Endo Flashcards
The pulp lacks ___ circulation, which severely limits its ability to cope with __, __ and ___.
Collateral
Bacteria
Necrotic tissue
Inflammation
The pulp possesses unique, hard tissue-secreting cells called ___ as well as ___ cells that can differentiate into ___ that form more dentin in an attempt to protect the pulp from injury.
Odontoblasts
Mesenchymal
Osteoblasts
The sensibility of the dental pulp is controlled by __ and ___ afferent nerve fibers.
A-delta
C
A-delta fibers are [large/small] myelinated nerves that enter the root canal and divide into smaller branches, coursing __ through the pulp. What kind of pain do they perceive?
Large
Coronally
Immediately perceived as quick, sharp, momentary pain, which dissipates quickly upon removal of the stimulus
The intimate association of A-delta fibers with the odontoblastic cell layer and dentin is referred to as the ___ complex
Pulpodentinal
In pulpitis (pulpal inflammation) the response is ___ and disproportionate to the challenging stimulus (aka: ___) This response is induced by the effects of ____ that are released in teh inflammed pulp.
Exaggerated
Disproportionate
hyperalgesia
Inflammatory mediators
Progression of pulpal inflammation can change the quality of pain response. As the exaggerated A-delta fiber pain subsides, pain ___ and is perceived as a ___. This second pain symptom is from __ fibers.
Seemingly remains
Dull, throbbing pain
C nerve
Describe C fibers
Small, unmyelinated nerves that course centrally in the pulp stroma
In contrast to A-delta fibers, they are not directly involved with the pulpodentinal complex and are not easily provoked.
When does C fiber pain surface?
With tissue injury and is mediated by inflammatory mediations, vascular changes in blood volume, and blood flow, and increases in tissue pressure.
When C fiber pain dominates, it signifies irreversible local tissue damage
True or false, with increasing inflammation of pulp tissues, C fiber pain becomes the only pain feature.
True
True or false… hot liquids or foods can increase intrapulpal pressure to levels that excite C fibers
True
The pain is diffuse and can be referred to a distant site or to other teeth
What happens with sustained inflammation?
It is detrimental to pulpal recovery, finally terminating in tissue necrosis.
Describe the signs/symptoms of a normal tooth.
Asymptomatic
Produces mild/moderate transient response to thermal or electrical stimuli that subsides almost immediately after removal of stimulus
No painful response to percussion or palpation
In reversible pulpitis, thermal stimuli causes what kind of a response?
Quick, sharp, hypersensitive response that subsides as soon as the stimulus is removed
What kind of irritant can affect the pulp and may cause reversible pulpitis?
Early caries or recurrent decay
Periodontal SRP
Deep restorations without a base
True or false… reversible pulpitis is a disease not a symptom
False, the opposite. It is a symptom, not a disease
If the irritant is removed, the pulp reverts back to an uninflammed state
If the irritant remains the symptoms may lead to irreversible pulpitis
What are the two ways reversible pulpitis (RP) can be clinically distinguished from a symptomatic irreversible pulpitis (IR)?
1) RP causes momentary painful response to thermal change that subsides as soon as stimulus is removed. IR causes painful response to thermal change that lingers after removal of stimulus.
2) RP does not involve complaint of spontaneous (unprovoked) pain.
What is the most frequent crossover point from RP to IP?
Frank penetration of bacteria into the pulp
True or false, symptomatic irreversible pulpitis may resolve if caries is removed.
False. By definition the pulp has been damaged beyond repair
What are microscopic findings of symptomatic irreversible pulpitis (SIP)?
1) Microabscesses of the pulp begin as tiny zones of necrosis within dense acute inflammatory cells
2) histologiclaly intact myelinated and unmyelinated nerves may be observed in areas with dense inflammation and cellular degeneration
What occurs following irreversible pulpitis?
Pulp death may occur quickly or may require years; it may be painful, or more frequently, asymptomatic. The end result is necrosis.
SIP is characterized by ___ pain
Spontaneous, unprovoked, intermittent or continuous
How do temperature changes affect a tooth with SIP?
Elicit prolonged episodes of pain that linger after the thermal stimulus is removed.
True or false. Radiographs are generally sufficient for diagnosing IP
False.
True or false.. occasionally, patients may report that a postural change, such as lying down or bending over, induces pain in a tooth with SIP
True
how are radiographs helpful in diagnosing SIP?
Can be helpful in identifying suspect teeth only.
Thickening of the apical portion of the PDL may become evident on radiographs in the advanced stage.
