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endodontics Flashcards

(102 cards)

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1
Q

what is the cause of endodontic disease

A

bugs fungi archaea

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2
Q

what do we need for a PA lesion

A

bugs aka bacteria

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3
Q

what are the three things needed for endodontic problems

A

microorganisms
host response
time

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4
Q

why do we study endodontic microbiology

A

We can identify which bacteria play a key role in progression of disease
Helps develop a treatment strategy in terms of microbial eradication – present/future
To see how the microbes interact (tackling biofilm is diff to planktonic)

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5
Q

what type of bacteria do we find in the apical region

A

lower oxygen
less number of species
less accessible to tx
nutrients form the peri radicular tissues

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6
Q

what type of bacteria do we find in the coronal region

A

higher oxygen count
nutrients from carbs in oral cavity
higher bacteria count
easier to treat

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7
Q

how does the root canal microflora act

A

in a biofilm or planktonic

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8
Q

what do we see in the biofilm

A

calcium in the protective layer that can denature the sodium hypochlorite and makes it difficult to remove

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9
Q

state some resistance of biofilms to eradication

A 
physical barrier 
mechanical 
shape 
metabolism 
transfer
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10
Q

issues with diagnosing endo

A

We are reliant on the pt. description of symptoms which may be confusing
There is a poor correlation between symptoms & histological status of the pulp
SOCRATES always tends to help
Character is most important part of SOCRATES for endo
When a pt. describes character of pain THINK about it, don’t just write it down
Other tests are available to aid diagnosis such as speciality tests & radiographs
Unless cortical plate has been lost, lesion may not be visible with conventional radiograph
We may need to use CBCT imaging to take slices of the lesion

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11
Q

what do we need to consider with multi rooted teeth

A

Pt’s may have one dead tooth and other teeth are vital

A positive result will be seen with EPT & TTP but tooth is partly necrotic & needs RCT

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12
Q

what is the first stage of RCT

A

isolation

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13
Q

why is isolation so important

A

stress for their comfort and improve prognosis of tx

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14
Q

what are some key facts for chemo mechanical prep

A

Instruments shape, irrigants clean

We aim to achieve a shape that optimises irrigation & simplifies obturation

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15
Q

what does the canal look like in CS

A

narrower at every point apically

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16
Q

where do we find the apical foramen

A

emain in its original position & we clean as much as poss. up to there
The apical opening should be kept as small as possible

