RDS 323

KING SAUD UNIVERSITY College of Dentistry Department of Restorative Dental Sciences DIVISION OF ENDODONTICS COURSE OUTLINE 323 RDS Pre-Clinical Endodontics Three (3) Credit Hours Third Year 2011-2012 I. COURSE PROSPECTIVE The scope of the course includes preparing the third year students to understand, recognize, diagnose and successfully treat pulpally involved or potentially involved teeth. Important fundamentals are stressed with emphasis on the correlation between basic clinical and biological principles. The course will have two main components: 1. Classroom lecture series, which correlates clinical with biological principles of endodontics. 2. Laboratory exercises to perform endodontic treatment on mounted extracted human teeth. II. COURSE OBJECTIVES Based on the content of the lecture series, laboratory exercises, and recommended reading material, at the end of this course the student should be able to: 1. Demonstrate clear understanding of the morphology of the Root canal anatomy. 2. Understand the theoretical and biological principles of every endodontic clinical procedure. 3. Carry out fundamental operative procedures in endodontics. 4. Recognize the dental materials and instruments used in endodontics. 5. Recognize and demonstrate the different levels of sophistication and complexity of endodontic cases and able to make a decision of referral when it is needed. 6. Evaluate his/ her own clinical competency and know the extent of his /her diagnosis, treatment planning and operative capabilities. III. COURSE REQUIREMENTS 1. Students must attend all the lectures and lab sessions. Absences will be reported to the administration when it reaches 25% or above. The lecture starts at 8:00 AM. The lab session starts at 9:00 AM. and should be finished at 11:30 AM Those who come 10 min after 8:00 AM may not be allowed in the lecture hall. The lab session will begin immediately after the lecture. The attendance sheet will be passed around for the first 10 minutes of the lecture and the laboratory. 2. Freshly extracted teeth will be used in this course. a. The teeth must be clean, free of debris and preferably have sound crown or with minimum caries destruction. b. The pulp chamber and canals must be accessible as confirmed by radiographs (teeth with immature apices, calcified canals, severely curved canals, previous root canal treatment, external or internal root resorption, or with too short or too long root should not be used). c. The selected teeth should be stored in a jar containing 0.9% physiological saline until mounted. d. All the required teeth (2 anteriors, 3 premolars and 4 molars) must be mounted in acrylic using the rubber mould. e. Additional teeth (2 anteriors, 2 premolars, 3 molars) with inappropriate root morphology (as confirmed by radiographs) should be mounted individually in plaster of paris blocks for the purpose of access opening and other practical exercises. f. Between the practical sessions, the mounted teeth should be covered with gauze pads soaked with saline solution and kept in a sealed container to ensure 100% humidity and prevent tooth cracking during instrumentation and obturation. 3. At the end of the first half of the course, the student must have finished: a. Root canal therapy on two anterior teeth or one anterior and lower premolar with single canal. b. Root canal therapy on two premolar (including one with two canals) teeth. c. Access openings on one anterior tooth and two premolar teeth including one with two canals) mounted individually in plaster. d. The fourth anterior tooth mounted in acrylic should be saved for midterm practical exam. e. Instrument spotting exam will be carried out as the first laboratory assessment. 4. At the end of the second half of the course, the student must have finished: a. Root canal therapy on three molar (upper and lower) teeth. b. Access openings on two molars (one maxillary and one mandibular) mounted individually in plaster. c. Retreatment, and Ca(OH)2 application on a previously obturated single rooted tooth. d. Post space preparation on a previously obturated canal. e. Three teeth (an anterior, a premolar, and a molar) should be saved for the second laboratory assessment. d. The fourth molar should be saved for final practical exam (upper or lower). 5. At the end of each laboratory session students must have their instructor sign their finished assignment before they leave. 