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4th Year BDS > Re-Endodontics > Flashcards

Re-Endodontics Flashcards

(108 cards)

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1
Q

How to diagnose post-treatment disease?

A

may not be straight forward as you may be dealing with partially treated pulp canals, missed canals or procedural mishaps. These should be included in the diagnostic description.

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2
Q

What is included to enable you to gain a good pain history?

A

When RCT was fine and if any problems arised
Rubber dam used?
Check for:
- swellings/sinus
- TTP
- Mobility
- PPD > 3mm
- tenderness on buccal palpation
Special tests:
- hot and cold sensitivity

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3
Q

Remember the SLOB radiography rule?

A

SAME lingual
Opposite Buccal

If you move the x-ray head medially the two roots will move dismally but the buccal one will be the opposite direction of the movement and the lingual will be the one in the same direction

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4
Q

Name the 3 diagnostic categories for post treatment disease?

A

Previously treated:
- (a)symptomatic PRP
- chronic apical abscess
- acute apical abscess

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5
Q

Name the 4 causes of post treatment disease?

A

Intraradicular microorganism
Extraradicular infection
Foreign body reaction
True cyst

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6
Q

Name the 9 possible reasons for the canal to have intra-radicular microorganisms?

A

Poor access cavity design
Untreated major or minor canal
Poorly prepared canals or poorly obturated
Procedural complications
Ledges
Perforations
Separated instrument
Newly introduced microorganisms
Coronal leakage

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7
Q

Name the 8 main reasons for endodontic treatment failure?

A
  1. Leaking around intubation
  2. Non-treated canals
  3. Underfilled
  4. Complex canal system
  5. Overfilled
  6. Iatrogenic
  7. Apical biofilm
  8. Cracks
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8
Q

What is the definition of an extraradicular infection?

A

Microbial invasion and proliferation into the preriradicular tissues.
- perio endo lesion where pocketing extends to the apical foramina
- extrusion of infected dentine chips during instrumentation
- overextended instrumentation/filling material

Biofilms which grow through the apical constriction and form an external apical biofilm

Extraradicular microbes

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9
Q

What is the defintion of a foreign body reaction?

A

In the periradicular tissue have been associated with a chronic inflammatory response:
- vegetables
- cellulose fibres
- onturatiob material (sealer or GP)

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10
Q

What is the defintion of a true radicular cyst?

A

Form when retained embryonic epithelium begins to proliferate due to the presence of chronic inflammation

Can’t tell between abscess, granuloma or cyst - radiographically

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11
Q

Cystic characteristics in a radiograph?

A

The larger it is, the more likely it’ll be cystic

However, treatment is still the same

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12
Q

Name and deacribe the 2 types of radicular cysts?

A

True radiculsr cyst:
- an enclosed cavity totally lined by epithelium
- no communication with RCS
- not heal after RCT

Periapical pocket cyst:
- epithelium is attached to the margins of the apical foramen
- cyst lumen is open to the infected canal and hence can communicate directly
- heal after RCT

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13
Q

Name the 7 things beware of when treating a tooth for an RCT?

A

History of bruxing
History of frequent decementing
Occlusal wear facets
Large/wide RCT/Posts
Large, narrow perio pockets
Can also indicate a perio endo lesion
Look for vertical root fracture

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14
Q

What is the most common cause of failed RCT?

A

Persistent or secondary infection of the RCS
Secondary intraradicular infections
Microbes are not present in the primary infection but have been introduced later

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15
Q

What species of bacteria can be found as a secondary intraradicular infection?

A

Propionibacterium
Actinomyces
Prevotella
E.faecalus
Streptococcus
Candida albicans
Fusobacterium nucleatem
Spirochaetes

Different combinations of bacterial can cause different ways of treatment failure

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16
Q

What are the 4 options after diagnosing a treated tooth with lost- treatment disease?

A

Nothing
Nonsurgical
Extraction
Surgical

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17
Q

When should Do Nothing be suggested for a patients failed RCT tooth?

A

No signs nor symptoms form the tooth and the radiolucency is not increasing in size
Evidence shows that it has little chance of becoming symptomatic

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18
Q

When should extraction be suggested?

A

When tooth has an obvious hopeless outlook

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19
Q

When should non-surgical re-treatment be suggested for a failed RCT?

A

The safer option that surgical
Most benefit with lowest risk
Greatest likelihood of eliminating most common cause (intraradicualr infection)
But could be more costly than surgical treatment and longer

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20
Q

When should surgical treatment be suggested for a patients failed RCT?

A

Surgery is chosen when no surgical re-treatmebt is not possible, or where the risk to benefit ratio is outweighed by surgery

RCTs can be improved, but somethings can be rectified

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21
Q

What are the aims of root canal re treatment?

