Question Paper Discussion-Conservative Dentistry & Endodontics-Part 7

[Music] Hello everyone, welcome back to another section of dentistry and more. Today we are going to discuss the previous year question paper that has comes under the topics observation of root canals, endoderodontic emergencies, procedure accidents, surgical endodontics and last one is endodonic periodontal relationship. Now we are moving to the first topic that is opturation of root canal and the long answer is it is a repeated question where is root canal opturation technique and explain about thermoplastic opturation technique and explain in detail about the lateral condensation technique and the short essays includes classify root canal sealers and mention the resin based sealers define opturation describe lateral compaction technique. The short notes includes guta percha ideal requirements of root canal sealers and add a note on calcium hydroxide sealer mix pattern compactor monoblock concept in anodonics and last one is vertical compaction technique of opturation. First one is definition that is according to American association of endodonics. This opturation is the method used to fill and seal a cleaned and shaped root canal using a root canal sealer and core filling material. And the major techniques of obsuration that is gaperture obsuration techniques includes cold lateral condensation, warm vertical condensation, continuous wave compaction theory, mix pattern thermomechanical compaction, thermoplasticized gutaperta injection, carrier based gutaperta that includes thermopil, thermoplasticized simply fill sectional opturation and chemically plasticized guta and last one is custom and corn. So this includes the techniques. Now we are moving to gapa. So the composition of the gutapa uh that is that includes both organic content and also inorganic content. And the organic content includes gutaerture and waxes that is matrix gutaperta about 20%age and waxes or resins that is about 3%. And the inorganic contents includes zinc oxide plus metal sulfates that is total 77%age and zinc oxide that is the filler uh 66%age and uh metal sulfates that is heavy metal that is 11%age and the types of guta includes uh alpha form and also beta form and this alpha form it is brittle at room temperature whereas the beta form it is flexible at room temperature. And this plasticized gutter plasticized thermoplasticized guta for vamp compaction technique is used in uh alpha form and uh in beta form that is cold compaction. Gata points used with cold compaction are in beta form. Next one is the properties of gata. The major properties includes bio compactability, ductility, uh melting point, it is about 60°C, dimensional stability that is expansion and shrinkage occurs due to heating and cooling. Um and ease of handling. It can be both used in alpha and beta for for obturation depending upon the handling features. So this is the figure that is showing the gutaperta points. Next one is the current available forms of gata. The gutaperta can be available in various forms like gutaperta points oscillary points greater taper gutaperta points gaucha pellets pre-corted co carrier gutaperta in case of um ga flow syringe system gaerta sealers and also medicated gaert like calcium hydroxide adopam or chlorhexidine containing gutaperture points. So these are the current available forms. Now we are moving to the advantages and disadvantages. Some of the advantages are it is uh adaptation to the canal walls that is compactability, dimensional stability somewhat like said in case of properties and the disadvantage is lack of rigidity and it can be easily displaced by pressure and it like adhersive quality. Next one is root canal sealers that the classification includes according to Engel, according to Cohen and according to Grossman. So according to Engel, it consists of uh cements paste and plastics. According to Grossman uh it includes that is zinc oxide resin cement, calcium hydroxide cement, para form alihide cements and also paste. And according to Cohen there is type one and type two. In type one also there is three classes and type two there is four classes. So you can read according to Cohen. Next one is idle requirements of a root canal sealers. Uh the some of the requirements are uh it is tacky when mixed. So as to provide good adhesion between it and canal boards. It is able to create hermetic seal. It is radioopac so it is visible on the radioaph. Uh so note shrink upon setting and non staining to tooth structure but bacteratic or at least uh note do not encourage the bacterial growth and it's set slowly because long working time allows placement and adjustment of root filling if necessary. So these are the ideal requirements and uh some is also includes insoluble in tissue fluids non-erritating and it is soluble in common solvent like that. Next one is resin based sealers. So some of the seers are dietit and its composition features and problems like uh toxicity are all mentioned here and A26 H+ it's so also composition features and problems are mentioned. Next one is calcium hydroxide sealers uh like seal aexics and uh this compositions