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NBDE Pt 2 Mosbeys > Endo > Flashcards

Endo Flashcards

1
Q

The pulp lacks ___ circulation, which severely limits its ability to cope with __, __ and ___.

A

Collateral

Bacteria

Necrotic tissue

Inflammation

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2
Q

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.

A

Odontoblasts

Mesenchymal

Osteoblasts

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3
Q

The sensibility of the dental pulp is controlled by __ and ___ afferent nerve fibers.

A

A-delta

C

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4
Q

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?

A

Large

Coronally

Immediately perceived as quick, sharp, momentary pain, which dissipates quickly upon removal of the stimulus

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5
Q

The intimate association of A-delta fibers with the odontoblastic cell layer and dentin is referred to as the ___ complex

A

Pulpodentinal

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6
Q

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.

A

Exaggerated

Disproportionate

hyperalgesia

Inflammatory mediators

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7
Q

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.

A

Seemingly remains

Dull, throbbing pain

C nerve

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8
Q

Describe C fibers

A

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.

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9
Q

When does C fiber pain surface?

A

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

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10
Q

True or false, with increasing inflammation of pulp tissues, C fiber pain becomes the only pain feature.

A

True

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11
Q

True or false… hot liquids or foods can increase intrapulpal pressure to levels that excite C fibers

A

True

The pain is diffuse and can be referred to a distant site or to other teeth

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12
Q

What happens with sustained inflammation?

A

It is detrimental to pulpal recovery, finally terminating in tissue necrosis.

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13
Q

Describe the signs/symptoms of a normal tooth.

A

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

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14
Q

In reversible pulpitis, thermal stimuli causes what kind of a response?

A

Quick, sharp, hypersensitive response that subsides as soon as the stimulus is removed

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15
Q

What kind of irritant can affect the pulp and may cause reversible pulpitis?

A

Early caries or recurrent decay

Periodontal SRP

Deep restorations without a base

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16
Q

True or false… reversible pulpitis is a disease not a symptom

A

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

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17
Q

What are the two ways reversible pulpitis (RP) can be clinically distinguished from a symptomatic irreversible pulpitis (IR)?

A

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.

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18
Q

What is the most frequent crossover point from RP to IP?

A

Frank penetration of bacteria into the pulp

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19
Q

True or false, symptomatic irreversible pulpitis may resolve if caries is removed.

A

False. By definition the pulp has been damaged beyond repair

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20
Q

What are microscopic findings of symptomatic irreversible pulpitis (SIP)?

A

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

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21
Q

What occurs following irreversible pulpitis?

A

Pulp death may occur quickly or may require years; it may be painful, or more frequently, asymptomatic. The end result is necrosis.

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22
Q

SIP is characterized by ___ pain

A

Spontaneous, unprovoked, intermittent or continuous

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23
Q

How do temperature changes affect a tooth with SIP?

A

Elicit prolonged episodes of pain that linger after the thermal stimulus is removed.

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24
Q

True or false. Radiographs are generally sufficient for diagnosing IP

A

False.

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25
Q

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

A

True

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26
Q

how are radiographs helpful in diagnosing SIP?

A

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.

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27
Q

True or false.. electrical pulp testing is an excellent way to diagnose SIP

A

False, it has little value

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28
Q

How does asymptomatic irreversible pulpitis (AIP) compare to SIP microscopically?

A

Very similar.

There are no clinical symptoms but inflammation produced by caries, caries excavation, or trauma occurs.

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29
Q

Pulp necrosis is death of the pulp that results from what three things?

A

Untreated irreversible pulpitis

Traumatic injury

Any event that causes long-term interruption of the blood supply to the pulp.

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30
Q

True or false… pulpal necrosis is all or none. How is this so?

A

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.

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31
Q

True or false… anterior teeth may show some discoloration in the crown due to necrosis

A

True

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32
Q

What occurs in the periapical space due to necrosis?

A

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.

