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BDS5 OSCE NR > Restorative+perio/ Tx planning > Flashcards

Restorative+perio/ Tx planning Flashcards

1
Q

perio dx
stage

A

severity of disease

1 - <15% bone loss or <2mm attachment loss

2 - coronal 1/3 of root

3 - mid third of root

4 - apical third of root

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2
Q

perio dx
grade

A

rate of progression

A - %bone loss/pt age < 0.5

B - %bone loss/pt age = 0.5-1.0

C - %bone loss/pt age > 1.0

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3
Q

currently stable

A

BoP <10%
PPD </=4mm
No BoP at 4mm sites

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4
Q

currenlty in remission

A

BoP </= 10%
PPD </= 4mm
No BoP at 4mm sites

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5
Q

currently unstable

A

PPD >/=5mm
PPD >/= 4mm and BoP

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6
Q

<10% BoP

A

clinical gingival health

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7
Q

10-30% BoP

A

localised gingivitis

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8
Q

> 30% BoP

A

generalised gingivitis

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9
Q

BPE 1

A

black band completely visible

no probing depths >3.5mm, no calculus/overhangs, no BoP

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10
Q

BPE 1

A

no probing depths >3.5mm, no calculus/overhangs,

but BoP

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11
Q

BPE 2

A

black band completely visible

no probing depths >3.5mm

supra-sub ginival calculus/overhangs present

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12
Q

BPE 3

A

probing depth(s) of 3.5-5.5mm present

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13
Q

BPE 4

A

black band entirely within the pocket

probing depth(s) of 6mm or more present

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14
Q

BPE *

A

furcation involvement

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15
Q

sytomatic irrversible pulpitis

symps

A

sharp pain on thermal stimulis
lingering pain
unprovoked/spontaneous
analgesia ineffective

causes: deep caires, extensive restorations, # exposing pulp

NEED RCTx

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16
Q

asymptomatic irrevsible pulpitis

signs

A

no clinical symptoms
responds to theraml testing

causes: trauma, deep caries, pulpal exposure

RCTx

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17
Q

symptomatic apical periodontitis

A

painful response to biting
TTP
radiographic changes poss

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18
Q

chronic apical abscess

A

gradual onset, little/no ttp, intermittent dischange of pus through sinus tract

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19
Q

acute apical abscess

A

rapid onset
spontanoeus pain
extreme TTP
pus foramtion and swelling

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20
Q

aymptomatic apical periodontitis

A

no TTP or pain on biting

radiographic changes present

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21
Q

condensing osteitis

A

diffuse radiopaque lesion at apex of tooth respresenting localised bony reaction to low grade inflammatory stimulus

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22
Q

why need cuspal coverage for endo tx tooth

A

more prone to fracture after RCTx

cuspal coverage will reduce this risk of fracture/failure and help provide a good coronal seal for the RCTx which will prevent microbial ingress

however - cost, more invasive sometimes (e.g. tooth destruction for crown), more than 1 appt (prep with imps, then fit), aesthetics can not be optimal if metal chosen

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23
Q

CHX

A

0.2%

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24
Q

NaOCl

A

3%

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25
Q

EDTA

A

17%

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26
Q

aims of perio tx

3

A

arrest the disease process
ideally, regnerate lost tissue
maintain perio health long term

RESULT= prevent tooth loss

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27
Q

perio therapy to aid restorative

A
  • Improves soft tissue management
  • Establishes stable gingival margin position
  • Contributes to aesthetics
  • Reduces tooth mobility
  • Informs prognosis
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28
Q

inflammed gingiva description

A
  • Linear band of gingival inflammation
  • Loss stippling
  • Puffy rolled margin

can be due to poor margins of restorations or plaque accumulation

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29
Q

why cannot do restorative before perio in tx plan

A

inflammed gingiva will bleed during operative procedures - moisture control issue
will be unstable in apico-coronal location

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30
Q

how long to monitor gingival margin before restorative

A

once deemed healthy perio (pockets </=4mm and <10% BOP and no BOP at 4mm sites)
monitor for 3-6months to allow gingval margin to stabilise

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31
Q

supracrestal attachment

A

histologically composed of the junctional epithelium and supracrestal connective tissue attachment

above crest of alveolar bone
average of 2mm – vary between people and sites in mouth

