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Restorative > Endo Booklet > Flashcards

Endo Booklet Flashcards

1
Q

3 symbiotic bacteria

A

strep
prevotella oralis
porphyromonas

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2
Q

how do bacteria in caries change over time

A

more gram negative anaerobes

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3
Q

assessment of individual teeth for endo 10

A
  • colour
  • caries/restorative status
  • presence of sinus
  • erythematous over apex
  • mobility
  • tender to tapping
  • tender to palpation over apex
  • vitality
  • local perio condition
  • radiography showing pulpal morphology (number of cusps, radiography)
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4
Q

what % of lower incisors have 2 canals

A

41%

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5
Q

what teeth have varied root anatomy/what is it

A

upper first premolar. may have 1 or roots

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6
Q

draw/label lower premolar apex

A

SEE BOOK

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7
Q

what to look for in radiographic evaluation of

a. pulp chamber 2
b. root canals 3

A

a. pulp chamber 2: position of roof and floor, amount of reparative dentine
b. root canals 4: number of roots/canals, degree of calcification, pulp stones, curvature

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8
Q

5 cell types in ‘apical war zone’

A

Means Pathogens Take a Proper Beating

  • polymorphonuclear leukocytes
  • macrophages
  • B lymphocytes
  • T lymphocytes
  • plasma cells
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9
Q

3 inflammatory mediators

A
  • neuropeptides
  • complement system
  • lysozymes
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10
Q

periapical lesion produced by 3 IN

A
  • prostaglandins
  • leukotrienes
  • cytokines
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11
Q

what to look for in endo assessment of mouth

A

dental status 3: missing teeth, active caries, restorative condition

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12
Q

what to do about

a. reversible pulpitis
b. irreversible pulpitis
c. necrotic pulp

A

what to do about

a. reversible pulpitis: pulpal irritant removed eg caries, tooth dressed
b. irreversible pulpitis + necrotic pulp: investigations, root canal therapy

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13
Q

what pre-operative radiographs to take

A

periapical
treatment tooth centrally located
3-4mm peri-radicular tissue visible
taken with film holder to minimise distortion
second film with 15-20degree horizontal parallax view
bitewing/DPT provide additional info

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14
Q

what to look for on pre-op radiographs 6

A
  • previous disease/tx (caries, restorations, pulp capping)
  • pulpal reactions (narrow chamber/canal, internal resorption)
  • relationship to surrounding structures (alveolar bone crest loss, general tooth form/height)
  • roots (number, shape, relations)
  • root canal patency
  • coronal structure
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15
Q

magnification with

a. loupes
b. microscope

A

magnification with

a. loupes: 2-4.5
b. microscope:16

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16
Q

shape of access cavity

a. incisor
b. canine
c. premolar
d. molar

A

shape of access cavity

a. incisor: 3 horns, triangular shape
b. canine: 2 horns, oval shape
c. premolar: 2 horns, oval shape
d. molar: variable horns, triangular in shape

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17
Q

burs/ handpieces for

a. initial access cavity
b. refinement of cavity
c. shape the coronal 1/3 of canal

A

burs for

a. initial access cavity: FAST small round (520), 554
b. refinement of cavity: SLOW speed SAFE-ENDED burs eg tapered fissue (endo Z/ blunt ended Batt), round burs eg goose neck (long shanks)
c. shape the coronal 1/3 of canal: SLOW gates glidden bur

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18
Q

bud diameter + calculation for gates glidden burs

A

0.5-1.5mm

D=20 (GG+1)+10

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19
Q

6 ways to locate canals

A
  • knowledge of pulpal anatomy
  • radiographs
  • magnification techniques
  • transillumination with white light
  • canal probe eg DG explorer
  • fine endo hand instruments
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20
Q

what is involved in

a. apical seal
b. coronal seal

A

a. apical seal: root fillings with stable, non-irritant and perfect seal
b. coronal seal: total obturation of canal space

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21
Q

examples of access problems

A
  • crown in situ –> loss of directional sense

- obstruction in canal –> pulp stones, post crown, fractured instrument

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22
Q

when to apply rubber dam during endo procedure

A

after access cavity drilled in to pulp chamber

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23
Q

how to drill access cavity

A
  • check depth from reference point of roof of pulp chamber on radiograph
  • tapered fissure bur to create outline in to dentine
  • continue to pulp chamber
  • remove roof of pulp chamber using slow speed shank bur
  • gently flare walls of pulp chamber/access cavity outwards so greatest diameter is at tooth surface
  • clear debris from pulp with excavator
  • irrigate with ultrasonic
  • locate orifice of canals and check straight line access
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24
Q

advantages of rubber dam in endo 4

A
  • protects oropharynx
  • protects tissues from caustic materials
  • retracts soft tissues and tongue and improves access
  • maintains clear, dry aseptic working field free from salivary contamination
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25
Q

what is used to seal the rubber dam in place

A

ultradent oraseal caulking agent

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26
Q

3 ways to measure working length

A
  • tables of average length: assumes tooth is ‘normal/average’
  • apex locator
  • radiography
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27
Q

