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BDS4 Restorative Dentistry > Endodontic BDS4 Summary > Flashcards

Endodontic BDS4 Summary Flashcards

1
Q

What is the main aim of root canal treatment? 2

A

To eliminate INFECTION
remove root canal contents

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2
Q

What do we assess for endodontics?

A

Tooth colour
Soft tissue - any swellings
Palpate the soft tissue
sinus presence
TTP?
Sensibility testing
Radiographs
Prev restoration?

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3
Q

How is pain transmitted?

A

Via CNV and its three branches

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4
Q

What are A delta fibres?

A

The A-delta fibers are somatic, myelinated fibers that have primary connections to the cortical regions of the brain. These fibers convey sharp, lancinating, easily localized pain signals; this pain sensation usually quickly passes

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5
Q

What are C fibres?

A

C fibers respond to stimuli which have stronger intensities and are the ones to account for the slow, lasting and spread out second pain. These fibers are virtually unmyelinated and their conduction velocity is, as a result, much slower which is why they presumably conduct a slower sensation of pain

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6
Q

What are the types of sensibility tests?

A

Ethyl chloride
EPT

test adjacent sound teeth first so pt knows what to expect

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7
Q

What do sensibility tests assume?

A

That tooth having a nerve supply correlates to mean it has a vital blood supply

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8
Q

What does EPT do?

A

This is where we apply conducting medium such as toothpaste to tooth and pt holds to complete circuit and it generates AP in A delta fibres (short sharp pain) and when pt feels pain breaks circuit

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9
Q

What does Ethyl chloride do?

A

Cold stimulus applied that stimulates A delta fibres

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10
Q

SIs for endo?

A

Sensibility testing
Radiographs
Tooth sleuth
Selective anaesthetisa

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11
Q

What are the types of pulpal diagnosis?

A

Normal pulp

Reversible pulpitis

Asymptomatic Irreversible pulpitis

Symptomatic irreversible pulpitis

Pulpal necrosis

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12
Q

What is a normal pulp?

A

This is where the pulp is symptom free, normal response to testing

Mild/transient response to cold testing which lasts 1/2 seconds following removal

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13
Q

What is reversible pulpits?

A

Inflammation of the pulp that is capable of healing following management of cause

Tooth experiences discomfort to cold stimulus/sweet stimulus when applied but assess after few seconds of removal

not spontaneous

common in carious or prev restored tooth

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14
Q

What is symptomatic Irreversible pulpitis?

A

This is where pulp is inflamed and incapable of healing and RCT is indicated

Radiogaphuically - may be winding of PDL or loss of LD and only if chronic will be PA radiolucency

spontaneous, lingering pain, hard to localise, hot and cold, awake at night, OTC analgesia not effective

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15
Q

What is asymptomatic irreversible pulpitis?

A

This is where pulp inflamed, not capable of healing but tooth is asymptomatic - hard to dx

may have widened PDL or loss of LD

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16
Q

What is pulpal necrosis?

A

This is where pulp is no longer vital - has died

may prev have been symptomaitic but now asymptomatic and pulp has liquefied

if long standing can get PA radiolucency

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17
Q

What are the PA diasnoses?

A

Symptomatic apical periodontitis

Asymptomatic apical periodontitis

Chronic apical abscess

Acute apical Abscess

Condensing osteitis

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18
Q

What is Symptomatic apical periodontitis?

A

This is where there is inflammation of the apical periodontium, widening of the PDL, loss of LD, tooth is TTP, sporadic pain, RCT indicated

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19
Q

What is asymptomatic apical periodontitis?

A

This is where there is inflammation of apical periodontium, widening of PDL, loss of LD but tooth is not symptomatic - often small bony swelling present

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20
Q

What is an acute apical abscess?

A

This is where there is an inflammatory rxn to pulpal infection and necrosis - rapid onset, spontaneous pain, TTP, pus, swelling, often no radiographic changes

systemic malaise

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21
Q

What is a chronic apical abscess

A

Longstanding response to pulpal infection/necrosis
pt often has bad taste and may have sinus tract with discharging pus nbut little to no symptoms
PA radiolucneyc

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22
Q

What is condensing osteitis?

A

This is where there is a diffuse radiopaque lesion as a result of low grade inflammatory response (infection)

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23
Q

What are the tx options in Endo?

A

No intervention with review
Orthograde RCT
Re-RCT
Retrograde surgical RCT

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24
Q

How do we carry out endo?

