Intro -- Textbook of Endodontology -- Contents -- List of contributors -- Foreword -- Preface -- About the companion website -- 1 Introduction to endodontology -- Endodontology -- Episteme -- Techne -- Phronesis -- Concepts of endodontology -- The objective of endodontic treatment -- Clinical problems and solutions -- The vital pulp -- The necrotic or infected pulp space associated with apical periodontitis -- The endodontically treated tooth -- The diagnostic dilemma -- The outcome dilemma -- The tools of treatment -- References -- Part 1 The Vital Pulp -- 2 The dentin-pulp complex: structure, functions, threats, and response to external injury -- Introduction -- The odontoblast and the dentin-pulp complex -- The primary odontoblast, dentinal tubules, and branching -- The dental pulp -- Cellular composition of the pulp -- Extracellular matrix -- Nerves -- Vascular supply and blood flow -- Lymphatics -- Immune responses in the dentin-pulp complex -- Inflammation, a crucial prerequisite for repair and regeneration -- Vascular events and inflammation -- Responses of the healthy dentin-pulp complex to nondestructive stimuli -- The dentin-pulp complex and responses to external injuries -- General response pattern -- Dental treatment procedures -- Restorative procedures -- Protective roles of dentinal fluid -- Preparation trauma - a catastrophic threat? -- Bacterial leakage -- Effects of restorative materials -- Summary -- References -- 3 Dentinal and pulpal pain -- Introduction -- Classification of nerve fibers -- Morphology of intradental sensory innervation -- Function of intradental sensory nerves -- Sensitivity of dentin: hydrodynamic mechanism in pulpal A-fiber activation -- Responses of intradental nerves to tissue injury and inflammation -- Peripheral neural changes affecting pain responses in inflamed teeth.

Neurogenic vasodilation and inflammation -- Inflammatory mediators -- Morphological versus functional changes of pulpal nerves in inflammation -- Local control of pulpal nociceptor activation -- Dentin hypersensitivity -- Central nervous system mechanisms -- Pain symptoms and pulpal diagnosis -- References -- 4 Clinical pulp diagnosis and decision-making -- Introduction -- Evaluation of diagnostic information -- Diagnostic accuracy -- Diagnostic strategy -- Clinical manifestations of pulpal and periapical inflammation -- Collecting diagnostic information -- Diagnostic methodology: assessment of pulp vitality -- Mechanical tests -- Thermal tests -- Electrical test -- Interpretation of test results -- Diagnostic methodology: evaluation of reported pain -- Diagnostic methodology: provocation/inhibition of pain -- Differential diagnosis of pulpal pain -- Diagnostic methodology: evaluation of tooth discolorations -- Diagnostic classification -- Diagnostic terms -- References -- 5 Caries pathology and management in deep stages of lesion formation -- Enamel lesions without clinical cavitation -- Understanding the topography of the enamel-dentin lesion -- Progressive stages of enamel-dentin lesions without surface cavitation and exposure of dentin to the oral environment -- The superficial enamel lesion and the early odontoblast response -- Dentin hypermineralization prior to demineralization of dentin -- Dentin demineralization -- Why is demineralized dentin discolored? -- Tertiary dentinogenesis and lesion activity -- Cavitation of the dentin lesion -- Lateral spread along the enamel-dentin junction and toward the pulp -- Bacterial invasion and innate and adaptive immunity -- Caries-induced inflammation in dentin differs from soft tissue inflammation -- Carious activity may change in the environment of an untreated deep lesion.

Radiographic definitions of deep and extremely deep carious lesions -- Histological picture of pulp inflammation in deep caries -- Histological picture of pulp inflammation in extremely deep caries -- Concluding remarks on the natural history of dental caries -- Strategies for the management of deep caries -- The need for updated terminology -- Detailed treatment protocol for deep caries management -- Evidence in support of stepwise caries removal -- Evidence in support of selective caries removal -- Managing deep caries and clinical pulp diagnosis -- References -- 6 Treatment of vital pulp conditions -- Introduction -- Indications and treatment concepts for preserving vital pulp functions -- Protocols for treatments aiming to preserve the vitality of the exposed pulp -- Pulp capping -- Pulpotomy -- Factors of importance in preserving vital pulp functions -- Type of injury -- Age -- Size of the pulp exposure -- Clinical procedure -- Integrity of permanent restorations -- Postoperative recall -- Capping materials and healing patterns -- Calcium hydroxide -- Dentin-bonding systems as pulp capping -- Hydraulic calcium silicate cements -- Tissue-biomaterial interaction and pulp healing -- A problem to solve-the loss of dentin-producing cells following pulp exposure -- Classical wound healing patterns -- Use of bioactive capping materials -- Future attempts to promote wound healing patterns -- Pulp-preserving treatments-a controversial treatment? -- Indications and treatment concepts for treating the irreversibly inflamed vital pulp (pulpectomy) -- Objective -- Treatment principles for an effective pulpectomy -- Inter-appointment dressing with calcium hydroxide -- Wound healing after pulpectomy -- Postoperative considerations -- Choosing between pulp-preserving vital pulp therapies and pulpectomy -- Irreversible pulpitis.

