Glossary of Endodontic Terms

A

  • abfraction – A v-shaped pathologic loss of hard tooth substance caused by biomechanical loading forces; such loss is thought to be due to flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading; most typically the facial cervical region.
  • abrasion – The pathologic wearing away of a substance or structure (such as a tooth), through some unusual or abnormal mechanical process.
  • abscess – A localized collection of pus within a tissue or a confined space.
  • absorption – The uptake or removal of substances into or through tissues, such as the biological removal of extruded sealer.
  • analgesia – Absence of sensibility to pain, designating particularly the relief of pain without loss of consciousness.
  • analgesic – Pharmacological agent used to reduce sensibility to pain.
  • anaphylactic shock – A severe, sometimes fatal, immediate allergic reaction, usually occurring seconds to minutes after exposure to an antigen, and mediated via histamine.
  • anaphylaxis – Immediate hypersensitivity response to antigenic challenge, mediated by IgE and mast cells, typically life-threatening.
  • anesthesia – The loss of feeling or sensation as a result of an anesthetic agent to permit diagnostic and treatment procedures.
  • apex – The tip or end of the root.
  • apexification – A method to induce a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulps.
  • apexogenesis – A vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end; frequently used to describe vital pulp therapy performed to encourage the continuation of this process.
  • apical scar – Dense collagenous connective tissue in the bone at or near the apex of a tooth with a distinctive radiolucent presentation; a form of repair usually associated with a root that has been treated surgically and noted to have perforation of both the facial and lingual osseous cortices.
  • attrition – The physiologic wearing away of a substance or structure, such as a tooth, in the course of normal use or parafunctional habits.
  • avulsion (exarticulation) – The complete separation of a tooth from its alveolus by traumatic injury; most commonly used in reference to dental injuries resulting from acute trauma.

B

  • bacteria – Members of a group of single-celled prokaryotic microorganisms; many of these are etiologic in diseases that affect all life forms including humans and other animals.
  • biofilm – The colonization and proliferation of microorganisms at a surface and solution interface.
  • biologic width – Combined width of connective tissue and epithelial attachment superior to adjacent crestal bone.
  • biopsy – The removal of tissue for histologic examination and diagnosis.
    • aspiration biopsy – Removal of fluid by suction through a needle for the purpose of establishing a diagnosis.
    • excisional biopsy – Removal of an entire lesion including a margin of contiguous, normal-appearing tissue for microscopic examination and diagnosis.
    • exfoliative biopsy – Removal of superficial layers of cells by scraping followed by fixation.
    • incisional biopsy – Removal of selected portion of a lesion for microscopic examination and diagnosis.
  • bite test – Diagnostic procedure in which a tooth suspected of being cracked is subjected to differential occlusal forces on individual cusps in an attempt to replicate the reported discomfort; usually accomplished by having the patient bite on various plastic, wood or rubber objects.
  • bleaching – The use of a chemical agent, sometimes in combination with heat, to remove tooth discolorations.
  • bonding – Procedure of using an adhesive, cementing material or fusible ingredient to combine, unite or strengthen.
  • bruxism – An oral habit consisting of involuntary rhythmic or spasmodic nonfunctional grinding or clenching of teeth.