like base and catalyst and next one is medicated sealers, silicone based sealers, glass anomalous sealers all are mentioned here. Now we are moving to the monolock concept. So literally meaning of monoclo it is a single unit and it means the creation of solid bonded continuous material from 11 19 volt to the canal to the other. So it strengthens the root by approximately 20%age and the classification it is based on number of interfaces that is present between core filling material and bonding substrate. The three types that is primary, secondary and tertiary. In this this uh primary case this opturation is completely done with co- material that is use of hydrons MTA bio guta. And in case of secondary there are two circumferential interference that is one between the sealers and the primer uh dentine and the other between the sealer and the core material. And the third one is uh tertiary in that conventional gutter surface it is coed with resin which is bonded with the sealer which further bonds to the root uh canal b. So there is three circumferential interfaces are present in tertiary. So these are the three stages. So here you can see uh first figure shows the primary monolock concept. Second shows the secondary and third one is tertiary monolock concept. Now we are moving to the techniques that first one is warm vertical compaction technique. So this method of filling the root canal. It was an objective of filling all the portals of exit with maximum amount of gutaure and minimum amount of sealer. So in this technique the pressure it is applied in vertical direction to heat soften gaperta that uh causes it to flow and fill the canal space. So its basic requirements are continuous tapering uh final shaped for from orifice to aex and the ael opening is as to be small as possible to prevent the extrusion of the opturating material and decreasing the cross-sectional diameter at every point a and increasing at each point as canal is approached coronally. This one is the technique. So here in the figure you can see the technique that is uh the first figure shows the selection of the plugger that is according to shape and size of the canal and the second figure uh shows the confirm the fit of the cones. The con should be of appropriate size and shape. Um sorry this was the figure of warm compaction uh technique. So in the figure you can see a first figure that shows uh the selection of the master guta para cone. First figure and the second figure there is a select uh the plugger that is according to the canal shape and size this plugger is selected. After that there are two chances if the larger sized plug is used it may bind with the canal and may split the root. So in the figure C you can see uh the larger size plugers and in case if they are using a smaller plugger it may ineffective for the compaction. So in this figure you can see smaller plugger and next figure shows the heated plugger that is used to compact the gutter and from figures uh F2H you can see back filling of the canal. So uh preheated plugger is used to compact the guta so that it is compacted at the apex. Next we are moving to vertical compaction of uh guta w ga perta. In this case it cause dense obturation of the root canal while lateral compaction provides length control and satisfactory ease and speed. And the advantages of both these techniques are provided by newer device that is endotech 2 which helps the operator to employ length control with warm gutter pressure technique. It comes with battery which provides energy to heat the attached plugger and spreader and the technique used in case of vertical combaction is that master gutter is adapted in canal and the select plugger and activate the device. Insert this heated plugger in the canal beside master con to be within 3 to 4 mm of the aex using light ael pressure. Afterwards this unheated spreader can be placed in the canal to create more space for accessory cones and this process is continued until the canal is filled. So in the figure you can see that procedure vertical combaction. First figure shows the selection of the plugger according to the shape and size of the canal. And the figure B shows the confirm fit of the con. C uh the filling of the canal by turning the system. D compaction of gutaerture by keeping the plugger for 10 seconds with sustained pressure. and F uh it is the removal of the plugger is seen here and G a pical filling of the root canal is completed. So this about the vertical compaction technique. Now we are moving to the lateral compaction technique. So it is the most common methods that is used for root canal opturation and it involves the placement of tapered gutter cones in canal and then compacting them under pressure against the canal walls using the spreader. So a canal should have a continuous tapered shape with the definite ale top uh ale stop before it is ready to be filled by this method. So here you can see uh the technique that is following the canal preparation the master gutter con it is selected which has the diameter same as that of the master ale file and uh once we feel the tuck back with the master ga point this