Table Of ContentYOU’VE JUST PURCHASED
MORE THAN
A TEXTBOOK!
Evolve Student Resources for Chong: Harty’s Endodontics in
Clinical Practice, 7th Edition, include the following:
• Self-assessment section:
140 MCQs
16 Clinical cases with images
Activate the complete learning experience that comes with each
textbook purchase by registering at
http://evolve.elsevier.com/Harty/endodontics/
REGISTER TODAY!
You can now purchase Elsevier products on Evolve!
Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products.
2015v1.0
Harty’s Endodontics in
Clinical Practice
This page intentionally left blank
7th Edition
Harty’s
Endodontics in
Clinical Practice
Edited by
Bun San Chong
BDS, MSc., PhD, LDS RCS(Eng), FDS RCS(Eng), FDS RCS(Edin),
MFGDP(UK), MRD, FHEA
Specialist in Endodontics,
Professor of Restorative Dentistry/Honorary Consultant,
Endodontic Lead and Director, Postgraduate Endodontics,
Barts and The London School of Medicine and Dentistry,
Queen Mary University of London,
London, UK
Illustrations by
Antbits
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2017
© 2017 Elsevier Ltd. All rights reserved.
First edition 1976
Second edition 1982
Third edition 1990
Fourth edition 1997
Fifth edition 2004
Sixth edition 2010
Seventh edition 2017
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
ISBN 978-0-7020-5835-6
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient and
to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors or editors assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the
material herein.
For Elsevier
Content Strategist: Alison Taylor
Content Development Specialist: Sally Davies
Project Manager: Andrew Riley
Designer/Design Direction: Miles Hitchen
Illustration Manager: Nichole Beard
The
publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China – amend as necessary
Preface
The challenge of preparing a new, seventh edition of available for acquisition of practical, clinical skills.
this long-established book is a valued opportunity to Nevertheless it is important to ensure that students
review the current state of the science and art of endo- and new graduates should not only be conversant in
dontics. It is also an occasion to reflect on my personal managing common endodontic problems but also be
connection with, and to acknowledge, my predeces- able to recognize, where appropriate, the need for
sors. Fred Harty, whom this book is named after, was referral to a specialist. A growing number of patients
responsible for the first three editions and Tom Pitt can continue to benefit from management of challeng-
Ford for the next two editions. Apart from academia, ing or complex endodontic cases by specially trained
I have been a specialist in endodontics for over 25 practitioners and can expect to enjoy a favourable
years in the practice founded by Fred. Until the treatment outcome.
untimely loss of Tom, I had the privilege of working The international flavour of the list of contributors
with him for over 20 years. is recognition that there are no boundaries when it
The aim of this book remains the same: to be an comes to improving patients’ oral health and achieving
authoritative guide to proven, current clinical endo- equity in healthcare. However, given the international
dontic practice. Since it is imperative that practition- spectrum and the number of contributors, it is inevi-
ers keep up to date, this book is also intended for table that there will be some duplication of material
dental practitioners seeking to update or expand their in this book. This should be viewed as beneficial rein-
knowledge – to help and support especially those forcement of relevant information. Different contribu-
who have chosen to embark on postgraduate educa- tors will also have different writing styles and preferred
tion courses, or wishing to acquire extended skills, in terminology but, hopefully, not at the expense of
endodontics. clarity and cohesion.
Despite the recognition and the establishment of a I am grateful to the contributors for providing their
specialist list in endodontics in the United Kingdom perspective on, and for updating, the topics covered
in 1998, there are still insufficient specialists available in this new edition. I wish to express my appreciation
to treat all endodontic cases. Hence, endodontic treat- to contributors to the previous edition. I would also
ment will continue to be carried out mostly in general like to thank the team at Elsevier including Alison
dental practice, or other primary care settings. The Taylor and Sally Davies. Once again, I acknowledge
demands of the recently introduced new undergradu- the patience and understanding of my family, Grace,
ate dental curriculum in the United Kingdom has James and Louisa.