C

  • canal, pulp (root canal) – A passage or channel in the root of the tooth extending from the pulp chamber to the apical foramen; may be narrow, have lateral branches and/or exhibit irregular morphology.
    • accessory canal – Any branch of the main pulp canal or chamber that communicates with the external surface of the root.
  • caries, dental – A localized and progressive bacterial infection that results in the disintegration of a tooth usually beginning with the dissolution of enamel and followed by bacterial invasion.
  • carious pulp exposure – See pulp exposure–carious pulp exposure.
  • cellulitis – A symptomatic edematous inflammatory process that spreads diffusely through connective tissue and fascial planes; frequently associated with an infection by invasive microorganisms with subsequent breakdown of connective tissue.
  • cementodentinal junction (CDJ, dentinocemental junction) – The region at which the dentin and cementum are united; commonly used to denote the point at which the cemental surface terminates at or near the apex of a tooth; position can range from 0.5 to 3.0 mm from the anatomic apex.
  • cementoenamel junction (CEJ, cervical line) – The region at which the enamel and cementum meet in the cervical region of the tooth; cementum may overlap the enamel; cementum and enamel may meet abruptly or a gap may exist.
  • cementum – A mineralized tissue covering the roots of teeth that provides a medium for the attachment of the periodontal fibers that connect the tooth to the alveolar bone and gingival tissues; composed of approximately 45–50 percent inorganic substances and 50–55 percent organic material and water; softer than dentin; histologically differentiated as cellular or acellular.
  • collagen – A genetically distinct family of structural macromolecules of the extracellular matrix that contains one or more domains assembled in a triple helix; these proteins form a wide variety of structures.
  • composite – An organic, polymerizable resin mix that typically contains inorganic particles treated with a bonding or coupling agent polymerized by light or chemical mechanisms.
  • concussion – A traumatic tooth injury characterized by tenderness to percussion and no mobility or displacement.
  • condensing osteitis – Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.
  • core buildup – A restoration used to replace missing coronal tooth structure in a root-filled tooth.
  • cracked tooth – A phenomenon involving posterior teeth in which fractures usually involve the marginal ridges; primarily in minimally restored mandibular first and second molars; symptoms may vary but pain to chewing and thermal sensitivity are common.
  • crown-lengthening – A surgical procedure designed to increase the extent of supragingival tooth structure for restorative or esthetic purposes by apically positioning the gingival margin, removing supporting bone, or both; may be accomplished by orthodontic or surgical extrusion.
  • curettage – A surgical procedure to remove diseased or reactive tissue and/or foreign material around the root.
  • cyst – An epithelium-lined pathologic cavity that may contain fluid, semi-solid material or cellular debris; oral and perioral cysts frequently classified as odontogenic, nonodontogenic, soft tissue and pseudocysts.

D

  • dental dam (rubber dam) – A small latex or non-latex sheet used to isolate a tooth or teeth from the oral environment and to prevent migration of fluids or foreign objects into or out of the operative field; single or multiple holes punched through barrier allow placement around the tooth or allow teeth to be isolated; provides a dry, visible and clean operative field.
  • dental (rubber) dam clamp (retainer) – A spring metal or plastic device that is placed around a tooth at the level of the gingival to secure a rubber dam in position; available in varying configurations to fit differing tooth shapes.
  • dentin – A mineralized tissue that forms the bulk of the crown and root of the tooth, giving the root its characteristic form; surrounds coronal and radicular pulp, forming the walls of the pulp chamber and root canals; composition is approximately 67 percent inorganic, 20 percent organic and 13 percent water.
  • diagnosis – The art and science of detecting and distinguishing deviations from health and the cause and nature thereof.
  • differential diagnosis – The process of identifying a condition by comparing the symptoms of all pathologic processes that may produce similar signs and symptoms.
  • digital radiography – Use of receptors to produce electronic radiographic images that can be viewed on a monitor and that allow for a reduction in radiation exposure.

E

  • edema – An accumulation of fluid in a tissue.
  • enamel – A mineralized tissue that forms a protective covering of variable thickness over the entire surface of the crown of the tooth. The hardest tissue in the human body, enamel provides a resistant covering suitable for mastication. Its composition is approximately 96 percent inorganic and 4 percent organic substance and water.
  • endocarditis – Inflammation of the endocardial surface of the heart.
  • endodontics – The branch of dentistry concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including the biology of the normal pulp and the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.
  • endodontist – A dentist with two or more years of advanced training in the scope of endodontics who has received a certificate in endodontics from an advanced education program accredited by the ADA Commission on Dental Accreditation and who limits his or her practice to endodontics. (Dentists who limited their practice to endodontics prior to recognition of the specialty in 1963 are also recognized as endodontists.) The endodontic specialist is responsible for the advancement of endodontic knowledge through research, the transmission of information concerning the most recent advances in biologically acceptable procedures and materials and the education of the public as to the importance of endodontics in keeping the dentition in a physiologically functional state for the maintenance of oral and systemic health.
  • etiology – Factors implicated in the causation of disease; may be local or systemic.
  • extrusion – Movement of a tooth in an incisal or occlusal direction; can be intentional, physiologic or traumatic; also extension of obturating materials beyond the apical foramen.
  • exudate – Fluid, cells and plasma proteins that have escaped from the vascular system and accumulated in a tissue or tissues; usually the result of inflammation.

