COLLEGE OF DENTISTRY
DepartmentOFRestorative Dentistry [RDS]
PRE- CLINICAL ENDODONTICS [323 RDS]
III YEAR, 1st &2nd Semester
STUDYGUIDE
1
Message from the Dean
Assalamualaikumwarahamatullahiwabarakatahu
It gives me immense pleasure to welcome all the Students to the College
of Dentistry – Zulfi, Majmaah University, K.S.A. The College of Dentistry aims to
improve the dental health of the people in the Kingdom through providing the
students with excellent clinical trainings, supporting research and learning
environment. Towards this goal the Department of Restorative Dentistry has
prepared a course handbook for the benefit of the students.
I have read this handbook and found that the team has done an excellent
job in addressing all the questions a student will have at the start of the course.
This handbook is a comprehensive course guide for the students for the subject
Pre- Clinical Endodontics. I would like to congratulate the team for coming up
with this handbook.
It is for assured that the dedication of our energetic and benevolent
faculty and staff prompts the students to be skilled and knowledgeable in
attaining high standards in dental education.
Best wishes
Dr AbdulRahman Al Atram
2
Message from members of the course committee
Dear students;
I would like to welcome you to this preclinical course which contains the
core science of endodontics.
This course introduces you to the concepts and techniques of the
endodontic discipline. The course covers the principles of recognition,
examination, diagnosis and management of pulpally involved or potentially
involved teeth. The correlation between basic clinical and biological principles is
emphasized in this course. You will practice all endodontic treatment procedures
and instrumentation in a clinically-simulated environment.
Best wishes
3
Approval for the course
This course has been reviewed, revised & approved by;

The Department of Restoratve Dentistryinthe ……...meeting on-----------

College Curriculum Committee in the ……...meeting on-----------

College Council Committee in the ……...meeting on-----------
4
Table of contents
S. No.
Contents
Page No.
1.
Message from the dean.
2
2.
Message from the course committee.
3
3.
Approval of the course.
4
4.
Table of contents.
5
5.
General course information
6
6.
General course description
7
7.
General course objectives
8
8.
Course contents First Semester
9
9.
Course contents Second Semester
13
10.
Detailed objectives of lecturesFirst Semester
16
11.
Detailed objectives of lectures Second Semester
18
12.
Detailed objectives of Pre-Clinical part
20
13.
Students Assessment and Marks distribution
22
14.
Student expected needed study hours per week and student
23
support
15.
Teaching and learning resources
23
16.
Course evaluation and improvement process
24
17.
Recommended Text Books
25
18.
Facilities required
26
5
Course Title
Pre-clinical Endodontics
Course Code
323RDS
Course Components
Theory
Pre-clinics
Total
First semester
1
1
2
Second semester
1
1
2
Duration: 15 weeks / sem, (60 contact hours in total)
Lectures: 15hours / semester, 1 hour per week.
Pre-Clinical: 3 hours pre-clinical / week.
Year / Level
III Year, 1st&2nd semester,
Prerequisites
213RDS
Co-requisites
None
Course Coordinator DR Gaurav Garg
Course committee
Dr Mousa Abu Fadaleh, Dr Gaurav Garg
Table of course tutors and their contact details;
Sl. No.
1.
2.
Name
Rank
Email
Office hours
DR MOUSA ABU
Assistant
m.fadaleh@yahoo.com
FADALEH
Professor
Sunday,
Tuesday
8-11 a.m.
Dr Gaurav Garg
Lecturer
gaurav1059@gmail.com
Monday,
Tuesday
8-11 a.m..
6
General Course Description
This course introduces the concepts and techniques of the endodontic discipline to the students.
The course covers the principles of recognition, examination, diagnosis and management of
pulpally involved or potentially involved teeth. The correlation between basic clinical and
biological principles is emphasized in this course. The students practice all endodontic treatment
procedures and instrumentation in a clinically-simulated environment.
7
General Course objectives
Summary of the main learning outcomes for students enrolled in the course.
