Endo Flashcards
Wha are the clinical objectives of RCT
Removing canal contents
Eliminating infection
What special tests can you carry out for a tooth that many have endo problems
Sensinility testing
-Cold sensibility with Ethyl Chloride
-Heat test with hot gutta percha (use vaseline)
-Electris pulp test (Primarily A-delta fast conducting fibres)
How do carry out a EPT
Dry teeth and isolate
Probe place on incisal edge or cusp tip )pulp horn proximity)
Conducting medium used
Circuit completed
Current slowly increases until response
What does a EPT not show
No indication of reversibility of inflammation
No correlation between threshold and pulp condition
EPT of teeth with open apices unreliable
What happens in reversible pulpitis
Inflammation should resolve following appropriate management of the aetiology
Discomfort is experienced when a stimulus applied only lasting a few seconds
Exposed dentin (dentinal sensitivity), caries or deep restorations
No significant radiographic changes in the periapical region of the suspect tooth and the pain experienced is not spontaneous
Follow-up required to determine whether the “reversible pulpitis” has returned to a normal status
Although dentinal sensitivity per say is not an inflammatory process, all of the symptoms of this entity mimic those of a reversible pulpitis
What happens in symptomatic irreversible pulpitis
Vital inflamed pulp is incapable of healing and that root canal treatment is indicated
Characteristics may include sharp pain upon thermal stimulus, lingering pain (often 30 seconds or longer after stimulus removal), spontaneity (unprovoked pain) and referred pain
Pain may be accentuated by postural changes such as lying down or bending over
OTC analgesics typically ineffective
Common aetiologies may include deep caries, extensive restorations, or fractures exposing the pulpal tissues
Teeth with symptomatic irreversible pulpitis may be difficult to diagnose because the inflammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion
Dental history and thermal testing are the primary tools for assessing pulpal status
What happens in asympomatic irreversible pulpitis
Vital inflamed pulp is incapable of healing and that root canal treatment is indicated
No clinical symptoms and usually respond normally to thermal testing but may have had trauma or deep caries that would likely result in exposure following removal
What fibres in the pulp cause what type of pain
Alpha- Sharp pain
C fibres- Dull/aching pain
What are the differences between reversible and irreversible pulpitis
Reversible pulpitis:
-Pain to cold, lasts a short time
-Hydrodynamic expression- microleakage (A-fibres)
-No change in pulp blood flow
Irreversible pulpitis:
-Spontaneous pain, intermittent, sleep disturbance
-Negative to cold, pain to hot (e.g. tea/ coffee) (C-fibres)
-Increase in pulpal blood flow
What are the different reatment options for necorsis of the pulp in mature teeth and teeth with open apex’s
Mature teeth (closed apices):
-Root canal treatment
-Extraction
Immature teeth with open apices
-Pulpotomy
-Pulpectomy then full RCT
-Extraction
What are the design objectives of endo
Create a continuously tapering funnel shape
Maintain apical foramen in original position
Keep apical opening as small as possible
Why use sodium hypochlorite as the irrrigant
Potent antimicrobial activity
Dissolves pulp remnants and collagen
Only root canal irrigant that dissolves necrotic and vital tissue
Helps disrupt smear layer by acting on organic component
What factors are important for sodium hypochlorite function
Concentration
Volume
Contact
Mechanical agitation
Exchange
What naOCL conc. is best
3%
What are problems with NaOCL
Possible effect on dentine properties
Inability to remove smear layer by itself
Effect on organic material
What can be used with NaOCL to remove smear layer
17% EDTA
10% Citric Acid
MTAD
What is the objective of RCT
To provide an environment that allows healing of periradicular tissues so that the tooth is retained as a functional unit in the dental arch
What are the design principles for chemomechanical disinfection described by Herbert Schilder in 1974 for root canal shaping
Maintaining the original position and shape of the canal: This involves preserving the natural curvature of the root canal while shaping it to create a continuously tapering funnel from the coronal to the apical end
Creating a continuously tapering funnel shape from the coronal to the apical end: This involves shaping the canal in a way that ensures that all areas of the root canal are thoroughly cleaned and disinfected
Using a minimum of three instruments to achieve this shape: This involves using multiple instruments of increasing size to shape the canal and remove any remaining debris
What are the clinical objectives of RCt
Remove canal contents and eliminate infection
What is the endo-restorative interface
To provide an enviroment that allows healing of periradicular tissues so that the tooth is retained in the dental arch as a functional unit
What contraindications are there for RCT
Myocardinal infarction within 6months
Prognosis of RCT worst in diabetes so carefully monitor
Pregnancy, RCT in first trimester emergency only
What type of mirrors used in endo
Front surface
What is the prognosis of orthograde endodontics in irreversible pulpitis and necrotic teeth
up to 90% over 10 yrs for IP
up to 80% for NT
What form is there that helps with case selection of endo and what categories is there and when would a toth be in the other categories
AAE endodontic difficulty form
minimal= preop conditions indicate routine complexity and predictable outcomes
moderate= preop condition is complicated and at least 1 or more Tx factors listed in moderate difficulty
High= preop conditions exceptionally complicated expresssing several factors in moderate difficulty or at least 1 high factor