A

Front surface mirror
Good light
Magnification

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25
If pulp is NV and cause is endo what is tx?
RCT
26
If pulp is NV and cause is perio and endo what is tx
RCT then 7-10 days later perio tx
27
If pulp is vital and cause is endo what is tx?
RCT or if pulpitis reversible then caries removal
28
What causes endodontic infection?
It is causes by microorganisms which invade the root canal space and proliferate and develop biofilms which adhere to dentine and make eradication difficult
29
Wha are the design objects of chemomechanical disinfection? 3
Maintain apical foramen position Maintain size of apical foramen (keep as small as possible) Create a continuously tapering funnel shape
30
What are the aims of cleaning and shaping the canals? 4
Remove the infected hard and soft tissue create space for delivery of irrigants to disinfect canal system create space for obturation maintain structural integrity of apical periodontium
31
What are the stages in root canal?
LA, Dam Access cavity Straight line access with DG16 and 10k file to 2/3rds EWL Negotiate canals Create coronal flare Det WL Apical prep
32
What are ideal quality of irritant?
Removes smear layer disrupts biofilm kills microorganisms non allergenic low cost non toxic to peri-radicualr tissues
33
What irritants do we use in endo?
Sodium hypochlorite (Parcan 3%) EDTA 17% to disrupt the smear layer CHX - 0.2%
34
What is sodium hypochlorite?
Irrigant used that has anti-microbial activity that kills MOs and disrupts the biofilm and any pulp remnants and dissolves necrotic and vital tissue Conc of 0.5-6%
35
What factors affect sodium hypochlorite?
Concentration Time Volume Contact
36
Why is conc of sodium hypochlorite important?
At high conc higher risk of extrusion and higher conc more active against organic tissue
37
Why is time in sodium hypochlorite important?
It needs to be in root canal space to dissolve the biofilm - needs appropriate time
38
Why is volume of sodium hypochlorite important?
volume as it inactivates quickly in canal so need to replenish with sufficient volume to disrupt the biofilm and kill micro-organisms
39
Why is contact relevant in sodium hypochlorite?
Needs to contact all of canal coronally to apically to disrupt biofilm and kill MOs
40
How do we begin all endodontic procedures regardless of the technique used?
LA and create access cavity (with or without dam) Then use of dam identification of canal orifices with GD16 probe and can also use 10k file to 2/3rds EWL for Canal negotiation Glide path to EWL with 10k file
41
What are the types of endodontic techniques we use in RCT?
Modified double flare technique Protaper Hand Files Protaper Gold (rotary system) Reciproc Reciproc Blue
42
Describe the process of root canal treatment using modified double flare technique
Create access cavity (confirm witth DG16 and K files) Irrigate - sodium hypochlorite Coronal flaring - using Gates Glidden burs 1. start using GG4 to 2/3rds of EWL with light apical pressure and brushing movement then irrigate, recapitulate, then GG3 to 2/3rds EWL to drop prep more apically, irrigate, recapitulate, GG2 to 2/3rds EWL 2. now we can establish CWL with apex locator using size 10K file 3. after coronal flare we do apical prep - use a size 15k file to CWL with watch winding motion (30, 60)- IAR, then size 20k file to CWL with balanced force technique (1/4 forwards, 1/2 back) , IAR, then size 25K file IAR, then once we find file binding we want to go up two more sizes to create an apical stop and this is our master apical file 3. now we want to join coronal flare and apical prep - we do this by using step back technique - take one larger than master apical file and go to CWL - 1mm and then repeat with MAF 2 sizes bigger - 2mm until joined 4. irrigate protocol 5. dry 6. obturate
43
What is balanced force technique?
Quarter turn clockwise Half turn anticlockwise
44
What is watch winding technique
30 degree 60 degree
45
What is the steps involved in pro taper hand files?
Access cavity Straight line access DG16 and K files to 2/3rd EWL Then we want to establish CWL with 10k files and apex locator Then use of ISO 10 file to CWL Then use of ISO 15 file to CWL Protaper S1 for coronal third prep Irrigate and recapitulate Protaper S2 for mid third prep Irrigate and recapitulate Then Protpaer F1 for apical prep 1/3rd (ISO20) PROTAPER F2 FOR APUCAL PREP (ISO25) - if master apical file is 25k stop here but if larger canal may need F3, F4 F5 IRRIGATE AND RECAPITUALTE AND ESNRUE TUG BACK CHECK WIH ISO25K FILE IRRIGATION PROTOCOL DRY OBTURATE
46
What is proper gold?
This is a rotary instrument similar to pro taper hand files expect its done with motor system initially exposure with 10K files to 2/3rds, then S1 to 2/3rds EWL, calculate CWL, then use S1 to CWl and then S2 then F1 F2
47
How do we use reciproc for RCT?
Make assessment first for R25 R40 or R50 if canal is narrow or not visible on X-ray then use of R25 If canal if medium/wide test with 30K file --> if it reaches EWL then R50 as wide canal if it doesn't reach EWL then use a size 20k file and then R40
