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Endodontics > Endo board review > Flashcards

Endo board review Flashcards

1
Q

What is the most common cell type of the pulp

A

fibroblasts

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2
Q

what are the pulpal cell zones

A

-pulp proper -cell rich zone odontoblasts predentin dentin

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3
Q

Where are the undifferentiated mesenchymal cells and what do they do

A

cell rich zone replace irreversibly damaged odontoblasts

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4
Q

What are the three main types of dentin

A

Predentin secondary dentin tertiary dentin

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5
Q

What is predentin

A

unmineralized dentin

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6
Q

what is secondary dentin

A

dentin that is physiologically formed after root development is complete

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7
Q

what are the types of tertiary dentin

A

reactionary and reparative

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8
Q

what is reationary dentin

A

tertiary dentin that is produced in response to irritation by ORIGINAL odontoblasts

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9
Q

what is reparative dentin

A

tertiary denting that is produced in response to irritation by recruited undifferentiated mesenchymal cells after the original odontoblasts are destroyed

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10
Q

how many dentinal tubules per sq mm are at the DEJ/CEJ vs pulpal wall

A

10-25K vs 30-52K

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11
Q

What are the diameter of dentinal tubules at the DEJ/CEJ vs pulpal wall

A

1-2 microns v 3-4

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12
Q

What is dentin by Volume

A

45% inorganic 33% organic 22% water

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13
Q

Whats the hydrodynamic theory and who proposed it

A

Brannstrom Fluid movement inside exposed dentinal tubules caused by heat, cold, air, probing, etc stimulates the A delta fibers causing dentinal hypersensitivity

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14
Q

What are the afferent nerve types of the pulp

A

–A-δ: large, myelinated; quick, sharp, shooting pain; fully formed 3-5 yr post eruption –A-β: myelinated, but few in # –C: small, unmyelinated; delayed, dull, aching, or burning sensation

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15
Q

What are the efferent

A

–C: sympathetic fibers – vasoconstriction

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16
Q

What are the proprioceptive fibers of the pulp

A

trick question there are none

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17
Q

What is the pulpal response to caries

A

Inflammatory reaction precedes bacteria “Chronic” response –Predominant cells: lymphocytes, macrophages “Acute” response – 0.5mm Edema – localized Microabscess Pressure - localized Degeneration # bacteria vs inflammatory response

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18
Q

what is meant by the pathogen transition

A

Aerobic  Anaerobic (facultative anaerobes  obligate anaerobes)

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19
Q

What does kakehashi 65 tell us

A

Abiotic mice had no issues so…No bacteria … no periapical pathosis

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20
Q

Radiographic signs of additional canals

A

Sudden canal disappearance Sudden reduction in density –May represent canal division Root outline unclear –May represent additional roots Canal not centered in root

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21
Q

Radiographic signs of internal resorption

A

Enlarged canal area Canal not evident through lesion Usually symmetrical Well-defined margins Stays centered on canal with change in horizontal angulation

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22
Q

Radiographic signs of external resorption

A

Canal evident through lesion Usually asymmetrical Poorly-defined margins Shifts off canal with change in horizontal view

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23
Q

What is our endo diagnostic goal

A

Reproduce, Alter or Eliminate the Chief Complaint

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24
Q

What are the limitations of endo diagnosis

A

Diagnostic testing – imprecise Patient processing and feedback - imprecise Lack of pulpal proprioception (cannot localize) Referred pain Misdiagnosis by referring dentist

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25
Q

Do pulpal test evaluate nerve response or pulpal blood flow

A

nerve response,

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26
Q

What chemical do we use for cold testing

A

Tetrafluoroethane … -14° F

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27
Q

How should you properly cold test

A

“Educate” patient … why, how, what Use large, fluffy cotton pellet Establish controls Facial surface Directly on metal restorations OK?? Alternatives … ice, immersion

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28
Q

What might cause a false positive to thermal testing

A

–Anxiety –Gingival response –Adjacent teeth –Saliva –Periradicular response

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29
Q

what might cause a false negative response to thermal testing

A

–Calcified canals –Inadequate stimulus –Restorations –Immature tooth –Trauma

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30
Q

when might you use cold immersion and how?

