Treatment of Endodontic Disease Flashcards by Joseph Charnas

_____ difference between infiltrations and PSA blocks for maxillary first molars

No
Aggarwal

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Addition of palatal anesthesia ________ increase anesthetic success rates but does increase ______

Does not
Duration
Aggarwal

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No difference between ______ and ______ for maxillary teeth

Lidocaine and Articaine

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For mandibular anteriors and premolars _______ often provide sufficient anesthesia.

infiltrations

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Mandibular infiltration works as a _______ and ______ nerve block

mental and incisive

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Single mandibular infiltration has _____ success. Double infiltration has ______ success

80-87%
92-94%

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No advantage of ______ or _____ techniques over standard IANB

Gow-gates or akinosi

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_____ fold increase in parasthesias when articaine is used for IANB

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Anesthetic _______ has little-no effect on anesthetic success

volume

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_______ alone is not predictable enough to serve as primary technique for mandibular posterior anesthesia

infiltration

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Commonly cited reasons for local anesthetic failure (5)

Lower pH of inflamed tissue
unsuccessful techniques
Altered resting potential in inflamed nerves
Upregulation of anesthetic- and tetrodotoxin resistant sodium channels
Patient anxiety

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Success rate of standard IANB alone

15-57%
Reader

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Repeat IAN successful ______

32%

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Buccal infiltration after failed IANB

84%

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______ significantly more effective than ______ when used as buccal infiltration

articaine than lidocaine

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Caution with IO injection when coexisting ______ disease

cardiac
(increased heart rate)

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Intrapulpal success rate

92%

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Intrapulpal mechanism

pressure

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Use of rubber dam is standard of care according to ______

AAE 2010

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Rubber dam benefits (4)

isolation
visualization
aspiration
survival probability enhanced

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Microscope is an integral and important part of the performance of modern endodontic techniques.

AAE position 2012

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Shape and location of access preparation reflects _____

pulpal anatomy

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______ provides the most consistent landmark for the pulp chamber

CEJ

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High correlation between working lengths measured by ______ and _______

CBCT and electronic apex locators

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Conventional vs digital films for working length determination

Conventional more accurate with smaller file sizes

Apex locators are ______% accurate Author

96% Shabahang

Apex locators accuracy not affected by

presence of solutions

Apex locators safe to use with

pacemakers Wilson

______ increases irrigant efficiency at the apex

Maintaining patency Vera

Negative aspects of maintaining patency (2)

transportation increases apical cracks

Crown-down as defined by

Morgan and Montgomery

All instrumentation techniques ______ in terms or debris left behind

similar

Heat treated NiTi remains in

martensite and R phases (More flexible, better fatigue resistance)

______ instruments remain better centered in the root canal system

rotary

Minimum MAF of _______ allowed penetration of irrigants to the apex

30.02

MAF should be ______ sizes larger than the initial apical size

2 components of the smear layer

surface of the canal wall debris packed into dentinal tubules

Smear layer may block the _______ of NaOCl and CHX

disinfecting properties

Instrumentation leaves ______% of canal walls untouched

35%

_____ and _____ can not be instrumented

isthmuses and lateral anatomy

Properties of an ideal irrigant (5)

Broad antimicrobial effective against anaerobes and facultatives Inactivates LPS Dissolves vital and necrotic tissue Prevents or dissolves smear layer

Most common concentration of NaOCl

5.25%

NaOCl can only dissolve the ______ component of the smear layer

organic

EDTA _____ calcium ions

chelates

EDTA dissolves ______ components of the smear layer

both (organic and mineralized)

Caution when using both NaOCl and EDTA together to avoid

excessive erosion of root canal dentin

CHX binds to dentin and exhibits substantivity for up to _____ days

Carcinogenic precipitate when mixing NaOCl and CHX

Parachloroaniline

Passive ultrasonic irrigation improves cleanliness of both ____ and _____

main canal and isthmuses Gutarts

No difference in outcomes between single visit and multi visit tx Author

Penesis

pH of CH

between 11 and 12

CH reduces the cytotoxic response to LPS by destroying _____

Lipid A moiety

CH is less ______ to the apical papilla stem cells compared to ABX pastes

cytotoxic

______ or ______ should be used to remove CH from the canals

rotary instrumentation PUI

Drawbacks of CH (5)

decreased fracture resistance PDL necrosis tissue necrosis parasthesia inhibits setting of eugenol based sealers

GP is a naturally occurring polymer of _____

isoprene

Components of GP

65% zinc oxide 20% GP Other -- waxes, resins, metals

GP is in ______ form as a cone

beta crystalline

GP is in _____ form once heated to 42-49 C

alpha crystalline

In regards to GP, Care should be used in patients with

severe type I allergy to latex

Lateral condensation ________ faster than vertical condensation

leaks microbes

____ difference in outcomes noted between lateral and vertical condensation

Idea behind resilon

Mono block -- sealer bonds to both dentin and filling. Not supported by research.