it is notched at the working distance and locks to the level of incisal and occlusion at reference point and the fit of the cone it is radioraphically checked and if it is satisfactory Then remove the cone from the canal and uh this sodium hypocchlorite is placed there. And if the cone is too short to fit uh working length then uh dendip debris any ledge or curve in the canal and treat them accordingly. If cone selector is going beyond the forammen then either select the larger number cone or cut the cone to the working length. If cone sh shows S-shaped appearance in the radioraph, it means that the cone is too small for the canal. So in that case a large cone can be selected in order to fit the canal length without binding in the canal should occur. So there is a chance for tooth fracture with excessive pressure. And now dry the canal with paper points and then sealer is applied to the canal. After that place the master guta percha into the canal and the c the pre-measured corn with sealer and place into the canal. After the master corn placement place spreader into the canal alongside the corn. Spreader helps in compaction of the guta and it acts as a birds to squeeze the guta laterally under vertical pressure not by pushing it sideways and it should reach 1 to 2 mm of the prepared root length. Next one is remove the spreader by rotating it back and forth motion and this combs the guta part and it will creates a space for the accessory cones laterally to the master con. And now place the accessory cones to this pl space and then repeat the above procedure until the spreader no longer penetrates beyond the cervical line. Now server the protruding gaperta point at at canal orifice with hot instruments. So this is a figure showing the lateral compaction technique. Next one is mix pattern compaction or thermomechanical compaction of the guta. So this introduced a technique in which the heat is used to decrease the velocity of guta and thereby increasing the plasticity. So uh in this this is fitted to a large type handpiece and it is rotated at 8,000 to 10,000 RPM alongside guta cones inside the canal walls. So at this speed the heat is produced by friction that may softens the guta and designs the blade forces the material apply and the advantages and disadvantages are there. Advantages include it requires less chairside uh time and ease of selection and insertion of the gutter perchure. Disadvantages reliability in use in narrow and curved canals frequent breakage of the compactor blades and shrinkage of the gutter pressure on cooling and this all about the obsuration of root canal. Now we are moving to next topic that is endonic emergency and the long essay include first one is define endodonic emergency classify endonic emergencies and mention briefly about the management of each one and a note on definition and the short note crack tooth syndrome. The definition is pain and or swelling caused by inflammation or infection of the pulp and or peradicular tissues necessary and emergency visit to the dentist for immediate treatment and the classification of the anodonic emergency that is includes pre-treatment patients under treatment and also postendodonic treatment. First one is pre-treatment that includes dental hypers sensitivity pain of palpel origin that includes reversible and irreversible pulpitis acute aal perodontitis acute parapicalsis traumatic injury and cracked tooth syndrome. Next one is patient under treatment. It may includes mid- treatment flare up, exposure of the pulp, fracture of tooth, recently placed restoration, perodontal treatment. The post synodontic treatment includes over instrumentation, over extended filling, underfilling, fracture of root and high restoration. Now we are moving to the management of endonic emergencies that is pre-treatment emergencies. So first one is dendon hypers sensitivity. It is defined as a sharp short pain that is arising from exposed lending in response to stimuli typically thermal chemical tactile or osmotic and which cannot be ascribed to any other form of dental defect or pathology. So the two principal treatment options are uh plug the dentinal tubules that prevent the liquid uh that prevent the fluid flow and desensitizing the nerve that makes it less responsive to stimulation. So these are the treatment. Next one is acute reversible pulpitis and its management includes removal of the cause, recontouring the recently placed restoration, removal of the restoration and placing sedative dressing relieving the occlusion. Acute irreversible palpitis management include uh the anesthesia is given. After that uh a rubber dam is applied as this cavity is prepared. This pulp uh is removed from the pulp chamber and irrigation and debridement of the pulp chamber is done. Determination of the working length is done and after that the pulp is removed by cleaning and shaping the root canal. Irrigation through the root canal. Drying the root canal with the sterile absorbent points and dry cotton pellet is placed uh with formocrosol or eugenol in the pulp chamber and it is sealed with the temporary restoration and relief the occlusion. After