Pitt Ford's Problem-Based Learning in Endodontology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 543

Veröffentlichungsjahr: 2024

Beschreibung

Pitt Ford's Problem-Based Learning in Endodontology Pitt Ford's Problem-Based Learning in Endodontology, 2nd Edition, is an essential reference for Endodontology, enriched with the latest research and clinical evidence. Employing a problem-based approach, it consolidates readers' knowledge and diagnostic skills. Prepared by an international team of clinical academics, this edition reflects the latest advances in the field. Encouraging self-directed learning, the authors present diverse clinical cases covering topics such as non-odontogenic pain, pulp preservation, endodontic treatment, restoration, regenerative endodontic procedures, and trauma. Each section is accompanied by images as well as further reading recommendations. A touchstone to key areas concerning the dental pulp and the root canal system, Pitt Ford's Problem-Based Learning in Endodontology is a valuable resource for dental students, residents, and clinicians seeking the latest techniques and procedures in Endodontology.

Leseprobe

Pitt Ford's Problem‐Based Learning in Endodontology

Second Edition

Edited by

Elizabeth Shin Perry DMD FICD

Division of Postgraduate EndodonticsDepartment of Restorative Dentistry and Biomaterial SciencesHarvard School of Dental MedicineBoston, MA, USA

Shanon Patel BDS MSc MClinDent MRD PhD FDS FHEA

Postgraduate Endodontic UnitKing’s College London Dental InstituteLondon, UK

Shalini Kanagasingam BDS MClinDent MFDS MRestDent FHEA

School of Medicine and DentistryUniversity of Central LancashirePreston, UK

Samantha Hamer BDS MFDS MSc MClinDent MEndo

Postgraduate Endodontic UnitKing’s College London Dental InstituteLondon, UK

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Library of Congress Cataloging‐in‐Publication Data

Names: Perry, Elizabeth Shin, editor. | Patel, Shanon, editor. | Kanagasingam, Shalini, editor. | Hamer, Samantha, editor.Title: Pitt Ford’s problem‐based learning in endodontology / edited by Elizabeth Shin Perry, Shanon Patel, Shalini Kanagasingam, Samantha Hamer.Other titles: Problem‐based learning in endodontologyDescription: Second edition. | Hoboken, NJ : Wiley, 2025. | Includes bibliographical references and index.Identifiers: LCCN 2023017104 (print) | LCCN 2023017105 (ebook) | ISBN 9781119565970 (paperback) | ISBN 9781119566014 (adobe pdf) | ISBN 9781119565963 (epub)Subjects: MESH: Dental Pulp Diseases–diagnosis | Dental Pulp Diseases–therapy | Endodontics | Problems and Exercises | Case ReportsClassification: LCC RK351 (print) | LCC RK351 (ebook) | NLM WU 18.2 | DDC 617.6/342–dc23/eng/20230901LC record available at https://lccn.loc.gov/2023017104LC ebook record available at https://lccn.loc.gov/2023017105

Cover Design: WileyCover Image: Courtesy of Elizabeth Perry

The publishers thank the contributors and acknowledge that the images used in this textbook are owned by the individual contributors except where indicated.

Contributors

Abdulaziz A. BakhshBDS MClinDent MEndo PhDDepartment of Restorative Dentistry, Endodontic DivisionFaculty of Dental MedicineUmm Al‐Qura UniversityMakkah, Saudi Arabia

Benoit BallesterDDS MScDepartment of Endodontics and Restorative DentistryAix‐Marseille UniversitéMarseille, France

and

Practice Limited to Restorative DentistryAssistance Publique des Hôpitaux de MarseilleMarseille, France

Bhavin BhuvaBDS MFDS RCS MClinDent, MRD FHEAPostgraduate Endodontic UnitFaculty of Dentistry, Oral & Craniofacial SciencesKing’s College London, UK

and

Practice Limited to Endodontics, UK

Rahul BoseBDS MFDS MClinDent MEndoPostgraduate Endodontic UnitKing’s College London Dental InstituteLondon, UKandPractice Limited to Endodontics, UK