By the end of this course the student will be able to;
1. Prepare the student to demonstrate clear understanding of the morphology of the pulpal
spaces.
2. Prepare the student to demonstrate the ability to state the theoretical and biological
principles of every endodontic clinical procedure.
3. Prepare the student to demonstrate competency in performing fundamental operative
procedures in the field of endodontics.
4. Prepare the student to demonstrate adequate knowledge of the dental materials and
instruments used in endodontics.
5. Prepare the student to demonstrate the ability to recognize the different levels of
sophistication and complexity of endodontic cases that his patients present.
6. Prepare the student to a level where he will be able to evaluate his own clinical
competency and know the extent of his diagnosis, treatment planning and operative
capabilities. Therefore, he will not be hesitant in seeking the counsel of a specialist or a
colleague.
8
FIRST SEMESTER
Course content
A. Lectures. [total-15]
Lecture
[No.]
(1)
Lecture
[date]
Title of Lecture: Course contents
(3)
Endodontic instruments
1. Hand instruments
2. Rotary instruments
3. Isolation (principles and
rationale)
4. Rubber dam materials
Pulp champer, pulp horns
Root anatomy
Number of roots
Number of canals
Apical foramen
1
1
1
1
1
1
1
1
1
Endodontic Access Cavity
Preparation
1. Morphology of anterior,
premolar and molar teeth
2. Principles of endodontic
cavity preparation
(5)
1
Staff
Internal anatomy of root canal system
12345-
(4)
Contact
hours
Introduction and orientation
1. Review of objectives and
requirements of the course.
2. An overview of endodontic
therapy
3. Endodontic case presentation
4. Indications for root canal
therapy
5. Contraindications for root
canal therapy
(2)
No of
weeks
Endodontic radiography
1. Importance of radiographs
2. Vertical and horizontal
angulation
3. Buccal object rule
9
(6)
(7-8)
Working Length determination
1- Estimated working length
2- Corrected workinglength
3- Electronic apex locator
1
1
2
2
2
2
2
2
2
2
Cleaning and shaping of root canal
system
1. Principles
- Radicular cavity
preparation
2. Instruments and methods for
radicular cleaning and
shaping
- Determination of
the tooth length
- Step-back
technique.
Midterm Exam
(9-10)
(11-12)
(13-14)
Root Canal Filling Materials and
Obturation
1. Importance of obturation
2. Characteristics of an ideal
root canal filling materials
3. Extension of root canal
filling
4. Lateral Condensation
technique
Intracanal medicaments,
Temporizations
1. Antibacterial agents
2. Mode of action
3. Irrigation and chelation
4. Calcium hydroxide
Diagnosis and Treatment Planning
1. Patient history (chief
complaint, present dental
illness and medical history)
2. Clinical examination (vital
signs, extra and intra-oral
examination, clinical tests
and periodontal evaluation)
3. Radiographic examination
(interpretation, and
importance of radiograph in
diagnosis)
Final exam
10
B. Pre-clinical exercises. [15 sessions]
FIRST SEMESTER
Week
Week
Practical exercise
[date]
No of
Contact
weeks
hours
1.
Lab rules, lab sheets, distribute
instruments.
1
3
2.
Identify endodontic instruments &
extracted teeth for RCT
1
3
3.
Teeth selection and Endodontic
Radiography “Basic Concepts”
1
3
4.
Access preparation for anterior
teeth
1
3
5.
Access preparation for mounted
anterior teeth
1
3
6.
Working length Determination and
straight line access
1
3
7.
Cleaning and shaping of root canal
system for anterior teeth, Stepback
Technique
1
3
8.
Obturation and Temporization
1
3
9.
Access, Working length
determination and Instrumentation
on 2nd anterior tooth.
1
3
10.
Obturation and temporization of 2nd
anterior tooth.
1
3
11.
Access, Working length
determination on first premolar (2
canals)
1
3
12.
Instrumentation on first premolar (2
canals)
1
3
13.
