BDS4 endo posts

Question 1

Reasons that root treated teeth continue to give symptoms

Answer 1

PDL

Bone

Microorganisms

Tooth not sterile

Lateral / accessory canals (get bleach into apical 3rd)

Question 2

Re-RCT questions?

Answer 2

When was initial root canal treatment
Why was it required
Did treatment improve symptoms
Changed ?
Dental dam
Hypochlorite use
Procedural problems

Question 3

other special tests for endo?

Answer 3

Bite test( frac finder or tooth sleuth)
Test cavity
Staining and trans-illumination
Selective anaesthesia

Question 4

main factors of endo exam?

Answer 4

Extraoral exam
Intraoral exam
Soft tissue exam
Intraoral swelling
Sinus tracts
Palpation
Percussion
Mobility
Periodontal exam

Question 5

reasons why sensitive on an RCT

Answer 5

• missed canal - can find out using cone beam CT
• occlusal interefence
• not using sodium hypochlorite or dental dam
• periapical periodontitis
• inflammation periradicular tissues

Question 6

what is good for preventing fracture for RCT

Answer 6

full cuspal coverage

Question 7

what to think of for endo diagnoses

Answer 7

Top of tooth (crown)

Middle of tooth (pulp)

Bottom of tooth (apex, bone, and soft tissue)

Question 8

treatment options of endo?

Answer 8

Root canal treatment
Re root canal treatment
Extract the tooth
Monitor / don’t intervene
Surgical intervention (periradicular surgery)

Question 9

what to think about when deciding to Re RCT

Answer 9

Have you got a diagnoses?

Risk / benefit analysis

Have you got a good reason to retreat

Do you have consent ?

Is tooth restorable

Can i do a better RCT than current one

Question 10

what is apart of clinical assessment of endo treated tooth?

Answer 10

Coronal seal - restorations/crowns. Leakage? Caries?

Amount of remaining tooth structure- ferrule

Is the tooth restorable? Can you isolate it with rubber dam?

Swelling

Sinus

TTP

Buccal sulcus - tender to palpation?

Mobility

Increased pocketing – periodontal disease and root fractures

Question 11

what guideliens for endo

Answer 11

AAE - for diagnoses
ESE - for re rct

Question 12

what are indications fro RE CT?

Answer 12

1. teeth with inadeqaute RCT fillingwith radiological findings of developing or persisting apical perio and/or symptoms
2. teeth with inadequate RCT filling when coronal restorating requies replacment of coronal dental tissue is to be bleached

Question 13

what to assess radiographically for root treated tooth?

Answer 13

Root filling - length, quality of obturation e.g. voids

Unfilled/missed root canals

Shape of canal

Patency - fracture instruments, posts, sclerosis

Bone support – mild, moderate, severe

Crown to root ratio (1:1.5)

Pathology - periapical radiolucency – healing?, resorption, perforations

Question 14

problems after RCT/Re RCT?

Answer 14

• Amount of remaining tooth structure - externally and internally
• Restoration type
• Lack or no ferrule
• Wide post holes e.g. re-RCT
• Endodontic complications - fractured instruments, perforations, short/long root fillings

Question 15

Principles for restoring root treated teeth

Answer 15

Normally massive loss of coronal tooth structure

Consider cuspal protection( onlay / crown)
*Coronal seal
*Prevention of fracture

Question 16

Reasons for restoring root treated teeth

Answer 16

Coronal seal
Function
Aesthetics
Quality of life

Question 17

benefits and negatives of composite onlay

Answer 17

benefit less prep needed than crown

but if gingival can be hard to get good moisture control and need to use another resin to set so will leak

Question 18

instead of comp onlay what do

Answer 18

build up with comp then do 360 degree ferule prep

Question 19

what has replaced dt fibre posts

Answer 19

relyx look at ppt

Question 20

when do posts in posterior teeth

Answer 20

• long straight canal
• try avoid especially curved canal