A

CC not duplicated with Endo Ice Cracks, open margins, can’t localize Simulates “real-world” activity Single tooth RD isolation Establish control responses first

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31
Q

When and how to use hot immersion

A

Heat is primary factor of CC Cold test inconclusive Single tooth RD isolation Establish control responses first 150 F

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32
Q

What can you infer from EPT

A

No diagnostic value with vital pulp pathosis May defer if teeth respond to thermal test Implies only pulpal vitality or necrosis via negative nerve response A “yes or no” result … ignore the number

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33
Q

What may cause a false positive EPT

A

–Anxiety –Restorations –Gingival conduction

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34
Q

What may cause false negative EPT

A

–Inadequate contact –Immature tooth –Recent trauma

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35
Q

What are the different pulpal dx

A

Normal Reversible pulpitis Symptomatic irreversible pulpitis Asymptomatic irreversible pulpitis Pulpal necrosis Previously initiated therapy Previously treated

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36
Q

What are the different apical dx

A

Normal apical tissues Symptomatic apical periodontitis Asymptomatic apical periodontitis Acute apical abscess Chronic apical abscess Condensing osteitis

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37
Q

Symptomatic apical periodontitis

A

Pain - Yes Swelling - None Sinus tract - None Palpation – Maybe tender Biting – Maybe painful Percussion – normally painful Radiograph – with or without apical radiolucency

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38
Q

Asymptomatic apical periodontitis

A

Pain - None Swelling - None Sinus tract - None Palpation - WNL Biting - WNL Percussion - WNL Radiograph – Apical radiolucency

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39
Q

Acute Apical Abscess

A

Pain – Normally present Swelling – Present Sinus tract – None / maybe Palpation - Painful Biting - Painful Percussion - Painful Radiograph – WNL or apical pathology

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40
Q

Chronic apical abscess

A

Pain – None, maybe episodic Swelling - None Sinus tract – Present or recent Palpation – Maybe tender Biting - WNL Percussion – Maybe tender Radiograph – Apical pathology normally present

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41
Q

Condensing Osteitis

A

•A localized overproduction of apical bone •Apices of mandibular posterior teeth •Chronic pulpitis or pulp necrosis •A low-grade inflammation of the periradicular tissues

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42
Q

What is law of centrality

A

pulpal floor always located in center of tooth at level of the CEJ

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43
Q

Law of the CEJ

A

the CEJ is the most consistent, repeatable landmark for locating the position of pulp chamber

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44
Q

Law of concentricity

A

walls of pulp chamber are always concentric to external surface of tooth at level of the CEJ

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45
Q

Law of symmetry

A

except for max molars, orifices are equidistant from a line drawn in a MD direction through pulpal floor except for max molars; Orifices lie on a line perpendicular to a line drawn in a MD direction across center of pulpal floor

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46
Q

Who said the laws of the pulpal floor

A

Krasner & Rankow, JOE 2004

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47
Q

Law of color change

A

the color of the pulpchamber floor is always darker than walls

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48
Q

Law of orifice location

A

the orifices are always located at junction of walls and floor the orifices are located at angles of floor-wall junction the orifices are located at terminus of root developmental fusion lines

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49
Q

What are the canal configuration classifications

A

I single canal II 2 canals merge into 1 III two canals stay separate IV 1 canal splits into 2