True or false.. electrical pulp testing is an excellent way to diagnose SIP
False, it has little value
How does asymptomatic irreversible pulpitis (AIP) compare to SIP microscopically?
Very similar.
There are no clinical symptoms but inflammation produced by caries, caries excavation, or trauma occurs.
Pulp necrosis is death of the pulp that results from what three things?
Untreated irreversible pulpitis
Traumatic injury
Any event that causes long-term interruption of the blood supply to the pulp.
True or false… pulpal necrosis is all or none. How is this so?
False. It may be partial or total.
Partial necrosis may manifest with some of the symptoms associated with irreversible pulpitis. For example, a tooth with two canals could have an inflamed pulp in one canal and a necrotic pulp in other.
Total necrosis is asymptomatic before it affects the PDL, and there is no response to thermal or electrical pulp tests.
True or false… anterior teeth may show some discoloration in the crown due to necrosis
True
What occurs in the periapical space due to necrosis?
Protein breakdown products and bacteria and their toxins eventually spread beyond the apical foramen; this leads to thickening of the PDL and manifests as tenderness to percussion and chewing.
Describe the microscopic findings of necrotic pulp
As inflammation progresses, tissue continues to disintegrate in the center to form an increasing region of liquefaction necrosis
Because of the lack of collateral circulation and the unyielding walls of dentin, there is insufficient draining of inflammatory fluids
The result is localized increases in tissue pressure, causing the destruction to progress unchecked until the entire pulp is necrotic
Bacteria are able to penetrate and invade into the dentinal tubules (it is necessary to remove the superficial layers of dentin during cleaning and shaping)
What is hyperplastic pulpitis?
Reddish, cauliflower-like growth of pulp tissue through and around a carious exposure. The proliferative nature of this type of pulp is attributed to low-grade, chronic irritation of the pulp and the generous vascular supply characteristically found in young people.
What is internal resorption?
Most commonly identified during radiographic examination. If undetected, internal resorption eventually perforates the root.
Chronic pulpitis - (chronic inflammatory cells, multinucleated giant cells adjacent to granulation tissue. Necrotic pulp coronal to resorptive defect)
Only prompt endo therapy can stop the process and prevent further tooth destruction
Partial pulp vitality is necessary for active internal resorption
True or false.. a completely nonvital tooth can undergo internal root resorption.
False. Partial pulp vitality is necessary for active internal resorption.
Apical lesions of pulpal origin are ___ responses to irritants from the root canal system
Inflammatory
In regards to apical diseases, Patient symptoms may range from an asymptomatic response to various symptoms including…
Slight sensitivity to chewing
Sensation of tooth elongation
Intense pain
Swelling
Fever
Malaise
What is the most indicative sign of apical inflammatory lesions?
Radiographic bone resorption, but this is unpredictable. Apical lesions are frequently not visible on radiographs.
True or false.. there is no correlation between histologic findings and clinical signs, symptoms, and duration of the apical lesion.
True
The terms acute and chronic apply only to clinical symptoms
symptomatic apical periodontitis refers to painful inflammation around the apex and can result from…
Extension of pulpal disease into the apical tissue
Canal overinstrumentation or overfill
Occlusal trauma such as bruxism
True or false… symptomatic apical periodontitis may occur around vital and nonvital teeth, conducting pulp tests is the only way to confirm the need for endodontic treatment
True
Even with the presence of symptomatic apical periodontitis, the apical PDL may radiographically appear ___
Within normal limits or only slightly widened.
Is symptomatic apical periodontitis painful during percussion tests?
It may be
If a tooth is vital, yet has symptomatic apical periodontitis, ___ can often relieve the pain. If the pulp is necrotic and remains untreated, ___ symptoms may appear as the disease advances to the next stage, ___
Simple occlusal adjustment
Additional
Acute apical abscess
What often causes throbbing apical pain in symptomatic apical periodontitis?
Because of the little room for expansion of the PDL, increased pressure can also cause physical pressure on the nerve endings, which subsequently cause intense, throbbing apical pain
In histopahtologic examination of symptomatic apical periodontitis reveals a localized inflammatory infiltrate within the ___
PDL
Asymptomatic apical periodontitis is a ___, ___ lesion.
Long-standing, asymptomatic or mildly symptomatic lesion
True or false, asymptomatic apical periodontitis is usually accompanied by radiographically visible apical bone resorption.
True
In AAP, bacteria and their endotoxins cascading out into the apical region from a necrotic pulp cause extensive ___ of __ and __ bone.