F

  • file – See also reciprocating file; rotary file: A tapered and pointed metal instrument with cutting edges used to enlarge the root canal by rotation or filing action; classified principally on activation method, alloy, cross-sectional shapes, taper, tip design and length of cutting flutes.
  • fistula – An abnormal communication pathway between two internal organs or from one epithelial lined surface to another epithelial lined surface; not a sinus tract.
  • flap, surgical – A section of tissue, such as gingival mucosa, that has been partially detached from the underlying tissue but retains uninterrupted blood supply through an intact base; classified by position—apically positioned, lateral or vertical sliding; by geometric shape—curved (semilunar), rectangular, scalloped, trapezoidal or triangular; or by location of the incision—intrasulcular, submarginal or vertical.
  • flare-up – An acute exacerbation of an asymptomatic pulpal and/or periradicular pathosis after the initiation or continuation of root canal treatment.
  • fracture – A split or break in bone, cartilage or tooth structure; classified according to extent, location and type.
  • fremitus – A palpable movement of a tooth when subjected to occlusal forces.

G

  • gutta-percha – The purified coagulated exudate from the Palaquium gutta tree, commonly called the “mazer wood” tree, of the Burma and Malay archipelago.

H

  • Hank’s balanced salt solution – A balanced electrolyte solution commonly used for cell and tissue culture; has been shown to prolong the viability of periodontal ligament cells in cases of tooth avulsion.
  • hematoma – A localized collection of extravasated blood, usually clotted, that forms in a tissue, organ or space.
  • hyperalgesia – Increased pain sensation or lowered pain threshold that accompany an inflammatory reaction.

I

  • implant – Material inserted or grafted into the tissues of a host.
    • endodontic implant (endosseous implant) – A rod placed in the canal of the root of a tooth and extending into osseous tissues to stabilize the tooth in the dental arch.
    • osseointegrated implant (osteointegrated implant) – A direct structural and functional connection between bone and the surface of an immobile, load-bearing implant.
  • inflammation – The cellular and vascular response of tissues to injury.
  • informed consent – An agreement by the patient to have treatment rendered by the provider after the risks of the treatment, the results of no treatment, the alternatives to treatment and prognoses have been explained.
  • injection, intra-osseous – A technique in which the anesthetic solution is injected directly into the cancellous bone.
  • injection, intrapulpal (intraligamentary injection, ligamentary injection, PDL injection) – An injection of local anesthetic through the gingival sulcus into the periodontal ligament. The anesthetic solution is actually forced into the alveolar bone and therefore the PDL injection is an intra-osseous injection.

L

  • Ludwig’s angina – Severe, life-threatening infection, usually of odontogenic origin; arises if there is bilateral involvement of the submental, sublingual and submandibular spaces; is characterized by painful swelling of the floor of the mouth, tongue elevation, dysphagia, dysphonia and (at times) compromises the airway.
  • luxation – Displacement of a tooth from its original position in the alveolus, without total avulsion, resulting from acute trauma.

M

  • marsupialization (decompression) – The creation of a pouch; in endodontics, the surgical exteriorization of a large cyst by resection of a wall and insertion of a tube or other type of drain to decompress the lesion during healing.
  • mucocele – A cyst or cyst-like structure that contains mucous glycoproteins typically found in the lining of paranasal sinuses and salivary glands.

