Endodontics

Manual for the

General Dentist
Martin Trope, DMD
J.B. Freedland Professor and Chair
Department of Endodontics
University of North Carolina
Chapel Hill, North Carolina

Gilberto j. Debelian, DMD, PhD

Private Practice
Bekkestua, Norway

Quintessence Publishing Co, Ltd

London, Berlin, Chicago, Paris, Milan, Barcelona, Istanbul,
Sao Paulo, Tokyo, New Delhi, Moscow, Prague, Warsaw





, DMD



, ,

, DMD, PhD

,

, -, , ,
2005

British Library Cataloguing in Publication Data

Trope, Martin
Endodontics Manual for the General Dentist
1. Endodontics
I. Title II. Debelian, Gilberto
617.6'342

Copyright 2005
Quintessence Publishing Co, Ltd
Grafton Road
New Maiden, Surrey
United Kingdom
www.quintpub.co.uk

A. , .

B.

... .

, 2005
119048 , . , 62, . 1, . 14
.: +7(495) 245-52-79. ./: +7(495) 245-52-70
E-mail: info@dental-azbuka.ru
http://www.dental-azbuka.ru



ISBN 5-902-693-09-8

viii

ix

1
2

4
6

,

7
8

 10

14
15

.
17
17

17

20

(step-back)

- (crown-down)
-

.
29
29
33
38
41

44


-
-


56

58

65
,
68



70

VIII

,

. ,

, . ,
, , . . , ,
chamfer ,
.
. . , , .
, ,
. (-) - -
( ), . .
.
, , , , .. .
. , (perio-) (apical periodontitis), - (parodontitis apicale). , , , . . ,
, .
,
,

IX

.

. ,
. ,

.

. , . , , , , , , - . , , . , , (. 1-1). (. 1-2).

. 1-1. )
. ) ,

. 1-2.
() ()

. 1-.
. ,
, ..

(. 1- 1-), . ,

!
, ,

. 1-.
( ).
.
,

. 1-.
,

 . ,
. , .
, .

.

. ,
.
, , (. 1-4).

. 1-4. , ) () , ; ) ; )
; d) ( - Andre Ritter)

 ,
. , ()
(. 1-5 1-6).

. 1-5. ,
(. 2). ( - Leif Tronstad)

. 1-6. () ()

, .
( ).

1. Cohen R, Burns RC, eds. Pathways of the Pulp, 8th ed. St Louis: Mosby, 2002.
2. Mjor IA. Pulp-Dentin Biology in Restorative Dentistry. Carol Stream: Quintessence, 2002:39-76.
3. 0rstavik D, Pitt Ford TR. Essential Endodontology: Prevention and Treatment of Apical Periodontitis.
Oxford: Blackwell-Munksgaard, 1998.
4. Tronstad L. Clinical Endodontics, 2nd ed. Stuttgart: Thieme, 2003:1-64.

, , . .
, , , , , (. 2-1). , .
, , ,
, .
, - . -

. 2-1. (%), ,

 , . ,

.
.

,
: , (. 2-2).
,

/ 1

2|
1

1 $

. 2-2. ,
, ) -6-
; ) -

, ) ; )
, .

 , ) ; ) , ,
.
.
, .
, .
, ) ; ) ( )
, .
.
, ) ; )
() , . , ,
, , , .

. , .
. , , , , , .
.
.
. ,
, , ..
.
.

, .
-- . . -, , , , , , , , ,
.

, , . , ,

10

,
, . , .

.

, . ,
.
. ,
. ,
.

.
, , --, .
-.

(-40) (-70),
(-4) . ,
.
, -
- . ,
(. 2-3).
.
97%
( , ), . , , , - (, , , ).

11

. 2-3.
(-40) ( ) (-70).
.
(-4)

. 2-4.
.
,

.
. , . , (. 2-4).

12
,
, . , . , . , .

() .
.
- (. 2-5). , - .

. , . ,
. ,
,
.
.

. 2-5.
.

13

, .
, .
, ,

.
. ,
()
.
, . , (. 2-6). , . , ,
.

. 2-6. ) , ,
.
. )
, , ,

14
,
,
(. 2-6). ()
, .

, .

, , . , ,
. , !
( ) () . , , ( ) (. 2-7).

. 2-7.
() ()

15

. , .

