Endo Misadventures Flashcards Preview

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Flashcards in Endo Misadventures Deck (61):
1

What are some factors that contribute to providing wrong tooth/treatment?

 

  • Continue symptoms after dx
  • Teeth look alike
  • Failure to test vitality
  • Non-odontogenic lesion
  • Referred pain
  • Case difficulty

2

What are some non-odontogenic causes of pain?

  • Musculoskeletal - Myofasical pain, TD
  • Neutropathic - Trigeminal Neuralgia, Phantom tooth pain
  • Neurovascular - Migraine, Cluster HA
  • Inflammatory - Sinusitis
  • Systemic Disorders - Cardiac, Herpes Virus, Tumors
  • Psychogenic - Munchausens

 

3

What are some things you can do to prevent doing RCT on the wrong toth?

  • Time Out
  • Don't use RD INITIALLY
  • Complete vitality testing
  • Refer when necessary

4

What is canal transportation?

  • When the central axis is dislocated from original position
  • "Hour-glass appearance"

 

 

5

What is a zip perforation?

  • A transportation that leads to perforation apically

6

What is a ledge?

  • Iatrogenically created
  • Impedes Instrumentation
  • An artificial irregularity created on the surface of the root canal wall that impedes  the placement of instruments to the apex of an otherwise patent canal

7

What are some adverse consequences of ledging?

  • Incomplete canal debridement
  • Incomplete Obturation

8

What factors contribute to canal transportation?

  • Lack of expertise
  • Insufficient access cavity
  • Poor control of length
  • Lack of coronal flare
  • Use of end cutting files
  • Excesive axial filing
  • Oversized MAF

9

How do you avoid canal transporation?

  • Achieve excellent access
  • Control Length
  • Have good coronal flare which reduces coronal curvature, improves straight line access, reshapes "C" into "J"
  • Avoid end-cutting files
  • Use safety-tipped files: Flex-R, Sure Flex, NiTi rotary
  • Think small
  • Minimize axial filing motions - especially apically
  • Used balanced force technique

10

How do you treat a ledge?

  • Attempt to bypass - Short radius bend in file
  • If not, obturate, may require root end surgery

11

Define perforation...

Iatrogenic or pathologic communication between pulp space and oral cavity or attahment apparatus

12

How do you recognize a perforation?

  • Pain short of apex
  • Excessive bleeding
  • Visually inspect
  • Apex locator reads out
  • Bleeding on paper point
  • Confirm radiographically

13

What 3 factors influence perforation treatment?

  • Level
  • Size
  • Time

14

What is the most determinant of success when treateting a perforation?

The distance between the perforation and gingival sulcus 

Coronal to attachment = good

Apical to attachment = good

AT LEVEL OF ATTACHMENT = BAD!

15

Is a small or large perforation easier to seal?

Small eaiser to seal

Large harder to seal

16

How does time influence perforation?

Seal immediately for best prognosis

17

What are the 5 Perforation Types?

1. Coronal

2. Crestal

3. Chamber Floor

4. Midroot and Strip

5. Apical

18

What factors contribute to coronal and crestal perforations?

Disoriented during access

Calcified canals, etc...

19

What tooth factors work against you in avoiding a perforation?

  • Tipped tooth
  • Crown
  • Calcified toot
  • Crown-root deviations

20

What can a dentist do to help avoid a perforation?

  • Access without RD
  • Isolate multiple teeth
  • Make check radiograph
  • Observe dentin roadmap
  • Observe exit angle of file handle
  • Study chamber position and dimensions
  • Aim for largest pulp space, careful with highspeed round burs!
  • Make proper access

21

How do you treat a perforation?

  • Locate and protect canals
  • Control bleeding
  • External matrix
  • Composite, RMGI, Compomer (Geristore)

22

How do you avoid a chmber floor perforation?

  • Be aware of the dark chamber floor
  • DO NOT BE TOO AGRESSIVE WITH HIGH SPEED ROUND BURS!

23

What clues will the canal give you if it's calcified?

  • Sticky with endo explorer
  • "Dust spots"
  • White calcified dentin
  • Dentin road map
  • NaOCl chapagne bubbles

24

How do you treat a perforation?

1. Use NaOCl cautiously

2. Control hemorrhage

3. Internal matrix (prevents material extrusion: ie: Collagen materials, Calcium sulfate, Calcium hydroxide, FDBA)

4. MTA or RMGI

5. Once repaired, complete RCT

25

What factors contribute to a Midroot/Strip perforation?

  • Overzeals coronal flaring
  • Forcing instrument
  • Calcified canal
  • Previously obturated

26

How does one avoid a perforation at the mid root or strip?

  • Use caution near danger zone
  • Appropriate size and type of files
  • Anticurvature filing
  • Avoid aggressive files
  • Understand radicular anatomy

27

How do you treat a strip perforation?

1. Gutta-percha apically then MTA

2. Fill entire canal with MTA

3. Avoid sealer extrusion through perforation

28

How do you treat a midroot perforation?

1. Attempt to treat original canal

2. Clean and shape perforation and obturate with GP/Sealer

3. Use root ZX/paper point to determine WL

29

What factor contributes to an apical perforation?

Failure to control apical transporation in a curve

30

How do you prevent an apical perforation?

  • Excellent coronal access
  • Length control
  • Crown-down
  • Balanced force (hand files)
  • NiTi rotary files
  • Appropriate sized files

31

How do you treat an apical perforation?

1. Clean, shape, obturate perforation channel

2. Root ZX and paper points

3. Attempt to locate/treat original canal

32

What are some treatment options if you have a chamber floor perforation?