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33
Q

Describe the microscopic findings of necrotic pulp

A

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)

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34
Q

What is hyperplastic pulpitis?

A

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.

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35
Q

What is internal resorption?

A

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

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36
Q

True or false.. a completely nonvital tooth can undergo internal root resorption.

A

False. Partial pulp vitality is necessary for active internal resorption.

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37
Q

Apical lesions of pulpal origin are ___ responses to irritants from the root canal system

A

Inflammatory

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38
Q

In regards to apical diseases, Patient symptoms may range from an asymptomatic response to various symptoms including…

A

Slight sensitivity to chewing

Sensation of tooth elongation

Intense pain

Swelling

Fever

Malaise

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39
Q

What is the most indicative sign of apical inflammatory lesions?

A

Radiographic bone resorption, but this is unpredictable. Apical lesions are frequently not visible on radiographs.

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40
Q

True or false.. there is no correlation between histologic findings and clinical signs, symptoms, and duration of the apical lesion.

A

True

The terms acute and chronic apply only to clinical symptoms

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41
Q

symptomatic apical periodontitis refers to painful inflammation around the apex and can result from…

A

Extension of pulpal disease into the apical tissue

Canal overinstrumentation or overfill

Occlusal trauma such as bruxism

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42
Q

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

A

True

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43
Q

Even with the presence of symptomatic apical periodontitis, the apical PDL may radiographically appear ___

A

Within normal limits or only slightly widened.

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44
Q

Is symptomatic apical periodontitis painful during percussion tests?

A

It may be

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45
Q

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, ___

A

Simple occlusal adjustment

Additional

Acute apical abscess

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46
Q

What often causes throbbing apical pain in symptomatic apical periodontitis?

A

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

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47
Q

In histopahtologic examination of symptomatic apical periodontitis reveals a localized inflammatory infiltrate within the ___

A

PDL

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48
Q

Asymptomatic apical periodontitis is a ___, ___ lesion.

A

Long-standing, asymptomatic or mildly symptomatic lesion

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49
Q

True or false, asymptomatic apical periodontitis is usually accompanied by radiographically visible apical bone resorption.

A

True

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50
Q

In AAP, bacteria and their endotoxins cascading out into the apical region from a necrotic pulp cause extensive ___ of __ and __ bone.

A

Demineralization

Cancellous and cortical

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51
Q

True or false… there is always extreme tenderness to percussion or palpation in AAP

A

False. There may be slight tenderness

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52
Q

How is asymptomatic apical periodontitis diagnosis confirmed?

A

General absence of symptoms

Radiographic presence of an apical radiolucency

Confirmation of pulpal necrosis

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53
Q

A totally necrotic pulp provides a safe harbor for the primarily ___ microorganisms. If there is no vascularity, there are no ___ cells

A

Anaerobic

Defense

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54
Q

AAP traditionally has been classified histologically as ___ or ___. The only accurate way to distinguish them is by ___ examination.

A

Apical granuloma or apical cyst

Histopathologic

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55
Q

What is an acute abscess?

A

Painful with purulent exudate around the apex

It is a result of exacerbation of symptomatic apical periodontitis from a necrotic pulp

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56
Q

How does an apical abscess look radiographically?

A

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)

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57
Q

What is the only sign of an acute abscess?

A

Swelling

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58
Q

Acute abscess lesions can also result from infection and rapid tissue destruction arising from within ___

A

Asymptomatic apical periodontitis

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59
Q

What are the histopathologic findings of an acute abscess?

A

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

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60
Q

What are the presenting signs and symptoms of an acute apical abscess?

A

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)

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61
Q

How can an acute apical abscess be differentiated from a lateral periodontal abscess?

A

Pulp vitality testing and sometimes with periodontal probing.

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62
Q

What is a chronic apical abscess?

A

Associated with either a continuously or an intermittently draining sinus tract without discomfort

63
Q

The exudate of a chronic apical abscess can also drain through the ___, mimicking a ____

A

Gingival sulcus

Periodontal lesions with a “pocket”.

