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NBDE II > ENDO Adjunctive Endodontic Treatment > Flashcards

ENDO Adjunctive Endodontic Treatment Flashcards

1
Q

what are the 5 components of the pulp?

A

odontoblasts, fibroblasts, nerves, blood vessels, and lymphatics

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2
Q

after injury or irritation, what cells may die?

A

primary odontoblasts

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3
Q

after injury/irritation and primary odontoblasts die, ___ can form and produce ___ as a defense

A

secondary odontoblasts, reparative dentin

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4
Q

the pulp can defend itself against most ___ irritatnts

A

nonmicrobial

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5
Q

when the irritant is too great and deposition of reparative dentin is insufficient, pulp defenses become overwhelmed, what can happen?

A

when bacteria enter the pulp with sufficient quantity or virulence, complete pulpal necrosis is imminent and irreversible

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6
Q

___ are the main cause of serious pulpal injury and the main cause of pulpitis

A
  • bacteria from dental caries
  • this can be initial caries or caries developing under defective restorations (recurrent caries)
  • bacteria can penetrate beyond the more obvious carious lesion through dentinal tubules
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7
Q

materials for vital pulp therapy dressing can stimulate ___ formation

A

dentinal bridge

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8
Q

what are materials used in vital pulp therapy?

A

calcium hydroxide and MTA

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9
Q

___ has been used as a pulp capping material since the 1930s and has a solid history of clinical documentation

A

calcium hydroxide

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10
Q

calcium hydroxide has an inherent pH of ___, which causes ___

A

12.5 which cauterizes tissue and causes superficial necrosis

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11
Q

which vital pulp therapy material develops a sterile necrotic zone that encourages the pulp to induce hard tissue repair with secondary odontoblasts?

A

calcium hydroxide

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12
Q

MTA is a ___ derivative made of primarily fine ___ particles

A

portland, hydrophilic

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13
Q

MTA consists of ___ and ___

A

calcium phosphate and calcium oxide

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14
Q

how does MTA set?

A

in the presence of moisture

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15
Q

what is the setting time of MTA?

A

2 hours 45 minutes

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16
Q

when MTA is used as a filling material, it appears to be able to induce ___ to produce ___

A

cementoblastic cells to produce hard tissue

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17
Q

what are the 5 procedures that fall under vital pulp therapy?

A

indireact pulp capping, direct pulp capping, partial pulpotomy, pulpotomy, and apexogenesis

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18
Q

___ is a procedure in which material is placed on a thin partition of remaining carious dentin that, if removed, might expose the pulp in permanent immature teeth

A

indirect pulp cap

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19
Q

what are the indications for an indirect pulp cap?

A

when teeth have deep carious lesions approximating the pulp but no signs or symptoms of pulpal degeneration or apical disease

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20
Q

what is the clinical objective of indirect pulp capping?

A

to arrest the carious process and allow remineralization

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21
Q

what should the treatment plan include for a tooth requiring an indirect pulp cap?

A
  • after placement of the indirect pulp cap, wait 6-8 weeks to allow deposition of reparative dentin (at the rate of 1.4 um/day)
  • remove the remaining caries leaving healthy dentin and permanently restore the tooth
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22
Q

___ is a procedure where dental material is placed directly on a mechanical or traumatic vital pulp exposure

A

direct pulp cap

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23
Q

what are the indications for a direct pulp cap?

A
  • pulp has been exposed less than 24 hours
  • healthy pulp exposures during an operative procedure
  • asymptomatic
  • small exposure site
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24
Q

what should be completed during follow up visits for a direct pulp cap?

A
  • test for palpation, percussion, thermal pulp testing, and periapical radiograph
  • a hard tissue barrier may be visualized 6 weeks postoperatively
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25
Q

what is the prognosis of a tooth with a direct pulp cap?

A

prognosis depends on quality of bacteria-tight seal provided by restoration, degree of bleeding, and disinfection of the superficial pulp and dentin or elimination of any inflamed zone of pulp

26
Q

___ is a the surgical removal of a small portion of coronal pulp tissue to preserve the remaining coronal and radicular pulp tissues

A

partial pulpotomy (aka cvek pulpotomy or shallow pulpotomy)

27
Q

what are the indications for a partial pulpotomy?

A
  • inflammation is greater than 2mm into the pulp chamber but has not reached the root orifices
  • traumatic exposures longer than 24 hours or mechanical exposures
  • immature permanent tooth or mature tooth with simple restorative plan
28
Q

what should be completed during follow up visits for a partial pulpotomy?

A
  • same as pulp capping
  • sensitivity testing is unavailable because of loss of coronal pulp
  • use radiograph to assess continuation of root formation or development of periapical lesion
29
Q

what is the prognosis for a partial pulpotomy?

A

good prognosis depends on adequate removal of inflamed pulp, good disinfection of dentin and pulp, ability to avoid blood clot formation after amputation, and bacteria-tight seal of restoration

30
Q

___ is the surgical removal of the coronal portion of a vital pulp to preserve the vitality of the remaining radicular pulp

A

pulpotomy

31
Q

in pulpotomy procedures, what is the level of pulp amputation determined by?

