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Endo revision notes Flashcards

1
Q

Purpose of dental dam

A

tp retract and protect soft tossues
to reduce operator stress
prevent the pt from rinsing
prevent bacterial contamination
to prevent inhlation of insturments and materials

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2
Q

Ideal end point in RCT

A

CEJ/apical constirction

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3
Q

Recapitualtion

A

the introduction of smaller instruments into the canal to remove any debris present and to keep the canal clean

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4
Q

Pre op radiograph

A

to assess for peri-raiducalr pathology
canal calficiation
root -size, shape, number
pulp horns
the pulp chamber
the localtion of canals

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5
Q

Patency

A

communication between the root canal and peri-radicular tissues by passing small files beyond the apical constriction

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6
Q

Design objects in endo

A

create a continusally funnellnig shape
maintain the apical foramen
keep the apical opening as small as possible

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7
Q

Radigraphs used in rct

A

cwl radiograph
ppre and post radioraphs
maf rafigraph

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8
Q

eastimated working length

A

measured from a radiograph and is taken from a conronal refernce point to the apex of the tooth

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9
Q

Corrected working length

A

it is from a predefined coronal point to the apical terimnus of a tooth 1. radipgraph, 2. apex locator, 3. papper point length

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10
Q

Master apical file

A

the final file that is used in the apical portion of the canal to working length and is shaped and ready for obturation

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11
Q

GP consisits

A

GP (15%)
Radiopacifier (5%0
Plasticieser (15%)
zinc oxide (65%)

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12
Q

MTA

A

mineral trioxdie aggerate
used - root tips for apicectomy, root fracture repairs, internal root reosprtion, pulp capping

advantages - biocompatible, relases ca, alkaline ph, antibacterial
disadvangtages - long setting time, high cost, discolouration

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13
Q

Aims of NaoCl

A

disinfect the canal
to dissolve oragnic debris
to flush out debris
to lubricate insturments during root canal treamtnet

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14
Q

Factors for NaoCl function

A

volume
contact
exchange
chemical agigitation
concentration

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15
Q

NaoCl conc

A

0.5-6% - 3% the best

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16
Q

Problems with NaoCl

A

does not remove the smear layer
discolouration of fabrics
allergies
can cause eye damage
apical extrusion leading to tissue necrosis

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17
Q

Smear layer

A

a layer of inorganic debris and rganic material formed during cancl prep
it prevent sealer penetration

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18
Q

How to remove smear layer

A

17% EDTA - chealating agent that removes smear layer and opens dentinal tubules

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19
Q

Guidance for use for naocl

A

use a pt bib to prevent disoclouration of fabric
eye protection for pt
pass the syring behind the pts head
label all syrings correctly
test the naocl site with chx before using to ensure correct seal
use rubber dam
use side vented 27mm gauage 3ml syringe
depress plunger wtith finger rather than thumb
ensure only fill the syring 2/3rd full
correct concentration of naocl
use a rubber stop 2mm short of working length
avoid in tight canals and have a good opening

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20
Q

Symptoms of naocl extrusion

A

pain, swelling, neurological signs, heamoragge, airway obstuction, brusing

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21
Q

Risk factors for extrusion of naocl

A

concentration
needle locked in the canal
excessive pressure
loss of control of working length
proximity to sinus

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22
Q

NaOCl extrusion what to do

A

stop what you are doing imeediately and inform the pt of what has just occured
acheive heamostatis in the tooth and canal and place an intermedicament dressing
do not obturate or seal the canal
if small then advice pt cold compresses for first 24hrs, warm compressers thereafter, anaglesics for pain, anibiotics if only necorsis and spreading infeciton
review pt in 24hrs
if larger then may require advice and trasnfer to local max fax unit
document the incident in the pt notes and the accident incidicent book

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23
Q

Function of selaers

A

to lubricate during condesation
to fill voids and irregularies between GP and the canal
seals between dentinal walls and core

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24
Q

Properties of a sealer

A

biomcompatible
radiopaque
dimensially stable
does not dissolve in oral tissue fluids
can easily be removed from root canal if required
slow setting
no shrinkage
no staining
antibacterial
insoluble