meant that, in an increasingly crowded time-table,
while time dedicated to learning activities related B. S. Chong
to theoretical knowledge may be unaltered, less is 2017
v
This page intentionally left blank
Contributors
Cecilia Bourguignon DDS, Cert Endo(UPenn), Michael P. Escudier MD, MBBS, BDS, FDS
Foundation Fellow of IADT RCS(Eng), FDS(OM) RCS(Eng),
Specialist in Endodontics, FFGDP(UK), FHEA
Paris, France Reader/Honorary Consultant in Oral Medicine,
King’s College London Dental Institute,
Josette Camilleri BChD, MPhil, PhD, FIMMM,
London, UK
FADM
Associate Professor, Department of Restorative Massimo Giovarruscio DipDent(Rome)
Dentistry, Specialist in Endodontics/Clinical Teacher,
Faculty of Dental Surgery, University of Malta, King’s College London Dental Institute,
Msida, Malta London, UK
Nicholas P. Chandler BDS, MSc., PhD, LDS James L. Gutmann DDS, Cert Endo, PhD, FICD,
RCS(Eng), FDS RCPS(Glas), FDS RCS(Edin), FACD, FADI, FAHD
FFD RCSI Professor Emeritus,
Associate Professor of Endodontics, Baylor College of Dentistry, Texas A&M University,
School of Dentistry, University of Otago, Dallas, Texas, USA
Dunedin, New Zealand
Michael Hülsmann Dr med dent, PhD
Bun San Chong BDS, MSc., PhD, LDS RCS(Eng), Professor, Department of Preventive Dentistry,
FDS RCS(Eng), FDS RCS(Edin), MFGDP(UK), Periodontology and Cariology,
MRD, FHEA Dental School, University of Göttingen,
Professor of Restorative Dentistry/Honorary Göttingen, Germany
Consultant,
Francesco Mannocci MD, DDS, PhD
Endodontic Lead & Director, Postgraduate
Endodontics, Professor of Endodontology/Honorary Consultant,
Barts and The London School of Medicine and King’s College London Dental Institute,
Dentistry, London, UK
Queen Mary University of London,
Isabela N. Rôças DDS, MSc, PhD
London, UK
Professor, Department of Endodontics and Head,
Paul R. Cooper BSc, PhD Molecular Microbiology Laboratory,
Professor of Oral Biology, Faculty of Dentistry, Estácio de Sá University,
School of Dentistry, University of Birmingham, Rio de Janeiro, Brazil
Birmingham, UK
Ilan Rotstein DDS
Henry F. Duncan BDS, MClinDent, MRD RCS(Edin), Professor/Associate Dean, Continuing Education and
FDS RCS(Edin) Chairman,
Assistant Professor/Consultant in Endodontics, Endodontics, Orthodontics and General Practice
Division of Restorative Dentistry, Residency,
Dublin Dental University Hospital, Trinity College Herman Ostrow School of Dentistry of USC,
Dublin, University of Dublin, University of Southern California,
Dublin, Ireland Los Angeles, California, USA
vii
vviiiiii Contributors
Edgar Schäfer Dr med dent, PhD Simon J. Stone BDS, PhD, MFDS RCS(Edin), FHEA
Professor/Head, Central Interdisciplinary Ambulance, Clinical Lecturer in Restorative Dentistry/Honorary
School of Dentistry, University of Münster, StR in Endodontics,
Münster, Germany School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
Asgeir Sigurdsson Cand Odont, MS, Cert Endo(UNC)
Associate Professor/Chairman, John M. Whitworth BChD, PhD, FDS RCS(Edin),
Department of Endodontics, New York University FDS RCS(RestDent)
College of Dentistry, Professor of Endodontology/Honorary Consultant in
New York, USA Restorative Dentistry,
School of Dental Sciences, Newcastle University,
José F. Siqueira Jr DDS, MSc, PhD
Newcastle upon Tyne, UK
Professor/Director, Department of Endodontics,
Head, Molecular Microbiology Laboratory, Ferranti S. L. Wong BDS, MSc, PhD, FDS
Faculty of Dentistry, Estácio de Sá University, RCS(Edin), FDS RCS(Eng), FHEA
Rio de Janeiro, Brazil Professor/Honorary Consultant in Paediatric
Dentistry,
Anthony J. Smith BSc, PhD
Barts and The London School of Medicine and
Emeritus Professor, Dentistry,
School of Dentistry, University of Birmingham, Queen Mary University of London,
Birmingham, UK London, UK
