Disease; Working Length; Canal Preparation Flashcards

Types & aetiology of endodontic disease; importance of establishing working length & methods; limitations of these methods; instrumentation & their biological role.

1
Q

2 branches of endo disease

A
  1. of the pulp 2. of the periapical tissues
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2
Q

example of periapical disease and classification types

A

Apical Periodontitis. translucent area on x-ray. acute/chronic/abscess etc.

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3
Q

abscess vs granuloma

A

abscess: presence of puss
granuloma: chronic inflammation of tissue

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4
Q

two types of pulpal disease

A

reversible + irreversible pulpitis

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5
Q

overall cause of pulpitis

A

bacteria (fungi may cause APICAL periodontitis)

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6
Q

effect of trauma to pulp i.e. drilling partly through it in A STERILE ENVIRONMENT

A

will not cause pulpitis; bacteria needs be present; thus need for IPC & complete caries removal in endo

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7
Q

“itis” =

A

“inflammation of”

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8
Q

“ectomy” =

A

“removal”

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9
Q

what is common to both pulpal and periapical disease

A

the aetiological factors (irreversible pulpitis –> necrosis –> apical periodontitis)

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10
Q

3 categories of aetiological factors for endodontic disease

A

Microbial
Chemical (can only irritate pulp in absence of bacteria)
Mechanical (can only irritate pulp in absence of bacteria)

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11
Q

x2 microbial factors

A

caries.

leakage around restorations.

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12
Q

x2 chemical factors

A

dental materials - irritants (composite resins are cytotoxic; eugenol may kill a pulp, but it’s only chemical capable of this).
bleaching - (Hydrogen Peroxide = irritant)
*microbial biofilm also required for these to cause irreversible pulpitis)

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13
Q

x3 mechanical factors

A

operative dentistry.
dentine exposure.
trauma.
*microbial biofilm also required for these to cause irreversible pulpitis

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14
Q

the presiding aetiologic factor for irrevers pulpitis

A

microbial infection

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15
Q

3 categories of endodontic procedures & one thing to note.

A

Vital Pulp treatment.
Non-surgical endodontics.
Surgical endodontics.
*sometimes more than one may be required

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16
Q

meaning of Vital Pulp Treatment

A

pulp capping

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17
Q

another term for pulp capping

18
Q

meaning of Non-surgical endodontics

A

root canal treatment/retreatment

19
Q

types of Surgical endodontics

A

Apicectomy (root end surgical removal & substitution w a biocompatible material).
Hemisection (removal of one un-treatable root in a multirooted tooth)

20
Q

Non-surgical Root Canal Treatment - Pulpectomy

A

removal of the pulp. aka “first stage RCT”

21
Q

indications for pulpECTOMY

A

irreversible pulpitis OR

pulp necrosis.

22
Q

pulpECTOMY scenarios

A
  • deep decay
  • deep restoration (shallow doesn’t count)
  • cracked tooth
  • constant pain
  • swelling
  • Apical periodontitis may be present.
23
Q

6 stages of RCT

A
  1. Assessment, restorABILITY and Tx plan
  2. Access
  3. Chemo-mechanical prep
  4. Obturation
  5. Restoration
  6. Follow up
24
Q

q’s to ask in 1. Assessment

A

tooth saveable? pt’s desire to keep or extract? enough structure remaining?

25
working length
Distance (mm) between a coronal reference point (incisal edge OR cusp) and point at which canal prep and obturation should terminate. *
26
working length consideration
multi-rooted tooth: multiple working lengths
27
if working length shorter than reality
canal not cleaned sufficiently. --> bacteria left behind --> higher chance of failure
28
if working length longer than reality
tooth anatomy gets destroyed = hard to clean and obturate --> higher chance of failure
29
working length apical end point
close as possible to Apical Constriction
30
location of apical constriction
0.5mm - 2mm from the radiographic apex
31
Apical Constriction?
narrowest portion of the canal
32
apical constriction variables
Anatomical variation. Age - increased cemental deposition. Inflammation - Apical periodontitis: apical infection resorbs root = no apical constriction at all eventually
33
Dummer et al 1984
Apical constriction varies in ALL people
34
working length determination (x5)
1.tactile feel 2.bleeding point method 3.pt response 4.radiographs 5.electronic apex locators RECOMMENDED by ESE: radiog & electr apex locators COMBINED
35
electronic apex locators: indications
v. accurate pulp chamber must be dry (canals not critical) initial learning curve, but v useful later
36
electronic apex locators: contra-indications
1. meaningless if canal is blocked
37
electronic apex locators: principle
principle of electrical resistance. constant reading between LIP and PDL. the circuit is complete when file touches PDL
38
electronic apex locators: clinical procedure
a. preop periapical b. measure file against radiogr. "estimated working length" c. access tooth d. shape coronal portion of canal e. use apex locator to obtain length & introduce files f. confirm by another periapical* * if file on radiograph is >3mm away from radiographic apex, another radiograph must be taken
39
minimum file size & reason
size 20, smaller not clearly visible on radiograph
40
approx. no of x-rays needed for a non-surgical endo tx
4-5 radiographs
41
what to do w working lengths and reference points BEFORE exposing radiograph AND after processing?
record them accurately