that appropriate analesic therapy or antibiotic is given if infection is present. Next one is acute apical perodontitis. In that case uh the management includes anesthesia. After that assist cavity is prepared and the pulp is removed from the pal chamber. Working length is determined. Uh cleaning and shaping irrigation same as that of the management of acute aal perodontitis. Next one is acute parapical absis and its management includes pulp debridement, incision and drainage. Um in case of any infection the antibiotics are not localized infections the antibiotics are not provided but if there is any systemic features then antibiotics are given and the tooth is really from the occlusion in case of hyper occlusion and in case of post-operative pains are given. So this is a figure showing the incision and drainage. Next one is traumatic injury. U the major objective of the treatment should be immediate relief of the pain. Since the pain is basically caused by inflammation. Uh this and increased tissue pressure the reduction of the ir irritance or pressure or removal of the inflamed pulp should be the main goal of treatment. And also there is um reduction in tissue pressure in the pulp and radicular tissues or removal of any inflamed pulp tissue that result in the pain relief or reduction. Next one is very important that is cracked tooth syndrome. So it means incomplete fracture of the tooth with vital pulp. It is commonly seen to be associated with the teeth with large and complex restoration and the treatment includes urgent care of the cracked tooth involves the immediate reduction of the occlusial contact by selective grinding of the tooth at the sight of the crack and the definitive treatment uh that aims to preserve the palpal vitality by providing full occlusial coverage for casper pro protection. and full coverage crown. If fracture involves the crown portion only and if fracture involves the root canal then endoderic treatment is done and restoration is done and if the fracture extends the root then extraction of the tooth is more preferred. Next one is intra treatment emergencies that is mid treatment mid treatment flare up and it prevention include uh psychological preparation of the patient long acting anesthetics such as bivikin should be preferred complete cleaning and shaping of the root canal. Analesics is also prescribed and the treatment reassure the patient occlusion is adjusted debridement cleaning and shaping is done. Analesics and antibiotics are provided and drainage. Uh never leave the tooth open for drainage and recall the patient until the painful symptoms subside. Next one is exposure of the pulp. So it can result in severe sharp pain. In that case uh complete removal of the pulp has to be done whether the pulp has damaged or not. Next one is fracture of the tooth. It can result in pain due to contamination of the road canal. So in that case if fracture is vertical extending a to alvola crest one should go for an extraction of the tooth or in case of multi-rooted should go for any hemisection or red dissection. Next one is recently placed restoration. It can also present with pain with many factors like feeling, micro leakage, inadequate pul protection, galvvinis, galvvinism due to dissimilar metal restoration or chemical irritations like that and perodontal treatment. It can result in exposure of the lateral canals which can communicate with perodontal ligament space and it may also causes pain. Hypocchlorite accident. It may occurs when the sodium hypocchlorite that are extruded beyond the tooth aics that uh result in combination of symptoms like severe pain, swelling, profuse bleeding both through the tooth and hand management include immediate aspiration and application of the ice pack. Severe infection because of the tissue destruction uh that may prov should provide the antibiotics, analesics or antihistamines and in severe cases steroids and hospitalization is more preferred and the prevention include use needles with closed end and lateral vents. The tip of the needle should be 1 to 2 mm short of the aex. Oscillate the needle in the canal. Do not force the irrigant into the canal. Tissue emphymia. It treatment include antibiotics. Application of the moist heat. Hospitalization and medical attention is provided. Prevention. Air pressure while using the blast of tear should be directed at horizontal direction against the wall of the tooth and not perapuly. And during any surgical procedure use low speed or highspeed impact hand speed piece which do not direct air towards the tissues. Next one is post opturation emergencies that includes over instrumentation over extended opturation persistent pain vertical root fracture high restoration and the managements of the uh post opturation emergencies. In most cases, it is very discomfort following the objuration that may last for 2 to 5 days. And to manage this emergencies, reassure the patients. Analesistics are provided, occlusion is checked and um do not retreat randomly. Retreatment is done only in case of persistent untreatable problems. And these are the various analesics that used in anic emergencies like