A

Re treatment aims to regain access into the apical 1/3 of the the root canal system and create an environment conductive to healing

Need:
- coronal access (remove restorations)
- remove all previous obstruction material
- manage any complicating factors
- achieve full working length
- eliminate microbes

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22
Q

Should you remove the crown/bridge or not? Advantages and Disadvantages of keeping/removing?

A

Decision is easier if it is defective or replacement is required
Advantages of retaining the restoration:
- cost for replacement avoided
- isolation is easier
- occlusion preserved
- aesthetics maintained
Disadvantages of retaining indirect resto:
- removes dentinal core reduction retention and strength
- increased change of iatrogenic mishap as restricted vision
- removal of canal obstructions more difficult
- may miss something important

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23
Q

Name the 2 techniques to remove the crown without destroying it?

A

WAMKEY - dentsply maillefer
Metalift system

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24
Q

What influence the difficulty of post removal?

A

Fairly predictable
Depends on the post, location in mouth and material cemented with

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25
How to remove a post?
What it was cemented with and when the last time it came out Bonded restorations are more difficult to remove
26
Consider the types of post material? Name 2
Dentatus screw Quartz fibre - more time consuming
27
What arenthe initial considerations when thinking about how to remove a post?
Location in the arch of the tooth that requires post removal The more anterior in the arch, the more difficult to remove due to accessibility To remove a post firt remove all restorative materials all around- use ultrasonics
28
Explain the way in which you'd remove the metal posts?
Ultrasonics - eggler post remover Ruddle/Gonon post remover - masseran kit If metal threaded, can often unscrew using Spencer Wells or similar Quartz fibre posts - pilot hole then piezo reamer Zirconia and ceramic post - often irretrievable
29
Explain the process of post removal with ultrasonics?
Rubber dam Magnification and illumination Aim to reduce the retention sing ultrasonics at the interface between the post and the tooth Constantly move it around the circumference of the post to disrupt the cement along the post/canal wall interface Use copious coolant spray Owing to the heat that can be generated, stop every 15s
30
What to do if ultrasonics don't work?
A post puller is required
31
Explain the Eggler post removal system?
Post puller Device consists of two sets of jaesnrhay work independently - first jaw grips the core - the other jae pushes away from the tooth in line with the long axis A cast core may need reduced with a high speed hand piece - not recommended for the removal of screw posts
32
Explain the Ganon/Ruddle post removal system?
Effective for removing parallel or tampered non-actice preformed posts Hollow trephine bur played over the trimmed down post Trephine domes off tip of post to allow specific, matched size extraction mandrel to create a thread onto the exposed portion of the post The extraction mandrel is attached to the post, the extraction vice is applied to the tooth and post Turning the screw applies a coronal force But vice large access in molar/crowded incisors is difficult
33
Explain how to remove fibre posts?
Often come with drill for removal Need magnification Can drill a pilot hole in the long access Set a silicone stop at the depth of the post on the reamer and slowly take to this length LN burs v useful Speed at 600-900rpm
34
How to remove a fractured post?
Masseran Kit
35
Name the 6 potential complications of post removal?
Inability to remove Tooth is unrestroable Head transmission to PDL from ultrasonics Tooth/root fracture Perforation of root Fracture of post and inability to remove
36
How to gain access to the RCS on a RCT tooth?
Once coronal access is gained remove any residual cement using an ultrasonic blocking access jntonthe RCS
37
What should happen if the tooth has limited access?
If not possible to remove lost, surgery can often be performed
38
Name 3 types of ways to remove GP?
Solvents: - chloroform, halothane and oil of turpentine Thermal - ultrasonic - system b Mechanical - rotary NiTi files (ProTaper D)
39
Explain how to use chemical solvents to remove GP?
Very small amount in luer lock syringe Toxic if extruded Leave in canal for a minute then working into HP with a C+ file or a 15 or 20 hedstrom When all GP removed, add more solvent into canal and wick out paper points
40
Explain how to mechanically remove GP from the canal?
Rotary Notice files - Mtwo R - ProTaper D Use at 600rpm Always crown down Active tip to penetrate GP
41
In which order should you use the ProTaper D files?
D1 16mm D2 18mm D3 22mm
42
Removing carrier based systems?
Much more difficult with more errors chance
43
Guttacore
New
44
What to do after bulk of GP is removed?
Flood canals with solvent Use paper points to wicj out remains GP and sealer Carefully use hedstroms
45
Explain the irrigant protocol?