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50
Q

How many cnals in max ant

A

1

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51
Q

Man ant incisor

A

1 canal 57 2 canals 43 1 foramen 99

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52
Q

Man canines

A

2 canals 22%

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53
Q

max 1st premolars

A

2 canals 85 3 canals 6% 2 roots 57

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54
Q

Max 2nd premolar

A

50/50

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55
Q

man 1st premolar

A

1 canal 75 2 canal 24 3 canal 1

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56
Q

man 2nd premolar

A

1 canal 97 2 canal 3

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57
Q

Max 1st molar MB root

A

1 canal 20 2 canal 77 3 canals 3

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58
Q

max 2nd molar mb root

A

1 canal 63 2 canal 37

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59
Q

Man 1st molar

A

2 canal 7 3 canal 64 4 canal 29

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60
Q

man 2nd molar

A

2 canals 4% 3 canals 81% 4 canals 11% C-shape 3%

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61
Q

advantages of straight line access

A

– Vision improved – Reduces curvature … facilitates instrumentation & obturation – Improves instrument control … fewer misadventures

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62
Q

How do you arrive at an appropriate working length?

A

Estimate Radiograph (0.5 – 1.0 mm) Tactile sense Electronic apex locator Paper point Patient sensation

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63
Q

Apical Foramen Position

A

92 % deviation of major foramina from radiographic apex 0.59mm deviation from radiographic apex

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64
Q

How does the apex locator work

A

“Ratio method” Simultaneously measures impedance of two different frequencies, calculates the quotient of the impedances, and expresses this quotient as a position of the file inside the root canal No calibration required

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65
Q

What are the objectives of cleaning and shaping

A

Total removal of contents of pulp space –Tissue, debris, bacteria, byproducts Develop straight line access to apical region Maintain central axis of canal Keep apical constriction small and in original position Continuously tapering, smooth, funnel-shaped preparation

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66
Q

Curvature complications of instrumentation

A

Elbow Ledge Zip (w/ or w/o perforation) Transportation Strip Perforation

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67
Q

Consequences of transportation

A

Incomplete debridement Difficult to obturate with good seal Incomplete healing Inability to adequately re-treat

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68
Q

Causes of transportation

A

Insufficient access cavity extension Poor control of file insertion length Use of end-cutting files Attempting to achieve too large a MAF size Failure to recapitulate Excessive axial (in-out) filing in a curve Insufficient irrigation Dentinal mud at apex

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69
Q

Balanced force technique

A

Neutralize restoring forces Maintaining centering of prep, avoiding transportation of original canal Safe-ended instrument required (Flex-R) Very efficient way to cut dentin

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70
Q

Crown-Down Philosophy

A

Early opening of canal for better irrigant penetration Reduce curvature, better straight-line access to apical region Reduce binding of file along full length of canal Reduce apical packing and extruding of debris

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71
Q

Results of Proper Access

A

Straight line access to canals Eliminates coronal canal curvature Provides “gutters” into canal Allows “blind” instrumentation Significantly improves speed Minimizes coronal file binding Allows localization of all orifices Minimizes canal transportation Improved Obturation

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72
Q

what are the fundamentals of instrumentation

A

Don’t force instruments / Don’t Push Files Examine files for unwinding Copious irrigation/ lubrication Recapitulate

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73
Q

Properties of niti

A

Extraordinary flexibility Due to very low elastic modulus Superior fracture resistance Due to ductility of the NiTi alloy Outstanding shape memory

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74
Q

disadvantages of niti

A

cost Altered tactile feel Requires practice to minimize problems Mandel et al IEJ 1999 Can have little or no warning prior to fracture Negotiating ledges or complicated anatomy Instrumenting abrupt curves Instrumenting canals that come together at sharp angles

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75
Q

Advantages of niti rotary

A

Enlarge canal that has been negotiated to length Create smooth continuous taper Reduce operator fatigue Reduce time of instrumentation

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76
Q

Types of fx

A

Torsional fracture Flexural fracture

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77
Q

Torsional fx

A

Torque load on file causes unwinding and twisting in the opposite direction Instrument is locked in the canal while the shaft continues to rotate Occurs in smaller files

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78
Q

cylic fx

A

Breakage occurs abruptly, with little warning No other defects visible in association with fracture Occurs more frequently in larger size files

