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BDS4 Endo > Endo > Flashcards

Endo Flashcards

1
Q

Wha are the clinical objectives of RCT

A

Removing canal contents

Eliminating infection

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2
Q

What special tests can you carry out for a tooth that many have endo problems

A

Sensinility testing

-Cold sensibility with Ethyl Chloride
-Heat test with hot gutta percha (use vaseline)
-Electris pulp test (Primarily A-delta fast conducting fibres)

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3
Q

How do carry out a EPT

A

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

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4
Q

What does a EPT not show

A

No indication of reversibility of inflammation

No correlation between threshold and pulp condition

EPT of teeth with open apices unreliable

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5
Q

What happens in reversible pulpitis

A

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

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6
Q

What happens in symptomatic irreversible pulpitis

A

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

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7
Q

What happens in asympomatic irreversible pulpitis

A

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

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8
Q

What fibres in the pulp cause what type of pain

A

Alpha- Sharp pain

C fibres- Dull/aching pain

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9
Q

What are the differences between reversible and irreversible pulpitis

A

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

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10
Q

What are the different reatment options for necorsis of the pulp in mature teeth and teeth with open apex’s

A

Mature teeth (closed apices):
-Root canal treatment
-Extraction

Immature teeth with open apices
-Pulpotomy
-Pulpectomy then full RCT
-Extraction

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11
Q

What are the design objectives of endo

A

Create a continuously tapering funnel shape

Maintain apical foramen in original position

Keep apical opening as small as possible

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12
Q

Why use sodium hypochlorite as the irrrigant

A

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

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13
Q

What factors are important for sodium hypochlorite function

A

Concentration

Volume

Contact

Mechanical agitation

Exchange

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14
Q

What naOCL conc. is best

A

3%

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15
Q

What are problems with NaOCL

A

Possible effect on dentine properties

Inability to remove smear layer by itself

Effect on organic material

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16
Q

What can be used with NaOCL to remove smear layer

A

17% EDTA

10% Citric Acid

MTAD

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17
Q

What is the objective of RCT

A

To provide an environment that allows healing of periradicular tissues so that the tooth is retained as a functional unit in the dental arch

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18
Q

What are the design principles for chemomechanical disinfection described by Herbert Schilder in 1974 for root canal shaping

A

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

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19
Q

What are the clinical objectives of RCt

A

Remove canal contents and eliminate infection

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20
Q

What is the endo-restorative interface

A

To provide an enviroment that allows healing of periradicular tissues so that the tooth is retained in the dental arch as a functional unit

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21
Q

What contraindications are there for RCT

A

Myocardinal infarction within 6months

Prognosis of RCT worst in diabetes so carefully monitor

Pregnancy, RCT in first trimester emergency only

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22
Q

What type of mirrors used in endo

A

Front surface

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23
Q

What is the prognosis of orthograde endodontics in irreversible pulpitis and necrotic teeth

A

up to 90% over 10 yrs for IP

up to 80% for NT

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24
Q

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

A

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

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24
Q

What is the plexus of raschow and where does it origonate and what does it do

A

A network of nerves below the odontoblast layer in the pulpodentinal border zone of pulp

Originates from inf/sup alveolar nerves and innervate OD layer

25
Q

What seperates the plexus of raschow from the odontoblast layer

A

Cell free zone of Weil

26
Q

What happens to dentile tubules nearer the pulp and what about this is important for caries

A

Increase in number and diameter so the deeper the cavity the greater the dentine permability and thus the pulp getting buggered

27
Q

What nerves are in the dental pulp

A

Alpha fibres which give a sharp pain and stimulated by the EPT

C-fibres which give a dull ache

28
Q

What is vital pulp therapy

A

Protection of the pulp frpm bacteria, products and toxic setting materials

29
Q

What are materials used in vital pulp therapy and what must they be

A

Theu must adhere to dentine, Be thin, not dissolve and bacteria tight seal

ZOE
CaOH
Tricalcium phosphate
RMGI
Bioceramics e.g. MTA

30
Q

What does the mechanical preperation of a tooth in endodontics do

A

Creates space to allow irrigating solutions and medicants to move effectively to eliminate micro-organisms from RC

31
Q

What is NaOCL extrusion

A

It is when it is extruded beyond the RC into periradicular tissues

32
Q

What does NaOCL extrusion lead to

A

pain

swelling

Ecchymosis

Nerological complications

Airway obstruction

33
Q

What are the risk factors for NaOCl extrusion

A

Excessive pressure during irrigation

Needle locked within canal

Loss of control of working length

Larger apical diameters/constriction
-Root resorption
-Immature teeth
-Developmental anomalies

Anatomical factors/proximity to sinus

34
Q

How can excessive pressure lead to NaOCL extrusion and how is it prevented

A

Pressure generated by positive-pressure irrigation delivery systems at the periapex have to exceed the venous pressure in the superficial veins of the neck