64
Q

Do teeth with a chronic apical abscess respond to pulp vitality tests?

A

No, they have a necrotic pulp

65
Q

Describe the radiographic findings of a chronic apical abscess.

A

Presence of bone loss at the apical area

66
Q

What is the treatment of a chronic apical lesion sinus tract?

A

Sinus tracts resolve spontaneously with nonsurgical endodontic treatment.

67
Q

What is condensing osteitis?

A

Excessive bone mineralization around the apex of an asymptomatic vital tooth

Radiopacity may be caused by low-grade pulp irritation

68
Q

True or false… condensing osteitis requires immediate RCT

A

False. The process is asymptomatic and benign. It does not require endodontic therapy

69
Q

When a patient presents with orofacial pain the cause must be differentiated between ___ and ___

A

Odontogenic

Nonodontogenic

70
Q

What are some characteristics of nonodontogenic involvement? (Name 7)

A

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

71
Q

Endodontic treatment is not contraindicated with most medical conditions. What are the only two systemic contraindications to endodontic therapy?

A

Uncontrolled diabetes

Recent MI (within the past 6 months)

72
Q

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.

A

PDL

Pain

73
Q

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).

A

Proprioceptive sensory

Percussion

74
Q

True or false… pain can be referred to adjacent teeth or in the opposing quadrant.

A

True

75
Q

True or false.. odontogenic pain commonly crosses the midline of the head

A

False, it is rare

76
Q

In ____, pain can often be referred to the opposing quadrant or to other teeth in the same quadrant

A

Posterior molars

77
Q

Maxillary molars often refer pain to the ___, ___ and ___ regions of the head. Mandibular molars frequently refer pain to the ___, ___, or ____

A

Zygomatic
Parietal
Occipital

Ear
Angle of the jaw
Posterior regions of neck

78
Q

Define mode

A

The onset of symptoms spontaneous or provoked (i.e. sudden or gradual). If stimulated, are they immediate or delayed.

79
Q

Define periodicity

A

The temporal pattern of the pain (sporadic or occasional)

80
Q

When assessing the hx of tooth pain, what 4 qualities of pain should be identified?

A

Mode

Periodicity

Frequency

Duration (how long do symptoms last)

81
Q

How does pain with a bony origin appear?

A

Dull, gnawing, aching

82
Q

How does pain due to vascular response to tissue inflammation appear?

A

Throbbing, pounding, or pulsating

83
Q

How does pain due to pathosis of nerve root complexes, sensory ganglia, or peripheral innervation (irreversible pulpitis or trigeminal neuralgia) appear?

A

Sharp

Electrical

Recurrent

Stabbing

84
Q

How does pain in pulpal or apical pathoses appear?

A

Aching

Pulsing

Throbbing

Dull

Gnawing

Radiating

Flashing

Stabbing/jolting

85
Q

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?

A

Heat, cold, biting, chewing

Lying down or bending over (due to Chang in blood pressure to head and in pulp)

86
Q

After you ask the pt about provoking factors, ask about ___ factors. These are factors that relieve pain.

A

Attenuating

87
Q

How are sinus tracts traced?

A

With gutta-percha point by radiograph

88
Q

True or false… asymptomatic apical periodontitis has a + response to percussion.

A

False. The only way to diagnose this is a periapical radiolucency, all other symptoms are negative.

89
Q

True or false… acute apical abscess will have negative thermal testing response but positive percussion response.

A

True

90
Q

How is a chronic apical abscess diagnosed?

A

“Bump in the gum” and PRL

Negative thermal testing and percussion

91
Q

Describe why an apical area of a tooth would be palpation sensitive.

A

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

92
Q

What information does a positive percussion test give us?

A

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

93
Q

What are some factors other than PDL inflammation due to infected pulp that may yield a positive percussion test result?

A

Rapid orthodontic movement of teeth

A recently placed restoration in hyperocclusion

Lateral periodontal abscess

94
Q

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.

