dichlorodifluoromethane
endo ice - for cold testing
worst test for both pulp and perio diagnosis?
EPT
best test for pulp and perio diagnosis?
pulp= cold perio= percussion and palpation
most important technical aspect to RCT?
access prep
shape of accesses?
anterior= triangle canine= ovoid PM= ovoid MX molars= rhomboid or blunted triangle MN molars= trapazoid
which PM is most likely to have two roots?
MX 1st PM
SS Hand files vs NiTi rotary files
SS (stainless steele)= .02 taper
- K-file (Kerr)- square, watch winding method
- -H-file (Hedstrom)- spiral cone, only cuts in retraction
NiTi rotary files= .04-.06 taper, latch
color of endo files order
white, yellow, red, blue, green black (WYRBGB)
gates gilded vs barbed broaches vs reamer intruments
GG= open orifices for straight line BB= entangle and remove Reamer= twisted triangle
sodium hypochlorite (NaOCl)
irrigant, dissolves ORGANIC material
crown down vs step back cleaning&shaping
crown down= big to small, rotary
step back= small to big, hand
Ethylenediamine tetraacetic acid (EDTA)
chelating agent, lubricant, dissolves INORGANIC material (smear layer)
Microbes in primary endo infect?
bacteroides (G-, obligate)
Microbes in secondary endo infect (retreat)?
Enterococcus faecalis (G+, facultative)
trephination
surgical opening for hard tissue to release exudate and pressure
Chloroform
dissolves GP in retreatment
negotiation
use of smaller instruments to bypass a ledge
periapical microsurgery facts
- bevel/angle root tip 0-10 degrees
- retrofil 3mm
- fill with MTA
BIG NiTi files pro and con
Pro= flexible, less likely to ledge Con= flexible, more likely to fracture
canal transformation
file tries to straighten canal, makes ledge, BAD, artificial
mineral trioxide aggreagate
MTA, internal repair or filling material for apical micro surgeries
- stimulates cementoblasts to produce hard tissue
- 3 minerals: calcium, silicon, aluminum
CONS
- bismuth oxide= opacifier, shows on xray and can stain teeth so avoid on anteriors
- long 3 hr setting time
PRO
- sets in presense of moisture
- antimicroial
- nonresorbable so great for sealing
TRAVMA
Tetanus booster (avulsions only) Radiographs Antibiotics (avulsions only) Vitality More Appointments
Strip perforation
distal side of mesial root on MN molars due to excessive coronal flaring
Ellis Classifications
class 1= 1 layer 2= 2 layers 3= 3 layers 4= becomes non-vital 5= moves (luxation) 6= lose (avulsion)
uncomplicated vs complicated fracture
uncomplicated= without pulp exposure
- enamel- smooth
- enamel plus dentin= restore
complicated= with pulp exposure
- less than 24hr- DPC
- 24hr or more- Cvek aka partial pulpotomy
- 72+ hr -Pulpotomy (remove entire coronal pulp)
concussion vs subluxation
concussion- no mobility, no bleeding, no displacement but sore PDL… let it rest
subluxation- no displacement but increased mobility, PDL is ripped and bleeding… flexible splint
worst prognosis for an necrotic tooth?
intrusion with a closed apex
avulsion vs extrusion?
avulsion- completely lose tooth
extrusion- partial extruded from socket
what to do with avulsed perm tooth?
closed and <60min = reimplant and splint
open and <60min= same^ except apexification at first sign of infection
closed >60min= reimplant, splint, RCT
open and >60min= maybe reimplant? plan for implant
Hank Balanced Salt Solution
storage media for avulsed tooth
*milk, saline and saliva work too
external vs internal resorption
external
- damaged cementoblastic layer in periodontium starts resorption
- poorly defined margins
- MOVES with XRAYS
internal
- damage to odontoblastic
- better prognosis, RCT
- defined margins
- does NOT move with xray
replacement resorption
- ankylosis, replaces PDL with bone
- external
Cervical resorption
- subepithelial sulcular infection from trauma or nonvital teeth bleaching
- external
inflammatory root resorption
bacteria and byproducts from necrotic pulp travel through dentinal tubules to affect periodontium
Formocresol
used in pulpotomy for the fixation zone
calcific metamorphosis
trauma induces odontoblasts to rapidly make reparative dentin within pulp, yellow-orange tooth and more likely with open apices
calcium hydroxide
stimulates secondary odontoblasts to repair with dentinal bridge formation (aka tertiary dentin)
* HIGH pH of 12.5!!!!
Buckley’s Formocresol made mostly of?
35% - cresol
19% - formaldehyde
15% - glycerine
31% - water
bactericidal + “fixative”
indirect pulp cap vs direct pulp cap vs partial pulpotomy(cvek) vs pulpotomy vs pulpectomy vs RCT
indirect - CaOH or RGMI on thin partition of dentin
direct pulp cap - CaOH or RGMI directly on dentin
Cvek - shallow pulpotomy
pulpotomy- full removal of pulp
pulpectomy- RCT w/o gutta perch, temporary
RCT - full removal coronal and radicular pulp with gutta percha
apexogenesis vs apexification
apexogenesis - vital tooth, used to maintain pulp vitality in order stimulate root development for immature perm teeth
* CaOH or MTA placed on healthy or diseased pulp
apexification - immature perm tooth is dead so you just want to seal root
* CaOH or MTA placed at base of canal after pulp removal