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Endodontics II > Lecture 1: Working Length & Access > Flashcards

Lecture 1: Working Length & Access Flashcards

1
Q

When, why and how to refer your potential problems describes:

A

case selection

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2
Q

Most non-complicated cases follow:

A

one basic RCT technique

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3
Q

LEO:

A

Lesion of endodontic origin

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4
Q

What are our objectives with endo cases?

A
  1. correctly DIAGNOSE disease as LEO
  2. PERFORM quality NS endodontic therapy
  3. RESTORE & DOCUMENT healed outcome
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5
Q

What will cause your endodontic treatment to FX & fail?

A

lack of placing mandatory crown

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6
Q

Endo treatment is considered an extreme service to the patient as we:

A
  1. relieve acute pain
  2. retain otherwise lost natural tooth
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7
Q

More points are lost in lab to ____ than anything else

A

poor access

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8
Q

Most failures on WREBs & AEDC are due to:

A

poor access

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9
Q

What is the first step of access procedure?

A

Draw outline form on tooth

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10
Q

The shape of the outline form of the tooth is dependent on:

A

anatomy of the pulp chamber

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11
Q

After drawing the outline form on the tooth, what step is next?

A

Create outline form just through enamel with number 2 round bur or 330 bur on high speed

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12
Q

What layer should be drilled through when creating outline form?

A

Just through the enamel

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13
Q

What burs and what speed may be used when creating the outline form?

A

2 round bur or #330 bur on high speed

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14
Q

When creating the outline form the bur is somewhat _____ to the _____ surface of the tooth

A

perpendicular; lingual

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15
Q

When creating the outline form its important to stay ____ at this point; just through the enamel at less than_____mm

A

shallow; 1mm

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16
Q

After the outline form is created the next step to the access procedure is:

A

penetration

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17
Q

During the penetration step of access procedure, penetrate the pulp chamber roof with _____ approaching _____ in center of outline form

A

bur angled; parallel to long axis of root

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18
Q

During the penetration step of access procedure, penetrate the ___ with the bur angled approaching parallel to long axis of the root in the _____ of the outline form

A

pulp chamber roof; center

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19
Q

During the penetration step of access procedure, you should reach the pulp in most cases by:

A

7mm

(if not ask for help- never go beyond 7mm)

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20
Q

During the penetration step of access procedure, how should you confirm the pulp canal entry?

A

With endodontic explorer; DG16 (push)

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21
Q

Do confirm pulp canal entry during the penetration step of access procedure, you should NEVER look for canals with:

A

a bur

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22
Q

What step of access procedure follows penetration?

A

Un-roofing

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23
Q

Un-roof pulp chamber with:

A

brushing out strokes

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24
Q

When un-roofing the pulp chamber with brushing-out strokes, be careful not to:

A

Gouge axial walls

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25
Q

When un-roofing the pulp chamber, remove ____ & smooth ____

A

obstructions; the walls

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26
Q

When un-roofing, irrigate well with NaOCl for:

A
  1. vision
  2. removal of debris
  3. begin disinfection
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27
Q

Following the un-roofing step of the access procedure, we:

A

refine

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28
Q

Refine the access prep with ____ or ____ to help provide straight-line access to mid-root (mostly in molar access)

A

Safe ended diamond bur; Endo-Z bur

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29
Q

The Endo-Z bur is the ____ one

A

gold

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30
Q

Why do we use the safe endo diamond bur or endo-Z bur during the refining step of access procedure?

A

To help provide straight-line access to mid-root

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31
Q

During the refining step of access procedure, the non-cutting tip of the bur (safe end of diamond bur or endo-Z bur) is simply:

A

A pilot

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32
Q

Do NOT JAM the Endo-Z bur INTO the canal. This is a:

A

side cutting instrument only

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33
Q

After ACCESS your next big task is:

A

working length

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34
Q

The correct working length=

A

1 mm short of the canal exit

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35
Q

If you do NOT get the ____ right; you will likely result in a poor outcome

A

working length

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36
Q

Incorrect working length may instigate:

A

apical periodontitis

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37
Q

How you find the canal exit in your hand? (2)

A
  1. look at the canal exit
  2. measure BEFORE you mount the tooth
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38
Q

How do you find the canal exit in the mouth?