48
What are the steps of reciproc?
Access cavity Straight line access as above Irrigation and get glide path and apical patency with size 10k file R25 to 2/3rds EWL - irrigate and recapitulate - 3 pecks and ensure in movement until fully out canal and continue until get to 2/3rds EWL then CWL with apex locator Irrigate and recapitulate then R25 to CWL - 3 pecks and irrigate and recapitulate then check with ewuaivalnt K file (25K file) that we are at CWL and apical tug back - we have apical control irrigate dry obturate
49
What is the process of obdurating?
Remove any inter canal medicaments and confirm CWL and tug back to ensure apical control Dry canal using paper points (ensure final irrigation protocol has been carried out) Then try in master GP cone and check for tug back Mix root canal sealer (epoxy resin, GIC, RMGIC) Lightly butter GP cone and place into canal Use of finger spreader (a or B) and leave in position for 20 seconds then remove and place accessory cone into canal Heat excess GP with endo alpha or heated plugger and condense GP in orifice to level of ACJ seal with RMGIC to prevent coronal leakage
50
What are common symptoms of sodium hypochlorite extrusion?
Pain Swelling Bruising Profuse bleeding into root canal system Airway obstruction
51
Where doe bruising follow in sodium hypochlorite extrusion?
Along superficial venous vasculature
52
What are risk factors for sodium hypochlorite extrusion?
Loss of CWL/EWL - either through movement of rubber stop or not confirmed with radiograph or apex locator Excessive pressure whilst irrigating - use of thumb instead of index finger needle locked within Canal Large apical constriction (immature teeth, root resorption) Close proximity to maxillary sinus Delivery of irrigant to fast (1ml/15 seconds)
53
Why does inc pressure cause sodium hypochlorite accident?
Inc pressure means that delivery is increased pressure which exceeds venous pressure in neck
54
How do we manage sodium hypochlorite accident? 10
STOP TX Keep pt calm and reassure - we will take immediate management steps if pain --> LA (block) if profuse bleeding - allow bleeding into canal until HA irrigate with saline steroid containing medicament such as ledermix into canal (no obdurating at this visit) seal coronal access analgesia advice review in 24hrs ABX is case specific
55
What are the types of inter canal medicaments?
Ledermix (corticosteroid and antibiotic) Non setting calcium hydroxide (antibacterial)
56
What is ledermix?
This is a inter canal medicament that contains corticosteroid and antibiotic that is antimcibrobial and used when pulp is hyperaemic or inflamed to reduce inflammation
57
What is non setting calcium hydroxide?
This is used when pulp is inflammed and is alkaline pH and is used as inter canal medicament and helps remove tissue debris
58
What are the 3 criteria before obturating?
Pt is symptoms free Canal is able to be dried Canal has undergone full biomehcanical cleaning process (irrigation and shaping) No signs of infection.
59
What is the function of a sealer?
Fill the space between GP and root canal provide fluid tight sesl
60
Examples of RC sealer?
Epoxy resin GIC ZOE
61
Why do we instrument the canal?
TO CREATE SPACE FOR OBTURATION REMOVAL OF HARD AND SOFTI TISSUE THAT IS INFECTED TO CREATE SPACE FOR CHEMOMECHANICAL PREP - MEDICAMENTS, IRRIFARION RETAIN THE INTEGRITY OF PERI RADICULAR STRUCTURES
62
What is a watch winding movement?
30 degrees 60 degrees binds to dentine to break it good for small files
63
What is a balanced force technique?
1/4 turn clockwise 1/2 turn anti clockwise breaks dentine larger files
64
What is a barbed broach?
Instrument used to extirpate the pulp - not meant to bind in th ecanall
65
What are K files made of?
Stainless steel - have 2% taper
66
What are the advantages of Ni Ti file?
Shape memory inc cutting effiencecy increased flexibility in larger sizes and tapers more user friendly
67
How do we prevent instrument fracture?
Ensure clinical is trained in method utilising - knowns technique crown down technique constant motion with gentle pressure - no forcing into canal create a glide path avoid rotary files in curved canals
68
Why may a file separate?
Cyclic fatigue due to flexural stress torsional stressl
69
What is cyclic fatigue?
This is where instrument is freely rotating in the canal and generates a tension compression cycle which leads to work hardening and eventually fatigue and frcture
70
What is torsional stress?
This is where instrument binds to canal wall and encounters excessive friction and can lock into canal
71
What are the canal identification laws?
1. pulp chamber darker than canal walls 2.. LAWS OF SYMMETRY EXCEPT FOR MAXILLARY MOLARS THE CANAL ORIFICES ARE EQUIDISTANT FROM MD LINE THROUGH THE TOOTH AND ORIFICES LIE PERPENDICULAR ON MD LINE

BDS4 Restorative Dentistry (10 decks)

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