A

Nonsuspect

Blunt handle of a mouth mirror (or have the painter bite on the reverse end of a low speed suction straw)

95
Q

What chemical is endo-ice?

A

Dichlorodifluoromethane (-30C)

96
Q

What portion of the tooth is a cotton pellet sprayed with endo ice applied?

A

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

97
Q

Describe the four possible responses to thermal testing

A

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

98
Q

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

A

True

99
Q

What information about vascular supply does electrical pulp testing provide?

A

No information

100
Q

True or false… electrical pulp test readings directly correlate with the relative histological health or disease status of pulp

A

False. It does not correlate at all

101
Q

What is the electrical pulp testing technique?

A

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

102
Q

What can cause a false-positive electrical pulp test reading?

A

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

103
Q

What can give a tooth a false-negative response in electrical pulp testing?

A

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

104
Q

If a significant isolated pocket is discovered in the absence of periodontal disease, it increases the probability that it is a ___

A

Vertical root fracture

105
Q

To distinguish disease of periodontal origin from disease of pulpal origin, ___ tests along with ___ are essential

A

Pulp vitality

Periodontal probing

106
Q

_____ is directly proportional to the integrity of the attachment apparatus or to the extent of inflammation of the PDL

A

Tooth mobility

107
Q

The pressure exerted by the ___ of a/an ____ may cause transient mobility of a tooth.

A

Purulent exudate of an acute apical abscess

108
Q

What are some other causes of tooth mobility?

A

Horizontal root fracture in the coronal half of the tooth

Very recent trauma

Chronic bruxism

Overzealous orthodontic treatment

109
Q

What is the selective anesthesia test?

A

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

110
Q

When is test cavity used?

A

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.

111
Q

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.

A

Demineralization

Cortical plate

112
Q

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

A

Two

Vertical

10-15

Horizontal

113
Q

True or false… the status of the health and integrity of the pulp cannot be determined by radiographic images alone

A

True

114
Q

A sudden change in appearance of a canal from dark to light indicates that the canal has __ or ____

A

Bifurcated or trifurcated

115
Q

A ___ pulp does not cause radiographic changes until demineralization of the ____. Significant ___ bone destruction may occur before any radiographic signs start to appear

A

Necrotic

Cortical plate

Medullary

116
Q

The dentist should always be cautious accepting prior diagnostic radiographs, no matter how recent they were made. Why

A

Prior iatrogenic mishaps such as ledge formation, perforation, or instrument separation are more likely to occur

117
Q

Describe the SLOB rule

A

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

118
Q

Proper application of the SLOB rule allow the dentist to do what 6 things?

A

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

119
Q

What are radiographic differential diagnoses for apical radiolucencies?

A

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

120
Q

A long-standing vertical root fracture may be viewed as a variant of ___

A

Apical periodontitis

It may have an apical radiolucency

121
Q

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)

A

Lamina dura

Normal

122
Q

Osteomyelitis has a highly variable radiographic appearance with __ and ___ processes occurring sometimes in the same patient.

A

Sclerotic

Osteolytic

123
Q

An incisive canal cyst (nasopalatine duct cyst) may exhibit radiographic features similar to ___. Tooth vitality responses become particular important in differential diagnosis.

A

Apical periodontitis

124
Q

A traumatic bone cyst usually reveals a ____ outlined radiolucent area of variable size sometimes with a ___ border. Pulp vitality testing is ___ in most cases.

A

Smooth (sometimes scalloped)

Sclerotic

Normal

125
Q

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.

A

Fourth and fifth

Multilocular

Root resorption

126
Q

Cemental dysplasia lesions vary in radiograpic expression from ___ initially to more ___ later. It more commonly associated with ___ ___ ___ teeth.

A

Radiolucent

Radiopaque

Vital mandibular anterior

127
Q

Radiographically, a cementoblastoma appears as a ____ mass often surrounded by ____. ___ has a similar radiographic apperance.