A
  1. start with average length
  2. chart
  3. apex locator (if possible)
  4. radiograph with #15 file in canal
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39
Q

Average root length central incisor:

A

maxillary: 22.5
mandibular: 20.7

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40
Q

Average root length lateral incisor:

A

maxillary: 22.0
mandibular: 21.1

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41
Q

Average root length canine:

A

maxillary: 26.5
mandibular: 25.6

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42
Q

Average root length first premolar:

A

maxillary: 20.6
mandibular: 21.6

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43
Q

Average root length second premolar:

A

maxillary: 21.5
mandibular: 22.3

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44
Q

Average root length first molar:

A

maxillary: 20.8
mandibular: 21.0

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45
Q

Average root length second molar:

A

maxillary: 20.0
mandibular: 19.8

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46
Q

Usual number of roots & canals for maxillary incisors (teeth #7,#8,#9,#10):

A

one root, one canal

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47
Q

Usual number of roots & canals for maxillary canines (teeth #6, #11):

A

one root, one canal

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48
Q

Usual number of roots & canals for maxillary first premolars (teeth #5, #12):

A

two roots, two canals

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49
Q

Usual number of roots & canals for maxillary second premolars (teeth #4, #13):

A

Usually one, possibly two
Usually one, possibly two

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50
Q

Usual number of roots & canals for maxillary molars (teeth #1,#2,#3,#14,#15,#16):

A

Three roots, sometimes three but probably four or more

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51
Q

Usual number of roots & canals for mandibular incisors (teeth #23,#24,#25,#26):

A

One root, one canal possibly two

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52
Q

Usual number of roots & canals for mandibular canines (teeth #22,#27):

A

One root, one canal

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53
Q

Usual number of roots & canals for mandibular premolars (teeth #20,#21, #28, #29):

A

One root, one canal, possibly two

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54
Q

Usual number of roots & canals for mandibular molars (teeth #17,#18,#19,#30,#31,#32):

A

Two roots, three canals possibly 4 or more

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55
Q

How do we determine the correct working length in clinic?

A

apex locator

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56
Q

To determine the correct working length, place a _____ hand file in the access & extend it in the canal to the estimated canal length

A

15 hand file

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57
Q

Everything you do following an inaccurate working length is:

A

wrong

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58
Q

The goal for WL is:

A

1 mm short of the canal exit

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59
Q

The goal for WL is 1mm short of the canal exit, this placed WL in close proximity to :

A

the natural apical constriction

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60
Q

What happens if you WL is too short?

A

The canal is NOT well cleaned

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61
Q

What happens if you WL is too long?

A

Results in “Blow out” which guarantees:

  1. incomplete compaction at the apex
  2. an explosion of sealer in the PA tissues
62
Q

In regards to WL, your reference point should be: (2)

A
  1. easy to see
  2. easy to reproduce
63
Q

When selecting a reliable reference point for anterior teeth you should use the:

A

tip of incisal edge

64
Q

When selecting a reliable reference point for posterior teeth you should use:

A

tip of cusp for which the canal is named

65
Q

T/F: It is okay to reduce your reference point after WL is determined

A

False- don’t reduce it after WL is determined

66
Q

What is the first step after diagnosis?

A

access

67
Q

Access to the pulp chamber facilitates: (6)

A
  1. locating the canals
  2. negotiating the canals
  3. gaining patently
  4. establishing WL
  5. maintaining apical constriction
  6. a good outcome
68
Q

Arguable the single most important requisite contributing to routine endodontic success:

A

proper access

69
Q

Poor access yields problems such as: (5)

A
  1. No predictable result
  2. routinely missed canals
  3. unable to properly clean
  4. unable to shape completely
  5. unable to fill adequately
70
Q

Access involves:

A

drilling a hole through coronal structure to gain entrance into the pulp chamber

71
Q

The objective of access is to create an effective shape, this includes: (4)

A
  1. smooth
  2. constantly tapering
  3. respecting shape of natural canal
  4. constricting near terminus of root
72
Q

What is considered the “coke bottle effect” with access?

A

Canal is bigger than the cervical access at some more apical point in the canal

73
Q

List the requirements of access: (4)

A
  1. visibility of pulp chamber and ALL canal orfices from a SINGLE vantage point
  2. straight-line access to mid-root for instrument placement
  3. complete removal of pulpal roof & pulp horns
  4. avoidance of unnecessary weakening of tooth
74
Q

What do we mean when referring to “visibility” as a requirement of access?

