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BDS5 > Endo > Flashcards

Endo Flashcards

1
Q

What is the aetiology of pulpal and periapical disease

A
  • Microorganisms entry towards pulp/ root canal via:
  • Dental caries
  • Cracks
  • Trauma
  • Resorption
  • Perio related
  • Micro leakage
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2
Q

When distance should bacteria be to exhibit pulp change

A
  • No significant damage occur when bacteria have penetrated within 1.1mm
  • Irreversible damage if they penetrate to within 0.5mm of pulp
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3
Q

How does a periapical lesion form

A
  • Bacteria present in the root canals
  • Non-specific response
  • Specific host response
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4
Q

what is acute periodontitis

A
  • Acute inflammation at the apex
  • Infection may develop into primary abscess
  • Maybe from an acute exacerbation of a chronic apical periodontitis
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5
Q

What is chronic apical periodontitis

A
  • Inflammation at the tooth of a long standing nature
  • Presence of:
  • Granulomatous tissue
  • Predominantly lymphocytes, plasma cells and macrophages
  • Either epithelised or non epithelised
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6
Q

What is a periapical true cyst

A
  • It is a distinct pathological cavity completely enclosed in an epithelial lining so that no communication to the root canal
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7
Q

What is a periapical pocket cyst

A
  • A periapical pocket cyst, also known as a periapical abscess with sinus is a type of dental cyst that forms at the root apex of a non-vital tooth. It results from chronic periapical inflammation.
  • the cyst wall is not completely enclosed, and the lesion communicates with the root canal system
  • (responds to root canal treatment)
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8
Q

What bacteria found in necrotic pulp

A
  • Anaerobes mainly
  • Streptococcus
  • Fusobacterium
  • Lactobacillus
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9
Q

What are extra radicular infections

A
  • Minority of infections
  • E.g acute apical abscess
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10
Q

What are the contraindications for root canal treatment

A
  • Teeth cannot be made functional or restored
  • Insufficient periodontal support
  • Poor prognosis: extensive external/internal resorption, extensive vertical fracture
  • Patient unable to tolerate rubber dam
  • Complex anatomy
  • Uncooperative: limited mouth opening, unable to attend appointments
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11
Q

What are some limitations of radiographs

A
  • Degree of magnification
  • Superimposition
  • Geometric distortion
  • Lack of standardisation or reproducibility
  • Not all periapical lesions can be detected
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12
Q

What is the clinical classification of pulpal disease

A
  • Reversible pulpitis
  • Irreversible pulpitis
  • Hyperplastic pulp
  • Pulp necrosis
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13
Q

Tell me about reversible pulpitis

A
  • Transient
  • Pain doesn’t linger
  • Difficult to localise
  • Not TTP
  • Dentinal sensitivity mimic symptoms of reversible pulpitis
  • Treatment: remove cause, cover exposed dentine
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14
Q

Tell me about irreversible pulpitis and treated how

A
  • Results from more severe insult on the pulp
  • Pain spontaneous
  • Severe pain
  • Pain lingers
  • Pain to hot liquids relieved by cold
  • Later stages widened PDL
  • Treatment: RCT or extraction
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15
Q

What is a hyperplastic pulp and treatment

A
  • Form of irreversible pulpitis
  • Known pulp polyp
  • Due to proliferation of chronically inflamed young pulp tissue.
  • Treatment: RCT or XLA
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16
Q

What is pulp necrosis and treatment

A
  • Occurs at the end of irreversible pulpitis
  • Pulp is non-responsive to pulp testing and is asymptmatic
  • Reasons: calcification, history of trauma, simply tooth not responding
  • Treatment: RCT or XLA
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17
Q

What is internal resorption

A
  • Occasionally pulp inflammation may result in resorption of the dentine by dentinoclast cells
  • Clinically a pink spot can be seen
  • Special investigation: CBCT (perforation), PA
  • RCT or if too advanced XLA
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18
Q

What is pulp calcification

A
  • Secondary dentine: after eruption, laid of floor and ceiling of pulp
  • Tertiary dentine laid in response to environmental stimuli
  • Reactionary dentine response to mild stimuli
  • And reparative dentine in response to strong noxious stimuli
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19
Q

