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BOARDs > ENDO > Flashcards

ENDO Flashcards

1
Q

The Pulp contains

A
  • Loose fibrous CT w/nerves, BVs, and Lymphatics
  • Fibroblasts
  • Odontoblasts
  • Undifferentiated Mesenchymal Cells
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2
Q

Primary vs Secondary vs Tertiary Dentin

A

Primary Dentin:
* before complete root formation

Secondary Dentin: (aka Reactionary Dentin)
* after complete root formation
* reaction to minor damage
* ex: Chronic Attrition

Tertiary Dentin: (aka Reparative Dentin)
* repair major damage
* ex: pulp exposure

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3
Q

Fibroblasts

A

secrete fibrous CT

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4
Q

Odontoblasts

A

Secrete Dentin

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5
Q

Undifferentiated Mesenchymal Cells

A

Stem cells-> become new cells (secondary Odontoblasts)-> Tertiary Dentin–>protect pulp from injury

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6
Q

Pulp properties

A

Surrounded by hard dentin
* limits ability to expand

Lacks collateral circulation
* limited ability to deal w/infection

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7
Q

Scelortic Dentin

A

Calcification of tubules in respose to:
* slow advancing caries
* aging

Hardened Dentin

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8
Q

Histologic Zones of Pulp

A

Predentin: not mineralized

Odontoblastic layer: where nuclei are laying down dentin

Cell free zone of Weil: 0 nuclei/no cells

Cell-rich zone

Pulp core

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9
Q

Dentinal Pain Vs Pulpitis Pain:

A

Dentinal Pain=A delta Fibers
* large myelinated afferent nerve
* course coronally through pulp
* Sharp transient “First Pain”
* associate w/Cold

Pulpitis Pain=C fibers
* small unmyelinated afferent nerve
* course centrally in the pulp stroma
* Dull throbbing “Second pain”
* Heat

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10
Q

Pain Sensitization

A

Hyperalgesia
* heightened response to pain

Allodynia:
* reduced pain threshold, stimulus that usually doesn’t cause pain
* sunburnt skin is an example of aloe-dynia

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11
Q

Referred Pain

A

Preauricular pain(in front of ear)
* refers from mandibular molars
* both share V3 innervation

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12
Q

Endo Pulpal Diagnosis

A
  • Normal Pulp
  • Reversible Pulpitis
  • Symptomatic Irreversible Pulpitis
  • Asymptomatic Irreversible Pulpitis
  • Pulp Necrosis
  • Previously Treated Pulp
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13
Q

Endo Periapical Diagnosis

A
  • Normal Apical Tissues
  • Symptomatic Apical Periodontitis
  • Asymptomatic Apical Periodontitis
  • Acute Apical Absscess
  • Chronic Apical Abscess
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14
Q

Cold Test

A

Endo Ice: dichlorodifluoromethane, -30 C

chilled pellet applied to middle 1/3 of facial surface for 5 seconds

Intensity & Duration=pulp diagnosis

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15
Q

Pulp Capping

A

Place CaOH liner
* irritates odontoblasts to form Secondary/Tertiary dentin (depends on distance from pulp)
* forms dentin wall/barrier

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16
Q

Normal Pulp

A

Asymptomatic

Thermal & Electrical Stimuli=Mild to moderate transient response

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17
Q

Electrical Pulp Test (EPT)

A

Least reliable pulp vitality testing

Indicates: vital sensory fibers in pulp
* no info about vascular supply to pulp (Vascular supply=true determinant of pulp vitality)

Contraindicated: Pacemaker

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18
Q

What is the true determinant of pulp vitality?

