Download Textbook of Endodontology, 2nd Edition PDF

Textbook of Endodontology, 2nd Edition pdf

Textbook of Endodontology – The second edition of Textbook of Endodontology continues the aim of serving the educational needs of dental students and dental practitioners searching for updates on endodontic theories and techniques.

Significantly restructured and completely updated, the new edition maintains the ethos of the original, facilitating ease of learning through pedagogical features such as annotated references, core concepts and key literature. It features a number of new chapters on topics ranging from outcomes of endodontic treatment to managing endodontic complications to dental trauma.  Additionally, all other chapters have been thoroughly revised and brought up to date to reflect contemporary knowledge and practice.

Textbook of Endodontology continues its important function of providing lucid scholarship and clear discussion of biological concepts and treatment principles in endodontics, and as such will be an important update to its current readers and a valuable discovery to its new audience.


Gunnar Bergenholtz: Department of Endodontology and Oral Diagnosis, Faculty of Odontology, Sahlgrenska Academy, Göteborg University, Sweden.

Preben Hørsted-Bindslev: Department of Dental Pathology, Operative Dentistry and Endodontics, Royal Dental College, University of Aarhus, Denmark.

Claes Reit: Department of Endodontology and Oral Diagnosis, Faculty of Odontology, Sahlgrenska Academy, Göteborg University, Sweden.

Textbook of Endodontology – Preface

The Textbook of Endodontology is intended to serve the educational needs of dental students, as well as of dental practitioners seeking updates on endodontic theories and techniques. The primary aim has been to provide an understanding of the biological processes involved in pulpal and periapical pathologies and how that knowledge impinges on clinical management, and to present that information in an easily accessible form. Therefore, we have supplemented the core text with numerous figures and photographs, as well as with boxes highlighting key facts, important clinical procedures and key research. Case studies are given at the end of some chapters in order to further illustrate topics described in the text. In these various ways, the book provides information both at a foundation level, and at a more detailed level for the graduating student and practitioner. The key information boxes are color coded as an easyto-use navigational aid for readers. Core concepts are colored pink, while advanced concepts are purple. Clinical procedures are coded green and key literature boxes are blue. Although not designed to provide a comprehensive review of the literature, this book is also intended to stimulate the reader to delve into the research that forms our current knowledge base in endo dontology. To aid the reader, a selective reference list is provided and comments have been added to especially weighty or useful references. Important and interesting investigations are presented in the core and advanced concept boxes, and we hope that these features will encourage the student to carry on with his or her own exploration of the subject area. This is the second edition of the book, which features three new chapters reflecting the use of the surgical microscope, diagnosis and management of endodontic complications subsequent to dental trauma, and endodontic epidemiology. The dedicated support of our coauthors – 23 highly respected clinicians and scientists – who, in addition to the editors, have contributed to this book, is greatly appreciated. We thank them all sincerely for their time, effort and endurance during the editing process.


The word ”endodontology” is derived from the Greek language and can be translated as ”the knowledge of what is inside the tooth”. Thus, endodontology concerns structures and processes within the pulp chamber. But what about ”knowledge”? What does it actually mean to ”know” things? Most people would probably say that knowledge has something to do with truth and providing reasons for things. It is often believed that dental and medical knowledge is simply scientific knowledge – science is based on research and deals with how things are constructed and work. But as practicing dentists we also need other types of knowledge. Although it is important to know about tooth anatomy and how to produce good root canal preparations for example, we must also develop good judgment and ability to make the ”right” clinical decisions. There are at least three different forms of knowledge that the dental practitioner requires and, in a tradition that goes all the way back to Aristotle, we will refer to the Greek terms for these forms: episteme, techne and phronesis (1).