A

it is chosen arbitrarily but usually at the level of the root orifices

32
Q

what are the indications for a pulpotomy?

A
  1. vital pulp in immature teeth with carious, mechanical exposure or traumatic exposure after 72 hours
  2. no history of spontaneous pain
  3. no abscess, radiographic bone loss, or mobility
33
Q

T or F:

in pulpotomy procedures, operators cannot determine whether all diseased tissue has been removed

A

true

34
Q

___ is the maintenance of pulp vitality to allow continued development of the entire root

A

apexogenesis

35
Q

apical closure occurs how long after eruption?

A

approximately 3 years

36
Q

what are the clinical objectives of apexogenesis?

A
  • allow the body to make a stronger root
  • this procedure relates to teeth with retained viable pulp tissue in which the pulp tissue is protected, treated, or encouraged to permit the process of normal root lengthening, root wall thickening, and apical closure
  • nonsurgical endodontic therapy can be performed more safely and effectively to treat the pulpal disease
37
Q

what are the indications for apexogenesis?

A

immature tooth with incomplete root formation and with damaged coronal pulp and healthy radicular pulp

38
Q

what are the contraindications for apexogenesis?

A
  • avulsed teeth
  • unrestorable teeth
  • teeth with severe horizontal fracture
  • necrotic teeth
39
Q

what is the prognosis for apexogenesis?

A

good when pulp capping or shallow pulpotomy is done correction; conventional pulpotomy is not as successful

40
Q

success rate for apexogenesis depends on what?

A

extent of pulpal damage and restorability of the tooth

41
Q

___ is the removal of coronal and radicular pulp tissues

A

pulpectomy

42
Q

T or F:

pulpectomy is vital pulp therapy

A
  • false

- it is not vital pulp therapy because the tooth is pulpless

43
Q

what are the applications for pulpectomy?

A

temporary pain relief on teeth with irreversible pulpitis until nonsurgical endodontic treatment can be performed

44
Q

___ is a method to stimulate the formation of calcified tissue at the open apex of pulpless teeth

A

apexification

45
Q

T or F:

apexification is not vital pulp therapy

A

true, because the tooth is pulpless

46
Q

what is the indication for apexification?

A

infected teeth with open apices in which standard instrumentation techniques cannot create an apical stop to facilitate effective obturation of the canal

47
Q

what is the technique for apexification?

A

disinfection of canal followed by induction or placement of an acceptable apical barrier

48
Q

in apexification procedures, what two materials have been used to create an apical barrier?

A

calcium hydroxide and MTA

49
Q

describe the use of calcium hydroxide to create an apical barrier in apexificaiton

A
  • may be used to induce apical hard tissue formation
  • a thick paste of calcium hydroxide must be placed in the canal and replaced every 3 months until a hard tissue barrier forms, against which gutta percha may be placed to fill the canal
  • this traditional technique may require 1 year for hard tissue formation
50
Q

describe the use of MTA to create an apical barrier in apexification

A

-can be packed into the apical 3mm of the canal, and the remainder of the canal can be filled with gutta percha at the same appointment

51
Q

in the creation of an apical barrier in apexification, which material (MTA or calcium hydroxide) is superior?

A
  • MTA has established biologic outcomes in terms of healing and root end closure at least comparable to teeth treated with calcium hydroxide
  • MTA has the advantage of treatment completed in less time, improved patient compliance, and reduced cost of clinical time
52
Q

what are 9 causes of discoloration?

A

pulp necrosis (or remnants of pulp tissue), intrapulpal hemorrhage, calcific metamorphosis, age, fluorosis, systemic drugs, defects in tooth formation, blood dyscrasias (disorder), and obturation materials

53
Q

how does pulp necrosis (or remnants of pulp tissue) cause discoloration?

A

tissue disintegration by-products are released and penetrate tubules

54
Q

how does calcific metamorphosis cause descoloration?

A

extensive formation of tertiary dentin gives tooth a yellow color

55
Q

how does fluorosis cause discoloration?

A

gives teeth a mottle white-to-gray appearance

56
Q

how can obturation materials cause discoloration?

A

zinc oxide-eugenol, plastics, or metallic components of sealers

57
Q

what are the 2 intracoronal (nonvital or internal) bleaching techniques?

A

thermocatalytic technique and walking bleach

58
Q

describe the thermocatalytic bleaching technique

A

place oxidizing agent (30% hydrogen peroxide [Superoxol]) in the chamber and apply heat

59
Q

what are the complications of thermocatalytic bleaching?

A
  • external cervical resorption because irritation diffuses through the dentinal tubules to cementum and PDL
  • heat combined with chemicals may cause necrosis of the cementum and inflammation of the PDL
60
Q

describe the walking bleach technique

A
  • place mix of sodium perborate and water in the chamber
  • because Superoxol is not used, 2mm protective cement barrier is unnecessary
  • return in 2-6 weeks

NBDE II (35 decks)

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