DON’T want to infringe on supracrestal attachment when placing margins
margins should be in gingival sulcus if any (top 0.5-1mm)

need at least 3mm from alveolar crest to margin to prevent inflammation

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32
Q

issue if margins encroach on supracrestal attachment

A
  • persistent inflammation - chronic gingivitis associated with margins
  • loss of attachemnet - pocketing and recession (leading to exposure of margin)

respect interdental papilla - follow contour
palatal can be supra

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33
Q

when not enought space between restoration margin and alveolar bone can

A

surgically crown lengthen

relocate supracrest attachement apically - remove none and manipulate flap
wait 6months to stabilise

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34
Q

Ante’s Law

A

combined periodontal area of the abutment teeth should be equal to or greater than teh periodontal area of the tooth/teeth being replaced

prevent overloading of abutments

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35
Q

optimal gingival aesthetics

A

Gingival zenith – most apical point of gingival marginal scallop

Gingival papilla – dip coronally interdentally

Approximation line of zeniths – canine to canine, touching central incisors, lateral incisors generally 1-2mm below
* Parallel to incisal edges of centrals

smile line - ave, high, low

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36
Q

minimising black triangles

A

acrylic gingival veneer
careful restorations - esp if low smile line - supragingival, make contact point still cleanable but mask black triangle when smiling

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37
Q

favourable post design

3

A
  • Parallel sided (avoids ‘wedging’)
  • Non-threaded (avoids incorporating stress)
  • Cement retained (buffer between masticatory forces post and tooth)
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38
Q

assessment of RCTz

A

did you do it? if not check notes

when was it done?
how was it done - dam, NaOCl
is it radiographically acceptable - length, condensed, missing canals
has it been leaking/ how long? (>3months needs redone)

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39
Q

masticatory load transfer of posts

A
  • Tapered posts act as wedges leading to root fracture
  • Parallel sided posts do not cause wedging
  • Posts retained solely by cement tend to distribute masticatory forces
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40
Q

when assessing tooth for indirect with core/post
options

3

A
  1. Build up core (anterior or posterior teeth)
  2. Fibre post – some dentine, so can build core chairside around it
  3. Cast post – so little dentine left and non-optimal ferrule
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41
Q

ferrule effect

A

place crown on, get some bracing in coronal portion of tooth where crown meets ferrule preparation and cement retains the crown in place
* Resistance to rotational force and leakage

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42
Q

core design

A

taper and length important
* 6 degree taper
* Length required - to allow 2mm clearance incisally for MCC

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43
Q

parapost kit

A

Provisional post (titanium)
* Use in conjunction with protemp and putty matrix to construct provisional post crown
* cut from apical end - leave nail head in place to retain temp; want 2mm short of incisal edge

Burn out post (not important)

Para post drill (colour coded)
* narrowest size is 0.9mm = GG3

Impression post
* Smooth sided
* Placed into the tooth when taking definitive impression for indirect cast post (put adhesive on)

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44
Q

why cuspal coverage for posterior RCTx teeth

A

Prevent catastrophic fracture
E.g. furcation

Maintain coronal seal

Prevents microbial ingress

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45
Q

subalveolar fracture is unrestorable because

4

A

unable to get adequate moisture control
restoration margins are subcrestal - impression margins for indirect not possible
tooth excessively mobile
pt maintainance difficult - access to cleaning

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46
Q

factors for bridge to debond

5

A
  • poor moisture control when cementing
  • unfavourable occlusion
  • parafunction (bruxism)
  • trauma
  • poor OH
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47
Q

NaOCl accident
how

A

Extrusion of the irrigant through the apical foramen to the surrounding soft tissues
* Could be due high pressure injection,
* locking syringe in the canal
* not measuring needle prior to use against radiograph (EWL -2mm)

onto tissue if dam seal inadequate

Causes inflammation in the surrounding tissues – swelling and increased blood flow and possible necrosis of tissue due to high pH (11)