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17
Q

what are some hand instrumentation techniques

A

step back
modified double flare
balanced force
stem winding

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18
Q

what is the step back technique

A

Coronal flare, file all way down to apex and step back from there

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19
Q

describe modified double flare

A

Crown down first, step back from apex & blend coronal with apex

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20
Q

describe balanced force

A

60 degrees clockwise to engage dentine & 180 anticlockwise to cut it

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21
Q

describe stem winding

A

Simple rotation & pull , slower than balanced force but safer

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22
Q

define patency filing

A

taking a file K10/15 all the way to the apex to clear out any debris

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23
Q

define recapitulation

A

taking the MAP all the way to full working length to check

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24
Q

give some examples of rotary instruments

A 
rotary files( pro taper gold) 
wave one
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25
what type of instrument is the pro taper gold
it is a rotary instrument in one direction only
26
what type of instrument is a wave one
reciprocating- rotates in one direction and then in the other direction
27
what are automated instruments made form
Ni-TI
28
what is the advantages with Ni-Ti
less likely to cause procedural errors
29
what are some procedural errors we can get
dentine debris transportation ledge perforation
30
what are some types of file fracture we can get
torsional failure | cyclic fatigue
31
what is an apical granuloma
formation of tissue that forms at root tip
32
what is periapical periodontist
disease you have when you have an apical granuloma
33
how do we measure success of endo
should be measured 1 year cost op and subsequently for a minimum of four years
34
what do we look for in cases where the rct has succeeded
``` no abscess no pain no swelling no loss of function no sinus tract involvement normal radiographic PDL space around the root ```
35
give some examples of definitions of outcome
the strict criteria - the loose criteria survival failure
36
explain the strict criteria
The length of review should be for at least 4 years | Strict criteria we generally use for research purposes
37
explain the loose criteria
Tooth is functional, pain free, no signs of swelling, lesion has only reduce din size
38
explain the survival criteria
We do this as it’s easy to collect data on survival studies Difficult to follow up a lesion but easy to follow up presence of a tooth Allows for comparison between diff treatment options
39
explain failure
if fails- say the disease has persisted not that the tx has failed
40
what makes the difference in improving survival rates
Presence or absence of a lesion Filling should extend to within 2mm of radiographic apex but not extrude Well condensed filling with no voids Good quality coronal restoration
41
what are some things that decrease survival rate of rct
``` Pre op presence of sinus Increases size of lesion Presence of a flare up Perforation Mixing CHX & NaOCl ```
42
what are some things that increase survival rate of rct
Getting canal patency | Final rinse is with EDTA in retreatment
43
what is tx planning
What you’re going to do & when you’re going to do it
44
what is planning tx
How are you going to execute this treatment
45
what do we consider looking at the radiographic assessment
Root length Degree of canal sclerosis Canal symmetry Canal curvature
46
what is some distinctive features of Vertical root fracture
Sinus at mid root level Go round tooth, suddenly the probe will drop 13/14 mm (narrow isolated defect) Circumferential bone loss will be seen on both sides of tooth
47
what is the prognosis like with vertical root fracture
prognosis low if below the pulp chamber need extrac
48
what are some differential diagnosis options
reversible/ irreversible pulpits periapical periodontitis dentine hypersensitivity
49
what are some tx options for dentine hypersensitivity
fluoride varnish- 2x per year limit
50
what are some tx options for reversible pulpits
removal or caries removal
51
what are some tx options for irreversible pulpits
RCT / XLA
52
what do we need to consider with RCT
need informed consent as patient might just find it easier to remove the tooth
53
what do we need to check in reinfected teeth
remove the fillings to see what the leakage is like and how can we provide cuspal coverage for it
54
what are the four radiographs which need to be taken
pre op working length master point post op
55
what assessments of root filled teeth do we need to do before tx
endo periodontal coronal tissue
56
what does the coronal tissue assessment include
``` quality of tooth position of tooth rests aesthetics occlusion ```
57
advantages of restoring immediately after endo
good coronal seal protection from tooth fracture places tooth back in function
58
disadvantages of restoring immediately
risk of tooth fracture unsure of endodontic outcome expensive restoration if we need to re endo
59
what is the disadvtnages of delayed restoration
risk of endo failure may require revision increased risk of loss of coronal seal and tooth frac
60
what is the advantages of delayed restoration
endodontic success confirmed | expense of new crown avoided
61
what are some restoration options to build up a tooth
standard plastic Nayyar core pre fabricated post cast post and core
62
how do we do a standard plastic restoration
this involves cutting the GP back with hot excavator & plugging it down The definitive restoration is placed over the top of this Don’t forget to place an RMGIC lining over the GP to prevent coronal leakage
63
how do we carry out a Nayyar core
good option if a whole wall is broken down | remove 2-4 mm of the GP in the canal and line with RMGIC and fill will amalgam
64
advantages of Nayyar core
``` Can be placed immediately after endo Uses coronal tooth structure to improve retention Reduces stresses (compared to post placement) Usually easy to remove ```
65
what do we do if there is not enough tissue for a core
we need to use a post but this weakens the tooth
66
what is the principle of post design
Aims to maximise retention & minimise stresses within the root
67
what are some types of post
tapered serrated cast
68
what is the issue with tapered posts
as it acts like a wedge it can put pressure on the tooth and cause it to fracture
69
what is the issue with serrated posts
cuts into dentine and can break the tooth
70
what is the benefit of serrated posts
some just passively sit in the canal (most used)
71
what should the post length be
leave 5mm of apical Gp to stop contamination | should be greater than the crown of the tooth
72
what is the width of the post
not exceed 1/3rd of the width of the CEJ
73
where do we want the forces to be transmitted in the post
to the dentine then the PDL and bone to reduce the risk of root fracture
74
positives of fibre posts
Aesthetic Bond with dual cure resins (LC & Chemical cure) Flex properties close to dentine (slightly less) so when force occurs, it fracs before dentine Can be removed for revision of endo treatment Claimed to reinforce root but evidence doesn’t confirm this
75
main cause of failure of fibre posts
decementation
76
advantages of cast post and core
can go sub gingival | good in oval canals
77
disadvantages of cast post and core
extra clinical visit | temporisation is difficult
78
advantages of pre fab post and core
immediate coronal seal crown prep on same visit better aesthetics reduces number of stages
79
disadvantages of pre fabricated post and core
core takes time to build
80
what is the ferrule effect
360 degrees wrap around of dentine which increases strength and success of RFT
81
what is the job of the ferrule
improves resistance ot dynamic loading reduces potential for stress concentration helps maintain integrity of the cement seal
82
how dow e protect the tooth from fracture
using an extra coronal restoration
83
what do we need to consider in regards to occlusion
eg if working on a canine we need to change to GF from canine guidance to put less stress on the tooth
84
what are the three main points to success
preverse and protect remaining tooth tissue establish and maintain seal restore aesthetics and function
85
what does healthy periapical tissue look like
healthy PDL space seen as a radiolucent white line
86
what does the radiolucent white line represent
the lamina dura
87
what is the bone pattern of the maxilla like
less tabular and lower density
88
what is the bone pattern of the mandible
horizontal trabecular pattern
89
what are some shadows we can see that are radiolucent
antrum mental foramen nasopalatine foramen
90
what are some radiopaque shadows we can see
mylohyoid ridge zygoma sclerotic bone
91
what does rarefying mean
radiolucent
92
what does oestitis mean
inflammation go the bone
93
why might we see hypercementosis on the x ray
Idiopathic cause Stresses on the tooth Certain systemic diseases
94
what is osseous dysplasia
Condition with unknown aetiology | radiolucencies on apical region of teeth
95
who do we see a increased prevalence of osseous dysplasia
ANTERIOR TEETH in afro carribean middle age females
96
stages of periapical rarefying osteitis
ill defined well defined corticated Radiolucency increased in chronicity
97
early stages of periapical rarefying osteitis
Ill defined, symptomless, common to see pt.’s with grotty mouths and only 1 giving pain Diagnosis of ill-defines rarefying osteitis & non-vital This person has an abscess – pain, looks tight, shiny & pushing lip down Clinically we can diagnose an abscess Radiographically they have an ill-defined radiolucency associated with premolar Diagnosis of ill-defined rarefying osteitis & non vital
98
how long does ti take for radiographic appearance to catch up with symptoms
10 days approx
99
if lesions are less than 1cm then it can be
2/3 are granuloma
100
if lesions are 1-1.5cm then it can be
50% granuloma | 50% cysts
101
if lesions are greater than 1.5cm then it is a
2/3rd chance it is a radicular cysts
102
describe sclerosing osteitis
Even more chronic still May be no radiolucent component May be halo of sclerosing osteitis surrounding an area of rarefying osteitis Often seen around roots of lower first molars Also called condensing or focal sclerosing osteitis

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