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Endo > Day 4 > Flashcards

Day 4 Flashcards

1
Q

Post:

A

Remove cap of gutta percha, #3 GG bur in canal – go to post prep length, rubber of GP will wrap around bur. If 70 file binds at prep length, go 2 sizes higher and file away.

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2
Q

After post is placed, core material placed around post. Sometimes post and core called “

A

gutta percha cleanout.”

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3
Q

Take working length – —-mm. What is left is the amount of space you have for post space. Gates Gliddens are a max of 19mm. If you have 25mm working length, it is fine to be a bit short of 5mm remaning. Not a big deal honestly.

A

5

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4
Q

Pulp - Primary function is

A

FORMATIVE

Pulp tissue  odontoblasts  dentin  enamel

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5
Q

Pulp - Secondary functions

A

Tooth sensitivity
Hydration
defense

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6
Q

Development of the Pulp

——- (ectomesenchyme) migrate in and mix with cells of local ——–.

Bud stage: ——- condensing around the tooth germ

Cap stage: condensed —— within invagination leads to —–
Bell stage: ———— differentiation; —– is now “pulp.”

A

Neural crest cells

mesenchymal origin

ectomesenchyme

ectomesenchyme

dental papilla

ameloblast and odontoblast

dental papilla

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7
Q

Late cap stage

A

IDE differentiates into ameloblasts
No enamel yet
DP not differentiated into odontoblasts yet

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8
Q

Later cap stage

A

Odontoblasts forming from dental papilla
Now we have dental pulp (DP).
Ameloblasts fully differentiated
No enamel yet

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9
Q

Bell stage

A

Odontoblasts laying down dentin

Very little enamel still

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10
Q

Root Formation

Begins at the —–

A

cervical loop

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11
Q

Cervical loop

A

The point where the cells of the inner and outer dental epithelia meet

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12
Q

Root formation - Initiated by

A

Hertwig’s epithelial root sheath

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13
Q

HERS is the apical proliferations of the ———

A

fused inner and outer dental epithelia

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14
Q

HERS signals differentiation of —– and acts as a template for the root

A

odontoblasts

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15
Q

Cell proliferation in the root sheath is — determined.

A

genetically

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16
Q

—— binds cementum to dentin

A

Hyaline layer of Hopewell-Smith

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17
Q

Size and location of the apical foramen influences

A

blood flow to the pulp and determines how it reacts to traumatic events (i.e. young teeth with bigger foramina and large pulps recover better)

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18
Q

Posteruptive deposition of cementum at the apex creates the difference in

A

location of radiographic apex and anatomic location of apical foramen.

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19
Q

Induction

A

Initiates development of dentin, which then induces enamel formation

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20
Q

Formation

A

Odontoblasts form dentin
Primary dentin: early development, fast
Secondary: after tooth maturation, slow
Teritary: response to injury (reparative or reactionary)

21
Q

Nutrition

  1. Defense
  2. Sensation
A

Dentin formation and maintenance

Tertiary dentin
In presence of bacteria can elicit an immune response

22
Q

Pulp Morphology

Cells:

A

Odontoblasts
stem cells
Fibroblasts
immune system cells (dendritic cells, macrophages, neutrophils, T lymphocytes)

23
Q

Pulp Morphology

Extracellular components

A

Fibers: collagen, fibrillin; NO elastic fibers
Noncollagenous matrix: GAGs, proteoglycans, adhesion molecules (fibronectin)
Calcifications: pulp stones or denticles

24
Q

Pulp - Efferent: venules

Drain —– into the —- vein through the —— or anteriorly to the —– vein

A

posteriorly

maxillary

pterygoid plexus

facial

25
Q

Lymphatics: in periphery of the pulp
Remove inflammatory exudates, transudates, cellular debris
Drain into

A

submental, submandibular or cervical lymph nodes, then empty into the subclavian and internal jugular veins