A

Vasculary supply to pulp

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19
Q

Reversible Pulpitis

A

Symptomatic–>symptom NOT disease

Thermal (cold) stimulus causes:
* quick, sharp, hypersensitive, transient response
* Heightened but NOT NLINGERING
* No Spontaneous pain

Caused by:
* an irritant that affects the pulp

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20
Q

Symptomatic Irreversible Pulpitis

A

Symptomatic:
* Spontaneous intermittent or continuous pain
* Cold stimulus= Lingering pain

Postural changes (Bending over or lying down)
* exacerbate dental pain

Radiographs are insufficient
* EPT not valuable

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21
Q

Asymptomatic Irreversible Pulpitis

A

Asymptomatic

microscopically similar to sympatomatic irrervsible pulitis but NO Clinical Symptoms (normal)
* micro abscesses of pulp

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22
Q

Pulp Necrosis

A

Asymptomatic, but not always

Can be partial or total
* due to long term interuption of blood supply to pulp

Anterior Teeth=Crown discoloration
* tx w/RCT or internal bleaching

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23
Q

What happens if a necrotic pulp is left untreated?

A

Toxins spread beyond the apical formaen and leads to:
* thickened PDL
* tenderness to percussion/palpation
* Apical Disease

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24
Q

Normal Apical Tissues

A

Asymptomatic

No pain on percussion or palpation

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25
Q

Symptomatic Apical Periodontitis

A

Symptomatic:
* painful percussion-inflammation around apex
* intense throbbing pain

If vital tooth + symptomatic= occlusal adjustment

If Nonvital tooth=RCT

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26
Q

Asymptomatic Apical Periodontitis

A

Asymptomatic

Apical Radiolucency=Confirms pulp necrosis

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27
Q

Acute Apical Abscess

A

Rapid Swelling

Severe Pain

Purulent exudate around apex

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28
Q

Chronic Apical Abscess

A

Draining SINUS TRACT/Fistula (Neutrophils)
* no discomfort/swelliing

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29
Q

Acess Preparation

A

Most important part of RCT
* conserve tooth structure
* Deroof chamber to expose pulp horns & orifices
* Straight-line acess
* Standard of care=RUBBER DAM

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30
Q

Access Prep for Incisors

A

Triangular
* always 1 canal
* ensures removal of pulp horns (Deroofing(
* helps prevent marginal ridges
* helps attain straight line access

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31
Q

Access Prep for Canines

A

Oval
* 1 canal

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32
Q

Acces Prep for Premolars

A

Oval
* 1 or 2 canals
* Maxillary 1st premolar=2 roots

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33
Q

Access Prep for Max Molars

A

Blunted Triangle or Rhomboidal
* 3 roots
* 4 canals, MB root has 2 canals

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34
Q

Access Prep for Mandibular Molars

A

Trapezoidal
* 3 roots
* 4 canals, D root has 2 canals

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35
Q

SS Hand Files

A

.02 taper

K File (Kerr)
* twisted square
* watching winding method

H File (Hedstrom)
* spiral cone
* only cuts in retraction (pulling out)

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36
Q

NiTi Rotary Instruments

A

0.04 to 0.06 taper

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37
Q

Universal Color Code system

A

White (15)
Yellow
Red
Blue
Green
Black

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38
Q

Gates-Glidden Drills

A

Enlarge coronal canal area
* Open orifice for straight line access

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39
Q

Barbed Broaches

A

entangle and remove vital pulp or materials from canals

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40
Q

Reamer

A

twisted triangle

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41
Q

File Dimensions

A

D1: Diameter at tip
* size 15= 0.15 mm

D2 or D16: Diameter 16mm from tip
* cutting flutes end
* Sze 15 K file: 0.15 mm + 0.02(16mm)=0.47mm

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42
Q

Cleaning and Shaping

A

Crown-down: Big to small
Step-Back: Small to big

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43
Q

Irrigation and Medicaments used in Endo

A

Sodium Hypochlorite (NaOCl)
EDTA
Chloroform

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44
Q

Sodium Hypochlorite (NaOCl)

A

Irrigant
* dissolves organic material (Bacteria)
* Disinfects canals

Medicament of choice for RCT
Achieve Hemostasis in Vital Pulp Therapy

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45
Q

EDTA

A

Lubricant
* dissolves inorganic material (Smear layer of dentin)
* Chelating agent (decalcifies dentin)