A

Visibility of pulp chamber and ALL canal orfices from a SINGLE vantage point

75
Q

Visibility of pulp chamber and ALL canal orfices from a SINGLE vantage point =

A

draw

76
Q

Why is straight-line access to mid-root a requirement to access?

A

Straight-line access to mid-root is required for instruments and obdurating materials (without regard to long axis of tooth)

77
Q

Cross-hatched area of secondary dentin that should be removed to create better access to the mesial root:

A

dentin triangle

78
Q

What may be used to remove the dentin triangle to create better access to the mesial root?

A

.25/.12 rotary file

79
Q

Why is it important to preserve tooth structure during access?

A

to avoid unnecessary weakening of tooth

80
Q

What are the three main steps to access?

A
  1. outline form (2D surface shape)
  2. coronal access (extending into pulp)
  3. radicular access (adjustments to allow easy straight-line entry to mid-root of each canal)
81
Q

The 2D plan for the initial opening (could be traced onto crown):

A

outline form

82
Q

To allow unobstructed visualization of the pulpal floor and ALL canal orfices from a single vantage point:

A

coronal access

83
Q

During coronal access you should reach the pulp at ____ or less

A

7mm

84
Q

T/F: The pulpal floor should NOT be touched by access bur

A

true

85
Q

Walls of the coronal access should _____ to the occlusal

A

diverge

86
Q

Walls of the coronal access should DIVERGE to the occlusal because: (3)

A
  1. better light
  2. better visualization
  3. temp restoration placed between visits will not be easily dislodged to leak & contaminate
87
Q

To allow straight-line access to mid-root for all shaping instruments and obturation materials (observe canal path- not long access of tooth):

A

radicular access

88
Q

Facilitates “crown-down” procedure

A

Radicular access

89
Q

T/F: Hand files generally require 10 strokes/file before going to the next larger size file

A

False- generally require 100 strokes/file

90
Q

Common canal configurations:

-One canal from pulp chamber to apex

A

Type I

91
Q

Common canal configurations:

-Two canals from pulp chamber join prior to apex

A

Type II

92
Q

Common canal configurations:

-Two canals from pulp chamber to apex

A

Type III

93
Q

Common canal configurations:

-One canal from pulp chamber divides prior to apex

A

Type IV

94
Q

Which type of canal configuration is the most difficult to treat?

A

Type IV

95
Q

Label the type of canal configuration seen below:

A

Type I

96
Q

Label the type of canal configuration seen below:

A

Type II

97
Q

Label the type of canal configuration seen below:

A

Type III

98
Q

Label the type of canal configuration seen below:

A

Type IV

99
Q

What is the shape of access for a maxillary central incisor?

A

triangular access (base of triangle at incisal)

100
Q

T/F: For access with a maxillary central incisor, the angles of the triangle are slightly rounded

A

true

101
Q

For a maxillary central incisor what is the measurement of the triangle on all sides?

A

about 3 mm

102
Q

Total straight-line access on anteriors would involve access from the facial and create weakening of the incisal edge and an esthetic issue, this is called:

A

incisal compromise

103
Q

“Incisal compromise” is when total straight-line access on anteriors would involve access from the facial and create a:

A

weakening of the incisal edge and esthetic issue

104
Q

What is the shape of access of a maxillary lateral incisor?

A

triangular/oval

105
Q

The maxillary lateral incisor has a thinner root than the central incisor meaning:

A

narrower access M-D and narrower pulp horns

106
Q

When accessing a maxillary lateral incisor, its important to note that the root curves to the _____ and the apex tips to the ____

A

distal; palatal

107
Q

Due to the apex tipping to the palatal, what is the most difficult maxillary anterior tooth to access?

A

lateral incisor

108
Q

Phenomenon on all anterior teeth in regards to access:

A

Incisal compromise

109
Q

What is the shape of access for a mandibular canine?

A

Oval access

110
Q

If the mandibular canine has one root, its usually very wide:

A

F-L

111
Q

What type of canals can be seen in a mandibular canine? What type is seen most often?