,
. , . , , . ,
,
, , .

1. Cohen R, Burns RC, eds. Pathways of the Pulp. 8th ed. St Louis: Mosby, 2002.
2. Tronstad L. Clinical Endodontics. 2nd ed. Stuttgart: Thieme, 2003.
3. Trope M, Sigurdsson A. Clinical manifestations and diagnosis. In: 0rstavik D, Pitt Ford TR (eds). Essential
Endodontology: Prevention and Treatment of Apical Periodontitis. Oxford: Blackwell-Munksgaard, 1998.

,
( ),
. ,
, . .

, .
.
,
,
(. 3-1).
, , ,
, ,
- .

. 3-1. . ,

II

. 3-1.
(, - , b, d - )

19

. 3-2.

. 3-3.
,

Strindberg (1956)
89%
68%
Seltzer et al (1963)
92%
76%
Kerekes&Tornstad(1979)
94%
84%
96%
Sjogren etal (1990)
86%

(+) (-)

(+)
Engstrom etal (1964)
Zeldkow & Ingle (1963)
Oliet&Sorin(1969)
Bystrdm et al (1987)
Sjogren etal (1997)
Bender etal (1964)

76%
83%
80%

89%
93%
91%
95%
68%
94%

,
. (),
. , , , , . .
, (80 95% ) (. 3-2).
15% . ()
, , , , ( ).
90% (. 3-3).
, , , , , . , -

20

,
, ,
.

,
. , ( ), 90%.

: ( ) .

, , . , . , , .
.
, , .


,
- .

.
, . ,
, ( )
. , .


,
(. ).

21

,
. , , , .. .
, , , , ,
(. 3-4).
. ( )
1 , .

. 3-4. ()

, 1 i

(step-back)

. 25
30, 1 , 25. 35 1 .. 1
(. 3-5). ,
,
.

22

. 3-5.

25
<1 30
<1 35
<1 40
<1 45
<1 50

. -. .
,

. 3-7.
40,

23

. 3-8. . 20 () () ( - Richard Walton)

, , . 15%
, (. 3-6).

(. 3-7). , , , , ( ),
. , ,
, . . .
, , . ,
, . 10 40 50 ISO ,
(. 3-8). ,
( 40)
( 50) . ,
.

24

, . , 25 , (. 3-9).
30 , , , .

. 3-9. . ,

. 3-10.
, () ()

25

.
, 3-4 . ,
, . , (. 3-10).
- (crown-down) -
.
- .
, (. 3-11), , . - , . .
. , . .

. 3-11. - 40 . ,

26

0,02
0,32

0,06

ffl
0,96

. 3-12.

. 3-13. , . , () , , . , ()

27

, ,
(. 3-12). , 16 , - 2%/
( 32%), 2%/ 12%/ .
.
(. 3-13), .
. - (crown-down) , 4 , . 1 ,
3-4 . ,
,
. , ( ) , , , , 1 , . , .
- 25,
-, , , .
, , . , , .
, ,
.
, ,
.

- . ,
.
.

28

. , (
) . , . ,
,
.

1. Cohen R, Burns RC. Pathways of the Pulp. 8th ed. St Louis: Mosby, 2001.
2. Pettiette MT, Metzger Z, Phillip SC, Trope M. Endodontic complications of root canal therapy performed by dental students with stainless steel K-files and nickel-titanium hand files. J Endod 1999;
25:230-234.
3. Schafer E, Lan R. Comparison of cutting efficiency and instrumentation of curved canals with nickeltitanium and stainless steel instruments. J Endod 1999,25:427430.
4. Tronstad L. Clinical Endodontics. 2nd ed. Stuttgart: Thieme, 2003.
5. Trope M, Sigurdsson A. Clinical manifestations and diagnosis. In: 0rstavik D, Pitt Ford TR (eds). Essential
Endodontology: Prevention and Treatment of Apical Periodontitis. Oxford: Blackwell-Munksgaard,
1998.

, .

. , .

. 4-1. () ,

30

(. 4-1). () , . ,
, .
. ,

(. 4-2).
, , (. 4-3). .
,
(), , ,
(. 4-4).

. 4-2.

31

. 4-3. . ,

. 4-4. () .
, ,

32

,
(. 4-5).
,
.