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46
Q

Chloroform

A

dissolves GP in retreatment

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47
Q

Endo Microbiology: Primary vs Failed Endo Infection/treatment

A

Primary Endo Infection: Bacteriodes
* gram negative obligate anaerobes bacteria (No o2)

Failed Endo Treatment: Enterococcus Faecalis
* gram positive facultative anerobic bacteria

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48
Q

Obturation

A

To fill & seal canal system
* GP and Sealer= ZOE (main ingredient)

Warm vertical and Cold Lateral Condensation
* Warm Vertical: GP + Pluggers
* Cold Lateral: Using finger spreader to move GP and pack in accessory cones

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49
Q

End Treatment PLanning

A
  1. RCT
  2. Retreatment–> CANAL (IF problem is in)
  3. Surgical RCT (Aka microsurgery) –> APEX
50
Q

Incision & Drainage

A

Surgical opening in SOFT TISSUE
* to release exudate and pressure
* Best for localized and fluctuant swelling

51
Q

Trephination

A

Surgical opening in HARD TISSUE to release exudate and pressury
* Periapical surgery then Apicoectomy

52
Q

Endo Procedure Complications

A

Ledge Formation
Instrument Seperation
Perforation

53
Q

Ledge Formation

A

Flexible NiTi files are less likely to ledge

To bypass ledge:
* Renegotiation: use a smaller file to explore and discover anatomy
* Put a small bend in the file

54
Q

Why do ledges occur?

A

No straightline access
Inadequate irrigation/lubrication
Happens in longer canals, smaller diameter, or curved canals

55
Q

Instrument Seperation

A

Flexible NiTi are more likely to fracture

To Bypass-Us smaller instrument

Better prognosis=The later the instrument breaks
* if sufficiently disinfected=can leave instrument and seal canal

56
Q

Why do instruments seperate?

A
  • Using Excessive Force
  • Jumping up in a file size
  • Inadequate irrigation/lubrication
  • Not replacing files often enough
57
Q

Perforation

A

Coronal Perforation: Through the crown
Furcal Perforation: Through the pulp floor
Strip Perforation: due to excessive coronal flaring
* mandibular molars: Always favor M side of M root (THICKER DENTIN)
Root Perforation: more apical=better prognosis

Internal Repair with MTA
Later in tx process=better prognosis

58
Q

What are signs of perforation?

A

Immediate Hemmorhage
Sudden Pain

59
Q

Trauma Protocol

A

TRAVMA
* Tetanus booster (Avulsions only)
* Radiographs
* Antibiotics (Avulsions only)
* Vitality testing: False positives are common for 2-8 wks after trauma due to damaged sensory nerves, vascular suppy may be intact
* More
* Appointments: 3 wks, 3 mos, 6 mos, 12 mos

60
Q

Ellis Classification

A
  • Class 1: Enamel only
  • Class 2: Enamel & Dentin
  • Class 3: Enamel, Dentin, & pulp
  • Class 4: Nonvital tooth
  • Class 5: Avulsion
  • Class 6: Root Fracture
  • Class 7:Displacement of tooth
61
Q

Uncomplicated Fracture

A

W/o pulp involvement
* Enamel Only: Smooth Edges
* Enamel & Dentin: Restore

62
Q

Complicated Fracture

A

w/pulp involvement
< 24 hrs: DPC (Direct Pulp Cap)

24-71 hrs: Cvek
* partial pulpotomy 1-2 mm below exposure

72+ hrs: PPTY (pulpotomy)

63
Q

Horizontal Root Fracture

A

Take 3 PAs and 1 occlusal
* at different angles to view fracture line

Ideal Healing: Calcific metamorphisis

Vital: Splint ASAP, Oblique (/) is better than transverse (–)
* coronal fracture: rigid splint for 6-12 wks
* midroot fracture: flexibile splint for 3 wks
* apical fracture (BEST): flexible splint for 2 wks max to avoid ankylosis.