Carrier-based systems ______ significantly more than lateral or vertical condensation Author

leak Baumgardner

Instrumentation and obturation should terminate at the

CDJ

Extruded obturation materials have been associated with _______

chronic inflammation

_____mm thickness of cavit required for adequate seal

3.5mm

Cavit leaks after ______ days

Cavit and IRM both leak more than

Properties of eugenol (3)

alters neurotransmission, increases potassium, decreases sodium blocks neuropeptide transmission decreases vascular response to epi

Factors associated with recurrent apical periodontitis (7)

Coronal leakage intraradicular infection extraradicular infection untreated canal anatomy fractures foreign body reaction true cystic lesions

____ minutes of ultrasonic vibration is effective in metal post removal

Care must be taken when using ultrasonics to remove posts due to

Significant heat production capable of causing bony damage

Temperature increase of _____ within 15 seconds of ultrasonic without irrigation

10 degrees C

_______ is the only solvent capable of completely dissolving GP

chloroform

Silver points ____ in the presence of tissue fluid producing highly toxic byproducts

corrode Seltzer

______ of silver points is not indicated

Prophylactic revision

Two steps to carrier-based system retreatment

1. chloroform to soften surrounding GP 2. Hand files to remove the carrier

Surgical endodontic therapy is indicated when

orthograde endodontic treatment is not feasible

3 modern advances in surgical endodontics

1. Magnification - Von arx 2. ultrasonic retropreparations - de Lange 3. improved filling materials - Kim

With modern techniques, surgical endodontics provides _______ Author

Predictable means of eradicating periapical pathology Tsesis

Hemostasis is essential for ____ and _____

visibility minimize blood loss

Average of _____ mL of blood is lost during surgery

9.5mL Selim

Bone wax is no longer used due to ______

robust inflammatory response

Epinephrine acts by interacting with blood vessel ______ receptors, producing ________

alpha vasoconstriction

Local anesthestics containing 1:50,000 offer: (4)

1. Reduced blood loss by half 2. reduced surgical time 3. better visibility 4. improved post op hemostasis Buckley

Other hemostatic agents (6)

1. racemic epi pellets 2. ferric sulfate (curretage before close) 3. collagen based agents 4. cellulose based agents 5. gelatin based agents 6. calcium sulfate

Intrasulcular incision is associated with ______ compared to other incision types

increased post op recession and scarring

Submarginal incision requires _____ mm of attached gingiva

2mm

Papilla-based incision mitigates the risk of ______

recession

______ + ______ creates the soft tissue flap

horizontal incision vertical incision

1 vertical releasing incision produces a ____ flap while two produces a _____ flap

triangular rectangular/trapezoidal

Length to width ratio of _____ is recommended for rectangular flaps

2:1

_______ osteotomy preparations are associated with more favorable outcomes

smaller

_____mm of apical resection will remove the majority of apical deltas

3mm Block

_____mm of apical resection of MB roots of maxillary first molars may be necessary due to isthmuses

4mm Weller

Bevels are associated with _____

leakage

Methylene blue uses: (4)

1. outlines root anatomy 2. delineates dentin from bone 3. stains isthmuses 4. stains fractures

_____mm of retropreparation is recommended Author

3mm Matisson

Bur retropreparations are covered in _______

smear layer

Amalgam retrofillings are associated with more ________ (4)

leakage - Torabinejad poor biocompatability and inflammation - Baek poorer outcomes - Setzer

Super EBA outcomes are ______ compared to MTA

as favorable Kim

Upon setting, MTA forms ____ and ______

Calcium silicate hydrate calcium hydroxide Camilleri

MTA provides a ______ apical seal even in the presence of ______

better blood Torabinejad

MTA promotes _____ and ______ coverage

cementum and bone

Bioactive cements are composed of _____ and ______

calcium silicate calcium phosphate

Bioactive cements are similar to MTA in terms of ______

in vitro and in vivo biocompatibility Damas, Ma

Bioactive cements create a ________ To dentin, providing an ________

mechanical bond excellent seal Damas

Retropreparation following root-end resection may be unnecessary for ____ and _____