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48
Q

NaOCl accident
management

A

Stop all tx
keep calm and try not to alarm pt, advise them what has happened

if out of dam - sit pt up and ask them to rinse multiple time with water (with dam in situ)

if there is pain - give LA as a block to area (not directly into area)

let canal bleed till haemostasis achieved

place steroid containing intracanal medicament (Ledermix) in canal with no pressure and temporarise

if acute respirartory or circulatory issues -> 999
if eye issues -> refer to hospital opthamology dept

report on DATIX

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49
Q

NaOCl accident
post op advice

A

alternative cold and warm compress to minimise swelling

analgesia (NSAIDs/Paracetamol)

review in 24hrs
review as may develop symptoms - haemotoma, mucosal/bone necrosis, suppuration, changes to nerve function, trismus, crepitus, eye bain

possible antiobiotcs is involvement of sinus, IDC, high risk bone necrosis

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50
Q

inhalation of foreign body

A

stop
keep calm and keep pt seated, inspect mouth to see if there
ask pt if aware of swallowing it
symptoms - difficulty or pain on swallowing, vomitting, retching, hypersalivation
encourage pt to cough - BLS; if uable to speak 999

pt unsure - search area

if object more than 5cm in length or sharp/long/pointed/inflexible -> refer to A&E

record on DATIX

give example of object with them for Doc to see

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51
Q

prevention of NaOCl accident

A
  • careful pre op radiographic assessment
  • PPE for pt – bib and eyewear; rubber dam
  • Ensure all syringes are labelled correctly
  • Use CHX to test seal of dam and possible use of Opaldam
  • Use of index finger for plunging syring
  • Do not fill syring to top (2/3-3/4 max)
  • Do not wedge the needle in the canal
  • Use of rubber stop on syringe so not going beyond EWL
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52
Q

size of post indications

4

A
  • No more than 1/3 root width
  • No more than 2/3 root length
  • At least ratio 1:1 with crown
  • 4-5mm GP apical remaining
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53
Q

methods of removing fractured post

6

A
  • Moskito forceps
  • Masseran kit
  • Ultrasonic
  • Eggler post removal
  • Sliding hammer
  • anthogyr
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54
Q

how to check to see bridge debonded

A
  • Press on it to see if there is movement or bubbles of saliva around wing
  • Probe around wing
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55
Q

factors to consider before placing a bridge

A

Health of abutment tooth
* Perio status
* Caries
* Root length

Occlusion

Length of span of proposed bridge

OHI of pt /motivation

56
Q

clincial assessment pre post placement

A

o Ferrule
o Coronal seal – any leakage/caries
o Is tooth restorable? Isolation possible
o Swelling
o Sinus
o TTP
o Mobility
o Increased pocketing – perio disease or root #

57
Q

radiographic assessment pre post placement

A

o Bone levels – mild, moderate, severe
o Root filling – length quality, quality of obturation
o Canals – shape (ideally straight), any missed canals
o Fractured instruments
o Crown to root ration 1:1.5
o Pathology -perforations, radiolucencies

58
Q

cavity prep principles

A

Access to carious

Remove the caries to see extent at the ACJ and smooth enamel margins

Once established extent peripherally, remove deeper caries over pulp

Modify cavity prep for restorative material and Outline form modification
* No sharp angles
* Possible bevel
* Retentive undercuts needed for amalgam

59
Q

criteria before can obturate

3

A

need to be able to dry canal
need to be asymptomatic
need to be fully biomechanically cleaned to working length

59
Q

how to assess RCTx on radiograph

A
  • Check to length – no more than 2mm short of radiographic apex
  • Condensed, No voids
  • Not extruded out apex
  • All canals filled
60
Q

GP constituents

6

A
  • gutta percha
  • Zinc oxide
  • Radiopacifies – barium salts
  • Waxes
  • Platisciers
  • Colouring agents
61
Q

function of sealer in RCTx

A

fill space between GP and root canal and go into lateral canals
provide a fluid tight seal

62
Q

common RCTx sealers

A
  • Zinc oxide eugenol
  • - Resin based
  • Calcium hydroxide
  • Calcium silicate
63
Q

methods of obturation

4

A
  • **Cold lateral compaction **
  • Warm vertical compaction
  • Thermoplastic injection
  • Thermofil
64
Q

% of upper 6s with MB2

A

93%

65
Q

design objectives of endodontics

3

A
  • Continuously tapering funnel
  • Keep apical foramen size
  • Maintain apical location
66
Q

advantages of crown down technique

5

A
  • Removes bulk of infected tissue,
  • reservoir for irrigant,
  • keeps reference point for WL,
  • makes straight line access easier,
  • limits spread of infected material at apical foramen
67
Q

laws of pulpal floor anatomy

A
  • law of colour change – pulp floor is darker
  • law of symmetry 1 – orifices lie equidistant from MD line through chamber (expect max. molars),
  • law of symmetry 2 – orifices lie perpendicular on MD line (except max.molars).
68
Q

rules for locating orifices in pulpal floor

3

A

always at junction of pulp floor and wall
always at angle of floor and wall
always at terminals of developmental fusion lines

