Guide to Clinical Endodontics

Question 1

why do we need to examine and diagnose endodontic problems

Answer 1

to determine diagnosis and treatment need
determine cases too complex for level of training
determine if wise to consult with others

Question 2

what is apexogenesis

Answer 2

vital pulp therapy performed to allow continued physiological development and formation of the root
remove portion of pulp and apply medicament

Question 3

what are the indications for apexogenesis

Answer 3

deep caries - pulp exposure
no pretreatment symptoms
controlled bleeding

Question 4

what are the aims of apexogenesis

Answer 4

prevent adverse clinical signs
prevent breakdown of periradicular tissues
obtain radiographs of root development

Question 5

what is a pulpotomy

Answer 5

surgical removal of coronal portion of vital pulp tissue and biological material placed in pulp chamber and restored

Question 6

when is a pulpotomy indicated

Answer 6

exposed vital pulps
irreversible pulpitis of primary teeth
emergency treatment for permanent if cannot start RCT
for permanent teeth with immature roots before RCT can happen

Question 7

what are the aims of a pulpotomy

Answer 7

prevent adverse clinical signs
get radiograph of root for endo treatment
prevent breakdown of periradicular tissues
prevent resorption or canal calcification

Question 8

what is pulpal debridement (pulpectomy/extirpation)

Answer 8

surgical removal of entire pulp tissue

Question 9

what are the indications for pulpectomy

Answer 9

relief for acute pain before conventional RCT when RCT cannot be accomplished at that appointment

Question 10

what is the aim of a pulpectomy

Answer 10

relief of acute pain until complete treatment can happen

Question 11

what is indirect pulp capping

Answer 11

2 visits 6 months apart
remove caries but leave some over pulp and place CaOH and restore
next visit remove all caries and CaOH and then restore

Question 12

what are the indications for indirect pulp capping

Answer 12

deep caries - pulp exposure
no pretreatment subjective symptoms
no periradicular pathology

Question 13

what are the aims of indirect pulp capping

Answer 13

prevent clinical signs
obtain radiographs for root development
prevent breakdown of periradicular tissues
prevent resorption or canal calcification

Question 14

what is direct pulp capping

Answer 14

material placed onto surface of vital pulp at exposure site and restored

Question 15

what are the indications for direct pulp capping

Answer 15

mechanical exposure of pulp
controlled bleeding
material can be in direct contact with pulp
exposure when tooth is under dam
coronal seal can be maintained

Question 16

what are the aims of direct pulp capping

Answer 16

prevent clinical signs
develop contact of biocompatible radiopaque capping material with pulpal tissue
maintain normal responsiveness to electrical and thermal pulp tests
prevent breakdown of periradicular supporting tissues

Question 17

what are the benefits of using dental dam for endodontics

Answer 17

minimise risk of contamination of root canal by indigenous oral bacteria
aid visualisation by providing clean operating field
prevent aspiration/ingestion of materials

Question 18

when would RCT be indicated on primary teeth

Answer 18

irreversible pulpitis or necrosis with no permanent successor
necrosis with/without periradicular disease
treatment will not damage permanent successor

Question 19

what do you obturate with when there is a permanent successor present

Answer 19

a material which will resorb at similar rate to tooth (not GP)

Question 20

if there is no permanent successor present what do you obturate primary teeth with

Answer 20

GP and sealer

Question 21

what are the aims of RCT in primary teeth

Answer 21

alleviate symptoms
create well obturated canal
prevent breakdown of periradicular tissues
allow resorption of root structures and material when successor erupts

Question 22

what are the indications for RCT for permanent teeth

Answer 22

irreversible pulpitis
necrotic pulp
compromising pulp due to dental procedures
placement of a post
fractured teeth with pulpal involvement
thermal hypersensitivity

Question 23

what is pulp regeneration

Answer 23

remove pulp
place antimicrobial in canal and temporise
bring patient back
open canal and irrigate
overinstrumentation to induce bleeding
clot in canal
place MTA (3-4mm)
close canal permanently
reassess root development