26
Q

Lymphatics: in periphery of the pulp
Remove inflammatory exudates, transudates, cellular debris
Drain into

A

submental, submandibular or cervical lymph nodes, then empty into the subclavian and internal jugular veins

27
Q

Connective tissue response to injury
Initial: ——
Secondary: ———

A

nonspecific, rapid

specific, antibody production

28
Q

Connective tissue response to injury

Largely mediated by ——
———– alter pressure, flow, distribution of blood at precapillary sphincters
Sensory fibers release —— via axon reflexes - - this neurogenic inflammation mechanism results in ——

A

local nerves

Sympathetic fibers

neuropeptides

increased blood flow and increased capillary permeability

29
Q

Principal pulp sensory innervation:

—–

A

Trigeminal Nerve (V2 & V3)

30
Q

Sympathetic motor innervation:

A

T1, C8, T2 via superior cervical ganglion – maintains vasomotor tone in precapillary sphincters which controls pressure and distribution of blood

31
Q

NO —— innervation of the pulp

A

parasympathetic

32
Q

Myelinated Aβ and Aδ fibers:

A

larger, faster-conducting
proprioception, mechanoreception, most sensitive to hydrodynamic stimulation of dentin; can be recruited for nociception in presence of inflammation
Terminate in coronal odontoblastic layer, predentin, inner dentin
Sharp pain

33
Q

Unmyelinated C fibers:

A

Slow-conducting
Terminate in the pulp and along pulpal blood vessels
Dull pain

34
Q

Hydrodynamic Theory
Thermal and osmotic changes alter fluid flow in dentinal tubules
Have to have —- tubules

A

patent

35
Q

Chemical Diffusion

Diffusion through dentin leads to

A

Direct stimulation of pulp nerves

36
Q

Calcific metamorphosis is a

A

separate term from pulpal sclerosis – CM occurs following trauma, not necessarily related to aging pulp, while pulpal sclerosis is something that occurs over time with aging.

37
Q

Pulpal sclerosis –

A

closed down/shrunken/occasionally elimination of pulp chamber. Natural process – not due to trauma. Overtime, pulp becomes less vascular, cellular, and has fewer nerve fibers. It is filled in with dentin.

38
Q

5 identified types of

A

cementum

39
Q

Cemento-dentinal junction (CDJ):

A

forms the apical constriction where the pulp and periodontium meet…this is the IDEAL point to end your root canal preparation.

40
Q

PDL width

A

0.21 mm (young) – 0.15 mm (old)

41
Q

Sensory nerves from V2 and V3

Highly sensitive mechanoreceptors concentrated in

A

apical third record pressures

Percussion test

42
Q

Alveolar bone proper =

A

lamina dura

Lines the socket
Bundle bone, cribriform plate
Continuity associated with periodontal health

43
Q

Lesions are only radiographically detectable if there is

A

perforation of the cortex, destruction of the cortical/cancellous junction, or extensive destruction of the outer surface of the bone. The loss of trabeculation is actually a destruction of the cortical/cancellous junction. Lesions that are contained entirely within the medullary space are not radiographically detectable.

44
Q

Primary endo infections

A

POLYMICROBIAL
40-50% are as-yet-uncultivated species
Heterogenous etiology of apical periodontitis…
Different individuals have different microbial profiles
Multiple combinations of bacteria = multiple ways a pulp can be infected

45
Q

Gram-negative bacteria are

A

the MOST COMMON microorganisms found in primary endodontic infections.

46
Q

What influences the composition of microbiota?

A

Oxygen tension and redox potential
Facultativesmore anaerobesobligate anaerobes

Type and amount of available nutrients

Bacterial interactions (mutualism, commensalism, competition, antagonism)

47
Q

Secondary infections

A

Persistent bacteria -

As a result of coronal leakage (secondary intraradicular infection)
Root canal system not adequately cleaned during first root canal

48
Q

Extraradicular infections

A

Acute apical abscess is the most common form.

Endo (5 decks)

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