MTA apical plugs -- Andelin Well-condensed GP -- Harrison and Todd

Sutures promote healing by ______ Author

primary intention Harrison

______ sutures are recommended

monofilament synthetic

Benefits of monofilament synthetic sutures (3)

1. Less traumatic 2. Discourage inflammation 3. promote less bacterial adhesion

_____ suture gauges are recommended to avoid tissue necrosis and scarring

Smaller (6-0 and 8-0)

Sutures should be removed _______ hours post-op

48-96 Velvart

3 categories of grafts

osteogenic osteoconductive osteoinductive

Osteogenic grafts

contain cells capable of producing bony matrix

Osteoinductive grafts

release mediators that signal the host to induce new bone formation

Osteoconductive grafts

serve as scaffolds on which new bone can grow

Graft categories by source (4)

Autogenous grafts Allografts Xenografts Alloplasts

Autografts derived from

host

Allografts derived from

non-host member of same species

Xenografts derived from

different species from host

Alloplasts are

Inert materials that serve as scaffolds (not derived from biologic donors)

Concomitant use of a bone graft and a membrane consititutes

guided tissue regeneration

For apical surgery with loss of only one cortical plate, use of membranes offer ______, but may improve outcomes for ______ and _____

no advantage -- Garrett through-and-through lesions -- Lin Large periapical defects -- Tsesis

_____ membranes are favored over _____ membranes

resorbable nonresorbable

Post-op pain is correlated with ______

pre-op pain -- Tsesis

Avoid post-op CHX rinses for _____ hours as it may negatively affect ______

48 hours tensile wound strength

Sinus perforations tend to _______ regardless of size

self-repair

Managing sinus perforations (3)

Primary closure Sinus precautions Rx decongestant

Aid in avoiding IAN during surgery

pre-op CBCT -- Kovisto

Sensory disturbance of the lower lip occurs in _____% of mn molar surgeries

20%

____% of patients retain permanent deficit following mn molar surgery

Stages of healing progression (5)

Clotting and inflammation epithelial healing connective tissue healing maturation remodeling

Day 1 of healing

Thin epithelial seal Blood clot PMNs predominate Periosteal necrosis

Day 2 of healing

Multi-layered epithelial seal Type III collagen production Macrophages predominate

Day 4 of healing

Clot replaced by granulation tissue Type 1 collagen production Osteocyte proliferation from the endosteum

Day 14 of healing

Normal sulcular epithelium Woven bony trabeculae occupy the wound New periosteum evident

Day 28 of healing

Maturing bony trabeculae occupy the wound

Tx recommendations for intentional replantation (5)

Atraumatic extraction minimal handling of root surface extra-oral time of less than 10 minutes biocompatible apical fill nonrigid post-op splint

Success rate of intentional replantation

81%

Ideal donor tooth for autotransplantation has a ______ root with an ______

partially developed root with an open apex

Maintaining pulp vitality in permanent teeth with open apices is called _______

apexogenesis

Pulp caps should be placed _______ for the best prognosis

immediately -- Bergenholtz

Histologic response to pulp capping is _____ followed by ______

coagulative necrosis hard tissue bridging

______ may become useful in vital pulp therapy (cholesterol medication)

Simvastatin

Removal of the coronal portion of a vital pulp to preserve the vitality of the radicular pulp

Pulpotomy

Indications for pulpotomy (2)

1. continued root development in immature permanent teeth 2. Emergency care in mature teeth until definitive care can be completed

______ enters systemic circulation following formocresol pulpotomies

Formaldehyde Pashley

______ and ______ are unsafe and ineffective, their use is unjustifiable.

Formaldehyde paraformaldehyde AAE

Restorative material options for pulptomy (3)

CH -- Cvek MTA -- Bakland Platelet-rich fibrin -- Keswani

Treatment aimed at apical barrier creation

Apexification

Apical barriers typically form in an average of _______

1 year

CH can be changed every _____ during apexification

3, 6, 8 months, or never

Long-term CH apexification has been associated with increased risk of _______

cervical root fracture Cvek

MTA apexifications outcomes are _____ or ______ compared to CH

equivalent or better

MTA apexifications mitigate_____ and _____

decreased fracture resistance from CH treatment time/follow-up

Biologically based procedures designed to physiologically replace damaged tooth structures as well as cells of the pulp-dentin complex