. 4-5.
( ,
- )

. 4-5.

33

, . ,
- . , ,
, , -
- .
. ,
(. 4-6). , , , .

23,5

22,0

26,5

21,8

21,0

19,5

20,1

21,5

22,4

25,2

21,4

21,4

20,9

20,8

. 4-. ()

34

. 4-.

, .
1. , -
() (. 4-7).
. ,
.
, .
,
. ,
.

35

. 4-7.

36

2. , (. 4-8).

. ,
. .
. .
3.
(. 4-9). , ,
.
,
.

. 4-8. .
, .

37

4V\
. 4-9.

38

, , .
, , - ,
. :
1. . ,
, , .
,
.
, , .. , (. 4-10).

, (. 4-11).

. 4-10. .

39

2.
2 (. 4-12), .
, .

. 4-11.

. 4-12. , )
. ) , )

40

. 4-13. ().
()

. 4-13.
() , ()

3. . ( ) (. 4-13),

.
4. ( ), ( ).
, ( ) (. 4-14).

41

. 4-14.

() ,
, ()
,

. ,
, ,
(. 4-15). ,
(. 4-16). ,
0,5 . , , , , 1-2 .
,

0,5-1 (. 4-17). , ! ,
. ( ) . , (. 4-18). - . , . .

42

. 4-15. .
0,5-1,0

. 4-16. .

43

IUU

90

80

70

60

50

40

30

D.

<g

\
\
\
\

/
/

20
10

0,6

0,7

0,8

0,9

1,0

1,1

()

. 4-17. .
,
. , ,

. 4-18.

44

, . , 1 .
, ( ) (. ), .
.

, ,
.
.
10. , - , . , - . ()
( 8, 10, 15 20). , 10 . 2-3
(. 4-19),
.
, .
, (.
4-20). .
,
(. 4-21).
,
. ,
.
- , (. 3
). - .

45

. 4-19. ( ) .

. 4-20.

46

. 4-21.
.

. 4-21.
.

,

47

,


.
, , , ,
.
:
1. 25 ( 30, 25 ) , .
2. ( 30 35) 1 . .
3. 40 4 .
4. - ,
4 (.. ,
3) , .
5. 30 .

.
6.
(. 4-22 4-23).

48

10152025

. 4-22. . 1 - ,

30

35

40

. 4-23. . 2 -

49

-
-
, -
.
. - .
() . , , , , .
, .
, .

- .
. , 150 2000 /. , , - .
, , .
- . -
, (. 4-25 4-26).
.
,
- .
-
. , , -
. ,
.

50

:
u-

. 4-24. -
,

. 4-25.
RaCe
,

. 4-26.

51

- , ,
, .
- :
- .
1. (. . 4-19).
2.
(. . 4-20).
3. (
8 ) 0,10, 0,08
0,06 ( 25) (. 4-27).
4. (
4 ) 0,6 0,4 ( 25) (. 4-28).
. 4-27. . , ,

. 4-28. . ,

52

, .
,
.

, , .
,
.

. 4-29.

.
,
,

. 4-30.

1-2

53

.
. , 10
, . . .
(. 4-29 4-31). , . ,
.
.

. 4-31. 1,5 .
0,5
. (1,5 0,5 ) ,

54

. 4-32. (
)

.
(. ) , (. 4-32).
,
, , .

- ISO 15 80 2 4%/ (. 4-33).
( 15) . , ,
( 20 25).
,
.

55

ISO 60

ISO 55
ISO 45
(
)

ISO 60

: ISO 40
: ISO 45

: ISO 40
: ISO 45

1 :
ISO 55

: ISO 40
: ISO 45

: ISO 40
: ISO 45

1 :
ISO 60

1 :
ISO 60

. 4-. ,

. 4-. -.

56

.
,

. .

, , .
5,25%- .
( 0,5 5,25%), .
. ,
. ,
0,5% , , , 5,25% 60
30 . , . ,
. , , , , .
(17%- ) ,
(. 4-34).
, ,

. 4-34. ()
. 17%- ()

57

, . , . , .
(2%) .
,
.
.

[()2] ,
. ,
,
. 2%-
. , 2 (. 4-35 4-36).
.

. 4-35.

. 4-36.

