MINISTRY OF EDUCATION & TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
BUI THI THANH TAM
THE IMPACT OF OPERATING MICROSCOPE ON THE
OUTCOME OF ENDODONTIC TREATMENT IN FIRST
MAXILLARY MOLAR
Specialty : Odonto and Stomatology
Student No : 62720601
SUMMARY OF MEDICAL DOCTORAL THESIS
HA NOI - 2020
WORK IS COMPLETED AT:
HANOI MEDICAL UNIVERSITY
Scientific supervisor:
1. Ph.D. Nguyen Manh Ha
2. Asso.Prof. Ph.D. Pham Thi Thu Hien
Opponent 1
Opponent 2:
Opponent 3
The thesis will be defended before school level Jury at Hanoi
Medical University.
You can learn about the thesis in:
National Library
Library of Hanoi Medical University
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PROBLEM STATEMENT
With the development of science and technology, microscopes
have also been applied in dentistry in many countries around the
world. Many scientific works have shown the outstanding advantages
of microscopes applied in dentistry. The use of endodontic
microscopes helps to identify symptoms, diagnose the disease
correctly, and detect the root canal more easily. With the remarkable
advantages of the microscope in terms of magnification and focus,
the microscope really opens a new era for dentsitry in general and
Endodontic in particular. In Vietnam, the research and application of
microscopy in endodontic treatment is still limited. In order to
evaluate the applicability of microscopes in dental treatment of
endodontics, we conducted the study "Study of microscopy
application in root canal treatment of upper first molar" with the
following objectives:
1. Describe the clinical and radiological features of the upper
first molar indicated for endodontic treatment.
2. Assessing the effectiveness of microscope application in the
treatment of upper first molar.
3. Evaluation of the results of the upper first molar’s endodontic
treatment.
The need of the study
Endodontic diseases always make up a high proportion in dental
diseases. Endodontic treatment is an important area of restorative
dentistry to restore function and aesthetics to diseased teeth. The
upper first molar is one of the earliest erupted teeth and has the most
endodontic treatment, but the rate of failure of endodontic treatment
is the highest among the molar teeth. Many studies show that the
presence of MB2, as well as unsatisfactory cleaning of the pulp
chamber, is the main cause of treatment failure. Therefore, the
application of technical advances such as dental microscopes to
detect root canals, wall crevices, pulp chambers, granules and
calcified blocks is extremely necessary to support the dentist in
detect, clean, shape the canal, and pulp chamber treatment.
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New contributions of the study
- This is a research project following the new trend of microscope
application in the accurate diagnosis and examination of fissures
before and during treatment, the discovery of calcified particles and
calcification chamber, and management of complications when
encountered in the treatment of upper first molar.
- The thesis specifically evaluates the efficiency of using a
microscope to detect the orifice of the root canal, of which the most
effective is to detect the MB2 is much higher than naked eye.
- The results of the study are monitored up to 24 months after
treatment, which is long enough to generalize the results, making
recommendations in the application of microscopes in endodontic
treatment.
Layout of the thesis
The thesis has 143 pages, including sections: problem statement (2
pages), introduction (44 pages), subjects and research methods (18
pages), results (47 pages), discussion (29 pages), conclusion (2 pages),
Suggestion (1 pages), The thesis has 49 tables, 47 pictures, 8 charts, 1
diagram. 131 references including Vietnamese and English documents.
CHAPTER 1: INTRODUCTION
1.1. Anatomy of the upper first molar root canal system
The upper first molar is the earliest permanent tooth, so it is the
first to decay. Upper first molar has three root: two buccal root (MB
and DB) and one platal root. Each root corresponds to 1 root canal,
sometimes 2 canals, usually found in the proximal canal.
1.1.1. Outer anatomy
Viewed from the occlusal surface: The contour is usually diamond
shape. Three large cusps form a typical pattern for maxillary molar
teeth, which are linked together into a triangle. These are important
anatomical landmarks applied when opening pulp for endodontic
treatment of the upper fist molar teeth.
1.1.2. Inner anatomy
The inner form includes the pulp chamber and the canal system.
1.1.2.1. Pulp chamber
On the near and far view: the pulp chamber has two horns, the horn is near
the outside and the horn is far away. The two canals are quite narrow.
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On the external outer view: the pulp chamber is wider, the horn of
the pulp is usually protruding. Usually has 3 legs with 3 root canals.
The proximal canal is shorter than the inner canal, the proximal canal
is usually very wide and in most cases there is an additional root canal.
On a view across the pulp chamber in the neck of the tooth: the
shape of the pulp chamber in the neck of the tooth is shaped like a
parallelogram.
* The pulp chamber ceiling is the upper limit of the pulp chamber,
usually far from the floor in young people and is lowered in the elderly
due to the development of dentine as well as mechanical and chemical
stimuli.
* The pulp floor is the lower limit of the pulp chamber, on the floor
of the pulp chamber has an opening of the root canal. However, the
calcification of the pulp chamber makes it difficult for endodontic
treatment, the orifices can be obscured making it more difficult to
access the pulp chamber and the risk of instrument fracture. This
phenomenon is quite common in root canal.
1.1.2.2. Root canal system
The root canal system starts from the orifice of the root canal at
the floor of the pulp chamber and ends at the end apex. There are 3 or
4 root canals forming triangles with acute distal angle.
The root canal system in the upper first molar is analyzed by the
Weine classification system, most teeth have 3 roots, each root
usually has 1 root canal, the additional root canal is MB (79.2%) and
DB (1.65%).
1.1.3. The study of internal anatomy of teeth
Laboratory or clinical studies to describe internal anatomy include
many different types of methods.
1.1.4. Some landmarks open marrow anatomy application
The entry point to the pulp chamber of upper first molar starts
from 1-2mm from the MB cusp towards the central groove, using a
round drill or Endo access to open into the pulp chamber. According
to Hess, the opening is a trapezoid shaped narrower than the pulp
floor. In the case of not seeing the orifice, open the chamber further
and follow the mesial diagonal.