Question 24

what are the indications for pulp regeneration

Answer 24

incomplete root development and incomplete apical closure
when you cant use apexogenesis due to necrotic pulp

Question 25

what are the aims of pulpal regeneration

Answer 25

treat apical periodontitis induce radiograph of apical closure without breakdown of supporting tissues retain dentition during craniofacial development promote root development

Question 26

what is apexification

Answer 26

clean and shape canal and pack with biologically appropriate material to create an apical barrier

Question 27

what is the indication for recalcification

Answer 27

treating external and internal resorptive defects perforating to external surface

Question 28

what is the aim of recalcification

Answer 28

encourage biological root repair

Question 29

what is the procedure for recalcification

Answer 29

clean and shape canals and pack with material promoting resorptive repair

Question 30

what are the indications for re-root treatment

Answer 30

continued periradicular pathosis defiecient RCF quality persistent symptoms restorative procedures requiring re-RCT

Question 31

what are the aims of re-root treatment

Answer 31

alleviate symptoms create well obturated canal maintain health of periradicular tissues

Question 32

what is incise and drain

Answer 32

make a surgical opening in soft tissue to release exudate or decompress area of swelling

Question 33

what are the indications for incise and drain

Answer 33

if pathway is needed to soft tissue with swelling to provide necessary drainage when pain due to accumulation of exudate in soft tissues when need to collect samples

Question 34

what are the aims of incise and drain

Answer 34

alleviate symptoms reduce localised soft tissue swellings promote repair of soft tissues prevent damage to teeth or anatomical structures

Question 35

what do you do for an enamel fracture

Answer 35

smooth or resin bond or bond fragment back

Question 36

what do you do for uncomplicated crown fracture

Answer 36

repair with bonded resin or bonding fragment back composite bandage

Question 37

what do you do for complicated fracture of immature tooth

Answer 37

pulp capping or partial pulpotomy

Question 38

what do you do for complicated fracture of mature tooth

Answer 38

if doesnt need a crown then vital pulp therapy if needs a crown then RCT

Question 39

what is the treatment for crown-root fracture of immature tooth

Answer 39

pulp capping then wait until mature to do RCT

Question 40

what is the treatment for crown-root fracture of mature teeth

Answer 40

RCT

Question 41

what is the definitive care of avulsion with less than one hour of dry time

Answer 41

for immature - apexification then RCT for mature - RCT within 7-10 days of reimplantation

Question 42

what is the definitive care of avulsion with more than one hour dry time

Answer 42

RCT

Question 43

what teeth are not suitable for re-implantation after avulsion

Answer 43

teeth with immature apices and extra-oral dry time greater than one hour primary teeth

Question 44

what is the emergency care for alveolar fracture involving teeth

Answer 44

reduction of alveolar segment and splint for 4-6 weeks

Question 45

what is the definitive care for alveolar fracture involving teeth

Answer 45

RCT after evaluating pulpal status of teeth

Question 46

what are the indications for a post

Answer 46

remaining coronal tooth structure is inadequate for retention of restoration sufficient root length to accommodate the post adequate ferrule

Question 47

what are the aims of placing a post

Answer 47

retain core place along long axis of tooth avoid perforations or root fractures preserve apical seal eliminate space between post and surrounding tooth structure place post in root structure that is supported by bone minimise contamination of root canal system

Question 48

what is the indications for a core

Answer 48

replacing coronal tooth structure enhanced retention and resistance to displacement is necessary

Question 49

what are the aims of a core

Answer 49

provide retention for final restoration occupy entire pulp chamber core does not perforate pulp chamber floor eliminate space between core and root canal filling material

Question 50

what type of restoration should be on a posterior tooth after RCT

Answer 50

full cuspal coverage

Question 51

when is it indicated to remove a post/post and core

Answer 51

loss of retention recurrent caries fracture of post/core access for RCT is necessary

Question 52

what are the aims of post and core removal

Answer 52

minimise damage to tooth/adjacent teeth alleviate symptoms remove entire post avoid root fractures or perforations