Episteme – Textbook of Endodontology

Episteme is the word for theoretical–scientific knowledge. The opposite is doxa, which refers to “belief” or “opinion”. There is a massive body of epistemic knowledge within endodontology, for example on the biology of the pulp, the microorganisms that inhabit root canals, the procedures and materials used in the clinical practice of endodontology (endodontics) and the outcome of endodontic therapies. Science produces “facts”. It must be understood that modern science is an industry and is affected by many factors, both internal and external. Although this is not the place to discuss the philosophy of science, the concept of “truth” and the growth of scientific knowledge is not unproblematic. There has been substantial contemporary philosophical discussion reflecting on epistemic knowledge, and the interested reader is referred to one of the many good introductory texts that are available (3). The results of science are presented in lectures, articles and textbooks. So from a student’s point of view the learning situation is rather straightforward, provided that the subject is structured well and ample time given for reading and reflection. This book, in large part, is composed of epistemic knowledge.

Techne – Textbook of Endodontology

The first person to challenge the deeply intrenched theoretical concept of knowledge was the British philosopher Gilbert Ryle. In his book The Concept of Mind (10) he introduces “knowing-how” and distinguishes it from “knowing-that”. “Knowing-how” is practical in nature and concerns skills and the performance of certain actions. This concept of knowledge implies the ability not only to do things, but also to understand what you are doing. To say that you have practical knowledge, it is not enough to produce things out of mere routine or habit. You have to “know” what you are doing and be able to argue about it. Practice must be combined with reflection. The idea that there is a tacit or silent dimension of knowledge has had a great impact on the contemporary discussion. Michael Polanyi, for example, said that “We know more than we can tell” (9).

When trying to explain how we master practical things such as riding a bicycle or recognizing a face, it is not possible to articulate verbally all the knowledge that we have. Certain important aspects are “tacit”. Likewise, it is not sufficient to teach students about root canal preparation simply by asking them to read a book or presenting the subject matter in a lecture. It has to be demonstrated. Knowledge is very often transmitted by the act of doing. A substantial body of endodontic knowledge must be characterized as techne. It is not possible to learn all about the procedures in endodontology by studying a textbook. Observing a good clinical instructor, watching other dentists at work, performing the procedures oneself and reflecting on what has been learned are all important.

Textbook of Endodontology – CONTENTS

List of Contributors.


1 Introduction to endodontology (Claes Reit, Gunnar Bergenholtz and Preben Hørsted-Bindslev).


The dawn of modern endodontology.

The objective of endodontic treatment.

Clinical problems and solutions.

The diagnostic dilemma.

The tools of treatment.

Extraction and dental implant?


Part 1 The Vital Pulp.

2 The dentine–pulp complex: responses to adverse influences (Leif Olgart and Gunnar Bergenholtz).


Constituents and normal functions of the dentine–pulp complex.

Basal maintenance.

Appropriate responses of the healthy pulp to non-destructive stimuli.

Responses to external threats.

Effects of potentially destructive stimuli.


3 Dentinal and pulpal pain (Matti Närhi).


Classification of nerve fibers.

Morphology of intradental sensory innervation.

Function of intradental sensory nerves under normal conditions.

Sensitivity of dentine: hydrodynamic mechanism in pulpal A-fiber activation.

Responses of intradental nerves to tissue injury and inflammation.

Local control of pulpal nociceptor activation.

Dentine hypersensitivity.

Pain symptoms and pulpal diagnosis.


4 Treatment of vital pulp conditions (Preben Hørsted-Bindslev and Gunnar Bergenholtz).


Clinical scenarios.

Treatment options.

Factors influencing choice of treatment.

Management of exposed pulps by direct pulp capping/partial pulpotomy.


Emergency treatment.


5 Endodontics in primary teeth (Ingegerd Mejàre).


The normal pulp.

Pulp inflammation in the primary tooth.

Wound dressings – characteristics, modes of action and reported clinical success rates.

Objectives of pulp treatment.

Operative treatment procedures.

Indications and contra-indications for pulp treatment in primary teeth.

Future directions.


Part 2 The Necrotic Pulp.

6 The microbiology of the necrotic pulp (Gunnel Svensäter, Luis Chàvez de Paz and Else Theilade).


Evidence for the essential role of micro-organisms in apical periodontitis.

Routes of microbial entry to the pulpal space.

Modes of colonization.

Ecological determinants for microbial growth in root canals.

Methods for studying the root canal microflora.

