309 - support during stages of endodontic procedures. Flashcards
What needle/syringe is used during irrigation in RCT?
Monoject
What may cause difficulty gaining access to the root canals?
Sclerosis
What is used to dry the canals after irrigation and before obturation?
Paper Points
What is done to maintain the vitality of a tooth?
Direct pulp capping
What is the main advantage of a rubber dam during endo procedures?
Reduce entry of micro-organism from mouth into root canal
Most sufficient method to protect patient from ingestion/inhalation?
Rubber dam
What solution is used to irrigate the canal during pulpectomy procedure?
Sodium hypochlorite
Which endo procedure involves a retrograde root filling?
Apicectomy
Which instrument is used to condense filling material into canal?
Finger spreader
What is the most suitable temp restoration during pulpectomy trt?
Zinc oxide and eugenol
What will shape and smooth the canal?
Hand files
What procedure is appropriate to save the tooth when the pt has irreversible pulpitis?
Pulpectomy
Which hand instrument assissts the dentist whilst obturating canals with gutta percha?
Finger spreader
Why would you use Calcium Hydroxide in a pulp capping procedure?
It promotes secondary dentine
What instrument is used to extirpate the canals?
Barbed broach
what are examples of non-surgical endodontics?
pulpectomy
pulpotomy
pulp capping
what is surgical endodontics called?
apicectomy
what causes the need for endodontic treatment?
any event that causes inflammation of pulpal tissues or breach pulp chambers
what other reasons for endodontic treatment?
thermal injury
chemical irritation
tooth fracture
severe impact injury
irritation
accidental pulp exposure
what does a swelling do to a tooth?
squeeze pulp contents and cut off blood supply resulting in its death
what is the correct term for inflammation of the pulp?
pulpitis
how can pulpitis occur?
reversible pulpits
irreversible pulpitis
what is reversible pulpitis?
not causing pulp death and treated by restorative filling of tooth only
what is irreversible pulpitis?
causing partial/full pulp death and requires one of the non-surgical endo trt to save it
what do vitality tests determine?
if the tooth is alive, dying or dead
what do vitality tests depend on?
painful response of pulp to temperature extremes or electrical stimulation
how to know pulps vitality?
if the pulp responds to stimuli it is vital or dying
if it doesn’t respond it is dead
what kind of radiograph can determine the health of a tooth?
periapical
what does a widened periodontal ligament space indicate?
some level of inflammatory response
how is a root fracture shown on radiograph?
black line across the root
how does a periapical abscess appear on a radiograph?
radiolucent area around apex of tooth
what symptoms may a patient experience until the tooth dies?
occasional sensitivity to cold/hot and sweet stimulation
develops into spontaneous spasms of pain
becomes continuous throbbing pain
eventually not affected by hot/cold/sweets
becomes hypersensitive to vitality tests
no longer TTP when tapped
what does TTP stand for?
tender to percussion
what should be considered when treatment planning non-surgical endodontics?
usefulness of tooth in occlusion
tooth restoration possibilities
dental health of patient
patient co-operation
medical history of patient
cost of treatment
what is the success rate of endodontics?
85%
what can a root curvature of more than 15 degrees result in?
referral to specialist endodontist for successful completion
root treated teeth can become brittle, what is advised after it?
crowning the tooth to protect and prevent future fracture
what is the risk if root apices are close to underlying nerves?
possibility of nerve damage
e.g. over-instrumentation of medicaments
what does endodontic procedure usually involve?
1/2 long appointments with mouth open
local anesthesia
rubber dam
antibiotics
temporary dressing
postoperatively anti-inflammatories
what is a pulpectomy?
traditional RCT
removal of all pulpal tissue from pulp chamber and root canal
replaced with sterile root filling
what is the name of the complete removal of pulpal contents?
extirpation
what does a pulpectomy involve?
extirpation
shaping of root canal
irrigation with antibacterial disinfectant
removal of irrigant and bacteria/debris
filling of root canal with non-irritant impermable material
restoration of tooth
what is obturation?
filling of the root canal
what does the first stage of a pulpectomy usually involve?
remove infective material and prepare the canal
what does the second stage of a pulpectomy usually involve?
ensure canal is clear of residual contamination before insertion of root filling
what instrument is used to extirpate the pulp?
barbed broach
what instruments are used to ream and file the canal to enlarge and shape it?
reamers and files
what antibacterial disinfectants are used to clean the canals?
sodium hypochlorite or chlorhexidine
what is the function of a metal ruler during endodontic treatment?
used with file to work out full length of each root canal
what is the function of an apex locator?
determine working length electronically
what is the function of spiral paste filler?
used with slow hand piece to spin sealant material into root canal
what are gutta percha points used for?
fill (obturate) the root canal system with same colour coded files used
what are the benefits of a rubber dam?
prevents micro-organisms entering root canal
prevents accidents like inhalation/swallowing small instruments
improves access and visibility for dentist
what is the working length?
the length of the root canal
what do paper points do?
dry the canals
At the 2nd visit, if the root canal isn’t dry what does this mean?
the apical infection is still present
what happens if the apical infection is still present?
canal is debrided and irrigated again
dried with paper points
place another temp dressing
what is a pulpotomy?
removal of infected part of pulp in pulp chamber
what teeth is a pulpotomy usually carried out on?
deciduous
In a pulpotomy where is the pulp tissue removed from?
pulp chamber within crown of tooth only
what is the amputated pulp stump covered with?
calcium hydroxide
what does calcium hydroxide do to an amputated pulp stump?
stimulate the radicular pulp in root canal to reduce inflammation and normal growth continues
what is an open apex?
wide apical foramen of root (end of root isn’t closed)
what endodontic technique is used on an open apex?
sealing the open apex over time by successive growth of calcium layers to narrow the open apex
what teeth can pulp capping be carried out in?
deciduous and permanent
what is pulp capping?
to seal and protect an exposed pulp
when is pulp capping carried out?
when there is unexpected pulp exposure in healthy tooth
when patient attends emergency with small pulp exposure after trauma
what does pulp capping buy time for?
tooth to exfoliate naturally
OR
patient to be recalled for pulpotomy/pulpectomy without developing pain or infection
what is the cap made of?
glass ionomer cervical matrix
what is an apicectomy?
surgical endodontic procedure to remove infected apex of tooth and surrounding infected tissue
what is the purpose of apicectomy?
save the tooth where root filling is unsuccessful or impossible
why is an apicectomy classed as minor oral surgery?
mucoperiosteal flap is raised and jaw bone drilled to gain access to root of apex
in an apicectomy, what is infected tissue scraped out with?
mitchells trimmer or surgical curette
what are the signs of acute infection of the tooth?
pus
raised body temp (pyrexia)
debilitation of patient (weak)
severe pain/loss of function of the tooth
swelling (intra/extra oral)
what antibiotics are usually prescribed for acute infection of the tooth?
amoxicillin 500mg 3x daily (erythromycin if allergic to penecillin)
metronidazole 200mg/400mg 3x daily
what is the difference between indirect and direct pulp capping?
in direct pulp capping protective dressing is placed directly above exposed pulp
in indirect pulp capping softened dentine is left an dressing is placed on top
