Page 6 - The Beauty and Sorrow in Endodontics-Chapter 3

Chapter 3

Vow to be the Guardian of Diseased Teeth – to Give them a Last

Chance before Extraction

By the end of this chapter, you should be able to answer the following questions:
1. How to assess if a painful tooth with a large peri-apical lesion and increased mobility

can be saved?
2. When is the best time to initiate endodontic treatment on teeth with periodontal

diseases?
3. What is the purpose of recalls and how do I determine its frequency after endodontic

treatment?

Supporting Structures of the Dentition

The attachment apparatus includes cementum, alveolar bone, and PDL fibres. They
support and make sure tooth roots are attached firmly in the boney sockets. Under normal

condition, they remodel and restructure overtime. However, once they have been infected
or traumatized from occlusion, if no correction is made to allow for healing, apical

lesions will develop and grow, resulting in a mobile tooth that cannot function to the

eventual loss of the tooth. From a developmental point-of-view, the attachment apparatus
and pulpal tissues all originate from mesenchymal cells, and therefore have a lot in

common. However, the greatest difference between the two is that pulpal tissues are
surrounded by dentin, and once root development is completed, collateral circulation is

disconnected from the pulp. With the limited blood flow and lack of collateral circulation
in the root canal system, systemic antibiotics cannot reach pulpal tissue and the pulp is

restricted in its ability to repair itself through natural inflammatory response. On the other

hand, the connective tissue around the root of the tooth is surrounded by an abundance of
blood circulation. As long as the individual does not have any pre-existing

immunodeficiencies, removal of the pathogen will initiate the immune response required

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