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25
ZOE sealer
antimicrobial but realses free eugenol which can be an irritant
26
GI sealer
minimal antibacterial activity diffierlt to remove if required increased solubility
27
Resin sealers
slow setting good flow
28
Calcium silicate sealer
biocompatible easy to use quick set non resosorbale excelleing selaing abilities
29
Aims of root canal fillng
prevents the intrioduction of microgoransisma dnfluids into the canal blocks any remaining micro-ogranisms in the canal blocks the apical formaina, dentinal tubules and accessory canals
30
Anti - microbial paste
odontopaste/ledermix contains both tertracyline and corotocosteriod aids in reduction of pulpal inflammation
31
Ns CaOH
alakaline ph 12.5 so antimicrobal effective in removing tissue debris thin so won't reduce striength
32
Ns CaOH used for
inter medicament sealer pulp capping interal resorption apical resoprotption root fracture open apex and immature tooth larger perapical lesions
33
Beofre tx failures of endo
pooh oh missed diagnosis case selection
34
during tx failures for endo
missed canals iotrogenic damage infeefftive cleaning, filling, shaping
35
after tx failures for endo
poor oh and caries develops damage when placing post leakage of conronal restoration
36
Failures of RCT
re infeciton missed canals perforation of root loss of conoral seal not adequate patenct communcaiton of canal necrotic material left
37
Extra radicular features of failure
radicular cyst present root fracture
38
Tx options for RCT failure
retreatment rct peridaciular surgery do nothing if aymptomatic XLa
39
Success for RCT
GP is withing 2mm of apex well conensed, no voids or irregularites present good cornoal resotration
40
Radiograph follow up
1 year and for 4years after
41
Periradicular surgery
apicectomy surgery which onvovles removing only the root tip of an infected tooth - about 3mm leaves the RCT intact Used - when peri-radicular infection coninues, cannot retreat rct, cyst or infection present, iotrogenic damage (perofration)
42
Endo retreatment
use protapers D1,2,3 for resin selaers - ultrasonic for GP - protaper D and ecalptus oil soluble paste - protaper with solvent
43
Special investigations for diagnsosi
percussion test - positive means inflammation mobility test sensbility tests occlusion - occlusal trauma intitates periadicular periododntitis Test cavity by drilling with no la Perio probing transilliumniation radiogrpahs cusp loading test - tests for cracked tooth sinus tract explration
44
Puliptis
inflammation of the pulp
45
Reversible pulpitis
inflammation of the pulp which lasts for only a few seconds and is to do with cold, sweet things, sharp quick shooting pain
46
Irreversible pulpitis
inflammation of the pulp which lingers for a period of time onces the stimulus has been removed the vital inflammaed pulp cannot heal referred pain
47
Pulp necrosis
death of the pulp - due to trauma or calcification
48
Don't pulp cap
non vital teeth pa path present irreversible pulpitis large exposure
49
Main causes of injury to pulp
bacteria present due to: -caries - perio disease (dentinal tubuls, furcal and lateral canals) - cracked teeth - trauma - erossion, attrition, abrasion (dentinal tublues) -developmental anomalies
50
Apical periodontitis or periapical periodontitis
inflammation of the tissues surroudn the root of a tooth - casues infection in root canal system inflammation of periradicular tissues pressure to biting, TTP, palaption PDL can sometimes be widening
51
Chronic peripapcal abscess
inflammatory reaction to pulpal infection and necrosis gradual onset, little discomfort and pus through sinus or perio pocket
52
Acute periapical abscess
inflammatory reaction to pulpal infection and necrosis rapid onsent, pain present, pus, swelling, maliase, fever, lymphadenopathy, TTP
53
Indirect pulp cpping
when the pulp of the tooth is not quite exposed but close use either calcium silcate or calcuim hydroxide with rmgic/gic and resotration
54
Direct pulp capping
<24hrs <=2mm exposure of pulp
55
Partial pulpotomy
pulp expose >=2mm, bleeding and inflammation cannot be stopped and acheieved
56
Full pulpomty
large portion of pulp exposed nd bleeding cannot be achieved if heamostasis continues may need to reusslt in pulpectomy
57
Follow up in endo cases
6months clincially 1 year radiographically
58
Obturation
warm vertical condensation lateral condesation carrier based thermomechanical compaction
59
PRevention of fractures on teeth
minimise internal wedging forces minimalr removal of intraradiuclar dentine avoid use of posts where possible
60
Types of tooth fractures
craze lines cracked cusp crack tooth split tooth vertial root fracture
61
Craze lines
seen on the enamel of teeth no tx required
62
Cracked cusps
occurs on 2 aspects of cusp by crossing the marginal ridge either buccal or lingually fracture of crown going subinginvally Tx -removal of the cusp and replace with onlay/crown
63
Cracked tooth
incomplete fracture from crown subgingivally marginal rdige and proximal surfaces more centred and apical than a cracked cusp likley to casue PA path and pulpal issues Tx = potential rct
