UNDER GUIDANCE OFDepartment of conservative and endodontics

MADE BYSONAL BATRABDS intern

Endodontic emergencies are usually

associated with pain and or swelling and

require immediate diagnosis and treatment.

These emergencies are caused by pathoses

in the pulp or periradicular tissues.

Grossman defined it as unwanted guest.

Pulpal DiagnosisPulpal Diagnosis Periradicular Periradicular DiagnosisDiagnosis

Reversible pulppitis

Irreversiblepulpitis

Necrotic pulp

Previously treated

Acute

periradicular

periodontitis

Acute

periradicular

abscess

Traumatic injuries

•PAIN

•PAIN WITH SWELLING

• The impulse travel from a delta fibers and c fibers nerve endings through plexus of raschkow to nerve trunk in the central zone of pulp .the a delta fibres are enclosed in myelin sheath while traversing the plexus of raschkow.

• The tissue injury excites c fibres which carry pain

• Mech of action of pain explained on the basis of inflammation ,inflammation accompany tissue injury and release of chemical mediators,this in turn stimulates c fibres and result in pain.

Determine the Chief Complaint

Medical history

Tests

Radiographic exam

Analyze and results

Treatment plan

•Acute reversible pulpitis

•Acute irreversible pulpitis

•Acute periapical abcess

•Acute apical periodontitis

•Localized inflammation of the pulp•Lowering of threshold stimulation for a delta nerve fibres•Exaggerated ,non-lingering response to stimuli

•Removal of cause

•Recontouring of restoration

•Removal of the restoration

•Relive the occlusion .

If inflammatory process proggress ,irreversible pulpitis can develop.it is characterized by following:.

History of spontaneous pain and exaggerated response to hot or cold that lingers after the stimulus is removed

Lingering pain occur after thermal stimulation of a delta nerve fibres while spontaneous dull,aching pain occur by stimulation of unmyelinated c fibres in the pulp

Mediators of inflammation directly stimulate the fibres .

Pulpectomy

Biphasic treatement :

Pulp debridement

Incision n drainage

In case of systemic

features antibiotics are

prescribed

To control post operative

pain analgesics are

prescribed

• It is localized collection of pus in the

alveolar bone at the root apex of a

tooth following death of pulp with

extension in the periradicular tissue.

• Large number of bacteria get past the

apex into periradicular tissues.

• Clinically ,swelling to various degree is

present along with pain and a feeling

that tooth is elevated in the socket

Inflammation of periodontal ligament caused by

tissues damage,extension of pulpal pathosis or

occlusal trauma

Pressure on tooth is transmitted to the fluid which

pushes on nerve ending in periodontal ligament

Tooth may be elevated out its socket because of the

build up in fluid pressure in the periodontal ligament

Discomfort to biting or chewing

Sensitivity to percussion

Determine the cause and

relive the symptoms

Adjustment of high points

Removal of irritants

Access opening followed

by placement of sedative

dressing followed by closed

dressing

Mid treatment flare ups

•Over-instrumentation• Inadequate debridement• Missed canal • Hyper-occlusion*• Debris extrusion • Procedural complications*

Missed canal

•PRE-OP PAIN

•PULP VITALITY

•PERCUSSION SENSITIVITY

•ABSENCE OF A PERIRADICULAR RADIOLUCENCY

•COMBINATION OF THESE SYMPTOMS

Relief of occlusion

Reassure the patient

Analgesics should be

prescribed

Antibiotics if required

are

prescribed

Perforation

Separated instrument

Zip

Strip

NaOCl accident

Air emphysema

Wrong tooth

It is pathological or mechanical

communication between root canal

system and external tooth surface

It occur at 3 level:

1. Cervical canal perforation

2. Mid root perforation

3. Apical root perforation

Isolation of the tooth Free from contamination Control of Bleeding Location of perforation Insertion of the thickest file in the canal

opening up to 5mm below the level of perforation. Calcium hydroxide paste (Dycal) is packed into

the perforation and allowed to set Soft mix of amalgam is gently packed over the

calcium hydroxide paste. After Initial setting of the filling material the file

is gently removed RCT should be perform as conventional method

Stripping is a lateral perforation caused by over instrumentation through a thin wall in the root canal & is most likely to happen on the inside or concave wall of a curved

canal. Causes : •Over zealous instrumentation in the mid-

root areas •Not use precurved instruments.

•Both internal and external repair may be required

•A small area may be sealed from inside the tooth.

A large one required surgical repair.

•International re-implantation can be considered.

Over preparation of the outer wall of the apical curvature of the canal with

inflexible instruments will cause zipping.

Causes : •Failure to used the precurve

the instruments •Rotation of instruments in

curved canals Use of large stiff instrument

When a zipping is present theremoplasticized GP techniques preferred along with sugical approach

Reassurence to patients

Complete debridment of root canal

Establishment of drainage

Relief of occlusion

Calcium hydroxidetherapy

Over instrumentation

Overextended filling beyond root apex

Fracture of crown and tooth

Failure of resolution of inflammation

Over extended filling Fracture of tooth

Reassurance

Analgesics

Retreatment

C E L L Sn eu trop h ils , lym p h ocytes ,

p lasm a ce lls , m ac rop h ag es ,os teoc las ts , ep ith e lia l ce lls , d en d rit ic ce lls

M O L E C U L A R M E D IA TO R Scytok in es (IL , IF N , C S F , TG F )

e icosan o id s (P G , L T)en zym atic e ffec to r m o lecu les

A N TIB O D IE Sim m u n og lob u lin s (Ig G , e tc .)

p rod u ced b y p lasm a ce lls

M ixed M ic ro flo ra

M IL D6 0 0 -1 0 0 0 ace tam in op h en

M O D E R A TE6 0 0 -1 0 0 0 m g ace tam in op h en

an d op ia te =6 0 m g cod e in e

S E V E R E1 0 0 0 m g ace tam in op h en

an d op ia te =1 0 m g oxycod on e

A sp irin -like D ru g s a re C on tra in d ica ted

Systemic involvement

Compromised host resistance

Inadequate surgical drainage

Grossman Text book of endodontics nisha garg