Necrotic: RCT
* 25% chance of necrosis in coronal segment
* apical segment=rare, if it does=extract/surgically treat

64
Q

Concussion

A

Bumped your tooth
* no displacement, no mobility, PDL Sore

Monitor & LET THE TOOTH REST
* avoid chewing w/it
* soft foods

65
Q

Subluxation

A

Bumped tooth and saw some bleeding around sulcus
* no displacement, increased mobility
* PDL Rips and bleeds

Flexilble splint for 1-2 wks
* 6% chance of necrosis w/closed apices, more favorable w/open apices

66
Q

Extrusion

A

Open Apex (Most favorable):
* Reposition
* flexible splint (1-2 wks)
* monitor

Closed Apex:
* Reposition
* flexible splint
* RCT if needed (if it becomes necrotic)
* 65% chance of necrosis

67
Q

Lateral Luxation

A

Displacement of tooth in any direction but axially
* usually crown displace palatally, and root apex labial

Same tx options as extrusion
Open Apex: Reposition, flexible splint (1-2 wks), monitor
Closed APex: Repositioin, Flexibile Splint, RCT If neeeded (Necrotic)
* 80% chance of necrosis

68
Q

Intrusion

A

Apical displacement of tooth

Open Apex: Allow to reerupt

Closed Apex: Reposition, flexible splint, RCT
* 96% chance of necrosis

69
Q

Avulsion

A

Extraalveolar dry time (EADT): amount of time a tooth has been out of the mouth while dry

Reimplant ASAP, flexible splint for 1-2 weeks (Not for primary teeth)

EADT<60 mins
Closed Apex: Reimplant, splint
Open Apex: Reimplant, splint, Apexification at first sign of infected pulp (No RCT)

EADT> 60 mins
Closed Apex: Reimplant, splint, RCT
Open Apex: May or may not reimplant, splint, RCT, plan for implant

70
Q

Avulsion: Storage Media

A
  1. Hank’s Balanced Salt Solution (HBSS)=BEST
  2. Milk
  3. Saline
  4. Saliva
  5. Water (least desirabe bc hypotonic)
71
Q

What are the possible long term responses to trauma

A

External Resorption
Internal Resorption

72
Q

External Resorption

A

starts in the periodontium
* due to damage to cementoblastic layer (Cementoblasts)

Margins: Ragged & poorly defined
* Moves w/angled radiographs

Types:
Replacement Resorption (RR)
Cervical Resorption (CR)
Inflammatory ROot Resorption (IRR)

73
Q

Internal Resorption

A

Initiates in the root canal system
* due to damage to odontoblastic layer (Odontoblasts)

Better prognosis/esier to tx
* RCT

Margins: Sharp and well defined
* does not move w/angled radiographs

74
Q

Calcific metamorphasis

A

Truma–> stimulate odontoblasts–> reparative dentin w/in the pulp

Results in:
* Yellow-orange tooth color
* Canal Obliteration

75
Q

Calcium Hydroxide (CaOH2)

A

Stimulates
1. secondary odontoblasts: Form dentin bridge
2: mesenchymal cells–> tertiary dentin to protect pulp

High pH=12.5
* cautterizes tissue
* kills bacteria

76
Q

MTA

A

Mineral Trioxide Aggregate

Stimulates cementoblasts–>Cementum
* 3 minerals: Calcium, silicon, aluminum

77
Q

MTA: Pros & Cons

A

Pros:
* sets in the presence of moisture
* Antimicrobial
* Nonresorbable=great sealing agent

Cons:
* Bismuth oxide=opacifer (Radioopaque on x-ray)
* Long 3 hr setting time

78
Q

Vital vs Non-Vital Pulp Therapy Procedures

A

Vital Pulp Therapy:
* Indirect Pulp Cap (IPC)
* Direct Pulp Cap (DPC)
* Cvek Pulpotomy
* Pulpotomy (PPTY)
* Apexogenesis

