ENDO Flashcards
Pulp contains:
lymphatic, nerves, loose fiborus CT
Firboblasts
Odontoblasts
undiff mesenchymal
T/F. Pulp has collateral circulation
FALSE.
dose not
Access prep for molar (max)
blunted triangle or rhomboid
T/F. Secondary odotoblasts secrete secondary dentin
FALSE. Secrete tertiary dentin to protect the pulp form injury
_____ = calcification of denitn tubules in response to slow adv caries /aging
sclerotic denitn
_____ dentin is made in response to minor damage
Reactionary (secondary) Dentin
Histologic zones of pulp (5) outter most to inner most
predentin ( non-mineralized layer b/w dentin and pulp)
odontoblastic layer ( nuclie - odont laying down dentin)
cell-free zone of Weil ( nerve bundles)
cell rich zone ( nuclei)
Pulp core
T/F. CaOH is used as a liner in pulp caps to irritate the odontoblasts to make reatctionary/reparitve dentint
TRUE
Size : color 10 15 25 30 35 40
10 - purople 15- white 25 - red 30 green 35 - blue 40- black
Tooth has been traumatized . Exam shows tooth displaced palatally
Lateral Luxation
alveolar fx
tx: Open apex = reposition, flexible splint, monitor
closed apex = repostion, flexible splint , RCT if necc
80% of necrosis with closed apex
the orifice location of the fourth canal common to tooth #3
Palatal to the orifice of the mesiobuccal canal
How long after endo therpay shld you see healing
6-12 mo
A clinician can expect bone to be redeposited in the apical area after RCT- when the lesion is healed, osteoblasts form a collagen matrix. Calcification of the collagen matrix typically occurs within 6-12 mo
The rule of thumb for post preparation is
that you prepare the canals so that ½ of the root has gutta percha remaining (or about 5 mm+)
Posts typically weaken the tooth because the removal of dentin causes stress and further thins the walls of the root, predisposing the root to fracture.
T/F. Teeth with sinus tracts do NOT require antibiotics because the infection drains.
TRUE.
The tooth should be treated with a RCT.
The sinus tract should heal w/i a month of the RCT. Root-end surgery should be performed if the tract persists after the RCT.
______ determines vitality of tooth
vascular supply
___1__ is CI in testing pulp with patients with __2__.
- EPT
2. Cardica pacer
spontaneous pain ; intermittent ; lingering
Irreversible pulpits
_____ is an irrigant and dissolves organic material
NaOCl ; bleach
organic ( bacteria)
____ is used to open orifice for straigh-line acess
Gates-glidden
Bacteria involved when an endo treatment FAILS
Enterococcus Faecalis
(repopulated with bac )
gram + facultative bac
_____ is the reduces threshold of pain , pain d/t stimulus that does not normally produce pain
Allodynia
Preaucricular pain is most commonly refered from?
Mand molar ( V3)
_____ is the heightened response to pain
Hyperalgesia
Dentin Pain nerves
A- delta fibers and C fibers
AD (large myleinated ; afferent- carrying form periph to center ; first sharp pain ; course coronally COLD)
Pulpitis Pain nerves
C fibers
C: small unmylinated ; course centrally in pulp ; ; dull throbbing second pain ; HEAT
Dicholordifloromethane =
Endo ICE for pulpal diagnosis
-30 C to DRY middle third of facial
EPT is the _____ test
Least reliable test ; doesnt give dx of pulp
tells if there are Vital sensory FIBERS
____ is made in response to major damage to dentin
Reparative (tertiary) dentin
____ dissolves Gutta percha
Cholorofrom
No pain on percussion or palpation
Normal Periapical Periodontitis
*main dx tools for periapical dx
Apical radiolucency ; asymptomaitc to percussion/palpation
Asymptomatic periapical Periodontitis
- confrimatin of pulpal necrosis*
painful percussion ; intense throbbing pain
symptomatic periapical Periodontitis
endo therapy necc
caused by localized inflamm infiltrate w/i PDL
Tx for root perforation
STOP. Repair with MTA .
