Chapter 54: Endodontics Flashcards
This specialty manages the prevention, diagnosis, and treatment of the dental pulp and the
periradicular tissues that surround the root of the tooth.
Endodontics
often referred to as
root canal therapy
endodontic therapy
The two main sources of pulpal nerve damage
physical irritation
trauma
localized area of pus
abscess
what happens when bacteria reach the nerves and blood vessels.
infection than can result in an abscess
a blow to a tooth or the jaw, can cause damage to surrounding tissues causes what
trauma
symptoms of pulpal nerve damage.
sensitivity
discomfort
pain
the most common signs and symptoms of pulpal damage include the following:
• Pain when occluding
• Pain during mastication
• Sensitivity to hot or cold beverages
• facial swelling
• Fever
• Tenderness of the surrounding gums
• Cracked or discolored teeth
Diagnosis of a tooth that requires endodontic treatment is based on an examination that consists of
subjective and objective components
The ________ examination includes an evaluation of symptoms or problems described by the patient
subjective
the subjective examination include the following :
• Chief complaint
• Character and duration of pain
• Painful stimuli
• Sensitivity to biting and pressure
this type examination is conducted by the endodontist, who evaluates the status of the tooth and surrounding tissues
objective examination
the objective examination include the following
• Extent of decay
• Periodontal conditions surrounding the tooth in question
• Presence of an extensive restoration
• Tooth mobility
• Swelling or discoloration
• Pulp exposure
When a questionable tooth is tested for vitality, a
_______ is selected to use for comparison.
control tooth
The use of a control tooth shows that the stimulus can achieve what?
a response
tests that are used to determine whether the inflammatory process has extended into the periapical tissues
percussion and palpation test
The dentist performs this test by tapping on the incisal or occlusal surface of the tooth in question with the end of the mouth mirror handle
percussion test
The dentist completes this test by applying firm pressure to the mucosa above the apex of the root and noting any sensitivity or swelling.
palpation test
In this test, the dentist uses ice, dry ice, or carbon dioxide to evaluate the response of a tooth to cold.
cold test
A thermal stimulus is never used on what ?
metallic restoration
gingival tissue
will a necrotic pulp respond to cold?
no
This test is generally the least useful of the vitality tests because it could indicate either reversible pulpitis or irreversible pulpitis
heat test
this testing is used in endodontic diagnosis to determine whether a pulp is vital or
nonvital.
electric pulp testing
The following images are required for the diagnosis and completion of endodontic treatment:
• Initial radiograph
• Working length image
• Final instrumentation image
• Root canal completion image
• Recall image
Requirements of Radiographic Images
• Show 4 to 5 mm beyond the apex of the tooth and the surrounding bone
• Present an accurate image of the tooth without elongation or foreshortening
• Exhibit good contrast
indicates that pulpal tissues have become inflamed.
pulpitis
occurs when the pulp is irritated and the patient is experiencing pain to thermal stimuli. eliminating the irritant and placing a sedative material may save the pulp.
reversible pulpitis
displays symptoms of lingering pain. Clinical diagnostic findings will show that the pulp is incapable of healing, indicating root canal therapy or extraction as the only treatment options.
Irreversible pulpitis
characterized by the presence of a draining sinus tract.
(The lesion is asymptomatic, with little or no discomfort, and an intermittent discharge of pus may be noticed)
Chronic periradicular abscess
an inflammatory reaction to pulpal infection.
Periradicular abscess
an inflammatory reaction that is frequently caused by bacteria entrapped in the periodontal sulcus.
a patient will experience rapid-onset pain, tenderness of the tooth to pressure, pus formation, and swelling.
Periodontal abscess
this cyst develops at or near the root of a necrotic tooth
Periradicular cyst
is the decrease of living cells within the pulp, causing fibrous tissue to take over the pulpal canal.
pulp fibrosis
also referred to as necrotic or nonvital, is used to describe a tooth that does not respond to a sensory stimulus.
necrosis
. The first line of treatment which is an attempt to stimulate pulpal regeneration and save the pulp
pulpal therapy
this procedure is used when decay is near the pulp chamber.
The goal is to remove as much decay as possible without exposing the pulp.
Pulp Capping
in pulp capping, a covering of this material is placed over an exposed or nearly exposed pulp to encourage the formation of new dentin.
calcium hydroxide
a technique used when decay is near the pulp chamber but has not been exposed
indirect pulp cap
the goal for indirect pulp cap treatment
- promote pulpal healing
2.stimulate production of dentin
is a procedure that is indicated when the pulp has been partially exposed.
with this procedure the tooth is still VITAL
direct pulp cap
involves removal of the CORONAL portion of an exposed vital pulp.