69
Q

reasons for chemical irrigation during endo tx

6

A
  • Chemical disinfection is needed as mechanical doesn’t remove all debris
  • Reaches areas files cannot reach
  • Flush out debris made during instrumentation
  • Dissolves organic and non organic matter
  • Removes smear layer (EDTA)
  • Lubrication
70
Q

sodium hypochlorite properties

A

3%

Dissolves inorganic and organic tissue (pulp, collagen, vital and necrotic debris)

71
Q

Ledermix

A

antibiotic and steroid mix, used when there is inflammation/hyperaemia pulp, works for 5-7days

72
Q

non setting CaOH (ultracal)

A

antibacterial, cannot be left in pulp long periods as can weaken tooth structure

73
Q

landmarks for IDB

A
  • Pterygomandibular raphe
  • 1cm occlusal plane
  • Thumb on coronoid notch
  • Fingers on outer border of ramus mandible
  • Angulation over contralateral premolars
74
Q

management if into parotid when IDB

A
  • Check if they can raise their brown – assess if stroke
  • Explain the situation, apologise and reassure,
  • Give eye patch advise on eyedrops possibly to prevent drying out
  • Advice on length of time of paralysis (likely 3-5hrs soft tissue)
  • Refer/ got to A&E if longer than this

too far posteiror injection

75
Q

RCP

A

retruded contact position

  • Reproducible mandibular position when condyles are in their most posterior superior position in the mandibular/glenoid fossa
  • Used as can be repeated for different appointments when checking occlusion for indirects/dentures
76
Q

new composite but has senstivity why

5

A

High in occlusion
* Check with articulating paper

Monomer not cured sufficient at base
* Ensure correct light cure used for material and time (2mm depth)

Encroaching on pulp with prep
* Use of liner e.g. CaOH vitrebond (RMGI)

Polymerisation contraction stress
* Use small increments that do not bond more than 2 walls together

Cracked tooth syndrome
* If large restoration plan in advance for indirect to prevent possible # with cuspal coverage

77
Q

overhang amalgam
why
issues
how to fix

A

why - poor matrix band adapation, wedge not used, inadequate condensing of amalgam
problems - plaque trap (secondary caries), gingval issues -perio bone loss
management -remove amalgam section and repair or removal of all and replace

78
Q

functions of facebow

A
  • Transfers relationship of maxillary teeth to mandibular condyles (axis of rotation)
  • Positions casts accurately when pt not present (in correct anatomic relationship for pt)
  • Measure intercondylar distance
  • Transfers the angulation of the maxillary occlusal plane in relation to a horizontal reference plane
79
Q

principles of crown prep

6

A
  • Preservation of tooth structure
  • Renetion and resistance
  • Structural durability
  • Marginal integrity
  • Prevsation of periodontium
  • Aesthetic considerations
80
Q

acquacem
for

A

glass ionomer cement

MCC, metal post+core, zirconia crown, gold crown, stainless steel crown

81
Q

glass ionomer cement
reaction
mix

A

acquacem

acid base reaction

1 scoop to 2 drops water
mix on glass slab ideally as exothermic reaction
mix 15secs
set- 3.5-9mins (approx 5mins); fully set over 24hrs

82
Q

properties of GI luting cement

5

A

acquacem

  • high compressive strength
  • low solubility
  • biocomplatible
  • fluoride release
  • chemically bonds to tooth
83
Q

why RMGI not as good for luting cement

A

polymersiation contraction stress, and HEMA absorbs and swells

84
Q

panavia
what
use

A

anaerobic cure compoiste

used for adhessive resin bridge (RBB)