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79
Q

Advantages of our K3 rotary system

A

Safe ended tip minimizes transportation ISO sizes through 60 similar to Profiles 3rd Radial Land (wide) stabilizes & keeps file centered in canal Smaller shank shortens overall length of files by 4 mm Variable Helical Flute Angle from tip to handle helps with debris removal Positive Rake Angle Variable Core Diameter+stronger tip

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80
Q

Gates glidden comparison to files size

A

size 1 = 50 file, 2 = 70 file

81
Q

Peeso reemer size to file size

A

1=70, 2 = 90

82
Q

Why do we need chemical shapers

A

All aspects of a canal system cannot be reached by files

83
Q

gold standard of irrigation

A

8% (full strength) NaOCl is “gold standard” – Dissolves necrotic tissue – Removes the organic portion of smear layer – Germicide – Detoxifies endotoxins – Lubricant – Bleaching agent – Deodorizer

84
Q

17% EDTA

A

– Chelating agent – Lubricant – Helps remove inorganic portion of smear layer – ethylenediaminetetracetic acid

85
Q

CaOH

A

High pH … alters environment Antimicrobial Dissolves tissue Favors calcification (alkaline phosphatase formation) Favors osteogenesis Causes limited tissue necrosis … elicits healing response Helps dry “weeping” canals Halts or slows resorptive processes Effective for 1 week

86
Q

Goals of obturation

A

Replicate root canal system Maintain materials inside Tight seal to fluids, bacteria, byproducts Seal in bacteria Seal out nutrients

87
Q

How do you disenfect gutta percha

A

–6 % NaOCl immersion –60 seconds

88
Q

GP composition

A

Zinc oxide 56 - 75 % Gutta-percha 19 - 22 % Metal sulfates 2 - 17 % Waxes & resins 1 - 4 %

89
Q

Roth cement composition

A

Powder Zinc oxide 42 % Staybelite resin 27 % Bismuth subnitrate 15 % Barium sulfate 15 % Sodium borate anhydrous 1 % Liquid Eugenol 100%

90
Q

what did ray and trope 95 say

A

Good restoration significantly more important then than the technical quality of the endodontic treatment for apical periodontal health.

91
Q

1 vs multiple visit endo

A

1-visit ▪ Pt unable to return ▪ Medically impaired ▪ Vital ▪ Esthetic concerns ▪ Negative per pathosis Multi-visit ▪ Canal system infection ▪ Most retreatments ▪ Acute apical symptoms ▪ Weeping canal ▪ Difficult case ▪ Sinus tract

92
Q

Perf prognosis

A

▪Good – Fresh – Small – Apical / Coronal ▪Poor – Old – Large – Sulcular / Crestal

93
Q

which type of instrument fatigue has warning signs? What are they?

A

Torsional – Too much apical force – Clicking sounds – Unwinding

94
Q

Management of NaOCL extrusion

A

– Calm patient – Augment anesthesia – Cold compress x 6 hrs – Warm compress x 2 days – Analgesics & antibiotics – Immediate referral if airway compromise – Daily recall

95
Q

What form of the local diffuses through the nerve sheeth

A

unpolarized form

96
Q

what binds internally to Na channel site to block transmission

A

the ionized form

97
Q

what controls onset time of local

A

low pKa faster

98
Q

what makes local ineffective

A

•Low pH shifts equation to less base •Dilution by blood and fluid •Rapid absorption into circulation •Tetrodotoxin Resistance •Central Sensitization •Hyperalgesia •Allodynia

99
Q

whats the key to success for intrapulpal injection

A

Backpressure, not solution

100
Q

what did okeefe 76 say about post op pain

A

perop pain=post op pain

101
Q

what is barodontalgia

A

Tooth pain caused by an increase or decrease in ambient pressure Usually reported by aircraft personnel and divers Tough to diagnose … pulp testing inconclusive Affects teeth with a vital pulp – defective restoration Look for etiology of chronic pulp inflammation