What are the 4 clinical classifications of periapical disease

A
  • Acute apical periodontitis
  • Chronic apical periodontitis +/-(Acute Excerbation)
  • Apical periodontitis with an abscess (Acute or Chronic)
  • Apical periodontitis with a sinus tract (Acute or Chronic)
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20
Q

How to distinguish between sinus tract and periodontal disease

A
  • Sensibility testing: normal if periodontal pocket, no response for sinus tract
  • Periodontal probing: wide pockets is perio and narrow tract is sinus
  • Clinical tooth status: minimal caries in perio and evidence of caries. Resto in sinus
  • General periodontal condition: poor is perio and normal if sinus
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21
Q

What are sources of communication into the pulp/canal

A
  • Apical foramen
  • Lateral canals : any part of root including furcation
  • Dentinal tubules: once root cementum is lost
  • Perforations
  • Fractures: horizontal and vertical
  • Developmental anomalies: root grooves allow bacterial colonisation
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22
Q

What is the classification of endo-periodontal lesions

A
  • With root damage: fracture, perforation, external root resorption
  • Without root damage: perio patients (3 grades) and non perio patients (3 grades)
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23
Q

What is cracked tooth syndrome

A
  • Vital teeth:
  • Sharp pain on biting on release
  • Occasional pain from cold
  • Difficult to localise
  • Tooth slooth, staining, transillumination
  • More common in mandibular molars
  • Treatment: ortho band, cuspal coverage
  • Non vital:
  • Dull ache on biting
  • TTP, narrow perio pocket adjacent to fracture
  • Radiographically halo or J shaped diffuse lesion around root
  • Treatment: RCT or hemisection
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24
Q

Non odontogenic pain-Neuropathetic that can mimic odontogenic pain

A
  • Trigeminal neuralgia
  • Atypical odontalgia
  • Glossopharyngeal neuralgia
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25
Q

What are some discussion with patient about RCT (3)

A
  • RCT not 100% success rate (85%-95%)
  • Re-RCT 77-80% success rate
  • Flare ups can happen after treatment
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26
Q

Why use a rubber dam in RCT

A
  • Prevents inhalation or ingestion
  • Prevents infection via saliva
  • Enhances access and retracts soft tissues
  • Better comfort for patient
  • Medico legal requirement
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27
Q

Name some irrigants

A
  • Sodium hypochlorite: antibacterial, dissolves organic tissue remnants
  • Chlorhexidine
  • EDTA
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28
Q

Why use calcium hydroxide intra canal

A
  • Antibacterial
  • High pH
  • Biocompatible
  • Non irritant
  • Degrades residual organic tissue
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29
Q

What is anatomy of maxillary incisors

A
  • 1 canal
  • 22mm
  • Triangle shape access cavity
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30
Q

What is anatomy of mandibular incisors

A
  • 40% have 2 canals that join
  • 20mm
  • Triangular access cavity
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31
Q

What is anatomy of maxillary canine

A
  • 1 root canal
  • 26mm
  • Triangular/ ovoid access
32
Q

What is anatomy of mandibular canine

A
  • 22.5mm
  • Mainly 1 canal (14% 2 that join)
  • Triangular/ ovoid access
33
Q

What is anatomy of maxillary 1st premolars

A
  • 20.6mm
  • 2 roots and 2 canals
  • Ovoid bucco-palatal
34
Q

What is anatomy of maxillary 2nd premolar

A
  • 21.5mm
  • Usually single rooted
  • Ovoid bucco-palatal
35
Q

What is the anatomy of mandibular premolars

A
  • 21.6mm
  • Single root
  • Ovoid bucco-palatal
36
Q

What is anatomy of maxillary 1st molar

A
  • 20.8mm
  • 4 pulp horns
  • 3 roots 4 canals usually (90%)
  • MB2 is the extra (usually type 2 that joins)
  • Mesial 2/3 of occlusal, oblique ridge intact
  • Triangular
37
Q

What is anatomy of maxillary second molar

A
  • 20mm
  • 3 roots 3 canals
  • 60% have 4 canals
  • Mesial leave oblique ridge intact
  • Triangular
38
Q