85
Q

how to use panavia

A

Own kit with etch and bond kept in fridge
Bonds to enamel

  • Use Opaque panavia,
  • have sandblasted wing
  • Etch tooth lingual surface for 30s, wash dry, Re-etch for 60s, wash dry
  • Mix A and B primer for 3-5secs, Apply to tooth and evaporate after 60s with gently air
  • One full turn of Panavia paste until it clicks, mix 20-30secs
  • Place panavia onto metal wing and apply to the tooth with finger pressure, after 60secs release pressure and remove excess with brush tip
  • OXYGUARD at margins 3mins then wash off, remove excess and polish with pumice (enables complete curing)
86
Q

panavia properties

A

high bond strength
low working strength
easy removal of excesss
most aesthetics

87
Q

NX3
what
use

A

dual cure composite

fibre post, veneer, composite inlay, porcelain inlay

resin so can bond to composite

88
Q

NX3
properties

A

excellent aesthetics
good mechanical properties
low solubility
high bond strength

89
Q

bonding to porcelain

A

Prep porcelain
* Porcelain needs etched with HF acid to roughen surface – this allows micromechanical retention
* Silane coupling agent is applied to porcelain - This is a bifunctional molecule. Inc surface energy of porcelain to allow resin bonding
* One binds to roughened porcelain whereas other binds to the comp resin cement

Tooth
* Etch tooth, wash away, apply bond

Apply resin to restoration, place, clean excess and light cure

90
Q

RelyX unicem

yellow

A

Self etching comp resin cement
* Easy to use
* Requires good moisture control
* Doubt about bond strength to enamel due to inadequate etching

Porcelain or composite

91
Q

RelyX Luting+

pink

A

For: composite onlay, metal,
* As it’s a resin it bond to composite

Resin modified luting cement

Easy to use

92
Q

MCC properties

A

Stronger than all
More aesthetics compared to all metal
More durable
Cheaper
Less destructive to tooth tissue compared all ceramic
Metal may became visible

bond with acquacem (GI cement)

93
Q

all metal crown properties

A

Gold or Stainless steel

Least amount of prep
Aesthetics
Strongest

bond with acquacem (GI cement)

94
Q

all ceramic crowns properties

A

Lithium disilicate – zirconia (stronger)

Good aesthetics
More likely to fracture
Can be abrasive
£££
Most destructive to tooth tissue

bond with nexcus (dual cure composite)

95
Q

RBB properties

A

Minimal/ nil prep
Debond
Secondary caries
Jeopordises health of retainer tooth
Heavier on occlusal load on abutment

Mesial cantilever preferred, distal abutment

96
Q

conventional bridge properties

A

Tooth prep
Needs to parallel
Non vital risk in 20% 5 years

97
Q

onlay material options

3

A

ceramic
metal
composite

98
Q

pre-cementaion checks
out of mouth

A

check correct pt

check pt cast - right tooth

check on cast
* rocking
* contact points - ensure adj teeth are in tact
* marginal integrity - ensure adj teeth are in tact
* aestheics
* occlusion - check natural contacts without crown and with crown are the same
* metal defects - cracks, breakages, blebs

remove from cast and check with callipers
* metal 0.5mm
* porcelain 1mm
check if tooth underprepped (functional cusp will need extra 0.5mm palatal upper, buccal lower)

99
Q

pre-cementation checks
try in

A

LA if vital tooth
remove provisional restoration and cement (US)

sit pt up, protect airway with butterfly spong or gauze
passive fit - don’t force; no tissu blanching

check contact points
check margins flush
check occlusion

100
Q

post cementation checks

A

excess cement removed
no space around margins
interporximal contact point exists and is clear
occlusion checked with articulating paper (in excursion as well)
restoration cleansable
confirm pt happy with aesthetics and feel

101
Q

indirect fails to seat

management

A

clinical faults - incolplete removal of temporary, gingival tissue encroachment (poor temp), distortion of impression (tray/time/storage)

lab faults - interproximal overextension, marginal overextension, resin epxansion, bleb on fitting surface

1 - check IP with floss for overextension or underextension - want good to prevent food pack
2 - check and adjust fitting surface (occlude spra)
3 - assess marginal fit - check for marginal leakage, overhang, remake

102
Q

articulating paper thickness

A

millers forceps
40micron

103
Q

shimstock thickness

A

8microns

104
Q

resorption types

A

internal inflammatory
internal replacemtn
external inflammatory
external surface resorption
external replacement resoprtion
external cevical resorption