Demineralization
Cancellous and cortical
True or false… there is always extreme tenderness to percussion or palpation in AAP
False. There may be slight tenderness
How is asymptomatic apical periodontitis diagnosis confirmed?
General absence of symptoms
Radiographic presence of an apical radiolucency
Confirmation of pulpal necrosis
A totally necrotic pulp provides a safe harbor for the primarily ___ microorganisms. If there is no vascularity, there are no ___ cells
Anaerobic
Defense
AAP traditionally has been classified histologically as ___ or ___. The only accurate way to distinguish them is by ___ examination.
Apical granuloma or apical cyst
Histopathologic
What is an acute abscess?
Painful with purulent exudate around the apex
It is a result of exacerbation of symptomatic apical periodontitis from a necrotic pulp
How does an apical abscess look radiographically?
Appears WNL or only slightly thickened.
Reveals a relatively normal or slightly thickened lamina dura (because the infection has rapidly spread beyond the confines of the cortical plate before demineralization can be detected radiographically)
What is the only sign of an acute abscess?
Swelling
Acute abscess lesions can also result from infection and rapid tissue destruction arising from within ___
Asymptomatic apical periodontitis
What are the histopathologic findings of an acute abscess?
Central area of liquefaction necrosis containing disintegrating neutrophils and other cellular debris
Surrounded by viable macrophages and occasional lymphocytes and plasma cells
Bacteria are not always found in the apical tissues or within the abscess cavity
What are the presenting signs and symptoms of an acute apical abscess?
Rapid onset of swelling
Moderate to severe pain
Pain with percussion and palpation
Slight increase in tooth mobility
Extent and distribution of swelling are determined by the location of the apex and the muscle attachments and the thickness of the cortical plate
Usually the swelling remains localized. However it may become diffuse and spread widely (cellulitis)
How can an acute apical abscess be differentiated from a lateral periodontal abscess?
Pulp vitality testing and sometimes with periodontal probing.
What is a chronic apical abscess?
Associated with either a continuously or an intermittently draining sinus tract without discomfort
The exudate of a chronic apical abscess can also drain through the ___, mimicking a ____
Gingival sulcus
Periodontal lesions with a “pocket”.
Do teeth with a chronic apical abscess respond to pulp vitality tests?
No, they have a necrotic pulp
Describe the radiographic findings of a chronic apical abscess.
Presence of bone loss at the apical area
What is the treatment of a chronic apical lesion sinus tract?
Sinus tracts resolve spontaneously with nonsurgical endodontic treatment.
What is condensing osteitis?
Excessive bone mineralization around the apex of an asymptomatic vital tooth
Radiopacity may be caused by low-grade pulp irritation
True or false… condensing osteitis requires immediate RCT
False. The process is asymptomatic and benign. It does not require endodontic therapy
When a patient presents with orofacial pain the cause must be differentiated between ___ and ___
Odontogenic
Nonodontogenic
What are some characteristics of nonodontogenic involvement? (Name 7)
Episode pain with pain free remissions
Trigger points
Pain travels and crosses midline of face
Pain that surfaces with increasing mental stress
Pain that is seasonal or cyclic
Paresthesia
Endodontic treatment is not contraindicated with most medical conditions. What are the only two systemic contraindications to endodontic therapy?
Uncontrolled diabetes
Recent MI (within the past 6 months)
If the inflammation has not reached the ___, it may be difficult fo the patient to localize the pain because the pulp contains sensory fibers that transmit ___ only, not location.
PDL
Pain
The PDL contains ____ fibers. When the inflammatory process extends beyond the apex, it is easier for the patient to identify the source of the pain (___test can be used).
Proprioceptive sensory
Percussion
True or false… pain can be referred to adjacent teeth or in the opposing quadrant.
True
True or false.. odontogenic pain commonly crosses the midline of the head
False, it is rare
In ____, pain can often be referred to the opposing quadrant or to other teeth in the same quadrant
Posterior molars
Maxillary molars often refer pain to the ___, ___ and ___ regions of the head. Mandibular molars frequently refer pain to the ___, ___, or ____
Zygomatic
Parietal
Occipital
Ear
Angle of the jaw
Posterior regions of neck
Define mode
The onset of symptoms spontaneous or provoked (i.e. sudden or gradual). If stimulated, are they immediate or delayed.
Define periodicity
The temporal pattern of the pain (sporadic or occasional)
When assessing the hx of tooth pain, what 4 qualities of pain should be identified?