Regenerative endodontics

Etiology of pulp necrosis is ______ when considering regendo

unimportant Law

Regenerative endodontics may provide a reasonable alternative to ______

Apexification

Requirements for tissue engineering (3)

Stem cells growth factors scaffold

Mesenchymal stem cells that infiltrate the canal space for regendo originate in the ______ Author

Apical papilla Lovelace

Hargreaves recommends _____ and _____ for regendo

minimal instrumentation gentle irrigation

Regendo recommended irrigation protocol (Martin)

1.5% NaOCl followed by 17% EDTA

Benefit of EDTA in regendo

Release of growth factors from dentin

An intracanal medicament should be placed for _______ weeks following instrumentation and disinfection during regendo.

2-4 weeks Law

Use of antibiotic pastes during regendo is problematic due to _____

negative effect on stem cell viability Ruparel

______ does not reduce stem cell viability

Introduction of stem cells, growth factors, and scaffolds into the canal space is achieved by _______

Overinstrumentation in to the apical papilla to stimulate bleeding

Capping material of choice for regendo is

MTA

MTA facilitates ______ when used in regendo

migration and proliferation of apical papilla stem cells Mente

______ serves as the scaffold during regendo Author

blood clot Hargreaves

2 aims of successful regendo

elimination of apical periodontitis increase in root length and width

Tissue formed from regendo resembles

cementum, PDL, and bone Wang

_____ has been associated with increased risk of resorption following internal bleaching.

Superoxol Madison and Walton

Non-surgical patients should have at least ______ post-op exam and use _____ to assess healing

1 year, PAI score Orstavik

_______ % of lesions take more than 1 year to heal Author

70% Murphy

______% of unhealed lesions at 1 year will improve over time while _____% will worsen

57% improved 31% worsened Yu

Predictors for worsening of unhealed lesions (4)

size symptoms (pain on biting at recall) history of post-obturation flare non ideal length

Surgical patients should be examined _____ post-op

1 year Rud

For surgeries that have healed at early exam periods, periapical status remains _____ for several years

stable Kim

Oral fluids may reach the apex in as little as _____ with exposure to the oral environment

3 days -- Swanson and Madison 3 weeks -- Torabinejad

Access opening reduces tooth stiffness by _____%

Tooth stiffness reduced by ______% when preparation involves both marginal ridges

60%

Significant _____ in failures in temporarily vs permanently restored teeth

reduction Chugal

_________ significantly improves outcomes of mn and mx premolars and molars

full coronal coverage Sorensen and Martinoff

Full coronal coverage does not impact outcomes for _____

anterior teeth

Full coverage restorations must respect principals of _____ and ______

biologic width ferrule

Biologic width should total ______

3mm Gargiulo

Biologic width consists of ______

sulcus depth epithelial attachment connective tissue attachment

Ferrule consists of

1.5-2mm of circumferential vertical wall

Proper ferrule decreases ______ and provides _____ and _____

fracture rate of endo treated teeth retention and resistance

Proper length of posts

Greater of the length of the crown or 2/3 the root length

Posts do not improve ______ or _______

strength longterm outcomes

Posts may actually _______ Author

decrease success rates of endo treated teeth Doyle 2007

_____mm of apical GP should remain following post space preparation

5-7mm Mattison

Absolute failure rate of both RCT and implants

6.1% Doyle

______% of patients with cracked teeth had symptoms eliminated with placement of a temporary crown.

89% Guthrie

_____% of crowned cracked teeth end up needing RCT

21% Krell

Ethical obligations often _____ legal duties

exceed

5 principals of ADA code of ethics

Patient autonomy Beneficience Veracity Justice Nonmaleficence

Patients' right to self governance

Patient autonomy

Do no harm

Nonmaleficence

Do good

Beneficence

Fairness

Justice

Truthfulness

Veracity

1 Cartridge of 2% LA is _____mg of anesthetic.

36mg

1 cartridge of LA is _____mL

1.8 mL

1 cartridge of LA with 1:100k epi contains _____ mg of epi

0.018 mg

Max dose of epi is _____ mg which is ______ cartridges of 1:100k epi

0.2 mg of epi 11 cartridges

Max dose of anesthetic is _____ mg which is _____ cartridges of 2%

300 mg 8.3 carps

Treatment of Endodontic Disease Flashcards

(211 cards)