Composition of the endodontic microflora.

Association of signs and symptoms with specific bacteria.

Concluding remarks.


7 Apical periodontitis (Zvi Metzger, Itzhak Abramovitz and Gunnar Bergenholtz).


The nature of apical periodontitis.

Interactions with the infecting microbiota.

Clinical manifestations and diagnostic terminology.


8 Systemic complications of endodontic infections (Nils Skaug and Vidar Bakken).


Acute periapical infections as the origin of metastatic infections.

Chronic periapical infections as origin of metastatic infections.


9 Treatment of the necrotic pulp (Paul Wesselink and Gunnar Bergenholtz).


Objectives and general treatment strategies.

Scheme for a routine procedure in RCT.

Considerations in complex cases.

Effects of RCT on the intracanal microbiota.

Management of symptomatic lesions.


Part 3 Endodontic Treatment Procedures.

10 The surgical microcope (Pierre Machtou).



Ergonomics and working techniques.


Critical steps.

Concluding remarks.


11 Root canal instrumentation (Lars Bergmans and Paul Lambrechts).


Principles of root canal instrumentation.

Root canal system anatomy.

Procedural steps.

Endodontic instruments.

Instrumentation techniques.

Limitations of root canal instrumentation.

Preventing procedural mishaps.


12 Root filling materials (Gottfried Schmalz and Preben Hörsted-Bindslev).




Gutta-percha cones.


Materials for retrograde fillings (root-end fillings) and replantation.

Mandibular nerve injuries.


13 Root filling techniques (Paul Wesselink).


Specific objectives. – Textbook of Endodontology

Selecting a root canal filling material.

Root filling techniques for gutta-percha.

Root filling techniques employing gutta-percha and sealer.

Procedures prior to root canal filling.

Assessing root filling quality.

Filling of the pulp chamber and coronal restoration.

Conclusions and recommendations.


Part 4 Diagnostic Considerations and Clinical Decision Making.

14 Diagnosis of pulpal and periapical disease (Claes Reit and Kerstin Petersson).


Evaluation of diagnostic information.

Diagnostic strategy.

Clinical manifestations of pulpal and periapical inflammation.

Collecting diagnostic information.

Diagnostic classification.

References. – Textbook of Endodontology

15 Diagnosis and management of endodontic complications to dental trauma (John Whitworth).


Common dental injuries.

Dental trauma and its consequences.

General considerations in the management of dental trauma.

Diagnostic quandaries – to remove or review the pulp after trauma?

Pulp regeneration – the dawn of a new era?


16 The multi-dimensional nature of pain (Ilana Eli and Peter Svensson).

Introduction. – Textbook of Endodontology

Neurobiological factors affecting the pain experience.

Psychological factors affecting the pain experience.

Gender and pain.

Special populations.

Management and treatment of pain.

Concluding remarks.


17 Clinical epidemiology (Claes Reit and Lise-Lotte Kirkevang).


Clinical epidemiology.



Prevalence, frequency and incidence.

Risk for AP.



Longevity of root filled teeth.

Back to the case.

References. – Textbook of Endodontology

18 Endodontic decision making (Claes Reit).

The outcome of endodontic treatment.

Factors influencing treatment outcome.

Prevalence of endodontic “failures”.

Variation in the management of periapical lesions in endodontically treated teeth.

Clinical decision making: descriptive projects.

Endodontic retreatment decision making: a normative approach.

Concluding remark.


Part 5 The Root Filled Tooth.

19 The root filled tooth in prosthodontic reconstruction (Eckehard Kostka).


Problems associated with root filled teeth as abutments.

Core build-ups. – Textbook of Endodontology

Clinical techniques.

Prosthodontic reconstruction.


20 Non-surgical retreatment (Pierre Machtou and Claes Reit).



Access to the root canal.

Access to the apical area.

Instrumentation of the root canal.

Antimicrobial treatment.

Preventive retreatment.



21 Surgical endodontics (Peter Velvart).


General outline of the procedure.

Pain control after surgery.

Bone healing.



Failures after surgical endodontics (Thomas von Arx).

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