Week 1

Question 1

what do endodontists do?

Answer 1

manage inflammation of
the specialized connective tissues within and surrounding the teeth; more specifically, they deal with inflammation (and infection) that generally commences in the pulp tissue and progresses to the periradicular tissues via portals of communication that convey the neurovascular supply

Question 2

Normal/Healthy Pulp

Answer 2

Requires no treatment
Routine diagnostic tools:
 Sensibility tests
    - Cold
     - Hot
     - EPT
 Percussion test
 Palpation test
 Periodontal probing
 X-ray

Question 3

Diseased Pulp

diagnosis?
histologically?

Answer 3

Diagnosis

1. Reversible pulpitis
2. Irreversible pulpitis
3. Necrotic pulp (non-vital)

Requires treatment/intervention
 Vital pulp therapy
 Non-vital pulp therapy (pulpectomy)

Histologically

• Inflamed: acute vs chronic (pulpitis)
• Infected or even localized abscess
• Necrotic as a result of infection or trauma

Question 4

ept stands for?

Answer 4

Electric pulp testing

Question 5

Non-surgical endodontic treatments

Answer 5

a. Vital pulp therapy
- - Purpose: to keep vital pulp
b. Non-surgical RCT for non-vital pulp (NSRCT)
- - Purpose: to remove infected pulp & root dentin to restore periapical health
c. Regenerative endodontics
- - Purpose: to revascularize and/or regenerate pulp tissue for immature teeth

Question 6

Surgical treatments

Answer 6

Purpose: to remove infected root end tissues (root tip, granuloma/cyst)

• Peri-radicular curettage
• Root-end resection (Apicoectomy)
• Root resection (root amputation) or hemi-section
• Intentional replantation
• Incision & Drainage (I & D)

Question 7

NSRCT stands for?

Answer 7

NON-SURGICAL ROOT CANAL THERAPY

Question 8

CDJ means?

Answer 8

Cementodentinal Junction

Question 9

Direct pulp capping

Answer 9

A dental material placed directly on a mechanical or traumatic vital pulp exposure

Question 10

Indirect pulp capping (step-wise caries excavation)

Answer 10

Incremental removal of caries over a period of time to allow pulpal healing and to minimize exposure

Question 11

Pulpotomy (pulp amputation)

Answer 11

• – Surgical removal of the coronal portion of a vital pulp as a means to preserving vitality of the remaining radicular portion
• – Usually performed as an emergency procedure for temporary relief of symptoms or as a therapeutic measure

Question 12

Partial pulpotomy (Shallow pulpotomy, Cvek pulpotomy)

Answer 12

Surgical removal of a small diseased portion of vital pulp as means of preserving the remaining coronal and
radicular pulp tissue

Question 13

Full Pulpotomy

Answer 13

• Removing infected coronal pulp and leaving only the vital intact radicular pulp
• Indication:
• Carious pulp exposure in deciduous and young
  permanent teeth
• Pulp must be vital and asymptomatic
• All the carious dentin and coronal pulp are to
  be removed

Question 14

Partial Pulpotomy (Cvek pulpotomy)

Answer 14

• Removing 2 mm of coronal pulp from the exposure site with a high-speed sterile
  diamond bur with ample flushing with sterile saline
• Bleeding control with saline solution
• Capping with Ca(OH)2 and sealed with ZnOE cement and later replaced with amalgam
• Follow the same protocol for direct pulp capping

Question 15

apexogenesis

Answer 15

Apexogenesis refers to a VITAL pulp therapy procedure performed to encourage physiological development and formation of the root end.

Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation.

Question 16

Apexification

Answer 16

Apexification = method of inducing a calcified barrier at the apex of a NONvital tooth with incomplete root formation.

Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.

Question 17

Functions of dentin

Answer 17

1. Form a network for the diffusion of nutrients
throughout dentin
2. Dentinal fluid and sensitivity
3. Protect coronal pulp
   a) Prevent bacterial penetration
    - Streptococci 0.5 μm in diameter
     - Usually no bacteria in the tubules at the extreme front of the carious lesion
   b) Dentinal fluid
   c) Tertiary dentin formation
   d) Sclerotic dentin formation
   e) Low thermal conductivity
4. Protect coronal & radicular pulp
5. Hardness, elastic modulus and shape for chewing and fracture resistance

Question 18

dentin tubules have what shape?