aspirin, ibuprofen, paracetamol, nicitis maximum effective dose ibuprofen 400 to 600 mg and in case of severe pain this nicid is combined with narcotics. Last one is definition and uh this is that when drainage through the canal is not possible due to restorative tissues or in case of certain conditions like failing treatments or necessary correction of procedural accidents surgical definition can be used as a palative measure. So it involves the surgical perforation of the alvolar cortical plate over the root end to release the accumulated exudates to release the pain. However, it is not the first line of treatment because of the additional trauma, invasiveness and questionable beneficial result. And that all about the endodonic emergency. Now we are moving to the procedural accidents and the short essay include list the end andic misshapes during cleaning and shaping describe briefly the diagnosis and prevention of root canal blockage and the procedural errors related to assess opening is there. Canal uh shaping and cleaning is there with opturation is also there in case of assess opening that includes treating the Wrong tooth. Incomplete removal of the carries. Inability to locate extra canals. Hydrogenic perforations. Procedural errors in canal shaping that is canal blockage. Deviation from the normal anatomy that is ledge formation, transportation, sweeping, separation of instruments, strip perforation and the procedural errors with obturation include underfilling and also overfilling. Canal blockage. This blockage of the canal it is usually because of inadvertent packing of the dentinal debris into the middle and a third of the root canal during shaping procedure. So the major causes are file combat debris uh this fibrous blockage and fractured instruments restorative material paper points or cotton. The corrections can be done by recapitul capsulation uh recurving and redirecting the instruments recurving and redirecting the instruments. Still if the block cannot be bypassed endonics can be used to dislodge the dental debris and forcing any instrument may further compact the debris or may leads to perforations. Next one is prevention that uh is always use a small sized instrument first and uh sequential this use of the instrument is in the sequential order and always use pre-curve as hand instrument. Use reproducible reference points. Use amount of the irrigance and always work in a wet canal. Recapsulates repeatedly. If there is any loss of working length at this step take the radioraph and confirm. Use smaller sized instruments to dislodge the debris and again flush before the proceeding with the next phase of cleaning and shaping and the prognosis that is depends on the stage of instrumentation disinfection and cleaning and vitality of the pulp. This all about uh that chapter. Now we are moving to the surgical endodonics. Next topic include this small long essay like explain aicoctomy and retrograde filling in endic surgery. Enumerate the post-operative CLA of endic surgery and the short access include classify retrograde filling material. Add a note on MTA. Enumerate the principles of endic surgical flap. Describe any of the indications and contra indication flap designs with figure and detail about um guidelines. Indications and contra indications of endotic surgery in different types of flap uh osenb loop flap and mentioned indications of periopical surgery and last one is classify andic surgery described in detail about different flap design and the short notes includes bicusation hemisection and radisection MTA and replantation now we are moving to the first topic that is a coctomy. It means surgical resection of the aex of the root uh aex of the tooth and the indications include when the anatomy of the canal system has been has not been dict uh conductive to the non-surgical treatment when root tip is resolved or fractured or when hitrogenic perforation or led prevents a ceiling somewhere like that there are many indications you can read. Next one is the steps. First one this radioraph is taken in order to determine the level at which the root should be amputated. And next cleaning of the area involved with antiseptic solution. Administration of the LA. Design the mucoperostal flap that is rise to make an opening into the parapical region. Extend the opening in the labial plate to obtain a good assess. Bone removal is done for assess the root tip. Uh next the root tip is this recession and curage is done. Retro preparation and retrograde filling done to seal the root aexics. Next one is debridement and suture the mucoperostal flap and it is maintain firm pressure over the area of 10 minutes and follow up the case and post obtain a post-operative radioraph to check the level of fruit amputation and future comparison. Next one is the classification. The classification include surgical drainage, peradicular surgery, root resection, replacement surgery, implant surgery. Surgical drainage include incision and drainage, cortical definition. Peradicular surgery includes curitage, biopsy, root end recession, root end preparation, filling, corrective surgery which includes