Concluding remarks on the avoidance of pulpectomy by vital pulp therapies -- Revitalization and/or regenerative endodontic procedures -- References -- Part 2 The Infected Necrotic Pulp and Apical Periodontitis -- 7 Apical periodontitis -- Introduction -- The nature of apical periodontitis -- Interactions with the infecting microbiota -- Bacterial elimination -- The bacterial front line -- The formation of the lesion -- The equilibrium between bacteria and host -- The endodontic flare-up -- Treatment and healing of periapical lesions -- Treatment of periapical lesions -- Healing of periapical lesions -- Persistence of periapical lesions -- Clinical manifestations and diagnostic terminology -- Normal periapical conditions -- Asymptomatic apical periodontitis -- Symptomatic apical periodontitis -- Acute apical abscess -- Chronic apical abscess -- Cellulitis -- Condensing osteitis -- References -- 8 Microbiology of the inflamed and necrotic pulp -- Introduction -- Historical background -- Clinical evidence -- Routes of microbial entry to the pulpal space -- The inflamed pulp -- The necrotic pulp -- Infections in root-filled teeth with persistent apical periodontitis -- Surviving in starvation -- Microbiology in failed root-filled teeth -- Microbial pathogenesis of apical periodontitis -- Association of signs and symptoms with specific bacteria -- Biological evidence -- Biofilms in root canals -- Extraradicular biofilms -- Ecological determinants for microbial growth in root canals -- Microbial interactions in biofilms -- Microbial resistance to antimicrobials -- Antibiofilm strategies -- Concluding remarks -- References -- 9 Clinical diagnosis of pulp necrosis and apical periodontitis -- Introduction -- Diagnostic procedures -- Microbial infection and host response -- Clinical features of pulp necrosis and root canal infections -- Pulpal necrosis.

Clinical features of root canal infection -- Clinical procedures for assessing pulpal and periapical status -- Radiographic features of apical periodontitis -- Bone tissue response -- Radiographic methods -- Interpretation of images -- Methods for follow-up and epidemiology -- A strategy for the formulation of a periapical diagnosis -- Combining the anamnestic, clinical, and radiographic data -- Diagnostic challenges during treatment -- Inter-appointment pain and emergencies -- Special cases of endodontic infections -- Root fractures and dental trauma -- dens invaginatus -- Endodontic-periodontal lesions -- Root resorptions -- Maxillary sinus involvement -- Differential diagnoses -- An integrated approach to endodontic diagnosis -- Clinical-radiological features and extent of infection -- Diagnosis and treatment options -- References -- Part 3 Endodontic Treatment Procedures -- 10 Endodontic emergencies -- Introduction -- General diagnostic considerations and emergency principles -- The etiology and pathogenesis behind emergency scenarios -- Acute pain from pulpitis -- Acute pain from apical periodontitis -- Symptomatic pulpitis-vital pulp -- Symptomatic apical periodontitis with or without acute abscess -- Posttreatment emergency -- Non-endodontic tooth pain-conditions of differential diagnostic interest -- Marginal (periodontal) abscess -- Referred pain from other teeth or nondental structures -- Idiopathic or neuropathic tooth pain -- Management of patients with acute dental pain -- From a psychological perspective -- Antibiotics -- Analgesics -- References -- 11 Controlling the environment-the aseptic working field -- Background -- History and evidence -- Preparing teeth for rubber dam isolation and the development of an aseptic working field -- Access preparation -- Rubber dam isolation -- Rubber dam clamp -- Punches and forceps.

Rubber dam frame.

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