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Endodontics I > 1. Surgical Removal of Caries > Flashcards

1. Surgical Removal of Caries Flashcards

1
Q 
Dentinal Caries
Progress more \_\_\_\_ than enamel
Tubules are natural \_\_\_\_ for bacteriologic migration 
\_\_\_\_ is first defense
coagulation of \_\_\_\_ at orifice
absorption of \_\_\_\_ 
Softened dentin may be \_\_\_\_
Denatured collagenous matrix= impossible to \_\_\_\_
A 
rapid
channels
intratubular fluid
fluid
minerals
remineralized
remineralize
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2
Q

Infected Dentin- ____ dentin with ____ bacterial infection

Affected Dentin- ____ dentin with ____ infection

A

softened
significant
slightly softened
minimal

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3
Q

Criteria for Deep Lesion Therapy

  1. ____ carious teeth without a history of ____ pain, pain on percussion and only to ____ stimuli (cold or heat)
  2. Teeth with no ____
  3. No ____on radiograph
  4. Teeth that could be ____ by a rubber dam
A 
deep
spontaneous
provoked
percussion sensitivity
periapical pathology
isolated
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4
Q

How do we decide what is decay in the cavity preparation?
____- compressive force Spoon excavator
____ rotating ____ bur
Dyes

How much \_\_\_\_?
How sticky is sticky?
How \_\_\_\_ do we 􏰄scoop􏰅?
What is the ideal \_\_\_\_ of dentin?
of enamel?
A

explorer
slowly
round

force
hard
color

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5
Q 
Round Bur
\_\_\_\_ speed handpiece 
\_\_\_\_ rotating
\_\_\_\_ pressure
Select the \_\_\_\_ bur that will fit in the preparation, slowly rotating
A

slow
slowly
light
largest

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6
Q

Caries Removal
Open cavity to allow ____
Remove all decay from ____
Excavate decay pulpally, but do not ____
Determine how ____ remaining dentin is
If dentin is extremely soft continue ____
If dentin is leathery or firm, decide whether or not
dentin should remain based on pulp ____, ____ and likelihood of pulp ____

A 
access
periphery
expose
soft
removal
health
demineralization
exposure
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7
Q

Occlusal Caries
Carious process accompanied by enamel decalcification on lateral walls of ____
Visible with ____ air drying of the tooth
Dessicated demineralized enamel is ____

A

fissures
5 sec
opaque

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8
Q

Early or Occlusal

Carious process not apparent with: ____ inspection
May or may not be visible with ____ drying
Lesion may be arrested
These difficult to discern on ____

A

visual
extensive
radiograph

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9
Q

Carious Pulp Exposure
Is it ____?
What are the ____?
What are the important ____?

A

necessary
alternatives
decisions

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10
Q

How do we remove caries
____ invasive lesion access
Must be adequate for appropriate ____ caries instrumentation and creation of a peripheral ____
Avoid ____ to adjacent teeth and pulp dentin complex
Potential for caries ____ excavation techniques

A 
minimally
peripheral
seal
iatrogenic
limiting
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11
Q 
How much caries do we remove
Peripheral caries (DEJ & peripheral dentin) 
Caries removal to clinically sound \_\_\_\_ to achieve a peripheral seal is essential.
A

hard enamel/dentin

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12
Q 
How much caries do we remove
Peripheral caries (DEJ & peripheral dentin) Caries removal to clinically sound hard enamel/dentine to achieve a peripheral seal is essential.

Pulpal caries
Remove carious tissue to optimize ____ (minimal thickness needed for material

A

restoration performance

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13
Q

How much caries do we remove
Leaving infected, demineralized, stained dentin is proven and ____ scientifically
____ dentin should be removed
____should be avoided
Every tooth should be assessed for pulp ____ …no ____
…no sensitivity to ____

A 
accepted
soft "mushy"
pulp exposure
health
periapical pathology
percussion
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14
Q

Deep Caries Lesion Management

Indirect Pulp Cap
____ Caries Removal
To ____ or not re-enter
What is the ideal ____ for both?