6. Each finished case must be handed over to the course director in the endodontic form (envelope), within the same week. Delayed submissions will be marked down. a. The endodontic form must be completed (e.g. student’s name, serial number, university number, tooth number, working length, size of MAF – etc.) b. The radiographs of the finished case must be mounted, dated and submitted in the endodontic form (preoperative, working length, master apical file, master gutta percha point, final + intermediate). IV. READING TEXTBOOK: Endodontics, 6th Ed. J. I. Ingle and L. K. Backland, 2010. V. COURSE ASSESSMENT I. Practical 50% a. Daily work (12 projects) - 30% b. Practical assessments (2) - 5% c. Practical midterm (1) - 5% d. Final practical - 10% II. Written (didactic) 50% a. Quizzes - 5% b. Oral Exam - 5% c. Midterm 10% d. Final exam - 30% RDS 323 PRE-CLINICAL ENDODONTICS Lectures (8:00 am - 9:00 am) Week Date Lecture Faculty 1 Sept. 10, 2011 Introduction Dr. Basoudan Endodontic instruments and isolation Dr.Balto 2 Sept. 17, 2011 Endodontic access opening Dr. Al-Madi 3 Sept. 24, 2011 Happy national day 4 Oct. 01, 2011 Root canal preparation Dr. Basoudan 5 Oct. 08, 2011 Root canal filling materials and obturation Dr. Basoudan 6 Oct. 15, 2011 Endodontic radiography and local anesthesia Dr.Basoudan 7 Oct.22, 2011 Endodontic Mishap Dr. Al-Madi 8 Oct.29, 2011 Histology and physiology of the pulp Dr. Al-Sulaimani 9 Nov. 12, 2011 Microbiology and immunology Dr. Al-Sulaimani 10 Nov. 19, 2011 Midterm Examination Dr. Basoudan Includes all material covered up to the exam 11 Nov. 26, 2011 Pulpal disease Dr. Basoudan 12 Dec. 03, 2011 Periradicular disease Dr. Basoudan 13 Dec. 10, 2011 Intracanal medication Dr. Balto 14 Dec. 10, 2011 Pulpal reaction to caries and dental procedures Dr. Basoudan 15 Dec. 24, 2011 Endodontic diagnostic procedures Dr. Basoudan 16 Dec. 31, 2011 FINAL EXAMINATION Dr. Basoudan 323 RDS PRE-CLINICAL PROTOCOL PART I WEEK DATE PROCEDURES 1 Sept. 10, 2011 Teeth selection & Preoperative radiographs for mounted teeth should be taken and approved by the instructors. Mounting of separate teeth for access 2 Sept. 17, 2011 Instrument familiarization. Demonstration of rubber dam isolation. Students should continue to mount their teeth 3 Sept. 24, 2011 Happy national day 4 Oct. 01, 2011 Project #1 Access preparation in plastic and 2 natural teeth (anterior and one premolar). 5 Oct. 08, 2011 Project #2 Access cavity preparation, working length determination, and Demonstration of Step Back Technique (Students complete access cavity preparation, working length determination on the first anterior tooth and have it graded)Demonstration of obturation (Students complete obturation of first anterior tooth, place a temporary restoration and have it graded & submit the envelope) 6 Oct. 15, 2011 Project #3 Demonstration of gates glidden drills .Access cavity preparation, working length determination and instrumentation the second anterior tooth and have it graded 7 Oct. 22, 2011 Continue instrumentation and obturation of the second anterior tooth coronal restoration and have it graded & submit the envelope. 8 Oct. 29, 2011 Project #4 demonstration of gates glidden drills, practice of gates glidden use on teeth mounted in plaster. Access cavity preparation, working length determination and instrumentation on the third anterior tooth and have it graded 9 Nov. 12, 2011 Obturation of the third anterior tooth, coronal restoration and have it graded & submit the envelope 10 Nov. 15, 2011 Project #5 Demonstration of Buccal Object Rule. Access cavity on the lower premolar (two canals), working length determination, and instrumentation and have it graded. 11 Nov. 26, 2011 Continue the instrumentation, obturation and coronal restoration of the first premolar (two canals) and have it graded & submit the envelope 12 Dec. 03, 2011 FIRST PRACTICAL ASSESSMENT– INSTRUMENT SPOTTING 13 Dec. 10, 2011 Project #6 Access cavity preparation, working length determination and instrumentation on the second premolar (one canal) and have it graded. 14 Dec. 17, 2011 Continue the instrumentation, obturation and coronal restoration of the second premolar (one canal) and have it graded & submit the envelope 15 Dec. 24, 2011 PRACTICAL MIDTERM – ENDO TREATMENT ON ANTERIOR TOOTH 323 RDS PRE-CLINICAL PROTOCOL PART II WEEK DATE PROCEDURES 1 28 Jan. 2012 Students should take preoperative radiograph for the posterior teeth and approved by the instructor. All molars (max. and mand.) should be mounted. 