3 ways apex locators used to work

A
  • measure electrical resistance with direct, alternating and high freq currents
  • measure voltage GRADIENT
  • calculate RATIO between impedances
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28
Q

name and describe 2 electrodes on apex locator

A

straight: file electrode
curly: lip electrode

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29
Q

value of impedance between apical tissues and mucosa to which the lip electrode is attached

A

6.5Kohms

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30
Q

3 problems with apex locators

A
  • wet canals (absolute apex locator machines only. hypochlorite, pus, tissue exudate)
  • heavily restoted crown (all machines. amalgam, gold inlay)
  • poor contact of lip electrode)
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31
Q

how to calculate working length

A

Rerefence point to radiogrpahic apex MINUS 1MM

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32
Q

define working length

A

distance from fixed reference point on crown to terminus nr radiographic apex

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33
Q

difference between modified stepback and coronal flare

A 
modified stepback (double flare): coronal aspect opened up before creating terminal stop and flaring backwards towards original flare
crown down: canal instrumented from coronal aspect towards terminus
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34
Q

when modified stepback and coronal flare are used

A

modified stepback: large canals, esp max anterior teeth, single rooted premolars
coronal flare: small canals

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35
Q

ideal shape of canal 3

A

widest coronally
narrowest apically
gradual outward flare

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36
Q

describe shape of hedstrom file/how it is made

A

machined from a round tapered blank by cutting spiral groove in to shank –> 90 degree cutting blade, aggressive cutting action, diamond shape

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37
Q

name of sharper burs not used by students for endo, how to use them 3

A

gates glidden burs

  • start with largest bur
  • never force bur in to canal
  • cut on out stroke
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38
Q

shape of gates glidden bur

A

long-shanks, bud-shaped non-cutting tip

narrowest nr shank (most likely to fracture here)

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39
Q

how to calculate diameter of gates glidden bur

A

20 (GGsize+1) +10

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40
Q

diameter of bud of GG bur

A

0.5-1.5mm

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41
Q

describe shape of K file/how it is made

A

twisted to 90 degrees

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42
Q

describe ends of K and hedstrom burs

A

blunted (Batt tips) so can be guided through curved canal

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43
Q

what does ISO stand for and what do they do 3

A 
international standards organisation
K and hedstrom files
-standardised sizing of endo filed related to diameter 1MM FROM TIP
2% taper
16mm cutting length
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44
Q

3 lengths of endo files

A

21mm
25mm
31mm (for canines)

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45
Q

how big is size 25 file at tip? explainn

A

0.25 mm

each file is measured in hundredths of a mm at 1mm FROM tip

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46
Q

taper of endo files

A

2%

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47
Q

what movement to check for patency

A

3-5 watch winding

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48
Q

3stages of shaping a canal msb technique

A
  • orifice enlargement (first flare)
  • apical stop
  • stepback (2nd flare)
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49
Q

4 reasons for orifice enlargement

A
  • removes heavily infected material
  • improves access to apical 3rd of canal
  • improves irrigation
  • reduces effective curvature of canal
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50
Q

how to do orifice enlargement in curved canal

A

outer side of curvature only (9 to 3 o’clock) –> reduce effective curvature but dont create fin shape

51
Q

msb: how many instrument changes to create
a. apical stop
b. step back

A

a. apical stop:9

b. step back: 14

52
Q

why must instruments be used in certain way/order 2

A
  • avoid blockage

- avoid damage to root (apical zip, hour glass shape, elbow

53
Q

how to create apical stop msb technique

plus how to identify master apical file (MAF)

A

10
15-10
20-15
25-20 etc until file binds

2 sizes above first file to bind = MAF
eg size 20 binds –> size 30MAF

54
Q

order/where files used msb to create step back

A

1 file size above MAF to working length, eg size 30MAF–> size 30 to WL
size 35 to WL-1mm
size 40 to WL-2mm
size 45 to WL-3mm
until all files used
recapitulate with MAF to maintain patency

