Endodontic Principles Flashcards
(45 cards)
A patient presents with pain from the upper right quadratnt. Tooth 17 has a cavity, and the patient tells you a white filling fell out recently. The tooth has a normal periradicular appearence, and pain only occurs when the patient eats sweets.
Give a provisional diagnosis, and describe you management of the case.
Pain history: Lasting less than 10 minutes and is difficult to localise.
Reversable pulpitis
Dress the exposed dentine with a restoration.
Follow up in 1-2 weeks to see if pain has resolved.
If resolved, monitor for three months then annually.
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
Name three alternative treatment options to periradicular surgery.
Orthograde re-treatment
Extraction
Monitor the teeth if asymptomatic
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
List six things you would discuss with the patient to achieve valid consent.
- Give all the other options available.
- The risks and benefits of the treatment options.
- The likely long term prognosis of the teeth in both cases.
- What may happen if no treatment is carried out.
- The costs that are involved for treatment.
- Your professional opinion on what should be done.
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
What are the risks and benefits of periradicular surgery?
Risks:
- Infection
- Swelling and discomfort
- Nerve damage
- Root fracture
Benefits:
- Preservation of the tooth
- Elimination of infection
- Improved overall prognosis
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
Which factors dictate the long term success of peri-radicular surgery, and what is the average prognosis for the treatment?
Success of the surgery
Patient compliance (OH etc.)
Tooth condition
Patient factors (MH, overal health, etc.)
Average success for releaving symptoms is 85% to 95%.
Around 80% of teeth last longer than 4 years.
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
What are the indications for peri-radicular surgery?
When orthograde root canal treatment cannot be completed due to persistent exudation into the root canal
If symptomatic or progressing periradicular disease associated with a well root-filled tooth.
When a biopsy of periradicular tissue is required.
When visualisation of the periradicular tissues and tooth root is required if perforation or root fracture is suspected.
Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been treated endodontically with posts and cores. There are radiolucencies in all of the teeth affected. The patient is referred to you for periradicular surgery.
What are the contraindications for peri-radicular surgery?
The primary disease has not been stabilised
The coronal seal is poor
The tooth is unrestorable
Suspected diagnosis of a combined periodontal–endodontic lesion
The prognosis of the tooth is limited
There is a root fracture
Susan is a 29 year old patient who is a regular attendee at your practice, she has previously undergone periodontal treatment, she attends as an emergency complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11, TTP and there is associated lymphadenopathy.
Give 2 differential diagnoses for what this condition could be.
Periodontal/periapical abscess
Periapical granuloma
Susan is a 29 year old patient who is a regular attendee at your practice, she has previously undergone periodontal treatment, she attends as an emergency complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11, TTP and there is associated lymphadenopathy.
Give two special tests you could perform to confirm a diagnosis.
Sensibility test with EPT/EC. If non vital would indicate periapical abscess, if vital then a periodontal abscess.
Periapical radiograph of the 11, would identify if there was a periapical radiolucency, indicating abscess location.
Susan is a 29 year old patient who is a regular attendee at your practice, she has previously undergone periodontal treatment, she attends as an emergency complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11, TTP and there is associated lymphadenopathy.
Give two ways you could establish drainage of the swelling.
Soft tissue incision and irrigation with CHX/Saline.
Extripation of pulp and encourge draining through canal.
Extraction of the tooth also possible if indicated.
Susan is a 29 year old patient who is a regular attendee at your practice, she has previously undergone periodontal treatment, she attends as an emergency complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11, TTP and there is associated lymphadenopathy.
Outline your inital management of the patient if the 11 was not endodontically involved.
Incision and drainage of abscess
Gentle subgingival debridement, short of base to prevent trauma and infection spreading
HSMW
OHI
Pain relief
Anti-biotics - PenV: 250mg, 2 tablets, four times daily
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
What three criteria must be met before obturation is carried out?