NaOCl EDTA or citric acid Povidone iodine soak NaOCl Use copious irrigation Once working length is reached progressively larger diameter hand files are rotatwd passive, nonbinding, clockwise direction to remove the remaining GP until the files come out of the canal clean
46
Explain why silver points are bad for RCTs?
Poor success rate of RCT with points Not adaptable ti canal, limited seal and toxic products Do not retreat in single visit as risk of flare up
47
Explain how to remove a silver point?
Never apply ultrasonic energy directly on point - will disintegrate Difficult to remove Grippable using stieglitz Don't twist Apply ultrasonic indirectly to the stieglitz and vibrate out
48
Name the 4 options to fill the canals for retreatment?
Insoluble resin GP Silver points Soluble pastes
49
How effective are electronic aplex locators for retreatment cases?
Frequently misread the working length Regain accuracy when clean
50
How successful is retreatment?
Reduced success compared to de novo
51
What is the defintion of endodontic success?
If survival is used as the outcomes, longer is better If bony infill is taken as successful the more infill the better
52
What does retreatemnt rely on?
Maginficaiton and illumination and successfully removing all obtruation material
53
Name the 3 ways in which there is communication between the pulp and periodontium?
Dentinal tubules Apical foramen Lateral/accessory canals
54
How can dentinal tubules becomes exposed?
Developmental defects Disease processes Surgical procedures Trauma
55
Name the 4 types of morphology of the CEJ?
I: cementum iver enamel II: Edge to edge III: gap IV: enamel over cementum
56
What is the defintion of the apical foramen?
Is the principle route of communication between pulp and periodontium Pulpal inflammation can cause localised inflammatory reaction in the peridontium May be exposed due to severe LoA
57
Where are most lateral canals found?
Middle 1/3 30-40% have lateral canals - found apically Contain CT and BVs Furcal canals
58
Explain the problem of potential for exposed furcal canals?
All teeth with furcation involvement can potentially have exposed fiscal canals Lesions suggested radiographically may be due to infectious products from a necrotic pulp diffusing down a furcal or lateral canals Remember sensitivity testing: - lower 46 and 36 DL root - Upper and lower premolars can have between 1-3 roots - Canines have can 2 roots
59
Bacteria found in chronic/asymptomatic PRP and chronic peridontitis?
Aggregatibacter actinimycetesmcomitans P gingivalis Eikenella Fusobacterium P intermediate Treponema denticola
60
Name the 4 iatrogenically occurring communication between pulp and periodntium.
Developmental malformations Resorption lesions Perforations Cracks Mucosal fenestration
61
Name 3 types of developmental malformations?
Palatogingival grooves - upper incisors - maxillary lateral incisors If the epithelial attachment is breached, grooves becomes contaminated Self-sustainjng infrabony pocket develops LoA can quickly extend to the apical foramen causing pulapl necrosis Treatment: - difficult - scaling and RSI don't work - bur out grooves and use regenerative techniques
62
Name 3 types of responsive lesions?
External inflammatory Internal inflammatory Cervical inflammatory
63
What are the requirements of resoprtive lesions?
An injury A stimulus
64
Describe an internal inflammatory root resorption?
Only associated with increased probing depths and BOP when resorptive process has perforated through root
65
Describe an external inflammatory root resorption
Associated with increased probing depths and BOP In late stages, can interfere with gingival sulces and result in periodontal abscesses
66
Describe a cervical inflammatory root resorption?
Starts where the JE attaches to root surface Microbes in the giving sulcus situate and sustaon the resorptive process Associated with increased probing depths, gingival swelling and BOP
67
What is the defintion of a perforation?
Caused pathological by caries or iatrogenically by procedural errors Present with perio abscess - pain, swelling, pus draining and with infrabony pocket developing Having perforated an acute inflamamltry action will occur Closer to the gingival sulcus, increased likelihood of apical migration
68
What affects the prognosis of a perforation?
Location - mid to apical third better outlook as bounded by bone, but advanced perio bad Time Ability to seal Chance of new attachment Accessibility to RCS
69
Describe a horizontal root fracture?
Horizontal Pocket formation may occur - coronal 1/3 root fracture Can present with perio abscess or Deeping of perio pocket
70
Describe a vertical root fracture?
Vertical Microbial colonisation of crack space = periodontal inflammation = breakdown of CT and alveolar bone leading to deep infrabony pocket
71
How to diagnose vertical root fracture?
Parallax x-ray J shaped radiolucency Perio abscess or deepening periodontal pocket Deep, narrow pocket, pain on biting pain, abscess and chronic sinus Surgical exploration but hopeless prognosis
72
What is the defintion of a mucosal fenestration?
Pathological condition characterises by the perforation of the alveolar bone playe and overlying mucosa by the roots of the teeth
73
