D.Dental Implant Placement Dental Implants These are medical devices surgically implanted into the jaw to restore a person’s ability to chew or its appearance. “Dental Implants” are often referred to a combination of the implant or the artificial tooth root and the prosthetic tooth. This may be an option for people who may have lost one or more teeth due to periodontal diseases or injury and for those who prefer not to wear dentures. There are two types of dental implants: 1.Endosteal (in the bone)-The most common type of implant, placed directly into the jawbone in forms like screws, cylinders, or blades. -Each implant supports one or more prosthetic teeth and is an option for patients using bridges or removable dentures. 2.Subperiosteal (on the bone)-Positioned on top of the jawbone with metal posts extending through the gums for support. -These implants are typically used for patients who cannot wear conventional dentures and lack sufficient bone height for endosteal implants. E.Regenerative Therapy Regenerative Procedures: When the bone supporting the teeth has been damaged by periodontal disease, the periodontist may suggest a regenerative procedure to help rebuild lost bone and tissue. By folding back the gum tissue, bacteria are removed. Regenerative procedures involve the use of bone grafts, tissue-stimulating proteins, or membranes to regenerate lost bone and tissue around teeth affected by periodontal disease to promote the body’s natural bone and tissue regeneration. This is a treatment aimed at restoring lost bone and periodontal structures around teeth. When feasible, a bone graft is placed around teeth to encourage bone regrowth. These are two types of grafts commonly used: 1.Allograft ●Uses processed bone from a bone bank (cadaver bone), eliminating the need for a secondary donor site. The bone acts as a scaffold for new bone growth and eventually integrates as your own bone. 2.Xenograft ●The implantation of bovine (cow) bone graft. A secondary donor site is not necessary and this graft is able to maintain space well. Education and Training PathwaysHow to become a Periodontist in the Philippines 1.Pass the Qualifying Examination at your chosen dentistry school -To gain admission to their chosen dentistry school, students must successfully pass the qualifying exam required by the university. Depending on the institution, further assessments such as interviews or dexterity exams to assess the applicant’s manual skills and ability to adhere to instructions may be held. 2.Enroll and Complete the Pre-dentistry Course -The first step is obtaining a pre-dentistry course for around 2 years, usually in general education, basic sciences, clinical science, and dental public health courses.
Mañalac, 2024-This aims to provide quality education to prepare dental students for the general practice of dentistry as a health service profession 3.Finish the Dental Medicine Proper Program -Dentistry Proper (Years 3 to 6 of the Doctor of Dental Medicine program) is the main clinical phase where students transition from foundational sciences to hands-on dental training. -During these years, students deepen their understanding of dental and medical sciences, like oral anatomy, pathology, and pharmacology, and they gain practical skills through supervised clinical rotations. 4.Enroll and Complete the Pre-dentistry Course -Upon graduating, students must pass the Philippine Dentist Licensure Examination administered by the Professional Regulation Commission (PRC) to practice as a general dentist. 5.Enroll and Finish the Master of Science in Dentistry Major in Periodontics (MScD) -To specialize in periodontics, licensed dentists can pursue additional training and education in periodontology in an educational institution that offers the particular graduate program. -This three-year graduate program in periodontics involves didactic and clinical components. -In six regular semesters, dentists can have clinical proficiency and research capability in the field of periodontics. -By the end of the MScD, graduates are equipped with both clinical expertise and research skills, ready for certification and to practice as specialized periodontists. -phone (Brüllmann, 2011). Online interactive discussions and seminars can also be facilitated to foster collaboration among dental students, practitioners, and specialists (Tella et al., 2019). Materials and Equipmenta.Diagnostic Tools I.Periodontal Probes -instruments used for exploration, enabling practitioners to assess the extent of damage to the periodontal tissues. Their active part is marked in millimeters, serving as a chart that records the depth of the gingival sulcus in millimeters on both the vestibular and palatal side of the teeth. 1.North Carolina Probe: This is slightly thicker and is regarded as the most standardized option, making it easy to use. 2.Williams Probe: This is specifically designed to measure the depth of periodontal pockets, marked in millimeters at 1, 2, 3, 5, 7, 8, 9, and 10. 3.OMS Probe: This features a 0.5 mm diameter ball at its end and includes a black band indicating two lengths: 3.5 mm at the proximal end and 5.5 mm at the distal end. 4.Nabers Probe: With its curvature, it is utilized to examine the space between the roots of multi-rooted teeth. Its design allows for transverse penetration to detect the extent of furcal lesions, which refers to the bone located between the roots. II.Dental Explorers -intended for clinical examination of the teeth rather than the periodontium. They are used to evaluate the tooth surface for the presence of dental calculus, caries, fissures or recurrence decay in previously filled areas. b.Supragingival and subgingival dental calculus removal I.Dental curettes -instruments used for the removal of tartar, eliminating both subgingival and supragingival tooth calculus. They are also useful for scraping away necrotic soft tissue or cementum. 