Page 7 - The Beauty and Sorrow in Endodontics-Chapter 3

for healing to occur. When necessary, systemic antibiotics given will also aid in removal

of the pathogen in these cases. This can be seen in extractions of infected teeth, once the
tooth and granulation tissue are removed, the alveolar bone will eventually remodel and

fill the socket. The key role of dentists, then, is to be able to correctly diagnose and treat

the periapical lesions in order to stabilize the offended tooth and allow it to continue to
function in the mouth.

The Periodontal Status of the Offending Tooth is Crucial Both Before and

After Root Canal Treatment

Endodontic and periodontal treatment results often determine whether or not a tooth

can be preserved. Dr. Schilder often said that with a healthy periodontium, any diseased

tooth can be successfully treated with root canal treatment (either non-surgically or
surgically). He believed that the survival of the tooth is not dependent on the vitality of

its pulpal tissue, but rather the stability of the attachment apparatus surrounding the tooth.

Complete Healing Can Only Occur After Elimination of All Etiologies

1. Crevicular/Sulcular Vector

If the lesions around the root are solely due to the damage of the periodontal

apparatus from calculus deposits, such as breakage of the periodontal ligament or
resorption of the alveolar bone or cementum, resulting in gingival inflammation or

increased tooth mobility, as long as there is no secondary infection of the pulpal tissue,
then complete healing of the lesion can be expected with periodontal treatment alone.

2. Endodontic Vector
If the pulpal tissue is irreversibly damaged due to caries, mechanical or chemical

insult, tooth fracture, or pulp exposure, then root canal treatment must be completed to
relieve the swelling and pain for the patient. If the apical lesion is only of endodontic

origin, where the pathogens and toxins from pulpal necrosis had spread to the

surrounding structures via various portal of exits, then endodontic treatment alone will
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