Nonvital Pulp Therapy:
* Pulpectomy (PCTY)
* RCT
* Extraction
* Apexification

79
Q

Indirect Pulp cap

A

Indication:Deep caries approximating pulp

CaOH or RMGI
* if removed, might expose HEALTHY PULP

80
Q

Direct Pulp Cap

A

CaOH

healthy pulp expsoure
* Traumatic Exposure<24 hrs
* Carious or mechanical exposure < 2mm

Hard tissue barrier forms in 6 weeks

81
Q

Cvek Pulpotomy

A

Aka partial or shallow pulpotomy
* remove coronal DISEASED PULP
* 1-2 mm below exposure

Used for:
* Traumatic exposure: 24+ hrs
* Carious or mechanical exposure > 2mm

82
Q

Pulpotomy

A

Remove coronal DISEASED PULP

Uses:
* Truamatitc exposure 72+ hrs
* vital and restorable primary tooth w/pulp exposure (Asymptomatic)

ZOE in crown
* formocresol to obtain hemostasis

83
Q

Formocresol:
*General
* Contains

A

Contains:
* 19% formaldehyde
* 35% cresol
* 15% glycerine
* 31% water

Bactericidal & Fixative (fixates the pulp tissue)

Used for Vital Primary teeth Pulpotomy

84
Q

Pulpectomy

A

Remove ALL dead or dying pulp
* temporary relief for irreversible pulpitis until a RCT can be done

nonvital + restorable primary tooth w/pulp exposure (Asymptomatic)
* ZOE in crown
* CaOH in root (resorbed by underlying permanent tooth

85
Q

Extraction

A

Symptomatic root resorption
Nonrestorable
Primary 1st molars
* a lot of accessory canals, RCT=difficult
* higher success with ext

86
Q

Root Canal Therapy

A

Diseased or Dead Pulp

Pulpectomy + Cleaning, shaping, and filling

87
Q

Apexogenesis

A

stimulate root development=stronger root

CaOh or MTA placed on Healthy or diseased pulp

On immature permanent tooth, includes
* IPC
* DPC
* Cvek
* PPTY

Contraindication:
* Alvulsed
* norestorable
* severe horizontal fracture
* necrotic teeth

88
Q

When is Apexogenesis Contraindicated?

A

Avulsed
Nonrestorable
Severe Horizontal Fracture
Necrotic Tooth

89
Q

Apexification

A

Non Vital Pulp therapy- close root apex

Steps:
* remove dead or dying pulp
* CaOh or MTA placed at base of canal==apical barrier to prevent retrograde infection

immature permanent tooth, includes:
* pulpectomy

90
Q

Pulp Necrosis

A

Response to rapid advancing caries or other severe damage

91
Q

Replacement Resorption

A

External Resorption type

Replacement Resorption (RR)
* ankylosis
* replaces PDL w/bone

92
Q

Cervical Resorption

A

External Resorption type

Cervical Resorption (CR)
* subepithelial sulcular infection
* due to trauma or nonvital bleaching

93
Q

Inflammatory Root Resorption

A

Type of External Resorption

Inflammatory ROot Resorption (IRR)

Necrotic Pulp–> Bacteria & Byproducts–>Dentin tubules–>Affect periodontium

94
Q

Calcific metamorphosis is more likely to occur in?

A
  • open apices
  • intrustions
  • severe crown fractures
95
Q

How long does it take a periodical radiolucency to resolve after RCT?

A

1 year
* if < 1 year=monitor

96
Q

Silver Points

A

Obturation material
* More radiopaque than GP

Corrode spontaneously in serum & blood
* stain tooth and surrounding tissue
* Periradicular inflammation & pain

Tx: retreatment (replace silver points)

97
Q

Bioceramic Sealer

A

Goal: Fill small gaps b/w core obturation material & canals walls to MINIMIZE VOIDS