Direct Pulp Cap (for caries)
What is the ideal ____?

A

stepwise
re-enter
medication
medication

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15
Q

Deep Caries Lesion Management
Pulp Cap

Indirect Pulp Cap
Indication- \_\_\_\_ caries lesion Caries near \_\_\_\_
No Sensitivity to \_\_\_\_ 
No \_\_\_\_ 
“\_\_\_\_” dentin
NO \_\_\_\_
A 
deep
pulp
percussion
periapical pathology
leathery
caries exposure
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16
Q

Deep Caries Lesion Management

Pulp Cap

Indirect Pulp Cap
Technique- Excavate periphery to ____
Excavate ____ wall to 0.5mm
Place ____ and/or base

A

clean
axial
liner

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17
Q

Deep Caries Lesion Management

Pulp Cap
Indirect Pulp Cap
Medication- \_\_\_\_
\_\_\_\_
\_\_\_\_
A

CaOH
glass ionomer
composite

18
Q

Deep Caries Lesion Management
Pulp Cap

Indirect Pulp Cap
Technique- Excavate ____ to clean
Excavate axial wall to____mm
Place ____ and/or base

Close with ____ then re-enter and restore with
____!…. Or just restore with ____

A 
periphery
0.5
liner
temporary
amalgam
amalgam
19
Q

Deep Caries Lesion Management

Pulp Cap
Indirect Pulp Cap
Technique- Excavate periphery to clean Excavate axial wall to 0.5mm
Place liner and/or base What was the hitch… “leaving ____”

A

decay

20
Q

Deep Caries Lesion Management
Direct Pulp Cap
Indications: ____ exposure…ONLY
Exposure of

A

mechanical

0.5

21
Q

Deep Caries Lesion Management

Direct Pulp Cap Medication
- ____
____
____

A

CaOH
glass ionomer
composite

22
Q

Deep Caries Lesion Management
Direct Pulp Cap Medication- CaOH
Glass Ionomer Composite

The final restoration was “____”

A

amalgam

23
Q

Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of ____ should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’

A

discolored dentin

24
Q

Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of discoloured dentine should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’ (John Tomes-1859),
‘… it will often be a question of whether or not the pulp will be exposed when all decayed dentine overlaying it is removed … it is better to expose the ____ of a tooth than to leave it covered only with ____’ (G.V. Black-1908)

A

pulp

softened dentine

25
Q

Deep Caries Lesion Management
Where has the science led us?
10-year follow-up of occlusal restorations placed over moist, soft, infected dentine left both at the enamel- dentine junction and over the pulp. Lesion progression was ____ and there were no more ____ failures in this group than in control groups with conventional caries removal

A

arrested

clinical

26
Q 
Deep Caries Lesion Management
Where has the science led us?
Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation
Medication- \_\_\_\_
\_\_\_\_
\_\_\_\_
\_\_\_\_
A

CaOH
glass ionomer
composite
MTA - mineral trioxide aggregate

27
Q

Deep Caries Lesion Management
Where has the science led us?
Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation

____% success rates- no need to ____(M. Maltz, E.F. Oliveira, V. Fontanella, G. Carminatti Deep Caries Lesions after Incomplete Dentine Caries Removal: 40-Month Follow-Up
Study. Caries Res 2007;41:493–496)
(Ricketts D, Kidd E, Innes NPT, Clarkson JE. Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database of Systematic Reviews 2006, Issue 3)

A

88-95

re-enter

28
Q

Deep Caries Lesion Management

Where has the science led us?
Direct Pulp Cap (____ OR Mechanical)

Advantage: avoidance of more ____ treatment, such as root canal
____ or extraction
Decreased ____

A

carious
extensive
treatment
cost

29
Q 
Deep Caries Lesion Management
Where has the science led us?
Direct Pulp Cap (Carious OR Mechanical)
Medication- CaOH
Glass Ionomer
Composite
\_\_\_\_
A