Mode
Periodicity
Frequency
Duration (how long do symptoms last)
How does pain with a bony origin appear?
Dull, gnawing, aching
How does pain due to vascular response to tissue inflammation appear?
Throbbing, pounding, or pulsating
How does pain due to pathosis of nerve root complexes, sensory ganglia, or peripheral innervation (irreversible pulpitis or trigeminal neuralgia) appear?
Sharp
Electrical
Recurrent
Stabbing
How does pain in pulpal or apical pathoses appear?
Aching
Pulsing
Throbbing
Dull
Gnawing
Radiating
Flashing
Stabbing/jolting
You should ask the patient what are the affecting factors. Is it spontaneous or stimulated? Ask them “does the pain ever occur without provocation”?
What are some provoking factors?
Heat, cold, biting, chewing
Lying down or bending over (due to Chang in blood pressure to head and in pulp)
After you ask the pt about provoking factors, ask about ___ factors. These are factors that relieve pain.
Attenuating
How are sinus tracts traced?
With gutta-percha point by radiograph
True or false… asymptomatic apical periodontitis has a + response to percussion.
False. The only way to diagnose this is a periapical radiolucency, all other symptoms are negative.
True or false… acute apical abscess will have negative thermal testing response but positive percussion response.
True
How is a chronic apical abscess diagnosed?
“Bump in the gum” and PRL
Negative thermal testing and percussion
Describe why an apical area of a tooth would be palpation sensitive.
When apical inflammation develops after pulp necrosis, the inflammatory process may burrow its way through the facial cortical bone and begin to affect eh overlying mucoperiosteum
What information does a positive percussion test give us?
Although the percussion test does not indicate the health of the pulp, the sensitivity of the proprioceptive fibers reveals inflammation of the apical PDL
Indicates not only the presence of inflammation of the PDL but also the extent of the inflammatory process. The degree of response correlates with the degree of inflammation
What are some factors other than PDL inflammation due to infected pulp that may yield a positive percussion test result?
Rapid orthodontic movement of teeth
A recently placed restoration in hyperocclusion
Lateral periodontal abscess
The first percussion test should be performed with the clinican’s finer on a ___ tooth. If the patient is unable to discern, __ should be used.
Nonsuspect
Blunt handle of a mouth mirror (or have the painter bite on the reverse end of a low speed suction straw)
What chemical is endo-ice?
Dichlorodifluoromethane (-30C)
What portion of the tooth is a cotton pellet sprayed with endo ice applied?
Middle third of the facial surface of the crown
The pellet is kept in contact for 5 seconds or until the patient begins to feel pain
Describe the four possible responses to thermal testing
No response - nonvital pulp is indicated or it could be false negative due to excessive calcification or recent trauma
Mild-moderate degree of awareness w/slight pain that subsides writhing 1-2s = WNL
Strong, momentary painful response that subsidies within 1-2s - reversible pulpitis
Moderate to strong painful response that lingers for several seconds or longer after the stimulus has been removed - irreversible pulpitis
True or false… electrical pulp test does NOT suggest the health or integrity of the pulp; it simply indicates that there are vital sensory fibers present within the pulp
True
What information about vascular supply does electrical pulp testing provide?
No information
True or false… electrical pulp test readings directly correlate with the relative histological health or disease status of pulp
False. It does not correlate at all
What is the electrical pulp testing technique?
Teeth must be isolated and dried
Electrode of the pulp tester should be coated with a viscous conductor
Electrode should be applied to the dry enamel on the middle third of the facial surface of the crown
The current flow should be adjusted to increase slowly
The electrode should not be applied to any restorations (false reading)
Thicker enamel yields a more delayed response
Electrical pulp tester is contraindicated if pt has cardiac pacemaker
What can cause a false-positive electrical pulp test reading?
Electrode or conductor contact with a metal restoration or gingiva
Patient anxiety
Liquefaction necrosis may conduct current to the attachment apparatus
Failure to isolate and dry the teeth before testing
What can give a tooth a false-negative response in electrical pulp testing?
The patient has been heavily premedicated with analgesics, narcotics, alcohol, or tranquilizers
Inadequate contact between electrode or conductor and the enamel
A recently traumatized tooth
Excessive calcification of the canal
Recently erupted tooth with an immature apex
Partial necrosis
If a significant isolated pocket is discovered in the absence of periodontal disease, it increases the probability that it is a ___
Vertical root fracture
To distinguish disease of periodontal origin from disease of pulpal origin, ___ tests along with ___ are essential
Pulp vitality
Periodontal probing
_____ is directly proportional to the integrity of the attachment apparatus or to the extent of inflammation of the PDL
Tooth mobility
The pressure exerted by the ___ of a/an ____ may cause transient mobility of a tooth.
