Isolation and File ID Flashcards

1
Q

what does the rubber dam protect from

A

patient from swallowing or aspirating instruments and materials

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2
Q

the dental dam is defined as:

A

standard of care

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3
Q

effective isolation crucial to:

A
  • RCT success
  • patient protection
  • provider protection
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4
Q

what is one of the basic objective of successful contemporary RCT

A

the elimination of micro orgranisms within pulpal spaces

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5
Q

can you eliminate micro organisms in the presence of saliva

A

no it is impossible

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6
Q

what can ensure the absense of saliva in the surgical field

A

only a properly applied dental dam

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7
Q

failure to eliminate salivary leakage by proper placement of the rubber dam creates:

A

salivary contamination

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8
Q

what can salivary contamination cause and how

A

life threatening cellulitis by introducing additional micro- organisms which can greatly complicate the infection

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9
Q

what will cause NaOCl to leak into the mouth as you irrigate

A

if saliva is not effectively sealed by dam placement

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10
Q

what is 8.3% NaOCl commonly used for

A

flushing out debris and cleaning the prepared canal system

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11
Q

what are latex dams available in

A

black, white, blue, green color in various weights and thickness
- non latex dams also available in the clinic

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12
Q

which type of rubber dam frame should you select

A

one which is radiolucent so you can leave it in place when taking radiographs

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13
Q

how many teeth should be isolated with the rubber dam

A

isolate only the tooth to be treated

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14
Q

should you take the rubber dam off and frame off when taking radiographs

A

no

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15
Q

what is the “butterfly” labial clamp useful for

A

most anterior teeth and even some premolars

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16
Q

how are clamps without wings used

A

placed first on the tooth with the RD later stretched over the clamp and tooth

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17
Q

what tooth is rubber dam clamp #212 designed for

A

anterior tooth

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18
Q

how do you place the clamp

A
  • once dam is securely placed below the height of contour of the tooth, push the dam off the wings of the clamp
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19
Q

where should the clamp rest

A

at the cervical line below the height of contour to be adequately retained

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20
Q

when is it difficult to retain clamps over the height of contour

A

with young or partially erupted teeth

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21
Q

what happens when the dam has not been released from the wings of the clamp

A

leaks

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22
Q

even after the dam is released from the wings of the clamp, it may be necessary to use some type of ________ around the tooth to ensure isolation

A

sealing agent to caulk

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23
Q

what sealing agent can be used to caulk around the tooth

A

Oraseal by Ultradent

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24
Q

when would you use a caulk- seal agent

A

if you have any idea that leakage might occur

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25
Q

what do you do if you are unable to achieve 100% effective isolation of the tooth to be treated

A
  • provisionally restore tooth to obtain isolation base
  • clinical crown lengthening procedure
  • refer to endo specialist
  • if still cant treat, consider alternate treatment modality
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26
Q

if you cannot place an effective rubber dam:

A

you cannot do a RCT on the tooth

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27
Q

a badly broken tooth requiring RCT is covered with ____

A

hyperplastic gingiva

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28
Q

what must you do to a badly broken tooth before RCT

A

build up

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29
Q

how can you excise the gingiva to cover the badly broken tooth

A

electrosurgery, laser, or conventional surgery

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30
Q

what may excision of gingiva do

A

expose sufficient tooth structure to be able to place a clamp and isolate with dental dam to allow for RCT

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31
Q

what is the split dam technique

A

cant place a clamp on the tooth so the dam is stretched over neighboring teeth and the rubber dam over the tooth of interest is sealed by the use of oraseal

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32
Q

what are the types of endo files

A
  • hand files
  • reciprocal files
  • vortex file .25/.12
  • vortex blue files
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33
Q

why are there different types of files

A
  • each file type has unique attributes
  • each file type can benefit us in a specific way when used correctly
  • each type is important to consistent RCT success
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34
Q

describe the stainless steel hand file

A
  • takes a sharper edge
  • is fairly flexible up to #20
  • can be pre- curved easily to negotiate very curved canals- retains the shape
  • increases geometrically in stiffness as diameter increases
  • efficient when used by hand
  • separates if overused or abused usually with some warning
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35
Q

describe nickel- titanium motor driven

A
  • edge not as sharp- motor driven for efficient shaping
  • is extremely flexible - super elastic but difficult to pre curve
  • has nearly perfect shape memory - will not hold a curve
  • works efficiently in engine driven handpieces
  • separates if overused or abused usually with NO warning
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36
Q

what are SS K- type hand files made of

A

twisted tapered stainless steel wire having a square, triangular, or diamond shaped cross section