2 04 Feb. 2012 Project #7 Access cavity preparations for one maxillary and one mandibular molar. (Mounted separately) and have it graded. 3 11 Feb. 2012 Project #8 Access cavity and determination of working length on first molar tooth and have it graded 4 18 Feb. 2012 Instrumentation on first molar tooth and have it graded. 5 25 Feb. 2012 Obturation of first molar tooth and have it graded & submit the envelope. 6 03 Mar. 2012 Project #9 Access cavity preparation and working length on second molar tooth and have it graded 7 10 Mar. 2012 Instrumentation of second molar tooth and have it graded 8 17 Mar. 2012 Obturation of second molar tooth and have it graded & submit the envelope 9 31 Mar. 2012 SECOND PRACTICAL ASSESSMENT - ACCESS OPENING 10 07 Apr. 2012 Project #10 Access cavity preparation, determination of working length on third molar tooth and have it graded. 11 14 Apr. 2012 Instrumentation of the third molar tooth and have it graded 12 21 Apr. 2012 Obturation of third molar tooth and have it graded & submit the envelope. 13 28 Apr. 2012 Project # 11 Demonstration of post space preparation. Students prepare a post space on one canal. Demonstration for retreatment and Ca(OH)2 application. Student should retreat one canal, take a radiograph and apply Ca(OH)2 14 05 May 2012 Examination: access cavity preparation, working length determination and initial instrumentation for maxillary or mandibular molar. 15 12 May 2012 Examination: complete instrumentation and obturation CONTENTS OF THE LECTURES 1. Introduction and Case Selection - Introduction to the course and the requirements. - An overview of endodontic therapy - Endodontic case presentation - Indications for root canal therapy - Contraindications for root canal therapy 2. Endodontic Instruments and Standard Isolation - Hand instruments - Rotary instruments - Isolation (principles and rationale) - Rubber dam materials (armamentarium) 3. Endodontic Access Opening - Morphology of anterior, premolar and molar teeth - Principles of endodontic cavity preparation 4. Root Canal Preparation - Principles - Radicular cavity preparation - Instruments and methods for radicular cleaning and shaping - Determination of the tooth length - Step-back technique 5. Root Canal Filling materials and Obturation - Importance of obturation - Characteristics of an ideal root canal filling materials - Extension of root canal filling - Lateral Condensation technique 6. Endodontic Radiography and Local Anesthesia - Importance of radiographs - Vertical and horizontal angulation (buccal object rule) - Infiltration and block anesthesia - PDL injection - Intra pulpal anesthesia - Intra osseous anesthesia 7. Endodontic Mishap - Access related mishaps - Instrumentation related mishaps - Obturation related mishaps - Miscellaneous and irrigant-related mishaps 8. Histology and Physiology of the Pulp - Function - Development and anatomy - Histology - Age changes - Pulp response to inflammation - Pulpodental physiology 9. Pulpal Diseases - Hypremia - Reversible pulpitis - Irreversible pulpitis - Internal resorption - Chronic hyperplastic pulpitis - Necrotic pulp 10. Periradicular Diseases - Periradicular lesions of pulpal origin (endodontic origin) - Non-endodontic periradicular lesions - Differential diagnosis 11. Microbiology and Immunology - Role of bacteria in pulpal and periradicular diseases - Pathways of pulpal and periradicular infections - Flora of the root canal and periradicular lesions - Methods of control of root canal infection - Taking culture 12. Intracanal Medication - Antibacterial agents - Mode of action - Irrigation and chelation - Calcium hydroxide 13. Pulpal Reaction to Caries and Dental Procedures - Relationship between pulp and dentin - Pulpal reactions to dentinal caries - Effect of various restorative procedures on the pulp - Effect of local anesthesia on the pulp - Postoperative sensitivity and preventive measures 14. Endodontic Diagnostic procedure - Patient history (chief complaint, present dental illness and medical history) - Clinical examination (vital signs, extra and intra-oral examination, clinical tests and periodontal evaluation) - Radiographic examination (interpretation, root anatomy, conditions inside and outside the tooth, and importance of radiograph in diagnosis)