Name the 4 aetiologies of mucosal fenestration?
Root prominence Develolmenral anomalies Chronic periradicular Orthodontic tooth movement
74
Treatment for mucosal fenestration?
Generally asymptomatic but are plaque retentive factors Causes of exposed root end further periodontal destruction ingress of bacteria into the RCS Treatment: - endodontic treatment - surgery - CT graft
75
What is the defintion of a furcation?
horizontal loss of bony support in areas where roots of multi-rooted teeth conerge
76
What is the aetiology of furcations?
result of plaque indcued inflammation worse in elderly patients PRFs
77
Which teeth affected?
All multi-rooted teeth All molars, 14 and 24 Check from radiographs
78
How to investigate a furcation for a maxillary molar?
Mesio=-palatally, buccally and then distally
79
How to investigate a furcation for a maxillary premolar?
Check mesially and distally root bifurcation loacted at the mid-apical third - unsuitable for root resection
80
How to investigate a furcation for a mandibular molar?
Check buccally and lingually Mesial and Distal root More around the 6s as hinner buccal bone
81
What difference does a furcation have on a mandibular or maxillary molar?
Mandibular: - even if severe only buccal and lingual bone plates affetced - as long as no interproximal bone loss Maxillary: - potential for severe damage to the mesial and distal bone areas, affecting adjacent teeth - needs more aggressive strategies
82
How to diagnose a furcation involvement?
If you can prod it with your probe Radiographs can confirm your suspicisions and confirm amount of bone loss
83
Differential diagnoses for furcation?
Occlusal trauma widens the PDL and causes bone loss Do a sensibility test to identify vital or non-vital
84
How to treat a furcated tooth that is non-vital?
Endo treatemnt always prior to periodntal treatment
85
How to treat a furcated tooth that is vital?
TRreat as plaque induced periodontal disease and review for further sensibility testing
86
How to clinically assess a furcation?
Probe around circumference Determine extent Factors attributing to it Morphology Factors affecting treatment
87
Best tool for furcations?
Nabers
88
Root trunk length affecting RCT?
shorter can be exposed but more accessible
89
Root length affecting RCT
SHort roots may have little root left invested in bone, reduce functional demands
90
Root form affecting RCT?
awkward shapes can make access difficult
91
What part of the furcation anatomy can make RCTs harder?
Concaviities Accessory canals Bifurcational ridges
92
What is the definition of cemento enamel projections
Enamel below gingival margin
93
What is the defintion of an enamel pearl?
Enamel below gingival margin in a pearl shape
94
Name the 3 grades of furcation severity?
I II III
95
Describe Degree I furcation?
Horizontal loss of peridontal support not exceeding 1/3 width of tooth
96
Describe Degree II furcation?
Horizontal loss of peridontal support exceeding 1/3 width of tooth, but not encompassing the tota width of furcation area
97
Describe Degree III furcation?
Horizontal loss through and through destruction of periodontal tissues in the furcation area
98
Name the potential consequences of furcation involvement?
Caries Pulpal exposuire Pulpal necrosis FUrcal/accessory canal microbial invasion - pulpal death
99
Name the 2 objectives for RCT in furcated teeth?
Eliminate microbial plaque from the exposed root surface Establish an anatomy condutive to effective plaque control Need a plaque free zone
100
Name the 5 treatment options for a degree I furcation?
Repeated scaling Mechanical non-surgical debridement Furcationplasty Elimate plaque trap via smoothing Pokcet elimination surgery
101
Non-surgical therapy for furcation treatment?
OHI Needs furcation access Scaling and RSI
102
Wht is the defintion of furcationplasty?
a surgical resective treatment to eliminate the interradicular defect B or lingual furcations Tooth substance removed and alveolar crest remodelled at furcation level entrance
103
Name the treatment options for a degree II furcation?
Furcationplasty Tunnel prep Root resection Guided tissue regen Enamel matrix derivative Tooth extarction
104
Name the treatment options for a degree III furcation?
Tunnel prep root resection extraction
105
What is the definition of tunnel preps?
surgical treatment for DII and III furcations Needs unfused roots Flap reflectyed and granulation tissues removeed, root surfaces scaled and RSI Widened furcation area - allow easy teepee access Flaps replaced in more apical area High risk for sensitivity
106
What is the defintion of root resection?
Surgical division and removcal of roots of multi-rooted teeth Good for uneven bone support Must seal root Must devitalise tooth Bets to RCT before Max amount of dentine saved Direct resto after obturation
107
Which root to remove for resection?
The root or roots that will elimnate the furcation Greatest amount of bone loss of LoA Save better roots, lose worse roots
108
What is the ideal goal for regenaration?
regenrate lost attachment new formation of cementum, functionally orientated PDL, alveolar bone and gingiva PDL cells have ability to regen

4th Year BDS (21 decks)

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