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Endodontics > Pulp Care > Flashcards

Pulp Care Flashcards

1
Q

Healthy pulp

A

Vital, free of inflammation

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2
Q

Reversible Pulpitis

A
  • Vital
  • Sensitive to cold/sweet
  • short lasting pain as long as stimulus applied.
  • Respond to sensibility tests
  • NO CHANGE IN PULPAL BLOOD FLOW
  • No Rg change

Not TTP

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3
Q

Symptomatic Irreversible pulpitis

A

-Vital, responds to tests
-Sensitive to hot
-pain lasts longer than stimulus application
-Spontaneous, referred
-sleep disturbance
-Increase in pulpal blood flow
OTC analgesics ineffective
Not TTP

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4
Q

Necrotic pulp

A

Death of pulp
NO response to sensibility tests
TTP
Rg - osseous breakdown

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5
Q

Asymptomatic irreversible pulpitis

A

Vital inflammed pulp, no healing
NO clinical signs
respond to thermal tests
BLEEDS PROFUSELY IF EXPOSED

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6
Q

Previously treated

A

RC filling and non responsive to thermal/EPT

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7
Q

Previously initiated

A

Partial pulp treatment carried out - pulpotomy

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8
Q

Normal apical diagnosis

A
  • NOT TTP
  • no sensitive to palpation
  • LD intact and no radiolucency
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9
Q

Symptomatic apical periodontitis

A

TTP
Painful when biting
Rg - normal PDl space width
PA radiolucency

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10
Q

Asymp apical periodontitis

A

Pulpal origin of inflam
Apical radiolucency
NO TTP/palpation

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11
Q

Chronic apical abscess

A 
inflam and response to pulpal necrosis
GRADUAL ONSET
little/no discomfort
diacharging pus through sinus
Rg - sign of osseous breakdown
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12
Q

Acute apical abscess

A 
Inflam to pulpal inflam and necrosis
Pain, TTP, pain on biting
SPONTANEOUS
RAPID ONSET
Rg - No sign of osseous breakdown
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13
Q

chemomechanical disinfection principles

A
  • create a continously tapering funnel
  • keep apical foramen in the same position
  • maintain apical opening as small as poss
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14
Q

Ideal properties of disinfectant

A 
Cheap
lubricate canal
not affect dentine properties
not interact with dental materials
biocompatible
dissolve organic and inorganic mateial
non allergenic
washing action
friction reduction
bacteriocidal
Biofilm disruption
good penetration of canal
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15
Q

Sodium hypochlorite features

A

GOLD STANDARD DISINFECTANT
-NaOCl - Na and OCl, ionises in water forming an equilibrium with hydrochlorous acid
-Antibacterial action
-dissolves pulp remnants (necrotic & vital)
-Helps disrupt smear layer
-

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16
Q

Factors for NaOCl

A

Conc - 0.5-0.6%
Volume - 10-15ml in canal
Contact time
Mechanical aggitation

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17
Q

NaOCl - issues (Dis)

A
  • Affects dentine properties
  • Can’t remove smear layer by itself
  • Apical extrusion
  • Affect organic material
  • Discolour fabrics
  • OPTHALMIC INJURIES
  • Allergic reaction
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18
Q

Removal of smear layer?

A
  • EDTA (17%)
  • Citric Acid (10%)
  • Ultrasonic irrigation
  • NaOCl
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19
Q

Symps of apical extrusion

A
  • pain
  • bruising along superficial venous vasculature
  • swelling
  • haemorrhage
  • airway obstruction
  • neurological coplications
  • tingling lip
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20
Q

Apical extrusion risk factors

A
  • loss of control of working length
  • greater force during irrigation
  • needle locked in canal
  • larger apical diameter
  • higher NaOCl conc
  • root resorption

FLOW RATE - 1ml/15s

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21
Q

Management of apical extrusion of NaOCl

A 
LA
physiological saline - irrigate canals
reassure patient
dress tooth - nsCaOH
- advise on analgesia, swelling management, prevention of secondary inf

REFER IF SEVERE

22
Q

What is an intracanal medicament

A

usually an antimicrobial paste that is placed in a RC between appointments in order to prevent re-inf and reduce inflammation.
eg. corticosteroid/tetacycline

23
Q

ns CAOH features

A

pH12.5
antibacterial activity
removes tissue debris
hydrolysis of LPS - reduced inflam potential

24
Q

What is coronal flaring

A

the secind stage of root canap instrumentation.
Achieved using a combo of SS handfiles, gates glidden burs and/or NiTi instruments

-Sequentially smaller instruments are used as progress is made from coronal-apical third of canals

25
Q

Modified double flare technique - what is it

2 stages of apical prep are..?