Frédéric BukietDDS MSc PhD HDRDepartment of Endodontics and Restorative DentistryAix‐Marseille UniversitéMarseille, France

and

Practice Limited to EndodonticsAssistance Publique des Hôpitaux de MarseilleMarseille, France

Dermot CanavanBDentSc MGDS MSDublin Dental School & HospitalTrinity College DublinDublin, Ireland

and

Practice Limited to Orofacial Pain ManagementDublin, Ireland

Nadia ChugalDDS MS MPHDivision of Regenerative and Reconstructive SciencesSection of EndodonticsUCLA School of DentistryLos Angeles, CA, USA

and

Practice Limited to EndodonticsLos Angeles, CA, USA

Nestor CohencaDDS FIADTDepartment of Pediatric DentistryUniversity of Washington and Seattle Children’s HospitalSeattle, WA, USA

and

Practice Limited to EndodonticsKirkland, WA, USA

Raul CostaLMD LisbonPractice limited to Restorative DentistryLondon, UK

Matthew C. DavisDDSPractice Limited to EndodonticsWinnetka, IL, USA

Luis FerrandezBDS MScPractice Limited to EndodonticsPoole, UK

David FigdorBDSc LDS MDSc FRACDS Dip Endo FPFA PhD FASM FADI FICDDepartment of MicrobiologyBiomedical Discovery InstituteMonash UniversityMelbourne, Australia

and

Specialist Endodontic PracticeMelbourne, Australia

Massimo GiovarruscioDip Dent MScPractice Limited to EndodonticsBristol, UK

Thomas GiraudDDS MSc PhDDepartment of BiomaterialsAix‐Marseille UniversitéMarseille, France

and

Practice Limited to EndodonticsMarseille, France

Maud Guivarc’hDDS MSc PhDDepartment of Endodontics and Restorative DentistryAix‐Marseille UniversitéMarseille, France

and

Practice Limited to EndodonticsMarseille, France

Samantha HamerBDS MFDS MSc MClinDent MEndoPostgraduate Endodontic UnitKing's College LondonLondon, UK

and

Practice Limited to EndodonticsLondon, UK

Simon HarveyBDS MFDS MAThe Eastman Dental HospitalLondon, UK

and

Queen Victoria HospitalEast Grinstead, West Sussex, UK

Jianing HeDMD PhDDepartment of EndodonticsTexas A&M University College of DentistryDallas, TX, USA

and

Practice Limited to EndodonticsFlower Mound, TX, USA

Ali HilmiBDS BSc MJDF RCS MClinDent MEndoPractice Limited to EndodonticsLondon, UK

Shalini KanagasingamBDS MClinDent MFDS MRestDent FHEASchool of Medicine and DentistryUniversity of Central LancashirePreston, UK

and

Practice Limited to EndodonticsPreston, UK

Maria LessaniBDS MFDS MClinDent MRDUnit of Endodontology,Eastman Dental Institute, UCL, London, UK

and

Practice Limited to EndodonticsLondon, UK

Francesco MannocciDDS MD PhDPostgraduate Endodontic UnitDental Institute, King’s College LondonLondon, UK

Philip MitchellBDS MSc MRDPostgraduate Endodontic UnitDental Institute, King’s College LondonLondon, UK

Garry L. MyersDDS FICD FACDDepartment of Oral Diagnostic Sciences and EndodonticsVirginia Commonwealth UniversityRichmond, VA, USA

Kreena PatelBDS(Hons) MJDF MClinDent MEndoPractice Limited to EndodonticsLondon & Reading, UK

Neha PatelBDS MJDF MClinDent MEndo FHEAPostgraduate Endodontic UnitKing’s College London Dental InstituteLondon, UK

and

Practice Limited to EndodonticsLondon, UK

Shanon PatelBDS MSc MClinDent MRD PhD FDS FHEAPostgraduate Endodontic UnitKing's College London Dental InstituteLondon, UK

and

Practice Limited to EndodonticsLondon, UK

Elizabeth Shin PerryDMD FICDDivision of Postgraduate EndodonticsDepartment of Restorative Dentistry and Biomaterial SciencesHarvard School of Dental MedicineBoston, MA, USA

and

Practice Limited to EndodonticsWestfield, MA, USA

Tiago PimentelLMD MSc MClinDent MEndo RCSEdinPostgraduate Endodontic UnitKing’s College LondonLondon, UK

and

Practice Limited to EndodonticsLondon, UK

Taranpreet PuriBDS (Hons) MFGDP MFDS RCS PG Cert MClinDent MEndoRCSEng MEndo RCSEdPractice Limited to EndodonticsLondon, UK