N

  • neuralgia – Pain that extends along the course of one or more nerves; many varieties are distinguished according to the body part affected or to the cause.
  • neurogenic inflammation – Stimulation and persistence of inflammation by the vasoactive properties of neuropeptides.
  • neuropeptides – A class of proteins produced by neurons which have inflammatory, sensory and vasoactive properties; examples of neuropeptides identified in the dental pulp include substance P, calcitonin gene-related peptide (CGRP) and neurokinin A. Neuropeptides are potent mediators of pulpal pain, inflammation and vascular dynamics.
  • nociceptor – A peripheral pain receptor; afferent nerve receptors that respond to multiple types of stimuli are termed “polymodal,” while those responding to temperature change are termed “thermoceptors” and those responding to mechanical change are termed “mechanoreceptors.”

O

  • obturate – To fill the shaped and debrided canal space with a temporary or permanent filling material.
  • Occupational Safety and Health Administration (OSHA) – A federal governmental agency assigned the responsibility to provide a safe working environment for employees by providing guidelines for the workplace. http://www.osha.gov
  • odontalgia – Pain originating from a tooth.
  • odontoblast – A highly-differentiated connective tissue cell found on the periphery of the dental pulp adjacent to the predentin; main function is the formation of dentin.
  • odontoclast – A multinucleated giant cell responsible for resorption of tooth structure; functionally and morphologically analogous to the osteoclast.
  • odontogenesis – Tooth formation; the origin and histogenesis of teeth; involves initiation, histodifferentiation, morphodifferentiation and apposition.
  • oil of cloves – a natural analgesic, antiseptic derived from the essential oil of the clove. Eugenol is the main ingredient.
  • osteomyelitis – Inflammation of bone marrow and adjacent bone caused by an infectious organism, usually the staphylococcus species; inflammation may remain localized or may spread throughout the bone to involve the marrow, cortex, cancellous tissue and periosteum. Chronic osteomyelitis may follow acute osteomyelitis and usually necessitates treatment with surgical and chemotherapeutic (antibiotics) intervention.
  • osteoporosis – A metabolic bone disease of variable etiologies that results in a net decrease in bone mass; characterized by disproportionate osteoclastic activity in cells.

P

  • pain – A multifactorial noxious experience that involves not only the sensory response but also modification by cognitive, emotional and motivational influences related to past experience.
    • referred pain – Pain that is interpreted to originate in a part of the body other than the actual site of origin.
  • paresthesia – A sensation such as burning, prickling or partial numbness caused by neural injury; sometimes follows acute traumatic injuries or infection to the teeth and jaws, root-end resection or overfilling of the root canal with impingement upon a nerve.
  • percussion – A diagnostic procedure used to assess the condition of a body part by means of tapping; painful response may indicate periradicular inflammation; variations in sound may indicate other periodontal ligament conditions.
  • periodontal ligament (PDL) – The highly vascular and highly cellular connective tissue that surrounds the roots of teeth and attaches them to the alveolar bone.
  • periodontitis (pericementitis) – Inflammation of the periodontium.
    • asymptomatic apical periodontitis – Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.
    • symptomatic apical periodontitis – Inflammation usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.
  • periodontium – The tissues that surround and support teeth, attaching them to the alveolar bone; includes bone, connective tissue, vascular and neuronal elements.
  • phantom tooth pain – Regional pain that continues in an area after tooth extraction, similar to phantom limb pain; pathophysiology includes deafferentation, nerve sprouting, neuroma formation and sympathetic efferent activity.
  • previously initiated therapy – A clinical diagnostic category indicating that the tooth has been previously treated and the canals are obturated with various filling materials other than intracanal medicaments.
  • previously treated – A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials other than intracanal medicaments.
  • pulp cap – Treatment of an exposed vital pulp by sealing the pulpal wound with a dental material such as calcium hydroxide or mineral trioxide aggregate to facilitate the formation of reparative dentin and maintenance of a vital pulp.
    • direct pulp cap – A dental material placed directly on a mechanical or traumatic vital pulp exposure.
    • indirect pulp cap – A procedure in which a material is placed on a thin partition of remaining carious dentin that, if removed, might expose the pulp in immature permanent teeth.
  • pulp chamber – The portion of the pulp space within the anatomic crown of the tooth.
  • pulp exposure – An opening in dentin that uncovers pulp.
  • pulp necrosis – A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.
  • pulp stone (denticle) – A calcified mass occurring within the pulp or attached to pulp space walls; classified as true or false denticles, according to composition and morphology, and free, adherent or interstitial denticles, according to their location in relation to the pulp space walls.
  • pulp test (pulp sensibility test) – A diagnostic procedure to determine pulpal status; can be performed with electrical, mechanical or thermal stimuli, or by the assessment of the blood supply to the tooth.
  • pulpalgia – Pain arising from the dental pulp.
  • pulpectomy (pulp extirpation) – The complete removal of the vital dental pulp.
  • pulpitis – A clinical and histologic term denoting inflammation of the dental pulp; clinically described as reversible or irreversible and histologically described as acute, chronic or hyperplastic.
  • pulpotomy (pulp amputation) – The removal of the coronal portion of a vital pulp as a means of preserving the vitality of the remaining radicular portion; may be performed as emergency procedure for temporary relief of symptoms or therapeutic measure, as in the instance of a Cvek pulpotomy.

