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BDS4 EXAM PREP > endo > Flashcards

endo Flashcards

(59 cards)

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1
Q

features of loss of vitality

A

discolouration
sinus presene
gross caries
large restorations
PA radiolucency

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2
Q

dentine hypersensitivty

A

short sharp pain arising from exposed dentine in response to thermal or osmotic stimulus
thought to occur due to hydrodynamic theory - due to dentinal fluid movement in tubules stimulating pulpal pain receptors (A- delta and C-fibres)

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3
Q

management of dentine hypersensitivity

A

OHI
erosion prevention - straws, not swilling
densensitising tooth pastes (strontium fluroide, potassium nitrate)
Fluoride varnsihes

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4
Q

indications for RCTx

A

irrversible pulpitis
pulp necrosis
apical periodontitis

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5
Q

contraindications for RCTx

A

unrestorable tooth

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6
Q

aims of RCTx

A

treat inflamed/infected RCS by controlling infection via eliminating microorganisms and remove pulp system and filling with a material
to prevent Reinfection

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7
Q

dam purposes

A

prevent contamination
protect airway
impve access and vision
improve safety
improve isolation and moisture control
improve pt comfort
allows use of approp dsinfectants

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8
Q

access features

A

removal of existing restoration
removal of entire roof of pulp chamber -
removal of all coronal pulp and locate orifices of canals

finish cavity to have unimpeded STRAIGHT LINE access

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9
Q

aims of canal shaping

A

removal of pulp debris and microbes

produce ideal shape and space for effective irrigant penetration and reception of root filling material to working length
* continuously tapering funnel shape
* maintain apical formaten in original position
* keep apical foramen as small as possible

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10
Q

NiTi hand files

adv
disadv

A

adv - inc flexibility, inc cutting efficacy, so user friendly

disadv - instrument #, expensive,

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11
Q

benefits of rotary systems

A

predictability
easier to use
less time consuming
less files needed

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12
Q

EWL

A

estimated length at which instrumentation should be limited
obtained by measuring a pre op radiograph to determine distance between radiographic apex and coronal reference point, minus 1mm

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13
Q

CWL

A

length at which instrumentation and obturation should be limited to

defined by use of electronic apec locator after inital shaping

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14
Q

master apical file

A

largest diameter file taken to CWL
represents final size of apical portion of canal

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15
Q

recapitulation and patency filing

A

reintroducing smaller files to WL to re-establish ape and help prevent ledges

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16
Q

modified double flare technique
adv

3

A

coronal third preparation first
* improves straight line access
* avoid hydrostatic pressure build up in canals
* allows early removal of heavily contaminated contents

negotiation of apical third with smaller file
apical and mid third prep by step back technique

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17
Q

causes of instrument separation

A

torsional stress
flexural stress

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18
Q

RCT issues with hand files

6 common

A

incomplete debridement - inabilility to completely clean canal

ledges - internal transportation of canal. when working short of WL

blockages - caused by dentine debris packing into apical portion of root

apical transportation - transportation of apical foramen occurs as tendency of instruments to straighten inside a curved canal

perforation - when straight line access not complete and care not taken when intrumenting

zipping - over prep of outercurvature of canal and under prep of inner curvature of canal

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19
Q

aims for chemomechanical disinfection

A

disinfect root canal
flush out debris
eliminate microorganisms
dissolve organic debris and remove smear layer

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20
Q

key irrigants and concentrations

A

3% NaOCl
17% EDTA
0.2% CHX

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21
Q

NaOCl properties

A

dissolves organic material

disadv - unable to remove smear layer, irritant to soft tissues/tissue necrosis, allegry, bleach to fabrics

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22
Q

factors to improve NaOCl function

A

concentration
contact time
volume
mechnical agitation

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23
Q

possible reasons for NaOCl accident

4

A
  • excessive pressure during irrigation - use of forefinger and slow flow rate
  • needle locked in canal - use manual dynamic irrigation
  • larger apical constrictions
  • needle beyond apical constriction - not using rubber stop
  • poor seal - test with CHX prior, give pt PPE
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24
Q