John RhodesBDS FDS MSc MFGDP MRD RCSPractice Limited to EndodonticsDorset, UK

Isabela N. RôçasDDS MSc PhDLaboratory of Molecular MicrobiologyPostgraduate Program in EndodonticsGrande Rio UniversityRio de Janeiro, Brazil

Suhaila S. ShariffDMD MPHPractice Limited to EndodonticsIllinois, USA

José F. Siqueira JrDDS MSc PhDPostgraduate Endodontics UnitGrande Rio UniversityRio de Janeiro, RJBrazil

Nargis SondeBDS MFDS MSc PeriodontologySchool of Medicine & DentistryUniversity of Central LancashirePreston, UK

Peng‐Hui TengDDS MFDS MClinDent MEndoPostgraduate Endodontic UnitKing’s College London Dental InstituteLondon, UK

Shatha ZahranBDS MSD FRCDC ABE PhDDepartment of EndodonticsKing Abdulaziz UniversityJeddah, Saudi Arabia

First Foreword

Over the last 50 years of endodontics, we have witnessed immense technical and biological advances that have helped to underpin our understanding of pulpal and apical disease and the appropriate therapies to manage these conditions. Notably, many of these advancements have not been fully translated into practice with shortcomings in educational dissemination and limitations to conventional teaching methodology highlighted. Pitt Ford's Problem Solving in Endodontology, now in its second edition, uniquely addresses this in that it challenges the reader to be the problem solver, asking pertinent questions based around every day clinical vignettes. This form of case‐based learning increases the relevance for the reader and also challenges them to consider how best to manage these scenarios with a research‐led mindset. A particularly welcome facet of the book is that it does not aim to provide all the answers, but rather stimulates the reader to further develop their knowledge.

The book covers a wide range of topics from the biological rationale for endodontic treatment, diagnosis, and treatment planning, through vital pulp treatment, root canal treatment, regenerative endodontics, and endodontic microsurgery, while also covering critical areas that are often ignored such as pain of non‐odontogenic origin, dental trauma, and medico‐legal aspects. The topics have been brought together in such a way that the overall scope of this text is much greater than the simple summation of the individual components. It will appeal to postgraduates, residents in training, researchers, and practicing clinicians, and I am sure it will help to inspire many people in the clinical endodontic area. It is led by a talented and experienced editorial group that has recruited an exceptional range of talented and prominent endodontists working and researching globally. I am grateful to the editors and authors for providing us with this valuable insight and know that the text will become essential reading for those working in the area.

Of particular pride to me to see that the book carries the name and legacy of Tom Pitt Ford, a personal mentor and pioneer in the field and development of the science endodontology. I know he would have been immensely proud of the new edition of this important text.

Henry (Hal) Duncan BDS, FDS RCS, FFD RCSI, MClin Dent, MRD RCS, PhD

Professor in Endodontology, Dublin Dental University Hospital, Trinity College Dublin, IrelandPresident of the European Society of Endodontology

Second Foreword

In clinical dentistry, problem solving and critical thinking are crucial in the accurate diagnosis and delivery of clinical care for patients. In this second edition of Pitt Ford's Problem Solving in Endodontology, the editors have produced an outstanding pragmatic guide to endodontic therapy. Since the first edition, the field of endodontics has undergone impressive developments in the evolution of more conservative minimally invasive therapies that incorporate innovations in biomedical imaging, microscopy, and risk factor discovery to benefit patients. This edition beautifully holds up the legacy of Professor Tom Pitt Ford. The book brings together real‐life clinical scenarios to enhance the education of dental and postgraduate students alike on key principles involved in patient management, especially in situations of traumatic injury to the dentition and/or alveolus for the promotion of tooth support, function, aesthetics, and long‐term survival.

