Master de recherche : Protaper versus Wave-one





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TROCME Caroline Travail de master, endodontie 2011/2012






Master de recherche :

Protaper versus Wave-one



Plan

  1. Endodontie

Définition

Prévalence

Pronostic

Objectifs

  1. Instruments de préparation canalaire

  2. Irrigation canalaire

  3. Tendances actuelles/évolution innovation

  4. Etude


Endodontie




Définition



L’endodontie1 est le domaine de la médecine dentaire qui a trait à la prévention, au diagnostic et au traitement des maladies de l’organe pulpo-dentinaire et des tissus péri-apicaux.

Elle comprend ainsi un large panel d’applications cliniques allant des simples tests cliniques pour la détection d’une nécrose pulpaire ou d’une parodontite apicale, aux traitements de racine ou à la chirurgie péri-apicale, ….
Il a clairement été établi que la cause de l’infection endodontique est d’origine microbiologique2,3,4.

Elle surviet le plus fréquemment

Voir artcile de Bronnex = introduction avec étude de Kerashi

Zhender, 2006 = Infection of the root canal space occurs most frequently as a sequela to a profound

carious lesion (9). Cracks in the crown structure extending into the pulp chamber can

also be identified as a cause of endodontic infection (10). Primary root canal infections are polymicrobial, typically dominated

by obligately anaerobic bacteria (20). The most frequently isolated

microorganisms before root canal treatment include Gram-negative

anaerobic rods, Gram-positive anaerobic cocci, Gram-positive

anaerobic and facultative rods, Lactobacillus species and Gram-positive

facultative Streptococcus species (20). The obligate anaerobes are

rather easily eradicated during root canal treatment. On the other hand,

facultative bacteria such as nonmutans Streptococci, Enterococci, and

Lactobacilli, once established, are more likely to survive chemomechanical

instrumentation and root canal medication (24). In particular

Enterococcus faecalis has gained attention in the endodontic literature,

as it can frequently be isolated from root canals in cases of failed

root canal treatments (25, 26). In addition, yeasts may also be found in

root canals associated with therapy-resistant apical periodontitis (27).
Estrella = It was then confirmed that infections

of root canals are mixed, with predominantly

Gram-negative anaerobic bacteria.
Siquiera et al (2000)= It is well established that bacteria and their products play a crucial role in the development of periradicular diseases. Kakehashi et al. (1) exposed the dental pulps of conventional and germ-free rats to their own oral cavity and observed that pulp necrosis and periradicular lesions develop only in conventional rats with an oral microbiota. In a study of monkey teeth, Möller et al. (2) demonstrated that only devitalized pulps that were infected induced periradicular lesions whereas devitalized and uninfected pulps showed an absence of any pathological changes in the periradicular tissues. Sundqvist (3) confirmed the important role of bacteria in periradicular lesions in a study using human teeth, in which bacteria were only found in root canals of pulpless teeth with periradicular bone destruction
Oncag. O = However, because of bacterial interactions,

nutrient availability and low oxygen potentials in root

canals with necrotic pulp, the number of bacterial species

present in endodontic infections are restricted (Seltzer

& Farber 1994). These selective conditions lead to

the predominance of facultative and strictly anaerobic

microorganisms that survive and multiply, causing

infections that stimulate periapical bone resorption,

and are more resistant to endodontic treatment (Seltzer

& Farber1994).

Anaerobes, especially black-pigmented Gram-negative

anaerobes, are implicated in the development of

acute periradicular in£ammation, involving signs and

symptoms suchas pain, swelling, tenderness and exudation

(Yoshida et al. 1987, Sundqvist 1992, Ohara et al.

1993).
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