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37
Q

basically SSK hand files are:

A

screws

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38
Q

continual clockwise rotation will cause an SSK hand file to:

A

-screw itself to and out the end of the root or
- become locked in dentin and fracture

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39
Q

what are hand files essential for:

A
  • scouting the canal - #10 or #8
  • creating a glide path (#10 to patency and #15 to WL only
  • bypassing a ledge, blockage or separated instrument
  • gaining length
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40
Q

what hand files will be used for most cases

A

10 and #15

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41
Q

when would you use larger sized files

A

serial step back

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42
Q

what sizes to hand files come in

A

0.08 - 0.14

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43
Q

what are the measurements of hand files

A

the tip of the diameter in hundredths of a mm

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44
Q

what is the sequence of hand files

A

white,yellow,red,blue,green,black
from .45 to 0.80 and again 0.90 to 1.40

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45
Q

what is the last file size before the increments of sizes go up 0.1

A

0.60

46
Q

what mnemonic helps you remember the sequence of hand files

A

“Will You Really Be Going Back”

47
Q

hand files are supplied in ________ lengths,

A

21,25, and 31mm

48
Q

no matter which length is supplied, the fluted portion of the file is ____ long

A

16mm

49
Q

all standardized K-type hand files are

A

0.02 taper

50
Q

what does 0.02 taper mean

A

from D0 to D16 the diameter increases regularly by 0.02mm in diameter for each 1mm that one travels from D0 to D16

51
Q

what is the color sequence of hand files starting at #15

A

white, yellow, red, blue, green, black

52
Q

how much greater does the diameter become on a file every 1mm back

A

0.02mm

53
Q

what happens to a SS K hand file if bent too sharply in an angular fashion or distorted in any way

A

it cannot be bent back to a useful shape and must be discarded before placing in a tooth

54
Q

when can hand files break/separate within the canal

A

excessive engagement during clockwise rotation especially in smaller sizes

55
Q

what are the safest intra- canal instruments

A

hand files

56
Q

hand files give us the greatest ______ of all intra canal shaping instruments and serve as _____ and basic instrumentation to negotiate _______

A

greatest tactile sense; pathfinder, canal curves and blockages

57
Q

what motion are hand files used in

A

watch winding motion

58
Q

what motion is used to remove hand files

A

circumferential filing from length
- press against alternate walls of canals and pull back for a filing motion

59
Q

dont go to the next larger file until:

A

you have worked the smaller file to the point that the next larger file goes to the desired length without pushing

60
Q

never place a ____ file in a curved canal

A

straight

61
Q

what percent of canals are curved

A

all of them to some degree

62
Q

what should you do when entering canal

A

gently curve all hand files

63
Q

try to _________ the greatest curve you observe in the radiograph of the canal

A

match or slightly exceed the greatest curve

64
Q

what will happen if you slightly exceed the curvature of the canal

A

the file will track the inner wall of the curve and be conformed to the actual curve of the canal

65
Q

if you place a straight file in a curved canal what happens

A

the file will track the outer wall of the the curve and gouge the canal at that point creating what we call a ledge

66
Q

what happens if you create a ledge

A

it may be difficult or impossible to regain the true canal as subsequent file insertions tend to more easily follow the path of the ledge

67
Q

forcing a file from a ledge will lead to:

A

a root perforation or separated instrument and probable failure of the case

68
Q

when a scouting file fails to advance but is loose in the canal:

A

do not push but realize that the canal takes a bend at this point
- remove the scouting file and place a 45 degree bend in most terminal flutes
- use this in a light probing motion to indicate
-the path of the curve as in picking a lock
- once the path is discovered to patency it may be smoothed and carefully enlarged to #15 as a glide path