1. Gracey curettes: Characterized by its angulation (60 or 70 degrees), this makes them particularly effective for accessing gingival pockets in specific teeth, including canines, premolars, molars, or incisors, depending on the angle relative to the tooth neck. 2. Universal curettes: Versatile instruments that can be used on all tooth surfaces. They feature two cutting edges and a rounded tip, with a 90-degree angulation that allows for the removal of moderate to large amounts of calculus. In universal curettes, the cutting blade is designed to curve upwards only. c.Surgical Instruments and Suturing Materials I.Periosteal Elevators and Bone Chisels -aid in retracting soft tissue and reshaping bone during surgical procedures to enhance access to deeper areas and ensure better tissue healing. II.Sutures -utilized to secure tissues following surgery, with popular materials including silk, nylon, and polyglycolic acid, each offering different levels of tissue response and ease of use. d.Soft Tissue and Esthetic Tools I.Soft Tissue Lasers -are used for gingival contouring and minor surgical procedures. These lasers help minimize bleeding and reduce postoperative discomfort. An example of this is a diode laser. II.Gingival Grafting Materials -including autogenous grafts harvested from the patient’s palate or allografts, are used to help cover exposed roots and enhance gum aesthetics. e.Other Instruments 1.Dental blades -They feature a triangular cross-section design with two cutting edges and a sharp point. Due to this design, they are not suitable for the removal of subgingival calculus, as they could potentially injure the gums. -Their primary use is for the removal of supragingival calculus. Blades in dentistry are precision cutting tools used in various procedures, including surgical extractions, gingivectomies, and other soft tissue surgeries. 2.Dental files -These instruments have numerous cutting edges positioned at varying angles to the base. These serve three main functions: 1.they assist in removing calculus
Mañalac, 20242.polishing restorations on the free surfaces of teeth, and 3.preparing root canals. 3.Dental hoe -This is designed for manual trimming of small portions of dental tissue, removing both the supra and sub gingival calculus, and performing the last phase of cavity preparation. 4.Dental brushes -These are characterized by their long, rectangular blades with sharp, double or single bevels. They can be manufactured in either straight or angled shapes. -The larger dental brushes are used for sectioning bone tissue, medium-sized brushes for dentine or enamel, and small brushes are intended for use on the gums. E.Schools of Thought and Treatment Approaches b.Periodontics, the branch of dentistry that focuses on the structures supporting the teeth, including the gums and bone, employs various treatment philosophies and approaches to manage periodontal diseases. Philosophy/ Approach Description Indications Non-Surgical Periodontal Therapy Scaling and root planing (SRP), adjunctive therapies Early to moderate periodontal disease Surgical Periodontal Therapy Flap surgery, bone grafts, soft tissue grafts Advanced periodontal disease Regenerative Periodontal Therapy Guided tissue regeneration (GTR), growth factors Severe periodontal disease, bone loss Host Modulation Therapy Systemic antibiotics, anti-inflammatory medications Chronic periodontal disease, inflammation Minimally Invasive Periodontal Therapy Lasers, ultrasonic instruments Mild to moderate periodontal disease Personalized and Evidence-Based Treatment Tailored to patient’s condition and health All stages of periodontal disease Philosophy/ Approach Advantages Limitations Non-Surgical Periodontal Therapy Minimally invasive, promotes healing May not be sufficient for advanced disease Surgical Periodontal Therapy Effective for severe cases, regeneration of lost tissue Invasive, longer recovery time Regenerative Periodontal Therapy Promotes natural healing, regeneration Requires specific conditions, may be complex Host Modulation Therapy Targets underlying immune response Possible side effects, not suitable for a;; Minimally Invasive Periodontal Reduced discomfort, faster recovery Limited to less severe cases Therapy Personalized and Evidence-Based Treatment Customized care, better outcomes Requires thorough assessment and planning 01.Non-Surgical Periodontal Therapy -This method includes scaling and root planing (SRP), which clears plaque and tartar from tooth surfaces and beneath the gums. It helps to decrease inflammation and infection, fostering the healing of gum tissues. Additional therapies like antiseptics, antibiotics, and air polishing may be combined with SRP to boost its effectiveness. 02.Surgical Periodontal Therapy -A treatment approach where surgery may be needed, due to the inadequacy of non-surgical procedures. This could involve flap surgery to better clean the root surfaces, bone grafts to restore lost bone, or soft tissue grafts to cover exposed roots or enhance gum tissue. 03.Regenerative Periodontal Therapy -Focused on rebuilding lost structures like bone, periodontal ligament, and cementum, this approach uses methods like guided tissue regeneration (GTR) and growth factors to stimulate natural healing processes. 04.Host Modulation Therapy -This approach seeks to adjust the body’s immune response to better manage periodontal disease. It may involve systemic antibiotics, anti-inflammatory drugs, and other agents aimed at controlling inflammation. 05.Minimally Invasive Periodontal Therapy -By using less invasive techniques, this approach aims to minimize discomfort and recovery time. It involves lasers, ultrasonic tools, and advanced technology to achieve gum health with minimal tissue trauma. 06.Personalized and Evidence-Based Treatment -Modern periodontal care is tailored to each patient’s unique condition, risk factors, and health profile. Evidence-based guidelines guide clinicians in selecting the best treatment options for each individual. F.Challenges in Practice a.Timely and Proper Diagnosis of Periodontitis -About a third of periodontal cases are misclassified. This is due to periodontitis being a complex and multifactorial inflammatory disease. -It overlaps with other oral health conditions and its symptoms can be ambiguous in its early stage. The disease is usually painless and patients rarely seek care. -Moreover, comprehensive diagnosis involving X-rays, research, and newer treatment approaches that could be beneficial to diagnosing periodontitis better is expensive. b.Properly Controlling Factors Contribution to Periodontitis -The routine is usually direct regarding current treatment limitations, addressing the immediate cause such as removing plaque and tartar. While this method targets bacterial agents responsible for periodontal disease, they often do not address underlying host factors and responses to risks such as diabetes, smoking, stress, genetics, occlusal trauma, iatrogenic dentistry, and patient compliance.