What is anatomy of mandibular 1st molar

A
  • 21mm
  • 2 roots 3 canals
  • 2 mesial 1 distal
  • Trapezoid outline
39
Q

What is anatomy of mandibular 2nd molar

A
  • 19.8mm
  • 2 mesial 1 distal
  • Trapezoid outline
40
Q

What are objectives of cutting a coronal access cavity

A
  • Remove entire rood of pulp chamber
  • Allow visualisation of all root canal orifices
  • Straight line access
  • Have convergent walls in apical direction
  • Conserve as much tooth tissue as possible
41
Q

What are the aims of mechanical root canal preparation

A
  • Continuously tapered preparation is produced
  • Original anatomy is maintained
  • Foramen position is maintained
  • Apical foramen is kept as small as possible
42
Q

What are two basic motions of hand files

A
  • Rotational motion
  • Push pull filing
43
Q

Tell me about sodium hypochlorite

A
  • Anti-microbial
  • Dissolves organic tissue remnants
  • Usually 2.5%
  • Na(OH)2 accident: irrigate with saline, cause severe pain, blanching
44
Q

What is EDTA

A
  • Remove smear layer-inorganic tissue remnants (17% EDTA)
  • Helps in sclerosed canals, ledges
45
Q

What is chlorhexidine in terms of irrigation

A
  • Antibacterial, does not dissolve organic tissue
  • Used in concentration 2%
  • Do not use with sodium hypochlorite
46
Q

What are the basics of canal preparation sequence

A
  • Explore coronal 1/3-2/3’s with size 10 file
  • Prepare coronal 1-3- 2/3’s with GG’s
  • Explore apical 1/3 with size 10 file
  • Establish patency
  • Definitive Working length radiograph
  • Prepare apical 1/3 and apical gauge
  • Step back (shapes canal and cleans and provides resistance form which to obturate against)
  • Smooth canal circumferentially
  • Irrigation and patency in between each instrument
47
Q

Coronal preparation crown down approach

A
  • Necrotic case bacterial more coronal (removes bacteria and stops introduction apically)
  • Achieve straight line access: reduce curvature, improve tactile strength, greater volume of irrigate
48
Q

What is the endpoint of apical preparation

A
  • Apical constriction
  • 1mm for Radiographic apex
  • Apical foramen is larger as well
49
Q

What is apex locators

A
  • Only use zero reading
  • Generally work back 0.5mm to 1mm from the zero reading for WL
  • Do not use on patient with cardiac pacemakers
  • What is short circuit: canal too moist, touching metal resto, perforation
50
Q

How can you determine root length

A
  • Electronic apex locator
  • Working length radiograph
  • Tactile sensation
51
Q

What is patency filling and what are the advantages

A
  • Prevents blockage
  • Check whether exude present
  • Helps maintain and follow anatomy
  • Help deliver irrigant to apex
52
Q

What are the aims intracanal medication and name some

A
  • To eliminate any remaining bacteria after canal instrumentation and irrigation
  • Calcium hydroxide non setting
  • Cortico- Steroids – ledermix (good for inflammation)
53
Q

What are the problems of incorrect instrumentation

A
  • Ledges (file away with EDTA)
  • Packed dentine debris/blockages (copious irrigation)
  • Perforations (repair glass ionomer, MTA)
  • Separated instrument
54
Q

What is obturation

A
  • Sealing the root canal
  • Gutta percha (biocomp, insoluble)
  • Is a trans-polyisoprene
55
Q

What are the properties of ideal root canal sealer

A
  • Satisfy the requirement of a root filling material as well
  • Provide good adhesion to the canal wall
  • Expand whilst setting
  • Adequate working time and easy mix
  • Biocompatible, good flow
56
Q

What are the 4 aims of obturation

A
  • Prevent micro-organisms and their toxins percolating into the peri-radicular tissue
  • Seal the remaining bacteria in the root canal system in an environment that they cannot thrive
  • Prevent percolation of peri-radicular exudate (nutrient supply for the bacteria) into the root canal space
  • Prevent reinfection of the root canal system from the coronal aspect
  • Failure of this can be associated with non-healing
57
Q