A

Preparation of coronal aspect of RC - SS handfiles to a taper

  • Apical enlargement
  • Apical taper creation (Deep shaping)
26
Q

RC filling - Thermoplastic compaction techniques

A
  1. Cold lateral compaction
  2. Warm lateral compaction
  3. Warm vertical compaction
  4. carrier based systems
27
Q

Adv of cold lateral compaction

A
  • Golfd standard
  • long term success
  • allow good filling length control
  • Inexpenxive and easy to use
28
Q

Dis of Cold lateral compaction

A
  • time consuming
  • no homogenous mass of GP produced
  • in large canals multiple accessory cones needed
  • vertical r# risk
29
Q

examples of RC sealers

A

ZOE - Pulp canal sealer
CaOH - Sealapex
Resin - AH plus

30
Q

What is lateral compaction

A

Root canal filling technique
- lateral pressure applied with a spreader to a GP point. This allows space for accessory cones. Repeat process until canal filled.

31
Q

Factors that influence RCT outcome

A
  • preoperative status of PA tissues
  • quality of RC
  • CORONAL SEAL
  • MH
  • Files used
  • irrigant used
  • RC filling used
  • technique used to fill RC
32
Q

What is the purpose of canal instrumentation

A
  • Remove infected H/S tissue
  • give irrigant space to work in canal
  • create space for medicaments
  • retain integrity of radicular structure
33
Q

Name 2 techniques used during instrumentation and describe them

A
  1. watchwinding - 30-60 degree back/forward and light apical pressure
  2. Balanced force - 90 degree clockwise, 180 anticlockwise 3x then clean and recapitulate.
34
Q

ISO files colours

15/45, 20/50, 25/55, 30/60, 35/70, 40/80

A 
15/45 - white
20/50 - yellow
25/55 - red
30/60 - blue
35/70 - green
40/80 - black
35
Q

How do a blockage and a ledge happen

A

-Blockage - dentine debris packed into apical prtion of canal

-Ledge - internal transportation of canal (while working short of length)
Place curve in instrument

36
Q

What is apical zipping/transportation

How to avoid

A
  • result of the instruments desire to straighten inside a canal.
  • Overenlargement of outer aspect of curvature and under prep of inner

Precurvature of instrument / follow sequence / never rotate in curved canal

37
Q

Factore afffecting the prognosis of a perforated tooth

A 
time 
size
persistance of bleeding into canal
periodontal irritation
repair material
38
Q

NiTi vs SS instruments

NiTi adv / dis

A

NiTi adv
> flexibility, > size & tapers, >cutting efficiency, more user friendly

Dis - instrument #, >cost, difficult access, can’t be used in curved canals.H

39
Q

How can instrument separation occur

A
  1. Torsional stress - extensive instrument surface encounters excessive friction on canal walls
  2. flexural strength - repeated cycle metal fatigue. Freely rotating in curvature - tension and compression repeated cycles.
40
Q

Obturation materiall ideal props

A
  • easily manipulated
  • dimensionally stable
  • seals canal
  • non irritant
  • radiopaque
  • no tooth discolouration
  • easily removed
  • unaffected by tissue fluids
  • inhibit bacterial growth
41
Q

GP constituents

A

Beta form used in dentistry

20%GP, 65% ZnO, 10% radiopacifiers, 5% plasticiser

42
Q

Ideal sealer properties

A
  • Radiopaque
  • good adhesion
  • easily mixed
  • establishes seal
  • slow set
  • tissue tolerant
  • soluble on retreatment
  • no shrikage on setting
  • non staining
  • bacteriostatic
43
Q

Examples of root sealers

A 
ZO
ZO and E
ZOE
Resin - AH26, Epoxy
Calcium silicate - high pH(12.8) no shrink on setting, quick set, non resorbing
44
Q

Factors that could influence endo failure

A 
presence of inf (sinus/PA)
coronal seal
poorly condenesd root filling
iatrogenic - perforation
root #
patency achieved
instrument separation
blockage/ledge
45
Q

Laws of endodontics

A
  1. Centrality - Floor of PC located at CEJ level
  2. Concentricity - at CEJ level, the PC anatomy follows that of the external surface
  3. Law of CEJ - distance from PC to wall same circumferentially
  4. Symmetry 1 - orifices of canals located EQUIDISTANT to line placed m-d through floor NOT MAX MOLARS
  5. Symmetry 2 - orifices of canals loe on line perpindicular to m-d drawn line NOT MM
  6. Colour change - PC floor DARKER than walls
  7. Orifice location 1 - where floor/wall meet
  8. Orifice location 2 - at angles of floor/wall junction

9 Orifice location 3. - located at end of root development fusion

46
Q

Options for retreatment

A 
NS retreatment 
Surgical
XLA
orthograde RT
Keep under obvs
47
Q

Indications for periradicular surgery

A

failure of prev endo
anaomical deviation
procedural error
exploration surgery

48
Q

Contraind to periradicular surgery

A

Close to vital structure
inadequate perio support
not restorable tooth
MH contraind

49
Q

Periradicular surgery root filling materials

A

MTA - long set, good sealing ability, radiopaque, moisture tolerance, cementum regeneration, biocomp, dimensionalbly stable, no stain, corrosion
,
Amalgam

50
Q

Disadvantages/warnings for use of MTA

A

Material can reduce moisture in canal - this can make the tooth dehydrated and more prone to # (brittle)

Endodontics (1 decks)

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