s/s - immediate hemorrhage ; pain ( may not be numb at that part of the PDL)
the more apical has better prognosis
Pain w/ stimulus ; wears off ; quick sharp hypersensative
Reversible pulpitis
Danger zone
distal of mesial root of mand molar
easy to perforate ( less dentin ; mesial has more dentin)
Truama protpcol
Tetanus (avulsions) Radiogrpahs Abx (avulsions) Vitality testin More Appts ( following up)
Draining sinus tract , usually with pain/discomfort
Chronic Apical Abscess
Shape of H-file
sprial cone * teardrop cr sxn*
only cuts in retraction
Access prep for canine
oval/oviod
Which pm most likely to have two roots (canals)
Max 1st PM
hand files made from
Stainless steel
K-kerr- File
H-Hedstrom
- 02 taper in K
- 04-0.06 in H
A 0.02 taper indicates an increase of 0.02 mm in diameter per 1 mm of file length.
Access prep for pms
narrow oval
Rapid swelling, severe pain, purulent exudate around apex
Acute apical Abscess
Access prep for molar (mand)
trapezoidal
Rotary files are made of
NiTi
0.04 or 0.06 taper
Shape of K-file
twisted square
used in watch winding motion
what is the prognosis if the file breaks later in the RCT
better
b/c the canal is more cleaned out dec bac
In periapical microsurgery how much canal shld be filled
3mm
3mm root tip removed
0-10 degree bevel
What to do if ledge created?
use smaller file to bypass ; use flexible NiTi files ( likley to fx)
(also with instrument separation)
prevention ( replace files, use EDTA
Ellis class of trauma
1 : enamel only
2: enamel and dentin
3: enamel dentin pulp
4: traumtized tooth thats now non-vital
5: luxation
6: avulsion
uncomplicated fx involves
enamel and dentin (NO PULP involvement)
if enamel only > smooth edges
if both enamel and dentin > restore
______ is a lubircant, and dissolves INORGanic material ; acts as a CHELATING agent
EDTA
inorganic ( smear layer of dentin made w/files)
Tooth that has a coronal horizontal fx has ___ chance of becoming/being necrotic ( coronal portion)
25 % chance of coronal part being necrotic
very rare apical necrosis
EDTA stands for
EthyeneDiamine Tetraacetic Acid (EDTA)
TX for horizontal fx
xray = 3 PAs 1 Occlusal
if vital = splint
if necrotic = RCT
How long to splint vital traumatized tooth that has been fx?
Coronal = RIGID 6-12 wks
Mid root = flexible 3 wks
Apical = flex 2 wks max to avoid ankylosis
complicated fx involves
pulp ( + enamel and dentin)
Tx:
<24hrs = direct pulp cap
24hrs + = Cvek (partial) pulpotomy
72hrs = full pulpotomty
Tooth has been traumatized . Exam shows tooth apically displaced
Intrusion
tx:
open apex = allow to re-erupt
closed apex = repostion, splint, RCT
96% of necrosis with closed apex
Tooth has been traumatized . Exam shows tooth out of mouth
Avulsion
tx: replant, flex splint 1-2wks , RCT
** NVR in PEDO ***
Tooth is sensitive to percussion and does NOT have a periapical radiolucency
Symptomatic Periapical Periodontitis
Tooth has been traumatized but shows no displacement or mobility, but the PDL is sore
concussion
tx: let tooth rest
__________i s diagnosed by the presence of a lingering sensitivity after the cold stimulus is removed; may or may not elicit spontaneous pain.
Irreversible pulpitis (IP)
I and D : soft tissue as _____: hard tissue/bone
trephination
In periapical microsurgery how much root tip tobe removed
3mm
main ingredient in GP and sealer
ZOE - zinc oxide eugenol
_________ always demonstrates a periapical radiolucency and may or may not elicit pain on percussion and palpation; ____ also manifests a sinus tract.
Chronic apical abscess (CAA)
In periapical microsurgery angle of bevel of root tip tobe removed
0-10 degrees
Bacteria responsible for primary endo infxn
Bacteroides
1st time
gram - obligate anaerobes ( cnt live in O2)
Sodium hypochlorite is used to do the following(4) :
Dissolve the organic matter
Kill bacteria
Lubricate the canal
Irrigate the canal
____________ is used for vital tooth bleaching (external bleaching).
Carbamide peroxide
Which type of trauma is least likely to result in pulpal necrosis?
Concussion
No tooth mobility or displacement, but it can present with pain on percussion.