Obturation and temporization of first
premolar (2 canals)
1
3
Staff
11
14.
Obturation and temporization of 2nd
anterior tooth.
15.
Repetition of missed out classes
1
3
Final Exam
12
SECOND SEMESTER
Course content
C. Lectures. [total-14]
Lecture
[No.]
(1)
Lecture
[date]
Title of Lecture: Course contents
No of
weeks
Contact
hours
Isolation
1- Principles and rationale
2- Types of isolation
3- Rubber dam materials
(armamentarium)
4- Application of rubber dam
1
1
Case Selection & Treatment Planning
1- Patient history
2- Clinical examination
3- Radiographic examination
interpretation, root anatomy,
conditions inside and outside the
tooth)
2
2
Endodontic Mishaps
1- Access related mishaps
2- Instrumentation related mishaps
3- Obturation related mishaps
4- Irrigation-related mishaps
2
2
2
2
1
1
1
1
Staff
(2-3)
(4-5)
(6-7)
Histology and Physiology of the pulp
1- Function
2- Development and anatomy
3- Histology
4- Age changes
5- Pulp response to inflammation
6- Pulpodental physiology
Midterm Exam
(8)
(9)
Microbiology and Immunology
1- Role of bacteria in pulpal and
periradicular diseases
2- Pathways of pulpal and
periradicular infections
3- Flora of the root canal and
periradicular lesions
4- Methods of control of root canal
infection
Pulp reaction to caries and dental
Procedures
1- Relationship between pulp and
dentin
13
2- Pulpal reactions to dentinal
caries
3- Effect of various restorative
procedures on the pulp
4- Effect of local anesthesia on the
pulp
5- Postoperative sensitivity and
preventive measures
(10-11)
Pulpal Diseases
1- Hypremia
2- Reversible pulpitis
3- Irreversible pulpitis
4- Internal resorption
5- Chronic hyperplastic pulpitis
6- Necrotic pulp
2
2
2
2
1
1
(12-13)
(14)
Peri- Radicular Diseases
1- Periradicular lesions of pulpal
origin (endodontic origin)
2- Non-endodontic periradicular
lesions
3- Differential diagnosis
Revision
Final exam
14
D. Pre-clinical exercises. [14 sessions]
SECONDSEMESTER (14 sessions)
Week
Week
(Date)
Practical Exercise
No of
Contact
weeks
hours
1
Lab rules, lab sheets, distribute
instruments.
1
3
2
Access preparation for
Posterior teeth
1
3
3
Access preparation for
mounted Posterior teeth
1
3
4
Working length Determination
and straight line access
1
3
5
Cleaning and shaping of root
canal system for posterior
teeth, Stepback Technique
1
3
6
Obturation and Temporization
1
3
7
Access, Working length
determination and
Instrumentation on 1st maxillary
molar tooth.
Obturation and temporization of
1st maxillary molar tooth.
1
3
1
3
Access, Working length
determination on 2nd maxillary
molar tooth.
Instrumentation on 2nd maxillary
molar tooth.
1
3
1
3
11
Obturation and temporization of
2nd maxillary molar tooth.
1
3
12
Access, Working length
determination on 1st and 2nd
mandibular molar tooth.
Obturation and temporization of
1st and 2nd mandibular molar
tooth.
Repetition of missed out classes
1
3
1
3
8
9
10
13
14
Staff
Final Practical Exam
15
DETAILED OBJECTIVES OF THE CONTENTS:
FIRST SEMESTER
LECTURES
Lecture 1: Introduction
At the end of the lecture student should be able to –
1. Mention the objectives and requirements of the course.
2. Explain endodontic therapy
3. Write the indications and contraindications for root canal therapy
Lecture 2: Endodontic instruments
At the end of the lecture student should be able to –
1. Identify types and use of hand instruments
2. Identify types and use of rotary instruments
3. Isolation
Lecture 3:Internal anatomy of root canal system
At the end of the lecture student should be able to –
1.
2.
3.
4.
Know and identify different parts and the composition of the pulp.