Answer 18

inverted cone shape

Question 19

Surface dentin vs Deep dentin near pulp has ___ % surface area containing tubules

Answer 19

• Surface dentin: 1% surface area contains tubules, mostly intertubular dentin
• Deep dentin near pulp: 22% surface area contains tubules

Question 20

Number of tubules in crown per square millimeter

Answer 20

• 45,000 near the pulp
• 29,000 in the mid-dentinal area
• 20,000 in the periphery

Question 21

Cvek pulpotomy is aka?

Answer 21

Partial Pulpotomy

Question 22

___ shape curvature of dentin tubules due to crowding of _______ as they move toward pulp

Answer 22

S shape

• due to crowding of odontoBlasts as they move toward pulp

Question 23

1) coronal dentin is most and least permeable where?

2) is axial or coronal dentin more permeable?

Answer 23

1) Most permeable in pulp horn area; Least permeable
in central occlusal region

2) axial more permeable than occlusal dentin

Question 24

Cervical and mid-root dentin have higher permeability

and higher tubular density than?

Answer 24

apical dentin

• apical has more convoluted tubules, areas with no tubule openings, and more crowded

Question 25

decreased tubular permeability: 1) immediatly 2) long-term 3) chemically 4) physically

Answer 25

1) For vital teeth, dentin permeability can dramatically decrease during the first day following injury (85%) 2) laying down teritary dentin, crystalline deposits 3) desensitizing reagents 4) sealing off the tubular openings

Question 26

pupal changes with age? begins when?

Answer 26

BEGINS AT 20 yrs * decrease pulpal cells: odontoblasts and fibroblasts * increase relative fibrous content * decrease supportive elements like vessels and nerve endings - -- atherosclerotic and calcification * diffuse calcifications * pulp stones

Question 27

Calcifications in typically occurs in ______ pulp and ______ pulp

Answer 27

coronal pulp and radicular pulp

Question 28

diffuse calcifications

Answer 28

linear calcification usually close to blood vessels, nerves or collagen *predominantly in the radicular region of the pulp

Question 29

Dentin changes with age

Answer 29

BEGINS at 30 years * tubular area decreses - results in decreased fracture resistance by 20-40% * increase in minerals * decrease response or false negative responses to cold test * increase in hardness of outer dentin (near DEJ)

Question 30

1a) Transparent zone of pathologic scerotic dentin? | 1b) Tubules are completely or partially occluded by intratubular precipitation of?

Answer 30

1a) at the base of slow progressive active lesions and arrested lesions 1b) whitlockite (magnesium-substituted tricalcium phosphate) crystals or peritubular dentin-like deposition

Question 31

pulp stones? true vs false? free vs attached vs embedded pulp stones?

Answer 31

Discrete circular calcific masses within pulpal tissue ** True pulp stone = small island of dentin with tubules and odontoblasts ** False pulp stone = concentric layering of calcified tissue ** Free = island of calcified tissue ** Attached = fused to dentin wall ** Embedded = stones that have become surrounded by dentin

Question 32

MOLECULES AFFECTING DENTINOGENESIS

Answer 32

1) IL-1β - Promoting the proliferation of dental pulp stem cells - Short-term treatment with IL-1β increased gene expression of osteocalcin - long term decreses gene 2) TNF-α - Promoting mineralization in short- term cultures and inhibit mineralization in long term dental apical papilla cell culture 3) IL-1 α + TNF-α - Synergistically increased BD-2 mRNA expression 4) NGF 5) TGF-β

Question 33

MOLECULES REGULATING TERTIARY DENTIN | FORMATION

Answer 33

1) TGF-β - Expressed by odontoblasts - Secreted to dentin matrix and released upon demineralization - Important in pulp repair 2) NGF - Expressed by odontoblasts (mainly odontoblast process), pulp fibroblasts and nerve fibers - Upregulated under caries and cavity preparation in odontoblast cell bodies or newly differentiated odontoblast like cells

Question 34

primary, secondary, tertiary and Sclerotic

Answer 34

primary= before root forms secondary= after root completlyformed tertiary= Reparative and Reactionary dentin Sclerotic= Pathologic: abrasion, attrition, caries