Flow rate of 1mL/15 secs and use a Luer-Lok 27g needele to a 3ml syringe and use index finger

35
Q

Why are intra-canal medicants used

A

Between RC appt to destroy any remaining micro-organisms and prevent reinfection

36
Q

What intra canal medicants are there and describe them

A

Anti-microbial paste e.g. odontopaste
-Contains corticosteroid and tetracycline
-During ‘hot pulps’ to reduce pulpal inflammation
-effective 5 to 7 days

Non-setting CaOH
-pH 12.5 for antimicrobial activity
-Hyrdolysis of lipposaccharide reducing inf. potentional
-Removes tissue debris and effective with NaOCl
-7 days
-Palced via injection, Ultracal optident

37
Q

What is the aim of the instrumentation of a canal

A

Remove inf. soft and hard tissue

Give disinf. irrigants access to apical canal space

Create space for delivery of medicants and subsequent obturation

Retain integrity of radicular structures

38
Q

What is meant by chemomechanical preperation

A

Shaping of the canal mechanically to allow obturation and to allow delivery of NaOCL to working length

39
Q

What is the master apical file

A

The filer largest in diameter taken to calculated working length

40
Q

Whast types of motionss are there in canal instrumentation

A

Filing

Reming

Watchwinding

Balanced force

Envelope of motion

41
Q

Once shaping is complete of the roots what should you do

A

EDTA 17% for 1 min then NaOCL for 10mins

42
Q

What is the watch winding motion and what is it used with

A

Smaller instruments

Light apical pressure and oscillation of 30-60 clockwise and anti-clockwise

43
Q

What is balanced force and what is it used with

A

Bigger files to allow you to cut dentine with larger instruments and maintain safety of the instrument

Clockwise 90 with apical pressure and then anticlockwise >90

44
Q

What is meant by the glide path and when is it performed

A

Explore RC with small kfile to EWL

Is required to allow easier instrumentation of canal with larger diameters/tper instruments

Not performed until coronal flair established

Initial exploration with a 10kfile then a 15kfile using watch winding motion and then ensure at EWL on radiograph

45
Q

What is coronal falre

A

Created with gate glidden burs with each size advancing slightly more but make sure not more than 2/3 of RC

Use largest first then move down

46
Q

What is used to gague depth of access cavity and to identif canals

A

DG-16 probe

47
Q

What is the modified double flare technique and what does it do

A

Its a way to instrument the canal

Allows production of a continuesly tapering funnel shape prep and involves te development of a initial coronal flare and then a apical flare jined together

48
Q

What is meant by reciproc

A

Follows reciprocating movement of file with 2 differt angles of rotation to create a step wise rotary motion

49
Q

What are te angles of reciprocation

A

150 CCW 30CW

50
Q

Is it necessary to have a coronal flare with reciproc

A

no

51
Q

How do you select what drill to use in reciproc

A

Is the full canal fully visible on radiograph?

NO- R25

Yes- does a size 30 instrument inserted passively reach WL?

Yes- R50

No- does a size 20 instrument passively reach WL
yes-R40
no-R25

52
Q

What does filling of the RC do

A

Prevents passage of micro-organism and fluid along the RC

Blocks apical formina as well as dentinal tunules and accessory canals

53
Q

What must obturation materials be

A

Biocompatible
Dimensionally stable
Able to seal
Insoluble
Non-supportive of bacterial growth
Radiopaque
Removeable

54
Q

What is GP and what is it made out of

A

trans-isomer of polyisoprene

20% GP
65% zinc oxide
10% radiopacifier
5% plastisiser

55
Q

What operative factors contribute to success of a RCT

A

Filling extending to within 2mm of radiographic apex

Well condense and no voids

Good quality coronal restoration

56
Q

What are the laws of symmetry

A
  1. Except from maxiallry molars orifices of canals are equdistant from a line drawn in a mesial-distal direction through pulp chambers floor
  2. Except from MM orifices of canals lie on a line perpindicular to a line drawn in a MD direction across centre of pulp floor
57
Q

What are the laws of orifice

A

Orifices of RC’s are always located at junction of the walls and floor

Orifices of RC’s are located at angles in the floor wall junction

They are locatewd at the terminus of root developmental fusion lines

58
Q

When removing GP what could you use

A

Hand files and eucalptus oil if well condensed

If poorly condensed can use Hedstroem files

Protaper D’s

59
Q

What protaper D’s are used for GP removal

A

D1 for coronal filling removal

D2 for mid-root

d£ for apical

60
Q

What complications are there from endo

A

Blockages

Ledges

Apical damage e.g. zipping, transportation

Perforation

Fractures instrument

BDS4 Endo (2 decks)

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