Know root anatomy
Memorize number of roots and root canals of different teeth.
Identify and locate the apical foramen
Lecture 4: Endodontic Access Cavity Preparation
At the end of the lecture student should be able to –
1. Morphology of anterior, premolar and molar teeth
2. Principles of endodontic cavity preparation
Lecture 5:Endodontic radiography
At the end of the lecture student should be able to –
1.
2.
3.
4.
Know the importance of radiographs
Use peri apical X-ray machine
Know the concept of vertical and horizontal angulation
Interpret the buccal object rule
Lecture 6:Working Length determination
At the end of the lecture student should be able to –
16
1- Know the concept of estimated working length
2- Determine the corrected working length
3- Know the uses and parts of the electronic apex locator
Lecture 7-8:Cleaning and shaping of root canal system
At the end of the lecture student should be able to –
1- Know the principles
andstepsof radicular cavity preparation
2- Identify the instruments and methods for radicular cleaning and shaping
3- Determine the working length
Lecture 9-10:Root Canal Filling Materials and Obturation
At the end of these two lectures student should be able to –
1.
2.
3.
4.
Know and enumerate the importance of obturation
Memorize the characteristics of an ideal root canal filling materials
Determine the apical extension of root canal filling
Know and Practice Lateral Condensation technique
Lecture 11-12: Intracanal medicaments, Temporizations
At the end of the lecture student should be able –
1. Know the different types and uses of antibacterial agents
2. Explain mode of action
3. Differentiate between Irrigation and chelation
Lecture 13-14: Diagnosis and Treatment Planning
At the end of the lecture student should be able –
1. Take patient history (chief complaint, present dental illness and medical history)
2. Perform clinical examination (vital signs, extra and intra-oral examination,
clinical tests and periodontal evaluation)
3. Interpretate radiographs
17
DETAILED OBJECTIVES OF THE CONTENTS:
SECOND SEMESTER
LECTURES
Lecture 1:Isolation
At the end of the lecture student should be able to –
1.
2.
3.
4.
Know the principles and rationale
Identify and enumerate different types of isolation
Identify and use rubber dam
Applicatethe rubber dam
Lecture 2-3:Case Selection & Treatment Planning
At the end of the lecture student should be able to –
1.
2.
3.
4.
Take patient history
Perform intraoral and extraoral clinical examination
Analyze radiographs
Set up a treatment plan
Lecture 4-5:Endodontic Mishaps
At the end of the lecture student should be able to –
1.
2.
3.
4.
Identify access related mishaps
Identify and prevent instrumentation related mishaps
How obturation related mishapsoccur
Know irrigation-related mishaps
Lecture 6-7: Histology and Physiology of the pulp
At the end of the lecture student should be able to –
1.
2.
3.
4.
Know the histology andfunctionof the dental pulp
Explain the development and anatomyof the dental pulp Explain the age changes
Explain and identify the response of the pulp to inflammation
Lecture 8:Microbiology and Immunology
At the end of the lecture student should be able to –
1. Know and explain the role of bacteria in pulpal and periradicular diseases
2. Identify different pathways of pulpal and periradicular infections
18
3. Know types of flora of the root canal and periradicular lesions
4. Know and practice methods of control of root canal infection
Lecture 9:Pulp reaction to caries and dental Procedures
At the end of the lecture student should be able to –
1- Know the relationship between pulp and dentin
2- Explain and understand the pulpal reactions to dentinal caries
3- Identify the effect of various restorative procedures on the pulp
4- Identify and treat postoperative sensitivity and apply preventive measures
Lecture 10-11:Pulpal Diseases
At the end of the lecture student should be able to –
1- Know the concept of hypremia
2- Diagnose and treat reversible pulpitis
3- Diagnose and treat irreversible pulpitis
4- Identify the causes and treatment of internal resorption
5- Identify and diagnose pulp necrosis
Lecture 12-13:Peri- Radicular Diseases
At the end of these two lectures student should be able to –
1. Identify and explain periradicular lesions of endodontic origin
2. Differentiate between endodontic and non-endodontic periradicular lesions
3. Enumerate different types of periradicular lesions
19
PRE-Clinical Part
AB-
CD-
E-
F-
Freshly extracted teeth will be used in this course.