102
Q

whats an enamel infraction

A

incomplete fracture (crack) of the enamel without loss of tooth substance

103
Q

Whats the difference between uncomplicated and complicated fracture

A

pulpal involvement

104
Q

What are the ellis classifications

A

Ellis Class1: enamel only Ellis Class 2: Enamel plus dentin Ellis Class 3: Enamel plus dentin plus pulp

105
Q

What is the most commonly cracked teeth

A

man molars 70%

106
Q

where do vertical root fractures begin

A

root and move coronally

107
Q

What are some clinical signs of VRF

A

 Narrow probing defect w/sinus tract at base  2 narrow probing defects on opposite sides of root  Treatment: extraction

108
Q

What are the types of luxation injuries from best to worst

A

Concussion Subluxation Extrusive luxation Lateral luxation Intrusive luxation

109
Q

what are the potential sequelae of luxation injury

A

-pulp survival -pulp canal obliteration -pulp necrosis -marginal bone loss -resorption

110
Q

Who are the victim of 1/2 of all dental trauma

A

Children

111
Q

What is the cause of most dental trauma for kids under 1

A

Fall injuries

112
Q

Possible cause of dental trauma for kids under 3

A

Battered child syndrome

113
Q

Which age has the most dental injuries

A

8-12 Play/athletics

114
Q

Why might teens have dental injuries

A

Fights

115
Q

What are two common reasons for all ages of dental trauma

A

Auto injuries and fights

116
Q

Which teeth are most commonly injured

A

Max anteriors

117
Q

What are the most common types of injuries to primary teeth

A

Luxations/avulsions

118
Q

What is the type of injury most common to the permanent dentition

A

Crown fractures

119
Q

Steps of pt evaluation

A

History and Chief Complaint

Neurologic Assessment

Extraoral to Intraoral Soft / Hard Tissue injuries

Radiologic Evaluation

120
Q

What are the classification of crown fractures

A

Complicated (involving the pulp)and uncomplicated (no plural involvement)

121
Q

What radiographs are needed.

A

Multiple angulations recommended

  • Standard periapical
  • Occlusal Periapical with lateral angulations
  • Mesial & Distal
  • Consider soft tissue radiograph If lip or cheek laceration To search for tooth fragments
122
Q

How should percussion be tested in a traumatic case

A

with finger as a mirror handle is likely to much for a pt in pain

123
Q

Why is vitality testing important?

A

To have a baseline

124
Q

Emergency Management of Uncomplicated Crown Fracture

A
  • Seal exposed dentin
  • Bond tooth fragment If available
  • Composite Resin
  • Glass ionomer (Vitrebond)
125
Q

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx only in enamel

A

.2-1%

126
Q

What is the incidence of pulp canal obliteration in uncomplicated crown fx only in enamel

A

.5%

127
Q

What is the incidence of root resorption in uncomplicated crown fx only in enamel

A

.2%

128
Q

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx into dentin

A

1-6%

129
Q

What is the incidence of pulp canal obliteration in uncomplicated crown fx into dentin

A

0

130
Q

What is the incidence of root resorption in uncomplicated crown fx into dentin

A

0

131
Q

Assessing either type of crown fx

A
  • Assessment Radiographs
  • Percussion/mobility testing
  • Baseline vitality testing
  • Visualize Adjacent teeth
132
Q

Treatment options for complicated crown fas

A
  1. Pulp Capping
  2. Pulpotomy
  3. Pulpectomy
133
Q

Whats the main factor for tx of complicated crown fracture

A

Stage of Root Maturation

Mature root -Pulpectomy

Immature root -Pulpotomy -Pulp capping

134
Q

Pulp healing prognosis of pulp capping

A

71-88%

135
Q

Pulp healing prognosis of partial pulpotomy

A

94-96%

136
Q

Pulp healing prognosis of Cervical pulpotomy

A

72-79%

137
Q

Preffered tx for an immature root

A

Partial pulpotomy (apexogenesis)