This procedure is completed to preserve the vitality of the remaining portion of the pulp within the root of the tooth
pulpotomy
Also referred to as root canal therapy.
It involves complete removal of the dental pulp
pulpectomy
used in the initial debridement (cleaning) of the canal and during later stages of shaping and contouring the canal
k file
can be used for final enlargement of the canal after a Gates-Glidden bur or a Pesso reamer has been used
hedstrom file
Its functions are to remove dentin structure and to smooth and increase the size of the canal
reamer file
have tiny fishhook-like projections along the shaft that are used to remove vital, inflamed hemorrhagic pulp tissue from the canal
broach
prevents
perforation of the apex of the tooth during instrumentation
rubber stops
held with locking pliers and is inserted into the canal to absorb the irrigating solution and to dry the canal.
paper points
this instrument is beneficial for diagnosis, to the location of canals or missed canals, for cleaning and shaping the canal, and to the filling of the canal.
operating microscopes
The operating microscope accomplishes the following three objectives:
• Magnification
• Illumination
• Addition of accessories
Medicaments and dental materials used in endodontics include
-irrigation solutions
-antimicrobial agents
-intracanal medicaments
-root canal sealers
In endodontics, irrigating the canal facilitates:
-removal of materials from canal
-tissue dissolution
-bleaching
-deodorizing,
-hemorrhage control.
commonly known as household bleach, is diluted from 0.5% to 5.25% with sterile water for use as an irrigation solution.
This solution is an antimicrobial agent that has a solvent action on necrotic pulp tissue and organic debris.
Sodium hypochlorite,
is used for the removal of the inorganic portion of the smear layer and dentin debris.
Ethylenediaminetetraactic acid (EDTA)
a broad-spectrum antibacterial irrigation solution with a lower cytotoxicity and no foul smell or taste.
Chlorhexidine
two types of irrigation devices used to remove debris and bacteria from the root canal
manual irrigation
rotary irrigation
manual irrigation includes the following
agitation with brushes
files
gutta percha
rotary irrigation includes the following
-rotary brush
-continuous irrigation during instrumentation
-sonic or ultrasonic vibration
is used to disinfect the root canals between appointments and to possibly lessen any discomfort the patient may experience
Intracanal medicament
three categories of intracanal medicament
1.calcium hydroxide
2.chlorexdine gel
3.corticosteroids
used to adapt the gutta-perchas to the canal walls and to fill up any of the voids within the canal.
root canal sealers
These materials undergo very little shrinkage; must be easy to place; and must be radiopaque for detection on a radiograph, nonstaining to the teeth, bacteriostatic, gentle on the periapical tissues that surround them, and able to resist moisture.
root canal sealers
Types of Root Canal Sealers
- Zinc Oxide Eugenol Sealer
-Epoxy Resin Sealer
-Calcium Phosphate Sealer - Silicon Sealer
It is necessary to _____ a root canal after removal of the dental pulp or the space will lead to reinfection, resulting in a failed treatment for a patient.
obturate
are used to obturate the pulpal canal after treatment has been completed.
gutta percha points
can be made to flow in the pulpal canal with the use of heat or solvents.
gutta percha
The purposes of
debridement and shaping of the pulpal canal are
(1) to remove bacteria, necrotic tissue, and organic debris from the root canal and
(2) to smooth and shape the canal
Root canal therapy is successful approximately __% to __% of the time.
90-95
involves the surgical removal of the apical portion of the root with the use of a tapered fissure bur in a high-speed handpiece
Apicoectomy
means the removal of diseased tissue by scraping with a curette.
curettage
also referred to as root end filling, is completed when the apical seal is not adequate.
A small preparation is made at the apex and is sealed with filling materials such as gutta-percha, amalgam, or composite
Retrograde Restoration
a surgical procedure used to remove one or more roots of a multirooted tooth without removing the crown
root amputation
most often is performed on maxillary molars.
a procedure in which the root and the crown are cut lengthwise and removed
hemisection
Indications for surgical intervention include the following:
• Endodontic failure
• Exploratory surgery
• Biopsy
during root canal filling and preparation the working length is assessed and is referred to as the________
estimated working length
Problems that result from inaccurate measurement of length include
(1) perforation of the apex
(2)overinstrumentation or underinstrumentation of canal length
(3) overfilling or underfilling of the canal
(4) postoperative pain.
where would the access entry point be during access preparation in root canals ?
occlusal surfaces of posterior teeth and the lingual surfaces of anterior teeth.
The anesthetic techniques of choice for endodontic treatment are ______ for maxillary teeth and _______for mandibular teeth
infiltarion
nerve block