58

. ,
. ,
, ,
.
:

, ;
, , ;
, .
, :
;
;
, , ;
().
,
, , .
, , . , . ,
, . , , , ,
,
,

. 4-37.
, . , , ()

59

. .
, .
(. 4-37),
(. 4-38), .
,
. , 0,5% ( 3-7%).
(. 4-39), . . (. 4-39), . , ( ) (. 4-40).

. 4-38. , () , ) , )

. 4-39.
, . ,

60

. 4-40. .

1.
.
(. 4-41).
2. ,
. .
. , .
(. 4-42).
3. , , ,
.
, (. 4-43).
4. , . (FM MF), . . (),
(. 4-44).
, . , ,
. , 30 , , .
5. 40 , . , , (. 4-45).

61

. 4-41.

, .
() 2%

. 4-42. ,
.

,

62

. 4-43.
, ,
.

. 4-44. .

.
.
,

. 4-45.

40 .

63

1. Hasselgren G, Kerekes K, Nellestram P. pH changes in calcium hydroxide-covered dentin. ] Endod 1987;
8:502-505.
2. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique, j Endod 1979;5:83-90.
3. Leonardo MR, Silva LAB, Almeida WA, Utrilla LS. Tissue response to an epoxy resin-based root canal
sealer. Endod Dent Traumatol 1999;15:28-32.
4. Shipper C, 0rstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in roots filled with a
thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 2004;30:342-347.
5. Sundqvist C, Figdor D. Endodontic treatment of apical periodontitis. In: 0rstavik D, Pitt Ford TR (eds).
Essential Endodontology: Prevention and Treatment of Apical Periodontitis. Oxford: BlackwellMunksgaard, 1998:242-277.
6. Tronstad L. Clinical Endodontics. 2nd ed. Stuttgart: Thieme, 2003:167-177.
7. Vertucci F. Root canal anatomy of human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:
589-597.

, .
, , -
. ,

.

, . , . , , .

.
.

()

_
, _

. ,
.
.
,
.
, , , .

.

.

( ).
,
.
.

, .
.
,
, , ,
.

.

.
,
.

. ,
.
, .
American Association of Endodontists, 211 E. Chicago Ave Suite 1100, Chicago. IL 60611-2691, Phone 800/872-3636 or 312/266-7255; Fax- 866/451-9020 or 312/266-9867.
E-mail: infoaae org. Web sue: wwwaae.org

67

. ,

{* 1)

{ 2)

/
/
( 3-5)

( )

LJ

/
(,

- (<10)
D (<

1-
(10-30)
D (10-30)

/
(, ,

:.

rj

/ (.
, )

(<10)

(<1 )

z (10-30)


.
1-1,5

2- 3-
D (>30)
(>30)

3


- {>25 )
- (>1,5 )

1
2
3

,
, ,

, ,

4
5

(>30)
S-

,

D
/ (.
, dens in dente)

G

( )

(,
)
( )

(,
, ,
, )
rj


rj
D
-

,
.

24

www.asahq.org/clinical/physicalstatus.htm

68

, , , 90%. 60-75% . . .

, , , , ,
, . , , 10-25%. ()
() .
. , ,

.


.

,
, , ,
.

, . , , 1 ,
0,5-1 .
0-2
. ,
. . , ,

69

- :
90-98%
- : 80-90%;
50-60%
- : 89-96%
- : 60-74%

. 5-1

. , , ,
, (4%) .

, . . , .
80 , .
,
. , (. 5-1). , :
- , , ;
-
;
- ()
.

70

12 .
, .

1. American Association of Endodontists website (http:Wwww.aae.org).
2. Friedman S. Prognosis of initial endodontic therapy. Endodont Topics 2002;2:59-88.
3. Tronstad L. Clinical endodontics. 2nd ed. Stuttgart: Thieme, 2003:247-249.

06
(Martin Trope), DMD,

( , ). -
(, ). , -

, ,
. , -
.
. - Dental Traumatology
Endodontic Topics, Oral Surgery,
Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Journal of Esthetic and Restorative Dentistry.
2002 . - . (Louis I. Grossman) .

(Gilberto Debelian), DMD, PhD,

- (),
(, ) (). 10 -
, , .
(). - , , , , , . -

Journal of Endodontics. , . 1997 . -
, .
ISBN 5-902-693-09-8

785902

693093