138
Q

Average depth of inflammatory change in partial pulpotomy

A

less than 2 mmm

139
Q

Types of crown-root fx

A

Uncomplicated and complicated

140
Q

Emergency management of Crown to Root Fx

A

Radiographs

Splint fragments temporarily to alleviate pain from mastication

141
Q

What determines the definitive tx of crown to root fx

A

Level of the fracture

142
Q

Treatment modalities of uncomplicated crown to root fx

A

1 Fragment rem

2 restoration

143
Q

Tx of complicated crown to root fx (restorable)

A
  • Fragment removal
  • Gingivectomy/ostectomy*
  • Endodontic therapy Post-retained crown

*(can use orthodox extrusion/surgical extrusion instead of periodontal surgery)

144
Q

Clinical presentation of Root Fractures

A

Tooth usually slightly extruded

Tooth frequently displaced lingually

Diagnosis entirely dependent upon radiographic examination

145
Q

Radiographs for root fas

A

Periapical radiographs

  • Standard XCP radiograph
  • Increased vertical angulation
146
Q

Emergency Management of root fx

A
  • Reposition coronal fragment
  • Flexible Splint
    • -4 Weeks
    • -If Fx near the cervical area - longer splinting time is beneficial Up to 4 months
147
Q

What are the 4 types of root fx healing

A
  1. Hard tissue 2. Conenctive tissue 3. Interposition of Bone and Connective tissue 4. Interposition of granulation tissue
148
Q

What is the incidence of pulpal necrosis after root fx for both segments

A

Coronal segment - 20 to 44%

Apical segment - 0%

149
Q

What is the incidence of pulpal obliteration after root fx for both segments

A

69%

150
Q

What is the incidence of root resorption after root fx

A

60%

151
Q

What is the determinant of prognosis of root fracture

A

Fracture location

152
Q

Prognosis of root fx in cervical 3rd

A

poorer

153
Q

Prognosis of root fx in middle and apical 3rd

A

better

154
Q

Classifications of luxation injuries

A
  1. Concussion
  2. Subluxation
  3. Extrusive Luxation
  4. Lateral Luxation
  5. Intrusive Luxation
155
Q

Lunation injury complications

A
  • Pulp necrosis
  • Pulp canal obliteration
  • Root resorption
    • External
    • Internal
  • Loss of marginal bone support
156
Q

Types of Ext root resorption

A
  1. Surface resorption
  2. Replacement resorption (Ankylosis)
  3. Inflammatory resorption
157
Q

Surface resorption

A

Superficial resorption cavities

Mainly in cementum

Complete repair of PDL

158
Q

Replacement resorption

A

Direct union of bone and root

Resorption of root - replacement with bone

Direct result of loss of vital PDL

159
Q

Inflammatory resorption

A

Resorption of cementum and dentin

Inflammatory reaction in the periodontal ligament

Surface resorption of cementum exposing dentinal tubules

Pulp necrosis

Toxic products from the pulp provoke an inflammatory response in the PDL

160
Q

Internal root resorption types

A
  1. Internal surface resorption
  2. Internal replacement resorption
  3. Internal inflammatory resorption
161
Q

Internal inflammatory resorption incidence in lunated permanent teeth

A

2%

162
Q

Concussion injury description

A

No abnormal loosening No displacement

163
Q

Subluxation description

A

Abnormal Loosening No displacement

164
Q

Emergency management of concussion and subluxation injuries

A
  • Radiograph
  • Baseline vitality testing
  • Usually no splinting required 7-10 days for comfort
  • Trauma Dx adjacent teeth Occlusal adjustment, if needed
  • Recall
165
Q