A

Type I, II or IV; Type I most common

112
Q

According to Vertucci, ____% of mandibular canines have one canal, whereas ___% have two canals

A

78% ; 22%

113
Q

T/F: it is more common for a mandibular canine to have two canals than one canal

A

False- one canal is much more prevalent

114
Q

To avoid common errors of access, you should: (2)

A
  1. line up penetration in two planes (MD & FL)
  2. visualize cervical cross section
115
Q

A common iatrogenic error that often spell the demise of the tooth:

A

perforations

116
Q

List some common errors of access: (6)

A
  1. too large
  2. skewed to distal
  3. too small & round
  4. too cervically placed
  5. pulp horns not cleaned
  6. straight-line access to mid-root is inhibited
117
Q

Inadequate access compromises ____

A

shaping

118
Q

Inadequate access induces:

A

bending of th efile

119
Q

Inadequate access creates ____ of canal

A

apical transportation

120
Q

Access is ALWAYS gained through _____ approach on ALL posterior teeth

A

occlusal

121
Q

What is the shape of access for a maxillary first premolar?

A

thin (MD) oval access

122
Q

The thin oval shaped access for a maxillary premolar should be the width of:

A

4 round bur

123
Q

Most commonly in a maxillary first premolar we see ____ canals

A

two

124
Q

List the prevalence of the following canals for a maxillary first premolar:

____% two canals
_____% one canal
_____% three canals

A

85% two canals
9% one canal
6% three canals

125
Q

What is the shape of access for a maxillary second premolar?

A

Thin oval

126
Q

The thin oval shape of access for a maxillary second premolar should be the width of:

A

4 round bur

127
Q

Most often we see the maxillary second premolar have a type _____ canal with ____ root ____ canal (75-85%)

Type _____, ____ & ____ are less frequent

A

Type I; 1 root 1 canal

Type II, III, IV

128
Q

How often do we see two roots for a maxillary second premolar? How often do we see three roots?

A

2 roots: 15-25% of time
3 roots: rare

129
Q

In a maxillary second premolar, if one canal is found but is not in the center FL, then we should assume:

A

2 canals present

130
Q

In regards to a maxillary second premolar we should beware of type ____ because they are very hard to shape, clean & fill

A

Type IV

131
Q

What is the shape of access for a mandibular first premolar?

A

Thin oval

132
Q

Mandibular first premolars usually have _____ root(s) and ____ canals ____% of the time.

A

one root, one canal (73.5%)

133
Q

Mandibular first premolars usually have 1 root and 1 canal 73.5% of the time. They have type IV canals ___% of the time. They have three canals ____% of the time.

A

24%; less than 1%

134
Q

What is the shape of access for a mandibular second premolar?

A

Thin oval

135
Q

The mandibular second premolar usually has ____ root(s), ____ canals, ____%

A

one root; one canal (85.5%) Type I

136
Q

95% of the time, the maxillary first molar has ____ canals

A

4

137
Q

What is the shape of access for a maxillary first molar?

A

Triangle- apex to palatal

138
Q

The triangular shaped access with the apex to the palatal for a maxillary first molar should NOT cross the:

A

oblique ridge

139
Q

T/F: The maxillary first molar has four canals most of the time, but if not has five canals

A

True

140
Q

The access to the maxillary second molar is similar to _____ but more _____

A

maxillary first molar; more compressed MD

141
Q

What is the shape of access for a maxillary second molar?

A

triangle

142
Q

What is the shape of access for a mandibular first molar?

A

Trapezoid

143
Q

When accessing a mandibular first molar, the mesial and distal walls of th preparation lean towards the:

A

mesial

144
Q

The access prep for a mandibular first molar, does not cross:

A

distal triangular ridges

145
Q

T/F: Most often, the mandibular first molar has four canals followed by three canals

A

False- three canals most often, followed by four canals

146
Q

What is the shape of access for a mandibular second molar?

A

Trapezoid/triangle (similar to mandibular first molar)

147
Q

T/F: Most often, the mandibular second molar has four canals followed by three canals

A

False- three canals most often, followed by four canals

148
Q

When a mandibular second molar has two centered canals, we call this ______. When this occurs ____

A

C-shaped; REFER

149
Q

T/F: At UMKC, all second molars are done by advanced endo

A

true

150
Q

How should we line up the bur when accessing a tooth:

A

in two planes

151
Q

What is the WORST error you can make with access?

A

Perforation

152
Q
A

Endodontics II (10 decks)

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