symptoms of NaOCl accident

Study These Flashcards
A

pain
swelling
bruising
haemorrhage
airway obstruction

25
smear layer
formed during preparation contains organic pulpal material and inorganic dentinal debris prevents sealer prenetration nad causes bacterial contamination
26
how to remove smear layer
EDTA 17% irrigate and recap throughout instrumentation then penultimate 3% NaOCl for 10mins per canal (30mls) througholy dry EDTA for 1min, thoroughly dry then 3% NaOCl
27
intracanal medicaments functions
destroy MO and prevent reinfection reduce inflammation and control root resorption e.g. Ledermix or nsCaOH
28
objective of obtruation
provide a 3D hermetic seal to the RCS that will prevent ingress of bacteria and tissue fluids aims * fill/seal entire RCS * eliminate infection * prevent reinfection * incarcerate any remaining microbes
29
aims of obturating | 4
* fill/seal entire RCS * eliminate infection * prevent reinfection * incarcerate any remaining microbes
30
gutta percha constituents | 7
GP 20% Zinc oxide 59-75% Radiopacifiers – barium salts Waxes, colouring agents, anti-oxidants, plasticiers
31
properties of obturating materials | GP
non irritant inert radiopaque doesn't discolour tooth easy removal upon pretreatment moisture resistant bacteriostatic
32
functions of sealer | 3
* seal space between dentinal wall and GP * fill voids and irregularities between GP points, canal walls and seal lateral canals * TO MAKE A FLUID TIGHT SEAL
33
common sealers | 4
resin based ZOE calcium hydroxide calcium silicate (MTA)
34
properties of ideal root canal sealer
establish hermetic seal radiopaque no setting shrinkage non staining bacteriostatic soluble on retreatment
35
methods for obturations
cold lateral compaction warm lateral compation vertical compaction continous wave compaction carrier based obturation
36
cold lateral compaction
check for tug back with master GP point (matches to MAF) at CWL dry with paper points apply sealer to GP point (lightly) and place in canal to CWL try and place finger spreader in canal short of CWL and if room, leave for 20secs and then place corresponding accessory files in same manner cut GP at ACJ want no GP in pulp chamber so ensure cut and condense before RMGIC for coronal seal
37
success RCTx
asymp normal PDL radiographically no loss of function of totoh
38
success with incomplete healing
success but scar tissue formation rather than resoluation of lesion
39
unceratin RCTx outcome
radiographic lesion same size or only slightly reduced 4yrs post endo
40
unfavourable outcome
symptoms persist after endo radiographic lesion inc in size or same size or new lesion 4 yrs post endo continued resorption of root
41
risks in endo tx
perforation of RCS instrument separation failure of tx - unable to reach working length pain after tx NaOCl accident material extrusion beyoud apex
42
methods to prevent instrument failure
correct instrument use create manual glide path crown down technique
43
possible reTx options
orthograde RCT periradicular surgery XLA
44
what is periradicular surgery
surgical shortening of root apex (2-3mm) and retrograde sealing with MTA
45
law of centrality
floor of the pulp chamber is always located in the centre of the tooth at the level of the ACJ
46
low of concentricity
wall of the pulp chamber are always concentric to the external surface of the tooth at the level of the ACJ
47
law of the ACJ
ACJ is the most consistent repeatable landmark for locating the position of the pulp chamber
48
Law of symmetry | 2
1 - orifices of the canals are equidistant from a line drawn in the mesial-distal direction through the pulp floor 2 - orifices of canals lie on a line perpendicular to a line drawn in a MD direcction across the centre of the floor of the pulp chamber except maxillary molars
49
law of colour change
colour of the pulp chamber floor is always darker than the walls
50
law of orifice location | 3
1 - orifices are always located at the junction of the walls and the floor 2 - orifices of the root canals are always located at the angles in the floor wall junction 3 - origicies are located at the terminus of the root developmental fusion lines
51
pathogenesis of endo disease
?
52
glide path
sequential introduction of smaller diameter files WL to prevent fracture of larger diameter insturments
53
modified double flare technique
access identified and straigh line comfirmed (DG16 then 10K to 2/3 EWL) GG to create coronal flare * GG4 to 2/3 EWL with light apical pressure and brushing motion * then GG3 and GG2 to further prep coronal portion more apicaly after coronal prep, establish CWL with apex locator (10K) apical prep * 15K file set to CWL and watch winding motion * 20K file set to CWL with balanced force motion * then work up files till get apical gauging (MAF) stepback (apical taper) * take file size larger than MAF to 1mm less than CWL * do this 3x then irrigation protocol, dry, obturate | irrigation and patentcy throughout with 10K
54
% taper of K files
2%
55
hand file motions
watch winding - forward and backwards osscilating 30-60 balanced force - 90 one way, 180 other way x3 envelop of motion - brush up sides of canal?
56
protaper hand files
access and achieve straigh line glide path to 2/3 EWL to ensure straight line access then use apex locator to work out CWL use 10K and 15K to CWL with balanced force technique then S1 to CWL (shape coronal 1/3) S2 to CWL (shape mid 1/3) F1 to CWL (apical 1/3) F2 to CWL (apical 1/3) check is 25K has apical gauging (corresponds to F2) irrigation and patentcy throughout with 10K
57
reciproc
access and straight line (check with glide path 2/3 EWL with 10K) R25 to 2/3 EWL pecking motion - 3x light pressure once reached 2/3 EWL - establish CWL with apex locator and 10K then R25 to CWL check tugback with 25K file irrigation protocol | irrigation and patentcy throughout with 10K
58
reciproc
access and straight line (check with glide path 2/3 EWL with 10K) R25 to 2/3 EWL pecking motion - 3x light pressure once reached 2/3 EWL - establish CWL with apex locator and 10K then R25 to CWL check tugback with 25K file irrigation protocol | irrigation and patentcy throughout with 10K
59
size reciproc to use
canal narrow or partially/completely invisible = R25 canal medium/wide * 30K can be inserted passivley to EWL = R50 * 20K can be inserted passively to EWL = R40

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