MTA- mineral trioxide aggregate

30
Q 
CaOH- Calcium Hydroxide
Advantages
Provides \_\_\_\_
\_\_\_\_ Environment- stimulates remin
\_\_\_\_
Easy to apply-sets \_\_\_\_, convenient package
Disadvantage 
\_\_\_\_
Can not be used \_\_\_\_ 
Does not bond to \_\_\_\_ 
Low \_\_\_\_ strength
A

calcium
basic
cheap
fast

soluble
wet
tooth
compressive

31
Q

Glass Ionomer
Advantages
____ Environment
Cheap
Seals well- bonds to ____, does not mind moisture(?) Leaches ____- helps ____
High ____ strength
Easy to apply-sets ____, convenient package

Disadvantage
Not ____
____ must be stopped

A 
acidic
tooth
fluoride
remineralization
compressive
fast
soluble
bleeding
32
Q

Glass Ionomer

____ plus Polymaleic Acid

A

silicate glass

33
Q

Composite

Advantages
Seals well- bonds to tooth, does not mind ____ (?)
Very high ____ strength
Not ____
____
Easy to apply-sets ____, convenient package

Disadvantage
____ must be stopped

A 
moisture
compressive
soluble
cheap
fast
bleeding
34
Q

MTA- Mineral Trioxide Aggregate
____ in the form of ____, dicalcium silicate, tricalcium aluminate, and ____ oxide for ____
Developed for ____ (Mahmoud Torabinejad 1993) Similar to ____ (Joseph Aspdin 1824)

A 
calcium oxide
tricalcium silicate
bismuth
radiopacity
dentistry
portland cement
35
Q

MTA- Mineral Trioxide Aggregate

Advantages
\_\_\_\_ Environment
Seals well- bonds to tooth, does not mind \_\_\_\_
\_\_\_\_
\_\_\_\_ compressive strength
\_\_\_\_ must be stopped
Not \_\_\_\_

Disadvantage
Difficult to apply-sets ____ Expensive
____ must be stopped

A 
acidic
moisture
hydrophilic
high
bleeding
soluble

slow
bleeding

36
Q

Deep Caries Lesion Management

Where has the science led us?
Direct Pulp Cap (Carious OR Mechanical)
Medication- CaOH
Glass Ionomer
Composite
MTA- Mineral Trioxide Aggregate Multiple studies have indicated ____% success rates with mixed
data MTA v CaOH (Cochrane review- No Difference, Ferrecane- MTA superior)

A

70-97

37
Q 
When Direct Pulp Caps Fail- \_\_\_\_% require extraction, \_\_\_\_% treated
with endodontics (T.J. Hilton, J.L. Ferracane, and L. Mancl, Comparison of CaOH with MTA for Direct Pulp Capping: A PBRN Randomized Clinical Trial JDR July 2013)
A

2

98

38
Q

Deep Caries Lesion Management
Technique

Pre-treatment
1. Deep carious teeth without a history of ____ pain,
pain on percussion and only to ____ stimuli (cold or heat) 2. Teeth with no ____ sensitivity
3. No ____ on radiograph
4. Teeth that can be ____ by a rubber dam

A 
spontaneous
provoked
percussion
periapical pathology
isolated
39
Q

Deep Caries Lesion Management
Technique

Pre-treatment
1. Excavate to clean, firm, well supported enamel at
periphery of lesion
2. Excavate axially without ____
3. Pulp cap with “appropriate” ____
4. Restore ____
5. Discuss with patient that they need to see Dentist
____ if sensitivity to hot/cold/percussion/spontaneous pain develops

A

exposing
material
tooth
immediately

40
Q

Deep Caries Lesion Management
Technique

Pre-treatment
1. Excavate to clean, firm, well \_\_\_\_ enamel at
periphery of lesion
Avoid \_\_\_\_ and discomfort
Preserve non-demineralized and \_\_\_\_ tissue 
Achieve good \_\_\_\_ of restoration
Maintain pulp \_\_\_\_
Maximize restoration \_\_\_\_
A 
supported
pain
remineralizable
seal
health
longevity

Endodontics I (10 decks)

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