7. Endodontics Flashcards
What should you use before filling a deep cavity?
A lining material
List 3 types of liners:
Dycal
Vitrebond
Ionoseal
What type of material is dycal?
Calcium hydroxide
What type of material is vitrebond?
Resin modified glass ionomer
What is pulp capping?
Covering over an exposed pulp with material. Aims to form a dentine bridge by inducing the formation of tertiary dentine.
What two materials can you use for pulp capping?
MTA - mineral trioxide aggregate
Bio dentine
What is sensibility testing?
A type of test used to confirm diagnosis by reproducing the symptoms reported by the patient.
Give two examples of sensibility tests:
Thermal test
Electric pulp test
What does a normal response to sensibility testing suggest?
Vital tooth or reversible pulpitis
What does an intense, prolonged respond to sensibility test suggest?
Irreversible pulpitis
What does no response to sensibility test suggest?
Pulpal necrosis
What are the possible pulpal diagnosises?
- Normal
- Reversible pulpitis
- Irreversible pulpitis
- Pulpal necrosis
- Previous RCT
Reversible Pulpitis:
Signs
Tx
Short, sharp pain that is triggered
No radiogrpahic changes apically
Tx: removal of cause of pulpal irritation
Symptomatic Irreversbile Pulpitis
Sharp, lingering pain
Spontaneous or triggered by normal stimulus
TX: RCT or XLA
Asymptomatic Irreverbile Pulpitis
No symptoms
Normal response to sensibility tests
TX: RCT or XLA
Pulpal Necrosis
Asymptomatic until inflammation reaches periapical tissues
No response to sensibility tests
TX: RCT or XLA
List the 5 periapical diagnosises:
- Normal
- Symptomatic periapcial periodontitis
- Asymptomatic periapical periodontitis
- Acute periapical abscess
- Chronic periapical abscess
Symptomatic Periapical Periodntitis
Pain on biting
TTP
tender to paltpation
PDL widening/PA pathology present radiographically
Asymptomatic Periapical Periodontitis
Asymptomatic
Not TTP
Non sensitive to palpation
PA pathology radiographically
Acute Periapical Abscess
Rapid onset
Localised pain
Pus
Mobility
Systemic involvement
Swelling
Chronic Periapical Abscess
Asymptomatic
Not TTP
Sinus present
No response to sensibility tests
Radiolucency present
Dentine hypersensitivity
Exaggerated sharp pain of no other cause
Tooth fractures
Pain on biting
File Sequence for RCT and colours of each:
SX- gold short file
Cleaning and Shaping:
S1 - purple
S2 - grey
Finishing:
F1 - yellow
F2 - red
F3 - blue
F4 - black
F5 - black and gold
Final irrigation sequence:
3ml sodium hypochlorite
3ml citric acid
3ml sodium hypochlorite
Endo Dressing sequence:
Non setting calcium hydroxide
Cotton wool + coltosol
GI restoration
List 2 ways you can determine working length?
Radiographically
Electronic apex locator
Obturation Sequence (cold lateral compaction)
- Remove dressing
- Irrigate
- Trail Radiogrpah with master cone to length
- Insert main cone + sealer
- Insert finger spreader
- Remove finger spreader
- Insert multiple accessory cones until full
- Remove excess GP and compact
- Restore
Indications for RCT:
If the dental pulp is irreversibly damaged
E.g
irreversible pulpiitis
Pulpal necrosis
Periapical disease
Contraindications for RCT:
Insufficient periodontal support
Non restorable teeth
Vertical root fractures
Non functional teeth
What can cause pulpal inflammation?
Presence of micro organisms
Mechanical trauma
Chemical irritation
Common route of root cancel infection:
Caries
Mechanical injury
Trauma
How many roots do incisors have?
One
How can roots do canine s have?
One
What many roots do first premolars have?
Upper = two
Lower = one
How many roots do second premolars have?
One
How many roots do upper molars have?
Three (medial, distal,palatal)
How many roots do lower molars have?
Two (medial and distal)
What shape is the access cavity for incisors and canines?
Triangular
What shape is the access cavity for premolars ?
Oval
What shape is the access cavity for molars?
Square (ish)
What are the two types of endodontic files?
Stainless Steel: hand
Nickel titanium: rotary
List the two irrigants used for anti microbial purposes:
3% sodium hypochlorite
Or
2% chlorohexidine
List the two irrigants used to remove the smear layer:
Citric acid
Or
EDTA
What is the purpose of non setting calcium hydroxide in endodontics?