A

Well-circumscribed dense radiopaque

A thin, uniform radiolucent outline

Severe hypercementosis or chronic focal sclerosing osteomyelitis (condensing osteitis)

128
Q

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.

A

Central giant cell granuloma

129
Q

____ gives rise to a generally radiolucent apperance of bone and later may give rise to well-defined oval or round radiolucency

A

Giant cell lesion of primary hyperparathyroidism

130
Q

What are 5 clinical features of cracked tooth syndrome?

A

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

131
Q

What teeth are most likely to experience cracked tooth syndrome?

A

Mandibular molars with a slight preference of the first molar over the second

132
Q

What three methods are used to diagnose cracked tooth syndrome?

A

Trans illumination

Tooth slooth

Stain

133
Q

How do you treat cracked tooth syndrome that has a healthy pulp or has reversible pulpitis?

A

Splint with an orthodontic band and observe or prepare for crown (place sound temporary crown and observe before placing permanent crown)

134
Q

How do you treat cracked tooth syndrome for a tooth that has irreversible pulpitis or necrosis?

A

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.)

135
Q

What is the prognosis for a cracked tooth syndrome tooth that has presence and extend of an isolated probing?

A

Guarded prognosis

136
Q

What is the prognosis of a cracked tooth syndrome tooth with an extension of the crack to the floor of the pulp chamber?

A

Guarded prognosis

137
Q

What is the prognosis of a cracked tooth syndrome tooth with a fracture traceable all the way from mesial to distal?

A

Poor prognosis

138
Q

A vertical root fracture starts __ and progresses ___. It is usually in the ___-___ plane of the root

A

Apically

Coronally

Buccal-lingual

139
Q

True or false… in a vertical root fracture there is an isolated probing defect at the site of the fracture in most cases

A

True

140
Q

What are the important diagnostic signs of a vertical root fracture?

A

Radiolucency from the apical region to the middle of the root (“J” shape or “teardrop” shape)

141
Q

A vertical root fracture may mimic other entities such as __ or ___.

A

Periodontal disease

Failed RCT

142
Q

Predisposing factors of a vertical root fracture are a weakening of the root structure usually by what three things?

A

Extensive enlargement of the canal during RCT

Mechanical stress from obturation

Unfavorable placement of posts

143
Q

How do you diagnose a vertical root fracture?

A

Confirmed by visualizing the fracture with an exploratory surgical flap

144
Q

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.

A

Eliminate the fracture space

Extraction

Extraction
Hemisection or root resection with removal of only the affected root

145
Q

What is the prognosis for a vertical root fracture?

A

Hopeless

146
Q

What are four ways in which the pulp and periodontium may communicate?

A

Dentinal tubules

Lateral or accessory canals

Furcation canals

Apical foramen

147
Q

Endodontic pathosis can cause ___, but periodontal disease usually does not cause endodontic problems unless…

A

Periodontal disease

Periodontal disease involves the apex of the tooth

148
Q

How can Periodontal treatment can affect pulpal health?

A

Periodontal treatment (SRP) can result in bacterial penetration into exposed dentinal tubules, which can cause thermal sensitivity and subsequent pulpitis

149
Q

What is the clinical presentation of preimary periodontal lesions?

A

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

150
Q

What is the clinical presentation of primary periodontal lesions with secondary endodontic involvement?

A

Deep pocketing with history of extensive periodontal disease

Possibly past treatment history

Treatment = endodontic therapy followed by periodontal therapy

151
Q

What is the most important phase of the technical aspect of RCT?

A

Access preparation

152
Q

Proper access preparation maximizes ___, ___, and ___.

A

Cleaning

Shaping

Obturation

153
Q

what are the objectives of access preparation?

A

Straight-line access

Conservation of tooth structure

Unroofing of the chamber to expose orifices and pulp horns

154
Q

Describe Gates-Gliddon

A

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

NBDE Pt 2 Mosbeys (2 decks)

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