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Module 7 > Endo > Flashcards

Endo Flashcards

1
Q

What is the risk of accessing through existing crowns?

A

Higher risk of perforation as tooth alignment may be altered by the crown

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2
Q

How can you reduce risk of perforation?

A

carefully assess pre-tx radiograph

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3
Q

Why would you remove a crown for RCT treatment?

A

defective/caries
assessment of remaining tooth
visibility & accessed improved
avoid risk of perforation

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4
Q

What process is used to remove a crown?

A

Sectioning

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5
Q

What bur would be used to remove a porcelain crown?

A

Diamond

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6
Q

What bur would be used to remove a metal crown?

A

Tungsten carbide

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7
Q

Name 2 crown removers

A

Crown tapper
Kavo Coronaflex

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7
Q

Name 2 crown removers

A

Crown tapper
Kavo Coronaflex

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8
Q

What are the 2 main techniques of post removal?

A

ultrasonic energy
post pulling devices

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9
Q

What should you always warn pts before post removal?

A

Risk of root fracture

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10
Q

What frequency of ultrasonic is used for post removal?

A

pizoelectric 30-40 Hz

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11
Q

Do US tips for removal have a sharp or blunt end?

A

Blunt

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12
Q

How would you remove a screw type active post?

A
  • remove core material w/ high speed & ultrasconic
  • use wrench supplied by manufacturer for insertion
  • ultrasonic can aid to break cement
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13
Q

How would you remove a cast post & core?

A
  • remove coronal restoration
  • cut back core w/ tungsten carbide
  • use ultrasonic
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14
Q

Which canals are hardest to remove cast post & core from?

A

oval shaped canals

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15
Q

Name 4 types of post pulling devices

A

Egglers post pulling device
Ivory miniature post puller
Ruddle post pulling kit
Massarann kit

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16
Q

Which types of cements make retrievability of posts difficult?

A

adhesive resin cements

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17
Q

What would you use to remove a quartz fibre post?

A

RTD fibre post removal

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18
Q

Name 4 root filling materials that could require removal

A

Gutta Percha
Carrier based systems (thermafill & guttacore)
Silver points
Endodontic pastes

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19
Q

Name 4 methods of removing gutta percha

A

Rotary files
Ultrasonic
Heat
Solvents

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20
Q

What speed & torque would you use rotary protaper retreatment files?

A

600 rpm, 4 Ncm

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21
Q

What material are Hedstrom files made of?

A

Stainless steel

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22
Q

When would you use Hedstrom?

A

Poorly compacted GP
Single core obturation

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23
Q

Name 5 solvents for GP

A

Chloroform
Turpentine
DMS W (eugenol)
Endosolv R (resin)
Endosolv E (eugenol)

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24
Q

What is thermafil?

A

Plastic carrier covered in alpha phase GP

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25
Q

What is guttacore?

A

Carrier made from cross-linked GP

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26
Q

How would you remove silver points from root canal?

A

Stieglitz forceps
Trough around w/ fine ultrasonic tip

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27
Q

Why are endodontic pastes no longer recommended?

A

Contain paraformaldehyde
Mutogenic & carcinogenic

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28
Q

What can overextension of endodontic pastes cause?

A

Nerve paraesthesia

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29
Q

What are the 4 aims of endodontic tx?

A
  • assess, clean & disinfect RCS
  • reduce number of microorganisms
  • remove necrotic tissue
  • seal the system to prevent reinfection
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30
Q

What are the 2 types of periradicular cysts?

A

True or Pocket (bay)

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31
Q

What is a true cyst?

A

Cavities completely enclosed in epithelium

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32
Q

What is a pocket (bay) cyst?

A

Epithelium-lined cavity that is open to the root canal

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33
Q

What are the European Society of Endodontic guidelines for RCT follow-up?

A

Clinical & radiographic follow-up at least 1 year post tx
Further follow up for 4 years

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34
Q

When is RCT retreatment indicated? (3)

A
  • Persistent periapical pathology following RCT
  • New periapical pathology associated with a root-filled tooth
  • A new restoration is planned for a tooth & xray shows inadequate RCT
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35
Q

What are the signs of persistent PA pathology following RCT?

A

No radiographic signs of bony healing after 4 years

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36
Q

What are the prognostic factors of endo re-treatment?

A
  • Pre-periapical lesion
  • Apical extent of root canal filling
  • Quality of coronal restoration
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37
Q

How to prevent post-RCT disease?

A
  • rubber dam isolation
  • proximity of prep to apical constriction
  • sufficient taper of prep
  • adequate irrigation & medicament
  • correct extension of obturation
  • adequate coronal seal
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38
Q

what are the microbial causes of post RCT disease?

A
  • intradicular microbes
  • radicular cysts
  • extraradicular microbes
  • cracked teeth
  • coronal leakage
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39
Q

What are the non-microbial causes of post RCT disease?

A
  • cholestrol crystals
  • foreign body reaction in PA tissues
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40
Q

What causes intraradicular infections in root treated teeth?