Tooth has been traumatized . Exam shows tooth displaced from socket
Extrusion
tx: Open apex = reposition, flexible splint, monitor
closed apex = repostion, flexible splint , RCT if necc
65% of necrosis with closed apex
_______ is the treatment of choice for teeth with non-vital pulps resulting from trauma.
Root canal therapy
Teeth that do not respond to vitality testing are considered non-vital and possess a necrotic pulp.
Apical disease causes sensitivity to ___1___ & ___2___ regardless of restoration type.
percussion and palpation
Periapical radiolucencies can only be visualized
after the cortical bone surrounding the root apex is destroyed and the infection extends into the cancellous bone of the periosteum.
An electric dental pulp vitality test (EPT) is contraindicated just after a traumatic injury mainly because
a negative response may be temporary because the neural transmission was interrupted.
What is the most important factor for disinfection of a root canal?
Complete mechanical debridement
________ is an injury to the tooth-supporting structures. It results in increased mobility but does not displace the tooth. Bleeding from the gingival sulcus confirms the diagnosis.
Subluxation
the function of calcium hydroxide in apexification?
Creation of a High pH conducive to bone growth
Calcium hydroxide creates an alkaline environment that helps to calcify the root apex, which closes the root end of the pulpless tooth.
Periapical cemental dysplasia in its early stages is best differentiated clinically from an apical abscess by
pulp testing
A vital pulp designation suggests that the radiolucency is most likely due to other causes.
During the first phase of periapical cemental dysplasia or the osteolithic phase, there is usually bone loss seen predominantly along the apices of the mandibular central incisors. This radiolucency is usually mistaken as an apical abscess.
The presence of an intact lamina dura along the apical portion of the involved tooth also shows that the radiolucency did not come from an infected tooth.
The location of the apical foramen in relation to the anatomical apex is
0.5–1.0 mm from the anatomic apex.
Subluxation tx?
Flexible Splint 1-2 weeks
6% chance of necrosis with closed apex ; more favorable with open
Gutta-percha is an obturation material that is composed of the following (3) :
- Zinc oxide (70%)
- Barium sulfates (5%)
- Waxes, resins, and gutta-percha (24%)
describe functions of the pulp (4)
- Sensory (detecting heat, cold, and pressure)
- Nutritive (supplies nutrients necc to maintain the nerve cells and odontoblasts)
- Formative (forms 1 and 2 dentin by odontoblasts)
- Defensive (forms reparative dentin d/t carious insult.)
what has the greatest impact on the success of a pulpotomy performed on a primary molar?
The success of a pulpotomy procedure lies on the ability of the remaining healthy pulp to remain vital and not irreversibly inflamed after the procedure.
The ___1___ technique is an intracoronal bleaching technique which uses a mix of ____2___ and ___3___ or sterile water to create a paste to be sealed into the pulp chamber for ____days.
- walking bleach
- sodium perborate &
- anesthetic
- 14–21
Tooth has been traumatized . exam shows no displacement, inc mobility, bleeding in sulcus
Subluxation (PDL is ripped and bleeding)
tx: Flexible Splint 1-2 weeks
Cracks typically extend ______ deep into dentin in posterior teeth.
mesiodistally
They typically begin to propagate in the region of the marginal ridges.
In __________________, the permanent tooth bud is affected by an infection or a trauma to a primary tooth. Infection most commonly affects the canine, and trauma most commonly affects the maxillary central incisor.
Turner tooth (Turner hypoplasia)
The second mesiobuccal (MB2) canal is located ________ and is observed in 68–98% of permanent maxillary first molars.
lingual to the orifice of the mesiobuccal canal (MB1)
________ is added to gutta-percha to make the material opaque on x-ray films.
Barium
most common reason ledges are formed during endodontic procedures
Unachieved straight line access
The most common adverse effect of internally bleaching a tooth with superoxide is ______
external cervical root resorption.
It is recommended to keep the preparation length 0.5–1‑mm short of the ______ ______ during root canal treatment.
radiographic apex
Replacement root resorption happens more commonly among patients who suffered severe cases of __1__ & _____2____.
avulsion and luxation.
Immediately after tooth trauma, what clinical findings is least informative for determining the prognosis of the tooth?