Tooth must be asymptomatic
Canal must be fully dried
There must be full biomechanical cleaning on all canals.
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
The canal is obturated using gutta percha cones via cold lateral compaction. Name three constituents of the cones other than the GP.
Zinc Oxide 65%
Radiopacifiers 10%
Plasticisers 5%
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
Describe the function of root sealer when placing GP cones.
To seal surface between dentinal walls and cone.
To fill voids and irregularities/lateral canals.
To lubricate during obturation for better cone fit.
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
Give three types of sealer commonly used for obturation.
Calcium hydroxide (dycal)
Epoxy resin sealer (AH26 plus)
Bioceramic sealer (Calciul silicate/phosphate)
ZOE
RMGI
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
Describe how you can assess an obturation on a radiograph.
Correct legnth
Correct taper
Density is consistent, and no voids
All canals filled with sealer and GP
No sealer/GP above orifice.
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
What is the purpose of obturation?
To seal the remaining bacteria in
To provide apical/coronal seal (mircoleakage)
To prevent reinfection
A 49 year old woman has been seeing you for a root treatment of 16. The root canal system has been fully prepped, incuding the mesiopalatal canal. She is attending a third appointment with the aim of obturating the canal.
Give four methods for obturation.
Cold lateral compaction
Warm verical compaction
Continuous wave compaction
Carrier based obturation (thermafil)
Describe and explain the faults and mishapes that can occur when preparing a canal with a stainless steel file.
Ledges - occurs when working short of the length and are difficult to bypass
Canal blockage - caused by dentine debris getting packed into the apical portion of the root and attempted to remove this can result in false canal being cut and possible perforation
Apical zipping/transportation of the foramen -occurs as a result of the tendency of the instrument to straighten inside a curved canal and ultimately results in a teardrop shape canal.
Perforations/broken file - too much pressure put when using the instruments or binding of k-files.
Describe the endodontic process including calculating working length until the obturation stage.
- Pre-op radiograph to identify canals and get estimated working legnth - assess tooth for long term prognosis and restorability.
- Remove all caries and defective restorations from the crown
- Coronal access to the root canal system using rubber dam and LA
- Root canal system instrumentation and preparation and irrigation with
Sodium hypochlorite using either rotary or hand instruments. - Irrigation should be performed throughout, alternating between EDTA and hypochlorite.
- Corrected working legnth established with endo file radiograph, or apex locator.
- Canal shaped to provide a continuous taper down to apex, with the prep stopping 1-2mm before the apex.
- Canal should be dried, and prep checked before obturation.
Susan is a 29 year old patient who is a regular attendee at your practice, she has previously undergone periodontal treatment, she attends as an emergency complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11, TTP and there is associated lymphadenopathy.
Upon further investigation, a 10mm probing depth can be found on the palatal side of the tooth. What is your diagnosis and how would you manage this?
Periodontal abscess
Infection of existing pocket due to trauma/build up of bacteria.
Drainage via incision or via pocket with instrumentation to dilate
Gentle sub gingival debridement
Hot saline mouthwash use or 0.2% CHX mouthwash
Antibiotic use if there is systemic involvement
Follow up with HPT
A patient attends with pain coming from his 15. Upon investigation you find it is root treated, and has a 9mm pocket distal to the tooth, and a vertical bone defect.
Give three differential diagnosis for tooth 15.
Perio-endo lesion
Endo-perio lesion
True combined lesion
A patient attends with pain coming from his 15. Upon investigation you find it is root treated, and has a 9mm pocket distal to the tooth, and a vertical bone defect.
List two special investigations you could carry out.
6 point pocket chart of the area
Periapical radiographs
A patient attends with pain coming from his 15. Upon investigation you find it is root treated, and has a 9mm pocket distal to the tooth, and a vertical bone defect.
What inital treatment would you carry out?
Re-root treatment, then monitor to see if symptoms resolve.