Purulent exudate of an acute apical abscess
What are some other causes of tooth mobility?
Horizontal root fracture in the coronal half of the tooth
Very recent trauma
Chronic bruxism
Overzealous orthodontic treatment
What is the selective anesthesia test?
This test can be used when the clinician has not determined through prior testing which tooth is the source of pain. Because diffusion of the local anesthetic is not limited to a single tooth, the clinician cannot make a conclusive diagnosis on the basis of pain relief
When is test cavity used?
This test is done only in cases where pulp necrosis is strongly suspected and corroborated by other tests and radiographic findings, but a definitive test is required.
A radiolucency does not begin to manifest until ___ extends into the ___ of the bone. Clinicians should not rely exclusively on radiographs to arrive at a diagnosis.
Demineralization
Cortical plate
Because a radiograph is a two-dimensional image only, radiographic strategy should involve the exposure of __ films at the same ___ angulation but with a __-___ degree change in ___ angulation
Two
Vertical
10-15
Horizontal
True or false… the status of the health and integrity of the pulp cannot be determined by radiographic images alone
True
A sudden change in appearance of a canal from dark to light indicates that the canal has __ or ____
Bifurcated or trifurcated
A ___ pulp does not cause radiographic changes until demineralization of the ____. Significant ___ bone destruction may occur before any radiographic signs start to appear
Necrotic
Cortical plate
Medullary
The dentist should always be cautious accepting prior diagnostic radiographs, no matter how recent they were made. Why
Prior iatrogenic mishaps such as ledge formation, perforation, or instrument separation are more likely to occur
Describe the SLOB rule
Same Lingual, Opposite Buccal
The object closest to the buccal surface appears to move in the direction opposite the movement of the tube head when compared to the second radiograph. Objects closest to the lingual surface appear to move in the same direction as the tube
Proper application of the SLOB rule allow the dentist to do what 6 things?
Locate additional canals/roots
Distinguish between superimposed objects
Differentiate various types of resorption
Determine buccal-lingual positions of fractures and perforation defects
Locate foreign bodies
Locate anatomic landmarks in relation to the root apex
What are radiographic differential diagnoses for apical radiolucencies?
1) vertical root fracture
2) lateral periodontal cyst
3) osteomyelitis
4) developmental cysts
5) traumatic bone cyst
6) Ameloblastoma
7) cemental dysplasia
8) cementoblastoma
9) central giant cell granuloma
10) systemic disease
11) odontogenic/nonodontogenic lesion
A long-standing vertical root fracture may be viewed as a variant of ___
Apical periodontitis
It may have an apical radiolucency
Tracing of the ___ and ___ responses to pulp vitality testing aid in establishing the diagnosis of a lateral periodontal cyst (as well as an apical radiolucency)
Lamina dura
Normal
Osteomyelitis has a highly variable radiographic appearance with __ and ___ processes occurring sometimes in the same patient.
Sclerotic
Osteolytic
An incisive canal cyst (nasopalatine duct cyst) may exhibit radiographic features similar to ___. Tooth vitality responses become particular important in differential diagnosis.
Apical periodontitis
A traumatic bone cyst usually reveals a ____ outlined radiolucent area of variable size sometimes with a ___ border. Pulp vitality testing is ___ in most cases.
Smooth (sometimes scalloped)
Sclerotic
Normal
Ameloblastoma s primarily occurs in the the __ and __ decade of life. They are aggressive lesions that occur as ___ radiolucencies. They frequently cause extensive ___ in the area.
Fourth and fifth
Multilocular
Root resorption
Cemental dysplasia lesions vary in radiograpic expression from ___ initially to more ___ later. It more commonly associated with ___ ___ ___ teeth.
Radiolucent
Radiopaque
Vital mandibular anterior
Radiographically, a cementoblastoma appears as a ____ mass often surrounded by ____. ___ has a similar radiographic apperance.
Well-circumscribed dense radiopaque
A thin, uniform radiolucent outline
Severe hypercementosis or chronic focal sclerosing osteomyelitis (condensing osteitis)
A ____ is a lesion that produces a radiolucent area with either a relatively smooth or ragged border showing faint trabeculae. Associated teeth are usually vital.