The book is subdivided into nine valuable sections that comprehensively address areas such as aetiology, diagnosis, and treatment planning. Pertinent new chapters have been added on vital pulp therapy and regenerative endodontics and reflect the rapidly evolving area of tissue engineering and regenerative medicine, leading much of dentistry to improve clinical outcomes for enhanced delivery of the minimally invasive treatments that patients have come to expect. Chapters on management of both failure and/or complications during endodontic therapy are also very relevant, as we know that it is desirable to retain teeth for as long as practically possible. Advancements in endodontic microsurgery and the many challenges in managing exquisite restorative work to preserve teeth that require either initial endodontic treatment or retreatment have also been updated.

Additional considerations for patient management such as the (potential) association between apical periodontitis and systemic disease, medicolegal issues, and determining prognosis of teeth that may eventually support clinical decision making in patient risk stratification have been added in this second addition.

In summary, I am excited for readers to delve into this second edition of Pitt Ford's Problem Solving in Endodontology to partake in this assembly of pertinent clinical scenarios. This text will advance students' understanding in order to better deliver clinical care to preserve the dentition by enhancing long‐term endodontic outcomes. Please enjoy!

William V. Giannobile, DDS, MS, DMedSc

Dean, Harvard University School of Dental MedicineBoston, MA, USA

Preface

The success and positive feedback of the first edition of Pitt Ford’s Problem‐Based Learning in Endodontics led to the commissioning of this second edition. As with the first edition, the aim of this novel textbook is to enable readers to become adept problem solvers in real‐life clinical scenarios, mirroring their experiences in patient care. This case‐based approach fosters problem‐solving skills and cultivates critical thinking.

This book does not replace traditional Endodontology textbooks but is intended as a supplementary resource to help readers consolidate their knowledge. Each chapter maintains an accessible question‐and‐answer format, covering the core topics of endodontics. This approach encourages inquisitive readers to delve deeper into specific subjects and cultivates a self‐learning approach throughout their careers.

This textbook is designed to benefit undergraduate dental students in their final years looking to enhance their clinical skills, as well as postgraduates preparing for Royal College Diplomas or advanced graduate programs in North America. It is also a valuable resource for specialists in training in non‐endodontic disciplines who seek to understand the relevance of endodontics. Additionally, it serves as a contemporary reference for experienced endodontic specialists looking to update their core clinical knowledge. In recognition of its global scope, this book has been crafted to serve the needs of endodontists worldwide, embracing the universal tooth numbering system to ensure a consistent and comprehensive approach.

From the outset, we were committed to upholding the first edition’s focus on the biological rationale behind Endodontology, rather than merely providing a step‐by‐step guide. Each chapter and clinical case is intentionally structured to encourage readers to systematically and logically assess patients’ presenting complaints and clinical information. This edition has been thoroughly revised and incorporates the latest advances in our specialty where appropriate.

As with the first edition, the contributors and editors represent a spectrum of expertise, encompassing a range of backgrounds in academia, clinical practice, and professional development. The result is a publication that is richly diverse in its content and perspectives.

The original concept for this book originated from the late Professor Tom Pitt Ford, a true pioneer and well‐respected clinical academic. We hope you enjoy reading this new edition of Pitt Ford’s Problem‐Based Learning in Endodontology and that it contributes to the elevation of excellence in our specialty worldwide.

Elizabeth Shin Perry

Shanon Patel

Shalini Kanagasingam

Samantha Hamer

2025

Acknowledgements

We extend our heartfelt gratitude to our families, whose unwavering support and understanding have been instrumental in our journey to bring the second edition of “Pitt Ford’s Problem‐Based Learning in Endodontology” to fruition. Your patience and encouragement have been our pillars of strength.

We would also like to extend our thanks the dental teams we collaborate with daily in our specialist practices and within the universities where we are affiliated, as their dedication has been invaluable in shaping this work.

Furthermore, we wish to express our deep appreciation to the contributors who generously shared their knowledge, insights, and expertise to make this publication a comprehensive and valuable resource for the field of Endodontology.

This publication stands as a testament to the collective effort of many, and we are truly grateful for the support and collaboration of all those who have played a role in its creation.