Pulpal necrosis incidence after concussion

A

3%

166
Q

Pulp canal obliteration incidence after concussion

A

5%

167
Q

Root resorption incidence after concussion

A

5%

168
Q

Pulpal necrosis incidence after subluxation

A

6%

169
Q

Pulp canal obliteration after subluxation

A

10%

170
Q

Root resorption incidence after subluxation

A

2%

171
Q

Extrusive luxation description

A

Partial displacement of tooth out of socket

Tooth appears elongated

Lingual deviation of crown typically

Excessively mobile

172
Q

Emergency management of extrusive luxation

A
  1. Radiographs
  2. Baseline vitality testing
  3. Anesthesia
  4. Reposition tooth
  5. Flexible splint 2 weeks
  6. Follow-up
    • 2, 4 weeks 6-8 weeks 6 months 1 year Every year for 5 years
173
Q

Pulpal necrosis incidence after extrusive luxation

A

26%

174
Q

Pulp canal obliteration incidence after extrusive luxation

A

45%

175
Q

Root resorption incidence after extrusive luxation

A

9%

176
Q

Lateral luxation description

A

Eccentric displacement of tooth

Crown usually displaced lingually

Fracture of socket wall

Tooth immobile

Percussion may have ankylotic sound

177
Q

Emergency management of lateral luxation

A
  • Radiographs
    • PA
    • Lateral
    • CBCT
  • Baseline vitality testing
    • Usually negative results
  • Anesthesia
  • Reposition
  • Flexible splint 4 weeks
    • Add 3-4 weeks in case of marginal bone breakdown
  • Occlusal adjustment, if needed
178
Q

One week after lateral luxation

A
  • Start endo / Ca(OH)2
  • Complete within one month
  • Follow-up 2 weeks 4 weeks (splint removal) 6-8 weeks 6 months 1 year Every year for 5 years
179
Q

Incidence of pulp necrosis after lat luxation

A

58% (77 with closed apex)

180
Q

Incidence of pulp canal obliteration after lat luxation

A

28%

181
Q

Incidence of root resorption after lat luxation

A

27%

182
Q

Incidence of loss of marginal bone support after lat luxation

A

5%

183
Q

Intrusive luxation description

A

Displacement of the tooth into alveolar bone

Comminution or fracture of socket

Immobile with ankylotic percussion sound

184
Q

Emergency management of Intrusive lunation

A
  1. Radiographs
  2. Pulp vitality tests Usually negative
  3. Anesthesia
  4. “Slightly luxate the tooth with forceps”
185
Q

Emergency management of Intrusive lunation of teeth with incomplete root

A
  1. Allow eruption without intervention
  2. If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically or orthodontically
  4. Monitor pulp vitality -if becomes necrotic Pulp regeneration or apexification
186
Q

What may happen if deciduous tooth is intruded

A

May damage developing permanent tooth

187
Q

Emergency management of Intrusive lunation of teeth with complete root

A
  1. Allow eruption without intervention
  2. If tooth intruded <3mm If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically Pulp will be necrotic Pulpectomy 2 weeks after injury Ca(OH)2 for up to 4 weeks
188
Q

If intruded tooth is repositioned surgically or orthodontically

A

Flexible Splint 2 weeks 4 weeks if displacement is ‘extensive

189
Q

Intrusion follow up

A

Follow-up depends on treatment

190
Q

Pulp necrosis and intrusion

A

complete root 100% Overall 85%

191
Q

Pulp canal obliteration incidence in intrusion

A

10%

192
Q

Root resorption incidence in intrusion

A

66%

193
Q

Loss of marginal bone support incidence in intrusive injuries

A

24%

194
Q

Graph of open apex luxation injury complications

A
195
Q

Graph of closed apex luxation injury complcations

A
196
Q

what makes post trauma dx difficult

A

Transient paresthesia in >50%
Vital pulp may not respond to thermal or EPT!
May take 2 - 10 months to respond normally
Initial positive response may revert to negative within 2 months … usually indicates pulp necrosis
Baseline findings at time of injury important
Immature root formation improves prognosis

197
Q

Is RCT indicated on tooth with calcific metamorphosis

A

NO!

198
Q

what kind of pulp is associated with internal resorption

A

Endodontics (9 decks)

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