64
Split tooth
crack on tooth that extends subgingivally complete fracture occurs after the evoluation ofa cracked tooth Tx - mainly xla unless can remove segment
65
Vertical root fracture
complete or incomplete fracture going subingvally and then cornally Tx - xla or potentially hemisection
66
How to prevent fracturing endo insturments
allow a good striaght line access good vision and magnification and illumination use files in correct sequence aviod using files on numerous occasions do not put too much force or pressure in the files
67
What are the main cuases of failure of rct
bacterial contamination inadequate disinfection
68
Intrument fracture due to
small files operator inexperience poor root morphology/ curvatures torsional or flexure fracutre number of times files used technique used
69
Why carry out periradiuclar surgery
if failed RCT before biopsy of a periapcal path - radicular cyst external root resoprptioin ramage of damage - perforation management of peradicular infection direct inspection of fracture retirval of fracture insturments
70
File retrield procedure
apical 1/3 - do not achieve retirieval - obture to fractured insutrment and monotr middle 1/3 - try to bypass and if not obture to fractured insturment and potential for surgery cornal 1/3 - remove fracture intrument with minimal removal of dentine
71
If sepration occured before instrumentaion or disinfection
bypass fracture and if not then place interm ed caoh and wait 2-4weeks and then obturate adn follow up
72
Internal inflammatory root resoprtion
non vital pulp resorbs the internal surfaces of a root balloning appearnace intrenal and root surface intact pink spot may be present on tooth Tx - mechanical and chemical debrdiement, ns caoh placed for 4wks and then obturate
73
External inflammatory root resoprtion
intiatited by PDL damage which is maintained and propgated by necortic pulp tissue root surface indisitnct and the intact tramlines of internal canal Tx - chemical and mechanical debridment, nscaoh placed for 4wks then obturate
74
External cervical root resoprtion
resoortpio of root surface that occurs cervically on the root parallel lines present and apple core appearnaced Tx - monitor, XLA, interal repair and endo
75
External replacement reosprtion (ankylosis)
resoprtion of tooth sutructure which inturn tunrns to bone loss of PDL and lamina dura occurs after trauma - avulsion, luxation, intrusion Tx - no treament possible exepcet decorniate to ACJ if infra occlusion and monitor
76
Root resoprtion occurs due to
truama bleaching bruxism ortho exfoliation of decidous teeth impacted teeth
77
posts indicated
in premolar teeth when 1/2 marginal ridges are lost on tooth
78
Choice of post
root morphology internal canal antomy remoaing coronal dentine
79
Post crietira
4-5mm of GP present at the apex of the tooth no more than1/3 the diameter at the root of the tooth crown to post ratio 1:1 2/3rds the root length 2mm of ferulle present 2mm supra ging tooth remaining 1mm of coronal dentine present avoid lower incisors and curved canals
80
Ideal post
parallel sided - avoids wedging and reduces root fracture cement retained non threaded - less stress on tooth, howver is less retentive not rotated
81
Parallel sided
requires the removal of more dentine to be removed so risk of peroforation
82
Tapered sided
less dentine to be removed small tapered roots HOWEVER more stress into root so incrsaed root fracture
83
Serrated
increases root surface area for retention but does not increase stress
84
Post removal
USS Masseran kit Eggler post remover Mosquuito forceps Sonic scaler
85
Failure of posts
fibre - decementation carbon or metal - due to root fracture due to stress Perio Caries Vertical root fracture Root resoprtion Decementation Perforation endo failure post or core fracture
86
Nayyar core
uses amalgam or compiste used when loss of both marginal ridges and the pulp chamber small 2-3mm of g pis removed in the coronal portion
87
Ferrule
2mm of ferrule remaining to increases resitance from fracture due to lateral forces
88
Cores
composite - mainly for firbe osts, good aethetics, bonds to tooth strucuture, however mositure sens and tech sens Amaglam - easy prep, poor aesthetics and requires retnetion as can't bond to dentine adn takes 24hrs to set so dealy in tx GI - bonds to dentine adn relases fluoride, but it is weak and absorbs water and expands
89
Material
Ceramic - zirconia Cast metal - risk of corrision, ppor aesthitcs, radiopaque, root fracture fibre posts - glass, quartz, carbon - do not use if not enough ferrule as risk of root fracture
90
Ledge
a step made within a canal due to stopping the file too short of the working length
91
Zippeing
a tear drop shape created in apical 1/3 of the wall - due to overextending passed the apical forman or large files
92
Transportotion
creation of a new pathway - due to excessive force during instrumentation

FINALS!!! (20 decks)

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