R

  • radiolucency (rarefaction) – An area of darkness on a radiograph indicating that an object of low density is allowing complete or partial penetration by x-rays.
  • radiopacity – An area of lightness on a radiograph indicating that the density of an object is preventing penetration by x-rays.
  • replantation, tooth – The return of a tooth to its alveolus.
    • intentional replantation (extraction/replantation) – Insertion of a tooth into its alveolus after the tooth has been extracted for the purpose of performing treatment, such as root-end filling(s) or perforation repair.
  • resorption – A condition associated with either a physiologic or a pathologic process resulting in a loss of dentin, cementum and/or bone.

S

  • silver point (silver cone) – A rigid radiopaque cone produced from almost pure silver in a variety of sizes, usually corresponding to the diameters and tapers of root canal files; has been used to obturate root canals in conjunction with a sealer.
  • sinus tract – A pathway from an enclosed area of infection to an epithelial surface; opening or stoma may be intraoral or extraoral and represents an orifice through which pus is discharged; usually disappears spontaneously with elimination of the causative factor by endodontic treatment. The term fistula is often inappropriately used.
  • sodium hypochlorite solution (NaOCl) – A clear, pale, greenish-yellow, strongly alkaline liquid with a strong chlorine odor; has a solvent action on organic tissue and is a potent antimicrobial agent; used for irrigating root canals either in full strength or diluted solutions.
  • sodium perborate (NaBO3) – An odorless, white, crystalline solid that liberates oxygen in the presence of moisture; used either with water or hydrogen peroxide for intracoronal bleaching of discolored teeth.
  • surgical repositioning – Intentional loosening and realignment of a tooth in its alveolar socket; performed to manage coronal-third fractures, perforations or deeply placed tooth margins when extrusion or crown lengthening are contraindicated.
  • syndrome – A complex of signs and symptoms that together are pathognomonic of a particular disorder.

T

  • taurodontism – A dental morphologic variation in which the body of the tooth is enlarged and the roots are reduced in size; results in taurodont teeth with large pulp chambers and apically positioned furcations.
  • trephination – The surgical perforation of the alveolar cortical plate or apical foramen to release accumulated tissue exudate.

U

  • ultrasonic instrumentation – Preparation of the root canal system with a transversely oscillating diamond or file at a frequency above the audible range of perception (18,000 to 40,000 Hz); instruments activated by electrical current passing through arrangement of lamellar metal plates, creating alternating attractive and repulsive forces transformed into mechanical vibratory movement.
  • universal precautions – Methods designed for infection control to prevent transmission of bloodborne diseases, such as AIDS and Hepatitis B, in healthcare settings. These include engineering and work control practices, use of personal protective equipment, proper barrier techniques, bloodborne pathogen exposure control, sharps disposal system, hazard communication, and others.