105
Q

internal inflammatory resorption

A

incidental finding

coronal part necrotic, apical part vital bit will progress to necrotic
(inflammatory giant cells)

tx - orthograde RCTx

106
Q

inernal replacement

A

pulp chamber has radiopacities - being replaced by bondy mineralised tissue (dentine, cementum mix)

hard to tx 0 accept and monitor

107
Q

external surface resorption

A

mobile teeth
PDL intact, no PA radiolucency

RCTx not indicated as pulp healthy
splint mobile teeth

90% of ortho tx teeth

108
Q

external inflammatory resorption

A

pulp is necrotic so inflammation going on around it
persistent periapical radiolucnecy - apex nibbled away by chronic inflammation

tx - orthograde RCTx, surgical endo

109
Q

external replacement resorption

A

high pitch/metallic notes
no mobility
root disappearing and getting filled with bone
loss of PDL
trauma common aetiology

Tx - decoronation if infraocclusion >1mm in growing pt to perserve bone volume
or if stopped growing - mask with comp

110
Q

external cervical resorption

A

profuse BOP
pink spot
subgingival cavity hard to probe
radiographically - apple cores out from CEJ, can still see tramlines

Tx - monitor, resorption will cont
internal repair and orthograde endo
XLA and replace

111
Q

perio abscess in perio pt

(pre-existing pocket)

A

acute exacerbation
* untx perio disease
* non resposive to perio therapy
* supportive perio therapy

after tx exacerbation
* post scale
* post surgery
* post medication

112
Q

perio abscess in non-perio pt

A
  • impaction (Dental floss, ortho elastic, tooth pick, rubber dam etc)
  • harmful habits - nail biting
  • orthodonitc factors - ortho forces or crossbite
  • gingival overgrowth
  • alteration of root surface (root damage, resorption, invaginated tooth, developmental grooved, perforation)
113
Q

perio endo lesions

classifcations

A

ENDO PERIO LESIONS WITH ROOT DAMAGE
* ROOT FRACTURE OR CRACKING
* ROOT CANAL OR PULP CHAMBER PERF
* EXTERNAL ROOT RESOPRTION

ENDO-PERIO LESION WITHOUT ROOT DAMAGE
* ENDO PERIO LESIONS IN PERIODONTITIS PTS
GRADE 1 – NARROW DEEP PERIO POCKET IN ONE TOOTH SURFACE
GRADE II – WIDE DEEP PERIO POCKET IN ONE TOOTH SURFACE
GRADE III – DEEP PERIO POCKET IN MORE THAN 1 TOOTH SURFACE
* ENDO PERIO LESIONS IN NON PERIO PT
GRADE I – NARROW DEEP PERIO POCKET IN 1 TOOTH SURFACE
GARDE II – WIDE DEEP PERIO POCKET IN 1 TOOTH SURFACE
GRADE III – DEEP POCKET IN MORE THAN 1 TOOTH SURFACE

114
Q

MPBS

A

ramfjord teeth - 16, 21,24, 36,41,44

MBS - want less than 35%
MPS - want less than 30%
or >50% improvement

115
Q

6PPC records

A
  • gingival margin (-ve inflammation, +ve for recession)
  • pocket depth
  • BOP
  • mobitily
  • furcation
  • missing teeth

LOA= pocket depth + gingival margin

116
Q

review 6PPC

A

dots in sites <4mm
record sites >/=4mm, BOP, mobility, furcation

117
Q

implant care re perio

A

Baseline PAs for comparison

BPE not appropriate for peri-implantitis
* Examine for inflammation, BOP, suppuration, sub-mucosal deposits
* baseline probing depths measured with fix landmark

SDCEP prevention and tx of perio disease in primary care 2014

118
Q

notes and consent for perio

A

detail all findings,
* Pt C/O,
* provisional and final dx,
* tx options - BRAN,
* advice – risks of disease etc, referrals, recall interval.
* If pt declines tx or is uncooperative record

Consent to perio tx – explain disease process, their role, chronic condition, perio stable before advanced tx
Risk Factors – smoking, stress, poorly controlled diabetes, alcohol