A
  • persisting infection
  • new secondary infection through leakage
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41
Q

Which type of bacteria are most resistant to antimicrobial tx?

A

Gram positive

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42
Q

What number of species remain in well treated canals?

A

1-5 species

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43
Q

What number of species remain in inadequately treated canals?

A

10 - 20 species

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44
Q

What are the common microbes in RCT retreatment cases?

A

E faecalis
Streptococcus
Lactobacillus
Actinomyces
Propionibacterium
Candida Albicans

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45
Q

What are the possible origins of microbes post RCT?

A

Contamination during intial tx
Leaving tooth on open drainage
Coronal leakage

46
Q

Where does a radicular cyst form from?

A

Epithelial cells rests in periodontal ligament

47
Q

What is a true cyst?

A

Lesion enclosed by epithelial lining

48
Q

What is a pocket cyst?

A

Epithelial sac communicated with root canal system

49
Q

Which type of cyst will heal following RCT?

A

Pocket cyst

50
Q

Where do cholestrol crystals arise from?

A

from dying cells during chronic inflammation

51
Q

Which foreign bodies can cause post RCT disease?

A

Gutta-percha
Sealers
Paper points
Cotton pellets

52
Q

What do you have to do before re RCTing teeth with direct restoration?

A
  • remove existing caries
  • reduce unsupported cusps
  • ensure sufficient structure left
  • ensure rubber dam if possible
53
Q

What are the indication for endodontic surgery?

A
  • failure of previous RCT
  • anatomical deviations
  • procedural errors
  • exploratory surgery
54
Q

What anatomical deviations would require endo surgery?

A

Tortuous, curved roots
Canal calcification

55
Q

What procedural errors could need endo surgery?

A

ledges
blocks
perforation
file breakage
overfills

56
Q

What are the condtaindications of endo surgery?

A

anatomical factors
inadequate perio support
non-restorable tooth
medical history
skill & ability of surgeon

57
Q

What anatomical factors would contraindicate perio surgery?

A
  • proximity to neurovascular bundles
  • thick cortical bone
  • difficult access (palatal roots of upper molars)
58
Q

What is the triad of endodontic microsurgery?

A

Magnification
Illumination
Instruments

59
Q

What is magnification determined by?

A
  • power of the eyepiece
  • focal length of binoculars
  • magnification changer factor
  • focal length of objective loss
60
Q

What is low 3x - 8x magnification used for?

A

orientation & alignment of instruments

61
Q

What is midrange x10 - x16 magnification used for?

A

Working magnifications

62
Q

What is high x20 - x30 magnification used for?

A

inspection of fine detail

63
Q

What preoperative anti-inflammatory would you give and why before endo resurgery?

A

Ibuprofen 600mg immediately before
Inhibits cyclo-oxygenase, preventing the formation of inflammatory mediators

64
Q

What antibacterial rinse would you give pre-endo surgery & when would it be taken?

A

0.2% Chlorohexidine
Night before, morning of & 30 mins before appt

65
Q

If pt was very nervous, what premedication could be given?

A

5mg diazepam

66
Q

what are the rules for flap design?

A

must never cross a bony defect
releasing incisions should be over concave bone surface
incision meet free gingival margin at 90 degrees

67
Q

what are the issues with a semilunar flap?

A

disruption of blood supply
poor wound healing
limited surgical access
scarring

68
Q

what is osteotomy?

A

removal of cortical plate to expose root end

69
Q

what can be used intraopertatively for haemostasis?

A

epinephrine pellets
ferric sulphate
calcium sulphate

70
Q

what is the advantages of root end resection?

A

decreases dentine tubules peripheral microfiltration
removes majority of lateral canals
avoids endo-perio communications

71
Q

what is the aim of ultrasonic retrocavity preparation?

A

create a clean, well conformed type 1 cavity into the sectioned root

72
Q

what is best to use as a root end filling matieral?

A

MTA mineral trioxide aggregate

73
Q

what are the good properties of MTA?

A

high pH
good sealing ability
hydrophillic
radiopaque
good biocompatibility
regeneration of cementum

74
Q

what are the post op complications of endo surgery?

A

pain
swelling
ecchymosis
paraesthesia
infection
lacerations
sinus perforation

75
Q

what is the definition of resoprtion?

A

a physiological or pathological event mainly occurring due to the action of activated clast cells

76
Q

what is required for resorption to occur?

A

injury and stimulation

77
Q

what types of injury cause resorption?

A

mechanical - trauma, surgery, excessive pressure
infections of root canal or PDL
chemical - hydrogen peroxide

78
Q

what stimulation causes resorption?

A

infection
pressure

79
Q

what are the systemic causes of resorption?

A

hypo and hyperthyroidism
calcinosis
gauchers syndrome
turner syndrome
pagets disease
herpes zoster

80
Q

what is the mechanism of resoprtion?

