Endo Flashcards
What are the risks of leaving a carious tooth that needs endo tx?
Risk of infection
Abscess
Tooth breakdown
Root fracture
What are the tx options for a tooth with a post and core crown, with no endo tx, lingual caries but no pain?
Leave and monitor
Remove crown and remove caries
Remove post core and replace and RCT
Risk of tooth being unrestorable requiring XLA
What are the pros and cons of removing the crown and caries but leaving in the post where there is no RCT?
+ removes risk of post removal, potential root fracture
- not resolving the problem of no endo (risk of PA infection)
What are the pros and cons of removing the post and core and replacing and RCT?
Risk of removing post and core - root fracture, post and core fracture
RCT - tooth will be cleaned, disinfected and filled to prevent infection
Needs a series of appointment
What are the options for replacing a missing space?
Leave space
Bridge
Single tooth denture
Implant
Explain the procedure of RCT
LA - topical with CW, injection of LA
Rubber dam - isolation and moisture control, airway protection
Radiographs needed pre, during and post tx
Access - drill to remove nerve, slow and high seed
Files - series of files to clean and share canal
Irrigation throughout with NaOCl and EDTA
Canal dried with paper points
Intra canal medicament places - resolves infection and symptoms
Obturation - GP root filling, coated in sealer, packed with accessory pointe, burnt off
Lining placed to seal canal
Restoration - ideally indirect restoration and causal coverage
Rv appointment needed
What is the prognosis of RCT?
Up to 90% over 10 years for teeth with irreversible pulpitis
Up to 80% over 10 years for teeth with necrosis
What are the alternatives to RCT?
No treatment
Extraction
What are the risks of RCT?
Instrument separation
Failure to negotiate canals to WL
Hypochlorite incident
Material extrusion
Post-op pain
Post-op swelling
Need for pain control
Perforation
Root fracture
What are the benefits of RCT?
Resolution of infection and possibly symptoms
Retain tooth
No loss of bone
Abutment potential of tooth remains
Doesn’t require replacement for missing tooth
Best aesthetics
What irrigants can be used for instrumentation?
NaOCl 3%
EDTA 17%
CHX 2%
What clamps are used for each tooth?
Anteriors - C or E
Premolars - E or EW
Molars - A, AW, FW or K
What are the reasons for a failed RCT? (13)
Overfilled
Underfilled
Poorly compacted
Accessory canals missed
Missed canal
Inadequately repped
Extrusion of debris
Perforation
RCF of incorrect shape
Vertical root fracture
Endo file fracture
Blockage/obstruction of canal
Poor coronal seal (failed restoration)
What are the tx options for a failed RCT?
Leave and monitor - may flare up later
Re treatment - no surgery but chances of success decreased
Periradicular surgery - if retreatment not possible
XLA
What should you do if a file breaks?
Introduce yourself
Calmly explain that file has separated
Explain that thin metal files are used to clear out pulp tissue and shape canal
Consequences - may not be able to remove it, may require referral, tooth may need to be extracted
What are the possible treatments for a separated files?
Do nothing - dress and monitor
Refer to a specialist
Attemp to remove with tweezers if you can see it
Dislodge and remove file with US
Bypass the fragment by watch-winding a small file alongside the instrument and EDTA to soften dentine
If not possible to remove - accept and obdurate to file
Retrograde RTCT
XLA as last resort
Ask if they have any questions
Describe the root canals of an upper first molar
Quadrilateral shape access cavity
3 roots
93% have 4 canals - MB1, MB2, DB, P
7% have 3 canals, MB, DB, P
What are the endo restoration options for a molar?
Gold standard is cuspal coverage onlay- reduces risk of fracture or failure, less microbial leakage
Full coverage crown if less tooth structure remains
Core build up if necessary - composite gold standard
Direct restoration with composite or amalgam - only if occlusal cavity, more leakage, more likely to fracture
When can a direct pulp cap be carried out?
Tooth must be asymptomatic, vital, no history of pulpitis
Pulp exposure must be small and surrounding dentine must be relatively hard - otherwise extirpate
What is the procedure for direct pulp cap?
Dam placed before
If haemorrhage from exposed pulp, copious irrigation with sterile saline to arrest bleeding
Cavity irrigated with chlorhexidine after bleeding arrested
Blot dry with sterile cotton wool pledgers (don’t air dry)
Exposed pulp covered in hard setting CaOH (Dycal)
RMGI lining placed (vitrebond) and restoration as planned
Continuing vitality monitored, if symptomatic RCT needed
What is the procedure for a carious pulp exposure?
Dam placed
Extirpation - pulpectomy
Coronal pulp tissue removed with excavator, irrigated with saline and dried
Discuss with pt that RCT or XLA will be required
Ledermix as palliative agent
CW rol and GIC restoration
What is the procedure for an indirect pulp cap?
Clean cavity with chlorhexidine
Stained firm dentine left in situ and covered with setting CaOH (Dycal)
Vitrebond lining (RMGIC)
Restore with GI or RMGI
Monitor for 3 months and if vital and asymptomatic, provisional restoration removed, stained dentine carefully excavated and definitive restoration placed
If any pulpal symptoms, then RCT
What should be asked for a pain history?
Introduce self and BDS5 student
Ask about C/O and reason for attendance
When pain began, how long
Ask about changes over time
Site of Ian
Character of pain
Hot and cold
Relieving factors - analgesics
Duration of pain
Is pt kept awake
Provisional diagnosis
Note taking well legible and ordered