119
Q

RCTx procedure

A
  • multiple appts
  • LA - topical gel, injection
  • rubber dam - isolation, moisture control, airway protection, prevents NaOCl incident, test with CHX
  • radiographs required - pre, during and post tx
  • access with high speed and slow speed - remove any caries
  • files - to clean and shape
  • irrigation - NaOCl (bleach) throughout and EDTA at the end
  • canal dried with paper points
  • intracanal medicament - resolves infection/symptoms
  • obturation - GP root canal filling, coated in sealer packded with accessory points and heat used to seal off
  • lining material placed to seal the canal
  • restoration - temporary or permanent (ideally cuspal coverage)
120
Q

prognosis for RCTx

A

90% over 10 years for teeth with irrversible pulpitis
80% over 10years for teeth with necrosis

every time reRCTx go down by 10%

be specific for case

121
Q

alternatives for RCTX

A

no tx
XLA
orthograde RCTx
retrograde RCTx

122
Q

RCTx risks

A
  • instrument separation
  • failure to negotiate canals to WL
  • NaOCl accident
  • material extrusion
  • post-op pain
  • post-op swelling
  • need for pain control/analgesia after appts
  • perforation - out the side of the tooth
  • root #
  • failure to resolve symptoms
  • £££
123
Q

benefits of RCTx

A
  • resolution of infection and symptoms
  • retain tooth
  • no loss of abutment potential
124
Q

direct pulp capping

closed apex

A

vital symptom free tooth
* isolate under rubber dam if anticipate close to pulp
* irrigate with saline
* cleanse with CHX 0.2%
* blot dry with cotton wool pledgets
* cover exposure with hard setting calcium hydroxide (Dycal)
* cover with RMGI (Vitrebond), cure, place restoration
* KUO if any pulpal symptoms arise -> RCTx

125
Q

perforation what to do

A

stop - explain to pt want to asses how prep going and possible perforation may have occured

take PA to assess position and size of perf

determine why it has happened

explain when doing tx a hole was made at side of tooth adn now going to assess if we can seall off

pulp chamber
* small - stop bleeding, MTA and GIC
* larger - still restorable - MTA and GIC; unrestoratbel - XLA, hemisection

lateral perf
* gingival 1/3 - restore temporarily then crown/ onlay as normal (Subging on sound tooth)
* middle 1/3 - clean and shape from opposite side of perforation, cold lateral compaction to occlude
* larger - XLA, hemisection

apical 1/3
* apicetomy

DWP options to replace the space

126
Q

fractured instruments

A

introduce self and designation

explain - file separated in canal of tooth, thin metal file used to clean out pulp tissue and shape canal, can separate in tight/curved areas

do what you feel comfortable with and able to do
* dress, monitor and refer
* attempt to remove with tweezers
* dislodge adn remove the broken file with US
* bypass by watch winding small file alongside and EDTA to soften
* RCTx and monitor
* retrograde RCTx - apecitomy, peri-radicular
* XLA

any Qs?
do you understand?

127
Q

protaper hand files sequence

A

S1
Sx
S1
S2

F1 = 20k
F2 = 25k
F3 = 30k
F4 = 40k
F5 = 50k

protaper gold are rotary - 300rpm, 2nm torque

128
Q

when to use rotary files

A

used to widen canals after being intially explored with k files - glide path created

129
Q

failed RCTx why

3 categories

A

GP
* overfilled
* underfilled
* poorly compacted

prep
* canals missed
* inadequately prepped (short)
* perforation
* extrusion of debris
* file fracture

other
* traumatic root fracture
* poor coronal seal

130
Q

tx options for failed RCTx

A
  • KUO - infection may flare up later
  • retreatment - success chance decreased, if post present increased risk of fracture
  • periradicular surgery - if retreatment not possible, invasive, time consuming, £££, specialist
  • XLA - tooth loss, need replacement or nonfunctional
131
Q

non setting CaOH
properties

A

pH 12.5
high pH contributes to antibacterial activity
prolonged anti-bacterial
anti-inflammatory

Ultracal

setting - Dycal

132
Q

ledermix

A

is antibacterial and steroidal

used for hot pulps

133
Q

Kalzinol

A

ZOE

cannot place composite after
antibacterial
analgesic

134
Q

drugs which cause gingival hyperplasia

A

anticonvulsant (phenytoin),
immunosuppressant (cyclosporine A)
various calcium channel blockers (nifedipine, verapamil, diltiazem).

135
Q

tx plan stages

A

imediate - pain
initial - disease control
re-eval - assess disaese activity
recon - once disease under control can do indirects etc
maintenance - on going care

BDS5 OSCE NR (11 decks)

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