The teeth must be clean, free of debris and preferably have sound crown or with
minimum caries destruction.
The pulp chamber and canals must be accessible as confirmed by radiographs
(teeth with immature apices, with calcified canals, with severely curved canals, with
previous root canal treatment, with external or internal root resorption, or with too
short or too long root should not be used).
The selected teeth should be stored in a jar containing 0.9% physiological saline
until mounted.
All the required teeth (2anteriors, 2 premolars, 3 molars) with appropriate root
morphology (as confirmed by radiographs) should be mounted on a plaster of
Paris block for access opening exercises and practical assessment.
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 crack during instrumentation and obturation.
At the end of the first half of the course, the student must finish:
12345-
Access openings on one anterior teeth and one premolar.
Root canal therapy on two anterior teeth
Root canal therapy on two premolars (including one with two canals) teeth
The third anterior tooth should be saved for midterm practical exam.
Instruments spotting exam will be carried out as the first laboratory
Professionalism:
•
Gross violations of the formal codes are governed by University laws, which
delineate the procedures to determine whether a violation of the code of ethics
occurred and, if so, what remedies should be imposed.
•
We encourage students to abide with the more sensitive approach to this by
allowing the practice of a high Morality (or proper behavior), which defines right
and wrong by the society, philosophy, religion, and individual conscience.
•
Students and their instructors often make ethical choices reflexively/ But ethically
sensitive situations, where time, emotions and marks are pressured, it becomes
all too easy to be blind-sided by temptation/ The best antidote to ethical lapses
is to commit in advance to a set of ethical principles - your personal ethical code
that follows or grows to it.
•
Any difficulty or concern during the course should be passed directly to the
course coordinator.
Pre-Clinical work:
 The Lab work should be finished during the lab sessions.
 Undelivered work will not be marked
 All the instruments you need should be brought as soon as possible/ a list of that
will be provided.
 You should leave your worktop as clean as possible – Marks are counted
towards continuous assessment.
 Each student should set at the designated area/ the names will be mounted on
each bench.
 Cooperation and professionalism in the lab time are very helpful and encouraged
to facilitate your progress in the course.
 Makeup Exams:
20
It is applicable when an acceptable and valid excuse is presented at the
applicable time
Attendance:
•
It is mandatory for all lectures and laboratory sessions
•
Every students will be allocated to a clinic
Absence:
•
To receive course credit, a student should attend a minimum of 75% of the
contact hours of the class.
•
Students who are absent for the lecture must contact the course coordinator
prior to the class.
•
•
Any student who is absent on a test day, will have to demonstrate an acceptable
medical or social statement explaining the illness or personal crisis as instructed
by their faculty.
•
Individual instructors may accommodate by arrangements for a make-up test
only when a written request is sent to and approved by the Dean.
Participation:
•
All students are highly encouraged to participate in the classes and clinical
session.
•
The course coordinator is always available to talk with the student when
problems arise.
•
If you have any problems that require the attention of an instructor, do not wait
until the problem is insurmountable.
Additional Notes
1. Students must collect as many teeth as possible to be used in the practical part of
this course. Extracted teeth must not be kept dry; but in diluted Sodium hypochlorite
solution. This home bleaching agent is available in most supermarkets in a
concentration of 6.5% and can be diluted by adding 3 volumes of water to 1 volume
of bleach to obtain the concentration of 0.75%.
2. You should familiarize yourself with more clinically simulated conditions
3. Perform endodontic treatment in correct posture
4. Effectively work with reflected images in the mouth mirror
University rules regarding attendance, both in lecture, lab and make up exams will be
respected and strictly followed.