Antibacterial action
Reduces inflammation
What are the two materials used when obturating?
Gutta Percha
Sealer
List 3 different types of Endodontic sealer:
Zinc oxide Eugenol
Calcium hydroxide
Glass ionomer
List 4 restorative options following RCT:
Onlays
Crowns
Core and crown
Post crowns
List the 3 common causes of inter appintment pain during RCT:
- Endodontic flare up
- Pain following cleaning and shaping
- Extrusion of irrigant
List the 6 causes of pain following obturation:
High restoration
Over instrumentation
Over filling with GP
loss of apical constriction
Toxicity of sealer for 24-48 hours
Root fracture
List the 4 causes of pain following RCT:
Incomplete apical seal
Traumatic occlusion
Tooth fracture
Inadequate coronal seal
List the 3 stages of endodontic re treatment:
- Access the root canal system
- Remove root canal filling materials
- RCT retreatment
List the 4 principles for Removing direct restorations for endodontic retreatment:
- Remove all caries
- Reduce supported cusps
- Assess restorability
- Assess isolation
List the two options for endondtic retreatment if an indirect restoration is present:
- Access through restoration if restoration quality is good
- Remove the crown completely if restoration quality is poor
What is the process of removing a crown?
- Take sectional putty impression - to allow temporary to be made
- Section crown in two and remove
What burs would you use to section a crown?
Diamond fissure - porecelain
Tungsten carbide - metal
List 3 methods of removing post crowns:
Ultrasonic energy
Post pulling devices
Specific kits
List 5 methods of removing root canal filling materials in preparation for retreatment:
Pro taper retreatment files
Pro taper gold files
Headstrong files
Solvents
Ultrasonics
What are the stages involved in surgical endodontics?
- Pre op medications: antiinflmmaotries and antibacterial rinse
- Anaesthesia
- Flap cut
- Osteotomy: removal of bone to expose root
- Root end resection
- Root End Filling
- Flap sutured
List the 5 types of Resorption:
- External Root Resorption
- Cervical Resoprotion
- Internal Root Resorption
- Pressure Root Resorption
- Ankylosis Root Resorption
External Root Resorption:
Definition and Tx
Resorption effecting the external root surface
TX: RCT as soon as noticed
Cervical Resorption:
definition and Tx
Asymptomatic
Pink tooth
+ve sensibility
TX: restore or RCT if communication with pulp
Internal Root Resorption:
Definition and Tx
Resorption effecting the root canal walls
Pink crown
Radiolucency oval in root canal
TX: RCT
Pressure Root Resprotion:
Definition and Tx
Apical root resorption due to pressure applied during tooth movement
Asymptomatic
Vital
Shortened roots
Ankylosis Root Resorption:
Definition and Tx
Lack of mobility
Metallic percussion sound
TX: ? unpredictably asscoiated
List 4 common complications of endodontics:
Fractured instruments
Ledges
Canal blockages
Canal transportations
What should you do if you fracture a file in a root canal?
If can be bypassed - continue
If not and it is placed in apical 1/3 - leave file alone
If not and it is placed in middle or coronal 1/3 - remove if straight line access is possible
List 6 methods of removing a fractured file:
H files
Gripping devices
Excavators
Ultrasonics
Tube system
BTR pen
How to manage a ledge formation in endodontics:
- Locate ledge
- Preprare canal 1-2mm short of ledge
- Irrigate with chelater and sodium hypochlorite
- Probe with hand files
- Complete preparation
How would you manage a canal blockage in endodontics?
- Locate blockage
- Prepare canal 1-2mm short of blockage
- Irrigate with chelater and NaOCl
- Use hand file and chelater paste and rotate file
- Irrigate
- Repeat until removed
List the 3 indications for RCT retreatment:
Persitant PA pathology following RCT
New PA pathology associated with a RCT tooth
Inadequate root canal filling
List the 4 indications for surgical endodontics:
Failure of previous endodontic tx and retreatment not an option
Anatomical deviations preventing normal Endo Tx
Previous Procedural errors caused by previous operator
Exploration to find fractures
List the 8 contraindications for surgical Endo:
Proximity to neurovascular bundles
Thick bone
Difficult access
Inadequate periodontal support
Non restorable teeth
Blood disorders
Recent heart attack
Cancer Tx patients
List 3 causes of resorption:
Injury
Idiopathic
Systemic diseases