perforation repair, mechanical and resoptive and root recession, hemisection, uh replacement surgery, implant surgery that includes endotic implant and root form osteo integrated implants. Next one is classification of endotic microsurgical cases and it is classified into six type that is class A absence of peradicular lesion but persistent symptoms after non-surgical treatment. Class B that is presence of small periapic lesion with no periodontal pockets. C there is presence of large periap lesion that is progressing coronally but no periodontal pocket. D any of the class B or C with periodontal pocket. E perapal leion with uh endodonic and perodontal communication but no root fracture. F that is tooth with periapiculation and complete denuation of buckle plate. So these are the classification of endotic microsurgical cases. Class A, B, C, D, E and F. Next one is indication. Some of the indications are need for uh surgical drainage, failed non-surgical treatment, calcified metaposes of the pulp space, horizontal fractures of the root tip, procedural errors like instrument separation, ledging, root perforation, uh severe ale transportation and anatomical variations like root dilaceration, a root fenistration like that indications biopsy, corrective surgery, rement surgery, implant surgery. Then the contra indications includes many of them other paradonal health of the tooth. Patients health conditions like cannot be given in case of leukemia neutrmia uncontrolled diabetes meltus very old patients uncontrolled hypertension bleeding disorders immuno comp compromised patients patients mental and psychological status uh that does not deserve any surgery and patient that is unable to handle stress for long complicated procedures. These are some of the contra indications. Next we are moving to retrograde filling that is filling placed in the apical third of the tooth root to seal that affected part of root after surgical intervention. And the classification includes metals, cements and sealers and others metals that is gold foils, silver post uh titanium screw amalgam and the cements and sealers, zinc oxide, eugenol, polycaroxilate, gic, MTA and others includes composite resin and gutacherture. And these are the principles and guidelines for flap designs that is it uh first one is avoid horizontal and severely angled vertical incisions because gingial blood supply occurs from supraostial vessels and these follow vertical co parall to the long axis of the teeth. uh collagen fibers of gingiva and alvolar mucosumm form attachments for crystal bones and supra crystal cements to the ginger and perostium. Pace of the flap should be more than free ginger to preserve an adequate blood supply. Avoid incision over radicular eminence. Incision should be placed such that the flap is repositioned over the solid bone. So you should read the principles and guidelines that is given here. So very important. Next one is flap design. The classification include full mucoperiorostal flap and also limited mucoperiorostal flap. In case of uh full mucoperostal flap, it includes triangular, rectangular, trapezoidal and horizontal and limited that is sub gingial and sub marginal curved, submarine, scalloped, rectangular. And these are about the full mucoperedostial flap, triangular flap, rectangular flap, trapezoidal flap, envelope, semi lunar. Next three mark question that is question B loop care flap or submarinal scalloped rectangular flap. So it was developed by an endodonist and a prodist. Uh it is a modification of a rectangular flap. So in the figure you can see in this scalloped horizontal incision it is given in the attached ginger which forms two vertical incision that is made on each side of the surgical site horizontal and to vertical there is indication is given in case of gingivitis or perodontitis and advantages that includes the marginal and gingiva are not involved crystal bone is not exposed if there is adequate surgical assess and good wound healing. Disadvantages is also there. There is flab shrinkage, difficult flap reapproximation and wound closure, limited aallel orientation and limited or no use of mandibular surgery. Next one is mineral triioxide aggregate or MTA composition include triricalium silicate, trial aluminate, trirical calcium oxide, silicate oxide, bismouth oxide that is added for radio opacity and the properties that is setting time is 2 hours 45 minutes compre uh compressive strength that is 40 MPa insufficient weight loss following setting and these are the advantage and disadvantages. The MTA placement technique include preparation of the root end is completed. Bony crypt it is packed with the sterile cotton pellets. MTA powder and liquid they are mixed and to put the consistency and this mix it is carried to site with the help of an amalgam carriers and is placed into the preparation and this empty it is compacted with microp plugers and cleaning the surface is done with cotton pellet. Next one is replantation. So uh this intentional replantation is defined as the act of deliberately uh deliberately removing a tooth and following examination, diagnosis and nonic manipulation and