A

damage causes chemotactic process which attracts activated cells
these colonise the damaged surfaces and initiate resorptive process

81
Q

what is the most common cause of resorption?

A

pulp infection

82
Q

what usually causes external inflammatory root resorption?

A

trauma (intrusion, lateral luxation, avulsion)

83
Q

what is the tx for external inflammatory root resorption?

A

remove necrotic pulp as soon as signs of EIR
calcium hydroxide as interappointment dressing
many cases too advanced to treat

84
Q

what is invasive cervical resoprtion?

A

originates on external root surface but can invade root dentine in any direction
occurs when loss of protective non-mineralized layer at CEJ

85
Q

what are the predisposing factors of invasive cervical resoprtion?

A

ortho, trauma, surgery, intracoronal bleeding

86
Q

what are the clinical features of invasive cervical resorption?

A

asymptomatic
tooth may look pink
+ve sensibility test

87
Q

what are the clinical classifications of invasive cervical resorption?

A

class 1 - small with shallow penetration
class 2 - close to coronal pulp, no radicular extension
class 3 - deeper but not beyond coronal third
class 4 - extensive beyond coronal third

88
Q

what is the tx for invasive cervical resorption?

A

remove granulation tissue from defect w/ 90% trichloracetic acid
restore with GI, composite or biodentine
rct if communication with pulp canal

89
Q

what is internal root resoprtion?

A

originates in and affects root canal wall
follows damage to odontoblastic layer and predentine
pulp will become necrtoic and resorption will stop

90
Q

how does internal root resorption present clinically?

A

extensive resorption resulting in pink discolouration of the crown

91
Q

what is the treatment for internal root resorption?

A

rct if tooth can be saved
lesion difficult to clean and obturate

92
Q

how does orthodontic pressure root resorption appear radiographically?

A

shortened roots with no sign of radiolucency in bone

93
Q

what is ankylotic root resorption?

A

replacement resorption
lack of physiological mobility and sound metallic to percussion

94
Q

what are the types of rotary file fractures?

A

torsional stress - tip bends against a canal wall and the coronal part of the file rotates
cyclic fatigue - repeated cycles of tension and compression happened during bending

95
Q

what factors contribute to file fracture?

A

file size and taper
type of alloy
experience of operator
inadequate access and glide path
high speed
repeated use

96
Q

what factors influence successful removal of fractured files?

A

position of the file in relation to root curvature
depth within canal
whether file is visible using microscope

97
Q

what is the risk of removal of fractured instruments?

A

excessive removal of radicular dentine which may predispose root to fracture
ledging
perforation
limited application in narrow and curved canals
possibility of extrusion of the fractured file

98
Q

what are the techniques for removing fractured instruments?

A
  1. mechanical
  2. ultrasonic
  3. tube techniques
  4. other
99
Q

what are the mechanical techniques for file removal?

A

H files
gripping devices
excavators

100
Q

what happens if instrument cannot be removed?

A

favourable prognosis if pulp vital and not infected
and
if instrument fractures during advanced stages of preparation

101
Q

what is ledge formaton

A

an iatrogenically created irregularity in the canal that impedes access of the instruments to the apex

102
Q

where are ledges most common?

A

outer side of curved canals

103
Q

what are the causes of ledge formation?

A

inadequate access cavity
incorrect assessment of canal curvature
failure to pre bend ss files
negotiation of calcified canal
failure to use files in sequential manner

104
Q

how would you manage a ledge formation?

A

establish depth ledge is at
coronal flaring up to f2-f3 working 1-2mm shorter than ledge
PUI with chelator and NaOCl
probe with pre-bent 08 ss file and use a gentle picking motion
repeat with size 10, 15 and 20 files until ledge removed
use pre-bent hand protaper files to complete preparation

105
Q

what happens if the ledge is not possible to by-pass?

A

copious irrigation
dress with ns caoh2
obturate with thermoplastic technique

106
Q

how can ledge formation be prevented?

A

create a reproducible glide path
copious irrigation w 30 needle

107
Q

what may a blocked canal contain?

A

compacted dentinal mud
residual pulp tissue
remnants of filling materials

108
Q

what are the causes of canal blockage?

A

apical patency not confirmed
during instrumentation pulpal tissue is packed and solidified in apical constriction
instrumentation not accompanied by irrigation and recapitulation
instruments not cleaned before insertion into canal

109
Q

how do you recognise canal blockage?

A

instruments or gp no longer reaches full WL

110
Q

does blockage affect prognosis?

A

not if recognised and corrected

111
Q

how do you prevent blockage?

A

copious irrigation as soon as pulp chamber roof removed
coronal pre-flaring
recapitulation

112
Q

what is canal transportation?

A

removal of canal wall structure on the outside curve in apical half
may lead to ledge formation and possible perforation

113
Q

what are the causes of canal transportation?

A

insufficiently designed access cavity
canal curvature
instrumentation using ss files
leaving rotary files in same position
forcing a file into canal

Module 7 (8 decks)

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