When to obturate

A
  • Tooth must be asymptomatic
  • Temporary dressing must be intact
  • No sinus present
  • Root canal must be dry
58
Q

Examples of root canal sealers

A
  • Calcium hydroxide: antibacterial, high pH ( encourages repair, active calcification, neutralises lactic acid made by osteoclasts)
  • Resin based sealers
  • Bio ceramic sealers
  • Zinc oxide eugenol sealers (common)
59
Q

What are the basic steps in cold lateral

A
  • Rubber dam
  • Master GP with tug back in wet canal
  • Dry canal
  • Coat GP with sealer and place to WL
  • Finger spreader 1mm from WL
  • Add accessory points till canal is filled
  • Sear of GP at CEJ using Machtou plugger
60
Q

What are you looking at on post op rad

A
  • Length
  • Quality of condensation (voids)
  • Taper
61
Q

How to assess outcome of RCT

A
  • Tooth functional with no swelling or sinus tract
  • Patient free from symptoms
  • Radiographic evidence of normal peri-radicular tissue
  • Radiographic evidence of healing if there has been a periapical lesion at the start
62
Q

What are the obturation techniques

A
  • Cold lateral
  • Warm vertical compaction (cut off apex GP and backfill)
  • Single cone
  • Warm lateral ?
63
Q

What are the clinical applications of MTA

A
  • Pulp cap
  • Perforation repair
  • Root end filling
  • Apexification
  • Root resorption
64
Q

What are the clinical applications of biodentine

A
  • Pulp exposure
  • Dentine caries
  • Pulpotomy
  • Apexification

dentine substitute, biocomp, strong, and stimulates dentine formation

65
Q

What is pulp obliteration

A
  • Pulp canal obliteration occurs more frequently with open apices
  • Dental pulp undergoes calcification
  • Narrowing or obliteration of pulp chamber
  • Due to reparative process and placing dentine
  • Clinical signs and symptoms are minimal
66
Q

How to do safe irrigation

A
  • Use side venting needle in canal
  • Never use excessive force to inject
  • Irrigate slowly
  • Never bind irrigation needle in canal
  • Use high volume suction near cavity
67
Q

Whats the difference between odontopaste and ledermix

A
  • The main difference between Odontopaste and Ledermix paste is that clindamycin hydrochloride in Odontopaste replaces demeclocycline hydrochloride in Ledermix paste. Clindamycin hydrochloride has an equivalent spectrum of antibacterial activity and exhibits minimal staining of teeth.
  • Not routine
68
Q

When to send patient to A&E

A
  • Pyrexic
  • Limited opening
  • Difficulty swallowing
  • Large swelling near the eye
  • Crossing the midline under the chin ( bilateral)
69
Q

Perio endo lesion classification (5)

A
  • Primary endodontic lesion (RCT, good prognosis)
  • Primary endodontic lesion with secondary periodontal involvement (RCT, assess need for perio treatment)
  • Primary periodontal lesion extending to the apex (perio treatment)
  • Primary periodontal treatment with secondary endodontic involvement ( RCT and perio treatment)
  • Combined Lesion (RCT and perio treatment)
70
Q

What are the ideal properties of root canal filling materials (4)

A
  • Be radiopaque
  • Not stain the tooth
  • Removable
  • Allow good length control
71
Q

Tell me about rotary files

A
  • Non cutting tips for pro taper
  • Glide path be created with Stainless steel K files to the depth
72
Q

What does coronal flare do

A
  • Facilitates direct access into middle third of root canal and promotes access of irritants
73
Q

What is the ESE guideline for success of rct (4)

A
  • Absence of pain, swelling and other symptoms
  • No sinus tract
  • No loss of function
  • Radiological evidence of a normal periodontal ligament space around the root
74
Q

How to diagnose perforation (4)

A
  • Bleeding
  • Pain
  • Instrument angle outside cavity
  • Radiographic
75
Q

How to remove broken file

A
  • Magnification and light
  • Tweezers
  • Stieglitz forceps
  • Braiding of h files
  • Ultrasonic
  • Accept
76
Q

How to remove GP

A
  • Files H files
  • Solvents as adjunct – eucalyptus oil

BDS5 (10 decks)

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