repair returning the tooth to its original socket. And the classification include intentional reimplantation and uni intentional reimplantation. And these are some of the indications contra indications like curved or flared canals non-restorable tooth moderate to severe paranoidalis missing interceptal bone presence of vertical root fracture and some of the precursions that should be taken are this root surface it should be kept moist out of the socket the time should be of shortest possible one should take not to damage the pedial cells and cementum And next one is the technique. Now we are moving to the hemise section or root section or root amputation. So it is defined as removal of any unrestorable root which may be affected by the periodontal structural and carries cracks or carries and hemisection it is independent of by customization. It includes splitting of the tooth, extraction of one half that is followed by bridge. Whereas by caspidization, it involves retaining of both the split section of the tooth and then it is restoring with crown. Indication that is severely curved canals or extensive calcification fracture of the root resorption carries or perforation involving one root and the contra indications include fused root and cooperative patients endonically incompactable remaining roots and the technique before the root uh resection carry out endonic treatment in root to be retained. After this carry out root resection, it is basically two approaches that is vertical and horizontal in vertical. Here complete root is resected along with its associated portion of the crown. And this procedure is also called as semisection or tricsection. It is mainly done from meial to distal maxillary mers and buckle to lingual in case of mandibular mers. And horizontal in this the root is resected at the point where it is joined to the crown. It is also called as root resection. So this is the figure showing. Next one is by caspidization. It is defined as the surgical separation of multi-rooted tooth into two half then restoring each root with the separate crown. So it is commonly carried out in mandibular molas where the meial and distal root they are separated by the respective ground portions and indications uh it mainly used when the parodonal disease involves the fussion area and contra indications like fused root and cooperative patients it's not used. So this is the bicaspidization figure and that's all about the surgical endonics. Now we are moving to endodonic periodonal relationship and it's a very important chapter only one question that is classify endoperolion describe briefly about the management and the pathway of communication between pulp and parodonium. First one is the classification according to Simon atal most commonly employed one based on the ethiology diagnosis prognosis and treatment. It is classified into five group that is primary endic leion primary endic with the secondary periodontal lesion. Primary periodontal leion primary perodontal leion with the secondary endic involvement and two combined lesions. Next that is type of the lesion and treatment. Now we are moving to the each uh type that is first one is primary end andic lesion and this treatment involves conventional root canal therapy. So uh no root planning or planing can be done uh when the sinus tract is along the peral ligament because these fibers they are important for reattachment to occur. Next one is primary endic with the secondary perodontal lesion. So here first endodonic therapy is done that is including the root canal treatment. After that periodontal therapy is done and third one is primary perodontal leion. Here this perodontal therapy to eliminate the pocket is indicated. After that root canal therapy it is not usually indicated unless the pulp vitality test results change and periodic reevaluation is necessary in case of primary periodontal leion. Primary periodontal leion with the secondary endronic involvement. The treatment includes both endonic as well as the periodontal therapy. And the last one is true combined leion that it also includes both endonic and perodontal therapy including root recession and also hemisection is proposed. So these are about the type of delion endoperation and its treatment. Now we are moving to the pathway of communication between pulp and perodonium. So this is the flow chart that is showing the pathway of communication. So the infection can occurs from both the pulp as well as the periodonium. So in the flowchart you can see healthy pulp that is turned into infected pulp and from there uh the healthy perodonium is turned into deceased parodonium and this flowchart it is surrounding that is uh both the pulp as well as the perodonium is infected. This bacteria transfer occurs from both pulp and also from the perodonium. So this is the pathway of communication between the pulp and perodonium and this is how the endoperolions occurs. And this ends the endodonic periodontal relationship. Um so here ends the few topics of conservative industry question paper. Hope you all understood this section. We will come back with another section. Thank you all. [Music]