Mañalac, 2024c.Long-Term Maintenance of Periodontium in the Treatment of Chronic Periodontitis -Treating chronic periodontitis as a dentist presents several challenges, including the need to sustain patient motivation and compliance with treatment protocols. -Effective management also requires careful attention to various risk factors that can impact periodontal health, such as smoking, diabetes, and poor oral hygiene. -Additionally, clinicians must assess whether re-treatment is necessary, as the condition may evolve or require further intervention to maintain periodontal stability. d.The Prevalence of Severe Periodontitis Has Not Changed Since 1990 -Limited awareness regarding periodontal diseases and their prevention poses a significant challenge for periodontists, the misconception that periodontitis is primarily a cosmetic issue rather than a serious health concern diminishes its perceived urgency, making patients less likely to seek treatment. -For older adults, inadequate access to proper care further complicates the situation, as this population is at higher risk for periodontitis yet often lacks the resources or support to pursue effective treatment. -Together, these factors create substantial obstacles for periodontists, who must work not only to treat the disease but also to educate and motivate patients across varying age groups and levels of awareness. e.Clinic Rehabilitation Challenges -Challenges in restoring form, function, and esthetics due to weakened dentition and bone loss from severe periodontal diseases. This also includes meeting the patient’s satisfaction and compliance.G.Current Trends and Innovations a.Laser Dentistry ●Laser Dentistry (laser) is a minimally invasive and an effective option for various dental treatments such as removing decay, reshaping gums, and whitening teeth. ●These are also used to treat periodontal diseases by reducing gum pockets and eliminating bacteria, offering a safe and gentle experience with minimal discomfort. ●The use of lasers eliminates the need for stitches or other invasive procedures resulting in a significantly shorter recovery time. Laser dentistry is ideal for patients seeking effective and minimally invasive care. b.Digital X-Rays ●Digital X-ray imaging is a tool that provides detailed views of teeth and surrounding structures such as the roots and bones. ●This tool also aids in diagnosis and treatment planning, and can be easily shared with other dental specialists to improve coordinated care. c.Cone Beam CT Scans ●Cone Beam CT Scans offer a three-dimensional imaging of the teeth, bones, and soft tissues, enhancing implant placement accuracy, and assessing periodontal bone disease and bone loss. d.Intraoral Cameras ●Intraoral Cameras are small, hand-held devices that can be used to get a close-up view of the insides of your mouth. It allows periodontists to closely examine the teeth and gums—improving the overall treatment quality. e.3D Printing Technology ●3D Printing technology revolutionized many industries, and dentistry is no exception. In periodontics, this device enables dentists to create custom dental implants, bridges, and other prosthetics with precise fit and functionality. ●This tool uses a computer-aided design (CAD) file to create a three-dimensional model of the desired object. This model is then used to create a physical object using a 3D printer. ●Through this, much more precise manufacturing of dental implants and other prosthetics can be made to specifically fit each patient’s mouth resulting in better results and faster waiting time compared to traditional methods. ●Lastly, this can be used to create models of a patient’s mouth before surgery. This helps the surgeon plan the procedure more precisely; thus, yielding fewer complications and a quicker recovery time CONCLUSION★In conclusion, the fields of endodontics and periodontics play vital roles in dental health, each addressing distinct yet interconnected aspects of oral care. ★Endodontics focuses on the diagnosis, prevention, and treatment of diseases affecting the dental pulp, while
Mañalac, 2024periodontics manages conditions impacting the supporting structures of teeth, such as gums and bone. ★Both specialties emphasize preserving natural teeth and fostering overall oral health, using a combination of surgical and non-surgical techniques that continue to evolve with advances in technology and research. The historical progression of these disciplines reveals an enduring commitment to improving patient outcomes, adapting practices to meet both medical and cosmetic needs. ★With increased accessibility to sophisticated diagnostic tools and personalized treatment approaches, these specialties are well-positioned to meet modern dental challenges, ultimately contributing to enhanced quality of life and long-term dental functionality for patients. ★The continued development of regenerative methods, innovative equipment, and education will undoubtedly strengthen the impact of endodontics and periodontics in advancing oral healthcare.