  • Bicuspidization
  • Hemisection
  • Root Amputation
  • Extraction/Implant

33

What are some treatment options if you have a Midroot/strip perforation?

  • Hemisection
  • Root amputation
  • Extraction/Implant

34

What are some treatment options if you have an apical perforation?

  • Root-end surgery
  • Intentional replantation

35

What 2 factors contribute to seperated instruments?

1. Torsional fatigue

2. Cylic fatigue

36

What is the definition of Torsional Fatigue?

Instrument tip locks or drags in canal while shaft continues to rotate, thereby exerting enough force to fracture the tip

37

What are some warning signs of seperating instruments?

  • Too much apical force
  • Clicking sounds
  • Unwinding

38

How do you prevent sperated instruments?

  • Monitor file use
  • Examine files
  • LIGHT APICAL PRESSURE
  • Adequate irrigation/lubrication
  • Clean your files
  • Rotaries at correct RPM
  • Experience
  • Know your anatomy

39

What is cylic fatigue?

When cyclic load leads to metal fatigue - like bending/breaking a metal coat hanger - no warning signs

40

How do you prevent instruments from seperating?

  • Caution around abrupt curves
  • Discard rotary files after 3 uses
  • New files
  • Discard small SS files liberally
  • May be a case for hand instumentation

41

What considerations should you have when using a Lentulo Spiral?

  • Should be Pre-fit
  • FORWARD DIRECTION ALWAYS
  • Consider other delivery methods for CaOH sealer (NaviTip, Master cone)

42

How would you prevent amalgam scraps in root canal zone?

  • Refine acess prior to instrumentation of canals
  • Block orifices if access needs to be refined later

43

What are your 3 options when considerting treatment for a sperated instrument?

  1. Remove
  2. Bypass
  3. Leave

44

What are 3 methods one can use to remove a broken file?

  • Flush 
  • Vibrate
  • Grasp

45

When should you bypass seperated instruments?

  • Small files with short radius bends
  • Incorporate instrument into root fill

46

When you leave an instument, how do you treat?

  • Complete RCT to sperated file
  • Prognosis dependent upon: 1. Level of seperated file, 2. Size of seperated file, 3. Initial Diagnosis
  • Reserch has found NO DIFFERENCE IN SUCCESS RATE

47

What patient considerations should you have when an instrument seperates?

  • It is not malpractice to break an instrument
  • Inform pt of seprated file
  • Failture to inform is beneath standard of care
  • Document a sperated file occurred
  • "A file sperated in the root canal of your tooth" vs. "I seperated a file in your root canal"
  • Prognosis usually not adversely affected

48

What factors contribute to obturation overfilles?

  • Inadequate WL
  • Inadequate apical stop
  • Inappropriate use of thermoplasticized GP
  • Adversely affects success of case

49

How does one prevent overfilles?

  • Determine WL
  • Obseve paper points when drying canal
  • Good apical stop
  • Consider MTA barrier for open apex/resorption

50

What factors contribute to obturation underfills?

  • Inadequate instrumentation
  • Inadequate access/taper
  • Canal blockage/dentin plugs
  • Ledge
  • Lack of effort

51

How do you prevent underfills?

  • Adequate irrigation
  • Recapitulation
  • Avoid ledges
  • Make sure GP goes to length

52

How do you avoid Dentin Plugs?

  • Start with small files and gain patency early
  • Rotaries require glid path with #15 file first
  • Adequate irrigation to flush debris out
  • Avoid filing technique
  • Recapitulate WL with small files to break up dentin mud
  • Fill canal with NaOCl
  • Use #10 C file to "pick" at blockage to break up dentin mud

53

What are some sequaele of a Sodium Hypochlorite Accident?

  • Immediate severe pain - self limiting
  • Profuse bleeding from tooth
  • Rapid swelling
  • Ecchymosis

54

How do you treat a NAOCL Accident?

  • Recognize, reassure pt
  • Ice packs 4-6 hrs - Warm moist compresses on day 2
  • Antibiotics
  • Pain medication
  • Careful follow-up
  • If severe - Steroid, Hospitalization, Surgical Intervention

55

How would you prevent a NAOCL Accident?

  • Passive needle placement
  • Side-vented needle
  • MEasure length of needle
  • Substitute 2% CHX for Resorptive cases/perforations

56

Is CaOH neurotoxic? What teeth should you exercise care around when using CaOH?

  • CaOH IS neurotoxic
  • Exercise care - man premolars and 2nd molars (due to nerve proximity)

57

How can you prevent a CaOH accident?

  1. Quality Radiographs
  2. Recognize the intimacy of root apices to vital anatomy (IAN nerve)
  3. Correct WL - verify with Root ZX, radiogaphs and if need, paper points
  4. DO NOT bind CaOH needle in canal
  5. Place needle 2 mm short of WL before depositing CaOH
  6. Dispense slowly and look for back flow while withdrawing needle

58

How do you manage a CaOH accident?

  1. Inform Patient
  2. Immediately refer to OMFS for same-day management of CaOH extrusion into the IAN canal. Best to escort pt to OMFS
  3. Extract tooth and lavage sock with sterile saline
  4. If extrusion extends anterior or posterior in canal, may need to surgically expose canal and flush remainig CaOH out. 
  5. Pain mangement
  6. Paresthesia follow-ups

59

What is Air Emphysema?

  • Compressed air into tissue
  • Rapid swelling
  • Erythema
  • Crepitus

60

How do you treat Air Emphysema?

  • Palliative
  • Antibiotics
  • Airway management if necessary

61

How do you prevent Air Emphysema?

  • Microsuction/paper points to dry canal
  • No air/water syringe