  • Radiopaque
  • slow setting time
  • Antimicrobial

Bonds to root dentin
* helps seal cananl
* makes pretreatment harder

98
Q

MTA: Uses

A

Dental root repair

Sealing root perforation

Root end filling after apicoectomy

Apical barrier for open apex

99
Q

Post-Endodontic Flare Up

A

After RCT=Severe Pain & swelling in periapical region
* 5% of pts

Due to:
* extrusion of bacteria past apical foramen=most common
* overinstrumentation
* Extrusion of irritants & dental material into periapex (least common)

100
Q

Primary Endo Infection

A

Bacterriodes
* Gram Negative Bacteria (Lipopolysaccharides in cell wall)
* Obligate Anerobes

101
Q

Gram Negative Bacteria: Virulence

A
102
Q

Gram Negative Bacteria: Virulence Factor

A

Lipopolysaccharides in cell wall

103
Q

Sealer Extruded from apex:

A

Radioopaque puff

Due to:
* overinstrumentation
* lose apical stop

104
Q

Internal Bleaching: increased Risk?

A

Risk=external cervical resorption
* pink spot along gingiva

105
Q

What should a general dentist do if a file breaks during a RCT?

A

Tell the pt what happened and refer to endodontist

106
Q

Silver Point

A

Corrosion in presence of Blood and serum
* Stain tooth & surrounding tissue
* periradicular pain & inflammation

Result: Failed ENDO

Tx: retreatment (remove silver point)–> Clean canal system–> Replace w/GP

107
Q

Post

A

Extends into root canal
* Retain the core

Cast Post:
Ideal Post length: 2/3 length of tooth root
Ideal Post diameter: 1/3 diameter of tooth–>Rigidity

108
Q

What is the radiolucency b/w obturation material and Post?

A

Empty space

109
Q

Hardest tooth to treat with endo therapy?

A

Maxillary 1st molar

110
Q

What tooth is most susceptible to GP overflowing into maxillary sinus?

A

Maxillary 1st molar

111
Q

What tooth is most difficult to access bc of mesial surface?

A

Max 1st premolar:
* developmental depression on M surface=concavity: Increase perforation

112
Q

What does Bleeding After instrumentation indicate?

A

Vital tissue remnants at apex
*occur in teeth w/apical infection

113
Q

What should you do if a file separated in apical 1/3 during endo tx?

A

1.Do not attempt to remove
* cannot bypass

2.Obturate up to separated instrument

  1. Place on recall to further eval
    * obtain apical seal=can remain asymptomatic
114
Q

Rubber Dam: primary goal

A

patient protection
* prevents aspiration of instruments/materials

115
Q

What irritant is most likely to cause reversible pulpitis?

A

Restorative tx

116
Q

Recommended obturation material

A

Ceramic Based Obturation material:
* Guttacore
* BIoceramic
* Thermoplasticized injectable

Not recommended: Paraformaldehyde paste

117
Q

What is a good alternative to NaOCl?

A

Chlorhexidine:
* antimicrobial

118
Q

Acute Apical Abscess vs acute periodontal abscess

A

Acute Apical Abcess:
* Purulent Swelling
* Infection in root canal
* always NONVITAL

Acute Periodontal Abscess:
* Purulent swelling
* DEEPER perio pocket
* does not affect tooth vitality

119
Q

What is most useful in differentiating an acute apical abscess from acute periodontal abscess

A

EPT: Electric Pulp Test

Acute Apical Abcess:
* Purulent Swelling
* Infection in root canal
* always NONVITAL

Acute Periodontal Abscess:
* Purulent swelling
* DEEPER perio pocket
* does not affect tooth vitality

120
Q

SLOB

A

Buccal Object Rule
*Same Lingual Opposite Buccal

Object moves in same direction as x-ray machine=Lingual

Object moves in opposite direction as x-ray machine=Buccal

121
Q

Internal Bleaching: Options

A

Carbamide Peroxide
Sodium perboxate
Hydrogen peroxide w/o heat

122
Q

Pulp Vitality Tests: Most reliable to least reliable

A
  1. Cold (most reliable)
  2. EPT
  3. Heat (least reliable)

BOARDs (47 decks)

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