Vitality
Debris is forced in a coronal direction when rotating intruments are used in a ______ direction and vice versa.
clockwise
To prevent broken or separated instruments, an instrument that is locked into the dentin should not be _______.
rotated
The ______________of the mandibular first molar is most likely to undergo strip perforation during root canal instrumentation.
distal surface of the mesial root
____________ demonstrate the most consistent root canal morphology.
Maxillary canines
The maxillary canine is known to be the longest tooth with the longest root in the oral cavity. The root is also relatively straight, with only some slight palatal or labial tipping along its apex ; only one root canal most of the time. The canal diameter is relatively large and oval-shaped when viewed in cross-section.
A healthy pulp does not contain ________, because they are stimulated to migrate to the pulp with inflammation and infection.
plasma cells
A____- fracture may become more visible after root canal treatment, because the sealer flows out of the space in between the fractured pieces.
mid-root
_______ is a chelating solution used to remove inorganic components.
EDTA
Indications for apicoectomy:
- Persistant patho s/p RCT
- PARL lesion that enlarges s/p RCT
- Marked overxtn of obturation matieral stopping healing
- Apical portion of the root w/patho cant be cleaned/ect
- Failed existing RCT, cant retreat
contraindication for CaOH:
Pulp symptomatic for last month..
% EDTA
17
Chelating agents are good for sclerotic/calcified canals. Substitute sodium ions and soften
If a tooth with previous RCT becomes reinfected, it is best
to retreat it conventionally by removing the filling material, debride the canals, and refill.
However, if the tooth has been restored with a post, core, and crown, then apical curettage, then an apicoectomy and retrofill
Pulp is vital, pt’s a 8 year old. Apex is open. What do you do.
CaOH pulpotomy
Avulsion of tooth with open apex ; EDT <60min tx?(or kept in soln)
Clean tooth w/saline
Irrigate socket w/saline
Gently replant
Stablize with FLEX splint 1 wk ( or min mobility)
Follow up apt for pulp vitality/root development
If vitality doesnt not return -> Apexififcation
Reason for failure of replantation of avulsed tooth:
external resorption
Most important factor about avulsed tooth –
time
Avulsion of tooth with closed apex ; EDT <60min tx?
or kept in soln
Clean tooth w/saline Irrigate socket w/saline Gently replant Stabilize with FLEX splint 1 wk ( or min mobility) RCT at time of splint removal
why wld an implanted avulsed tooth fail:
too much extra oral time
What causes Pink Tooth Mummery?
internal resorption
treatment for internal resorption (endo):
RCT
The treatment-of-choice for an external inflammatory root resorption on a non-vital tooth is which of the following?
a.EXT
b. Surgical curettage of the affected tissue
C. Pulpectomy and obturation with gutta-percha and sealer
D.Removal of the necrotic pulp and placement of calcium hydroxide
E.Observation since it is a self-limiting process
D.Removal of the necrotic pulp and placement of calcium hydroxide
PMN cells
: Most common cell in necrotic pulp = PMN cells
Which of the following is not a property of gutta-percha . radiopacity, Biocompatibility, Antibacterial, Adaptation
Adaptation
GP dsnt adhere-needs sealer
Most common cause of vertical rt fracture?
In endo tx’d teeth: excessive lateral condensation of GP
In vital teeth: physical trauma
Chronic endo lesion, what type of bacteria?
Anerobes ANS (multiple anerobes)
bacterial
Advantages of using nickel titanium endo files over regular steel files
flexibility
bending memory
Remain centered
Stronger
DIS = more likely to fx
NiTi rotary files remain better centered, produce less transportation, and instrument faster than stainless steel files due to their superior flexibility and resistance to torsional fracture. They have 10x the stress resistances of stainless steel (stronger).
when does translumination shows the whole crown :
c) craze lines
Vertical Root Fracture is most likely found?
Mand posteriors
Mandibular second molars, followed by mandibular first molars and maxillary premolars are the most commonly affected teeth.
Taurodontism has enlarged pulp chamber in which direction?
apical,
trephination define
Trephination is a procedure in which the alveolar cortical plate or the apical foramen is surgically perforated in order to release accumulated tissue exudate. During the process, a minor vertical incision is made next to the tooth, and the mucosa is pulled back. This provides the sufficient drainage.
Xray shows internal ressorption in canal next thing to do ?
CBCT then RCT
prevent lateral resorption of periodontium
The diagnosis of pulpal status is predicated upon assessing the amount or extent of
A- Decay
B- Pain
C- Inflammation
D- Pathologic resorption
C