69
Q

what are the only way to scout a canal

A

hand files

70
Q

what are the only way to bypass a ledge or separated instrument

A

hand files

71
Q

what are the only way to negotiate and smooth a tight curve to smooth the glide path or to regain lost length

A

hand files

72
Q

what are most engine driven reciprocal and rotary files made of

A

nickel titanium and related alloys

73
Q

what are engine driven reciprocal and rotary files used for

A

the ability to stay centered in the canal was basic in their introduction
- based on their quality of performing in a super elastic manner
- easily follow a smoothyl created glide path and immediately return to their designed shape when stress is removed

74
Q

what are wave one gold files

A

motor driven reciprocal files

75
Q

what do motor driven reciprocal files do

A

push material ahead of the file
- used in 3 passes to prevent pushing debris out the end of the root where it would cause inflammation

76
Q

what size is the small wave one gold files

A

0.20/.07

77
Q

what do 6 black bands indicate on the .25/.12 vortex Ni-Ti rotary file

A

12 taper

78
Q

what is the maximum flute diameterin the .25/.12 vortex rotary file

A

1.20mm size #129

79
Q

the .25/.12 may not be appropriate to enlarge a smaller canal and may need to be carefully used to a depth less than the maximum flute diameter to avoid:

A

excessive root structure or possible strip perforation of the root
- about the depth of 12-14mm only

80
Q

what are the sizes of the vortex blue rotary files

A

.25/0.04 through .45/.04

81
Q

what size is the vortex rotary file

A

.25/.12

82
Q

what is the size of the patency file

A

.10/.02

83
Q

what is the size of the glide path file

A

.15/.02

84
Q

we will be using vortex blue files of the following sizes

A

-.25/.04
- .30/.04
- .35/0.4
- .40/.04
- .45/.04
- .50/.04

85
Q

larger than #50 we will do ____ with _____

A

serial step back; hand files

86
Q

vortex blue files tip sizes are identified by:

A

the color of the ring

87
Q

the taper of the file is identified by the number of:

A

black bands x 2

88
Q

what sequence are the vortex blue files used in

A

25-30-35-40-45

89
Q

what is the intended use of the barbed broach

A

rotated in canal to entangle and remove vital pulp organ

90
Q

describe the barbed broach

A
  • SS hand instrument with plastic handle
  • a round wire which is barbed by scoring and prying a tag of metal away from the long axis of the wire
  • if broach becomes bound within the canal or forced around a canal curvature, it will routinely break upon removal attempt
91
Q

when are barbed broach instruments recommended

A

large, straight canals

92
Q

when is the reamer useful

A

by advancement and rotation in straight canals

93
Q

why are reamer instruments dangerous in curved canal

A

ledging is the usual result

94
Q

the tip of the reamer is ____ in nature

A

cutting

95
Q

how is the reamer made

A

by twisting a square or triangular wire but the angle between the long axis of the instrument and the cutting blade is small so it is ineffective when used in a filing motion

96
Q

describe the hedstroem file

A
  • a ground round wire
  • cuts aggressively on pull stroke
  • vulnerable to rotation
  • prone to fracture
  • used by faculty
97
Q

how are reamers manufactured

A

by twisting a tapered triangular SS blank

98
Q

fewer flutes are created than _____

A

K type files

99
Q

reamers cut only upon ____

A

rotation

100
Q

reamers are ineffective with a ____ motion

A

filing

101
Q

why are reamers dangerous

A

they tend to stray away from natural canal

102
Q

how are K type files manufactured

A

by twisting a tapered square or rhomboidal SS blank

103
Q

how are K type files effective

A

when used with a rasping (pulling) motion

104
Q

K type files are _____ prone to fracture

A

less

105
Q

K type files tend to follow natural canal when ____

A

pre-curved

106
Q

what type of files do we use: Reamers, K-type files, Hedstrom files

A

K-type files

107
Q

how are hedstrom files manufactured

A

by machining (grinding) tapered round SS blank

108
Q

hedstrom files have a ________ when used in a filing motion

A

aggressive dentin removal

109
Q

why are hedstrom files weaker

A

due to machining

110
Q

if hedstrom files are used in a rotational manner:

A

they are very easily broken

111
Q
A