Central giant cell granuloma
____ gives rise to a generally radiolucent apperance of bone and later may give rise to well-defined oval or round radiolucency
Giant cell lesion of primary hyperparathyroidism
What are 5 clinical features of cracked tooth syndrome?
1) sustained pain during biting pressures
2) pain only on release of biting pressures
3) occasional, momentary, sharp, poorly localized pain during mastication that is very difficult to reproduce
4) sensitivity to thermal changes
5) sensitivity to mild stimuli, such as sweet or acidic foods
What teeth are most likely to experience cracked tooth syndrome?
Mandibular molars with a slight preference of the first molar over the second
What three methods are used to diagnose cracked tooth syndrome?
Trans illumination
Tooth slooth
Stain
How do you treat cracked tooth syndrome that has a healthy pulp or has reversible pulpitis?
Splint with an orthodontic band and observe or prepare for crown (place sound temporary crown and observe before placing permanent crown)
How do you treat cracked tooth syndrome for a tooth that has irreversible pulpitis or necrosis?
Endodontic treatment ( minimize the removal of tooth structure. Minimize condensation force)
Restoration (1. If sufficient tooth structure remains place a GI or acid-etched dentin-bonded core without a post to restore with permanent crown core material can go 2-3 mm into canal orifices. 2. If insufficient tooth structure remains, consider placing a post with margins of 2mm or more of sound tooth structure. Crown lengthening or extrusion or both may be necessary.)
What is the prognosis for a cracked tooth syndrome tooth that has presence and extend of an isolated probing?
Guarded prognosis
What is the prognosis of a cracked tooth syndrome tooth with an extension of the crack to the floor of the pulp chamber?
Guarded prognosis
What is the prognosis of a cracked tooth syndrome tooth with a fracture traceable all the way from mesial to distal?
Poor prognosis
A vertical root fracture starts __ and progresses ___. It is usually in the ___-___ plane of the root
Apically
Coronally
Buccal-lingual
True or false… in a vertical root fracture there is an isolated probing defect at the site of the fracture in most cases
True
What are the important diagnostic signs of a vertical root fracture?
Radiolucency from the apical region to the middle of the root (“J” shape or “teardrop” shape)
A vertical root fracture may mimic other entities such as __ or ___.
Periodontal disease
Failed RCT
Predisposing factors of a vertical root fracture are a weakening of the root structure usually by what three things?
Extensive enlargement of the canal during RCT
Mechanical stress from obturation
Unfavorable placement of posts
How do you diagnose a vertical root fracture?
Confirmed by visualizing the fracture with an exploratory surgical flap
The goal of treatment with a vertical root fracture is to ___. In single rooted teeth ___ should be performed. In multirooted teeth either ___ or ___ should be performed.
Eliminate the fracture space
Extraction
Extraction
Hemisection or root resection with removal of only the affected root
What is the prognosis for a vertical root fracture?
Hopeless
What are four ways in which the pulp and periodontium may communicate?
Dentinal tubules
Lateral or accessory canals
Furcation canals
Apical foramen
Endodontic pathosis can cause ___, but periodontal disease usually does not cause endodontic problems unless…
Periodontal disease
Periodontal disease involves the apex of the tooth
How can Periodontal treatment can affect pulpal health?
Periodontal treatment (SRP) can result in bacterial penetration into exposed dentinal tubules, which can cause thermal sensitivity and subsequent pulpitis
What is the clinical presentation of preimary periodontal lesions?
Periodontal disease is progressive - it starts in the sulcus and migrates to the apex as deposits of plaque and calculus produce inflammation that cause loss of surrounding alveolar bone and soft tissues
Manifestation of periodontal abscess during acute phase of inflammation
Broad-based pocket formation
Teeth are vital
Treatment = periodontal therapy
What is the clinical presentation of primary periodontal lesions with secondary endodontic involvement?
Deep pocketing with history of extensive periodontal disease
Possibly past treatment history
Treatment = endodontic therapy followed by periodontal therapy
What is the most important phase of the technical aspect of RCT?
Access preparation
Proper access preparation maximizes ___, ___, and ___.
Cleaning
Shaping
Obturation
what are the objectives of access preparation?
Straight-line access
Conservation of tooth structure
Unroofing of the chamber to expose orifices and pulp horns
Describe Gates-Gliddon
Long thin shaft with parallel walls and short cutting head, side cutting with safety tips
Used to preenlarge coronal canal areas; cut dentin as they are withdrawn from canal
