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RATIONALE OF ENDODONTIC
TREATMENT
Contents of these
presentation
INTRODUCTION
INFLAMMATION
INFLAMMATORY CELLS
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OF
APICAL
INTRODUCTION
Endodontic pathology is caused by
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All these reaction take place to eliminate the irritant and repair any
damage
Focal Infection
4
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THEORIES OF SPREAD
OF INFECTION
Focus of Infection
Cont of theories
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Cont of theories
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CULPRIT OF
ENDODONTIC
PATHOLOGY
Anachoresis
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Fig. : Radiograph
showing poorly
obturated canals
INFLAMMATION
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0
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Physical
Chemical
Infective
Immunological
while infection is invasion into the body by harmful microbes and their
resultant ill effects by toxins
Cont of inflammation
1
1
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Signs of Inflammation
Cont of inflammation
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2
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1.
Chronic inflammation
2.
o
Degenerative changes
.Continuous
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1.
. Suppuration
Tissue necrosis
Polymorphonuclear leukocytes
Digestion of the necrotic material by proteolytic enzymes released by
injured polymorphonuclear cells
Clinical significance:
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2. Proliferative changes
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4
INFLAMMATORY CELLS
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1.
Neutrophils
2.
Eosinophils
3.
Lymphocytes
4.
Osteoclasts
5.
Ephithelial
cells
Inflammatory Response to
Periapical Lesion
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6
1
7
1.
Polyclonal antibodies
2.
Monoclonal antibodies
like IgG and IgM, interact with the bacteria and its by-products to
form antigen-antibody complexes that bind to the platelets
resulting in release vasoactive amines thus increasing the
vascular permeability and chemotaxis of PMNs.
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Cont.
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mediators (Nonspecific
mediators of inflammation), and
Antibodies
(Specific mediators of
inflammation)
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Innate immunity
Acquired/adaptive immunity
1.
Innate immunity
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2. Acquired/Adaptive immunity
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ENDODONTIC IMPLICATIONS
(PATHOGENESIS
OF APICAL PERIODONTITIS AS
EXPLAINED BY
FISH described the reaction
FISH)of the periradicular
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1
tissues to bacterial
products, noxious products of tissue necrosis, and antigenic agents
from the root canal
FISH in 1939 theorized that the zones of infection are not an
infection by themselves but the reaction of the body to infection.
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Zone of Infection
Zone of Contamination
This zone was not invaded by bacteria, but the destruction was from
toxins discharged from the microorganisms in the central zone.
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Zone of Irritation
FISH observed evidence of irritation further away from the central lesion as
the toxins became more diluted.
Zone of Stimulation
FISH noted that, at the periphery, the toxin was mild enough to act as
stimulant.
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The knowledge gained in FISH study can be applied for better understanding
of reaction of periradicular tissues to a nonvital tooth.
The toxic byproducts of the microorganisms and the necrotic pulp in the root
canal are irritating and destructive to the periradicular tissues. These
irritants along with proteolytic enzymes (released by the dead
polymorphonuclear leukocytes) result in the formation of
chronic abscess
Granuloma
Sclerotic
Cyst
Zone A:
He compared the bacteria in the infected root canal
with the invaders entrenched behind high and
inaccessible
mountains, the foramina serving as mountain passes.
Zone B:
The exudative and granulomatous (proliferative)
tissue
of the granuloma represents a mobilized army defending
the
plains (periapex) from the invaders (bacteria). When a
few
invaders enter the plain through the mountain pass, they
are
destroyed by the defenders (leukocytes). A mass attack
of
invaders results in a major battle, analogous to acute
inflammation.
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Kronfelds Mountain
Pass Theory
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Zone C:
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Rationale of
Endodontic Therapy
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