MARKS DISTRIBUTION
FIRST AND SECOND SEMESTERS
21
-Pre-Clinical Endodontics (2 credit hours, 1 theory, 1 lab)
The following percentages (%) of the total grade will be assigned :
Theoretical part ………….…………..…………50%
Practical part..………….……………….………50%
In-course assessments……………………………………….….... 60%
o Midterm written examination …...…15%
o Midterm practical examination …..…5%
o Practical assessments ………….....30%
o Behavior and attitude ………..……...5%
o Research ……………………………..2%
o Presentation ………………………….1%
o Quiz….. …………………………........2%
Final examination …………………..……………………………….40 %
Final practical examination …………..……...10%
Final written examination ……….....………...30%
LAB ASSESSMENT SHEET
Tooth
#
Pre-0p Access
rad
cavity
EWL
CW
L
MAF
Cleaning
and
shaping
Master
cone
rad.
Obtur
ation
Grade
10
Signature
Date
Student additional private study hours per week & student support:
22
In Additional to the credit hours in the college, the student is expected to put in 2 hours of
private study/learning hours per week. (This is an average for the semester not a specific
requirement in each week).
The students are encouraged to interact with the tutors of the course for any additional help
required during the course. The staff members are instructed to inform the students regarding
the office hours when they can approach the faculty for their help
After each class the faculty member allocates a few minutes to clear the doubts of the students
if needed
The power point presentation of each class is uploaded on the faculty members website from
where the students can easily retrieve it and come prepared for the lecture.
Teaching and learning resources
Students will be shown power point presentations, quiz, and essay competition are
conducted. Use of more teaching aids during classes with special emphasis on the applied
aspects of the structures, impromptu questions asked during the class would also aid in
developing cognitive skills. In addition we would design quizzes and assignments in such a way
that the students would have to correlate the various topics and information given to them.
The students will be asked oral questions. Debates, group discussions, group tasks will be
designed so that the students learn to interact with their batch mates. In addition project work
will be assigned to small groups so that they learn to take up the responsibility and complete it.
During the Pre-clinical section students will be given demonstrations of particular
exercises and then allowed to do the same on their own.
SEMINARS
23
Guidelines for seminar sessions:
1. One seminar per 3-4 students is scheduled during the semester.
2. Duration of each seminar will be of 10 minutes.
3. The students will be given the topics for seminar at the beginning of the course.
4. The student is expected to prepare a powerpoint presentation for the seminar.
5. After each session group discussion will be allowed.
6. The tutor will give his comments and feed back about the presentation.
7. All the students are expected to be present during the seminars and prepare
themselves by reading about the topic of presentation so as to have an active and
productive group discussion.
Course Evaluation and Improvement Process:
The students will be given a feedback form, which will help in the improvement of the subject
teaching.
The head of the department or the Dean has informal meetings with groups of students to
discuss the contents of the course, method of teaching to evaluate the course and the
instructor.
Meetings will be conducted every week in the department to update the status of each student
and the difficulties felt by the colleague will be resolved accordingly. The dean randomly
attends lectures to assess the instructor. The power point presentation of each lecture is
distributed to all the staff members of the department for evaluation and suggestions for
improvement. Teachers will be subjected to go for up gradation of knowledge by attending the
relevant conferences and will be encouraged to carry on a self improvement.
Other staff members are invited to attend the seminar presentation of students to verify the
standards of student learning and their work.
RECOMMENDED TEXT BOOKS;
Textbook-1
24
Title
Author(s)
Pathways of the Pulp
Kenneth M. Hargreaves, and Louis H. Berman;Pub; 2010
Mosby
Textbook-2
Title
Problem solving in endodontics, prevention, identification and management
Author(s)
James L. Gutmann and Paul E. Lovdahl, Pub; ELSEVIER2010
Facilities required
25
Theory: A class room with a seating capacity of at least 25 students, equipped with a projector
and smart board.
Pre-Clinical: A well equippedlaboratory containing all the instruments and materials required
for endodontic and restorative treatment procedures.
Computing resources; Desktops/ Laptop
All the best
Department of Restorative dentistry
26