Elizabeth Shin Perry

Shanon Patel

Shalini Kanagasingam

Samantha Hamer

IAetiology, Diagnosis, Treatment PlanningNon‐odontogenic Pain

1.1: Microbiology of Primary Apical Periodontitis

1.2: Reversible Pulpitis

1.3: Symptomatic Irreversible Pulpitis

1.4: Treatment Planning

1.5: Maxillary Sinusitis of Endodontic Origin

1.6: Cracked Tooth with Radicular Extension

1.7: Vertical Root Fracture

1.8: Endodontic‐Periodontal Infections

1.9: Cemento‐osseous Dysplasia

1.1Microbiology of Primary Apical Periodontitis

José F. Siqueira Jr and Isabela N. Rôças

Objectives

Apical periodontitis is an inflammatory disease that affects the tissues surrounding the apical portion of the dental root and is primarily caused by bacteria infecting the root canal system. At the end of this case the reader should be able to recognise the infectious origin of apical periodontitis as well as understand some basic aspects of the microbiology of endodontic infections.

Introduction

A 34‐year‐old female was seeking replacement of defective and aesthetically unpleasant composite restorations in the maxillary incisors. The teeth had been restored more than five years previously. No significant symptoms were reported at the time of consultation.

Chief Complaint

The patient complained of the aesthetic appearance of the coronal restorations in all the maxillary incisors. She recalled having the restorations about five years ago due to decay in the teeth. Except for a mild sensitivity to sweet food in the UL2 a few years ago, all the maxillary incisors had been asymptomatic.

Medical History

Unremarkable.

Dental History

Last visit to a dental office for a check‐up appointment was two years previously. At that time, no apical periodontitis lesion was evident in the maxillary anterior region.

Clinical Examination

Extraoral examination was unremarkable. The patient had a moderately restored dentition, and her oral hygiene status was satisfactory. Composite restorations in all maxillary incisors were defective and discoloured.

All anterior teeth responded normally to thermal and electric sensitivity testing, except for the UL2, which was non‐responsive. No swelling or sinus tract was evident on the mucosa over the apices of the anterior teeth. The UL2 was discoloured with an existing restoration with marginal deficiencies.

Radiographic Examination

Periapical radiograph revealed (Figure 1.1.1):

Normal bone levels.

The UL2 with an existing restoration with secondary caries in proximity to the pulp chamber.

A radiolucency involving the apical region of the UL2.

Diagnosis and Treatment Planning

What was the diagnosis?

The diagnosis was asymptomatic apical periodontitis associated with pulp necrosis. The pulp became necrotic as a consequence of frank exposure to the bacterial biofilm associated with the recurrent/secondary caries.

What treatment should be carried out in this case?

Diet advice and caries removal with replacement of discoloured and deficient coronal restorations in the maxillary incisor teeth and endodontic treatment on the UL2.

What are the goals of antimicrobial endodontic treatment?

The ultimate goal of the endodontic treatment is to maintain or restore the health of the periradicular tissues. The treatment of teeth with irreversibly inflamed pulps is essentially a prophylactic approach, since the radicular vital pulp is usually free of infection and the rationale is to treat so as to prevent further pulp necrosis and infection, with consequent emergence of apical periodontitis. On the other hand, in cases like the one reported here, an intraradicular infection is already established and, consequently, endodontic procedures should focus not only on prevention of introduction of new bacteria in the canal, but also on elimination of those occurring therein.

Entrenched in the root canal system, bacteria are beyond the reach of the host defences and systemically administered antibiotics. Therefore, endodontic infections can only be treated by means of professional intervention using antibacterial procedures based on mechanical, chemical, and ecological effects.

Treatment procedures should ideally render the root canal system free of bacteria. Nevertheless, given the complex anatomy of the system, it is widely recognised that, with available instruments, irrigating substances and preparation techniques, fulfilling this goal is virtually impossible for most cases. Therefore, the reachable goal is to reduce bacterial populations to levels below those necessary to induce or sustain disease. The clinician should adopt an evidence‐based antibacterial protocol that predictably disinfects the root canal and allows this goal to be accomplished.

Discussion

How does caries cause pulp necrosis and subsequent apical periodontitis?