55
Q

when to use

a. watch winding
b. balanced force

A

a. watch winding: k file Size 10,15, hedstrom

b. balanced force: k file size 20 and above

56
Q

how to do watch winding

A

no more than 1/4 turn (45 degrees) clockwise and anticlockwise

57
Q

how to do balanced force

A

power phase ENGAGEMENT: clockwise 60 degrees until it binds

control phase CUTTING: apply apical pressure, anticlockwise 120 degrees

58
Q

advantages of balanced force technique 3

A
  • superior shaping
  • file remains central within canal
  • less debris pushed apically
59
Q

disadvantages of balanced force technique 3

A

flute cleaning
copious irrigation
discard damaged instruments

60
Q

what causes apical zipping

A

inappropriate rotation of instruments (eg balanced force gone wrong)

61
Q

what causes elbow formation

A

inappropriate pre-curving of instruments –> HOUR GLASS SHAPE

62
Q

when is longitudinal circumferential filing used SS

A

large irregular shaped STRAIGHT canals at step back stage. balanced force would be inappropriate as file would be loose in canal

63
Q

what did Roane describe

A

balanced force technique

64
Q

how/when to do longitudinal circumferential filing

A

hedstrom files up and down around edge of canal, INNER CURVATURE
-use in large irregular canals at step back stage (balanced force K files would be loose in canal)

65
Q

why not do circumferential filing in curved canals, what to do instead

A

would cause strip perforation, would not follow curve

step back technique

66
Q

6 ideal properties of irrigant

A
  • bacteriacidal/ anti-bacterial
  • dissolve organic material
  • non-irritant
  • remove inorganic material
  • non staining to dentine
  • lubrication of instruments
67
Q

4 irrigants used in root canal therapy

A
  • sodium hypochlorite
  • sterile saline
  • local anaesthetic soln
  • chlorhexidine
68
Q

% of sodium hypochlorite soln

A

0.5-5%

69
Q

which 3 ideal properties of an irrigant does sodium hypochlorite cover

A
  • bacteriacidal/ anti-bacterial
  • dissolve organic material
  • non irritant to vital tissues (at low conc)
70
Q

size of irrigating needles

A

27 gauge

71
Q

shape of irrigating needles and why

A

side delivery –> reduce risk of soln extrusion through apex (would cause infection, pain)

72
Q

% of Milton’s, how to use it in lab

A

1%

50:50 with sterile water

73
Q

name the chelating agent used,% and 3 functions

A

ethylene diamine tetra acetic acid (EDTA) 15-17%

  • breaks down inorganic debris
  • lubricant
  • smear layer removal (with sodium hypochlorite)
74
Q

contents of lubricating pastes 3

A

15-17% EDTA
10% urea peroxide
water soluble base

75
Q

what causes effervescence

A

urea peroxide

76
Q

alternative chelating agent

A

citric acid solution

77
Q

alternative lubricant, formation,2 advantages and more usual use of it

A 
chlorhexidine, hibiscrub
-low toxicity
-broad spectrum of activity
substantivity
more popular in periodontics
78
Q

what are gutta percha points made of

A

transisomer of rubber produced from latex of tropical trees

79
Q

4 purposes of instrumentation

A
  • remove pulp/most microbes
  • facilitate irrigation
  • enable medicament placement
  • enable placement of root filling
80
Q

where are the most tapered instruments used in crown down technique

A

coronal parts of canal

(TIPS of tapered instruments used for apex

81
Q

when can crown down technique be used

A

small canals with no/GENTLE curves

82
Q

name and material of crown down files

A 
ProTaper
nickel titanium (flexible)
83
Q

compare shape of finisher F and shaper S files

A

S: most tapered in middle of file/coronal
F: most tapered at tip (7-9%)

84
Q

max flute diameter of pro taper files

A

1.2mm

85
Q

cutting length of pro taper files

A

14mm

86
Q

effect of these properties of pro taper files

a. progressive taper design 2
b. files engage smaller area of dentine 3
c. balancing pitch and helical angles
d. convex triangular cross-section

A

a. progressive taper design 2: improves flexibility, cutting efficiency in tighter/curved canals
b. files engage smaller area of dentine 3: reduce torsional loads, file fatigue, potential for separation
c. balancing pitch and helical angles : greater cutting efficiency
d. convex triangular cross-section:reduces contact area between file and dentine

87
Q

2 unique properties of nickel titanium alloys SUPER

A
  • super elasticity

- shape memory

88
Q

2 crystallographic forms of nickel titanium. which has higher tensile strength
why are these essential to function

A
  • Austenite (parent shape)
  • Martensite (daughter shape, higher tensile strength)

good flexibility because crystal structure changes between austenite-martensite

89
Q

compare nickel titanium to stainless steel 2

A
  • 3-5x elastic flexibility

- decreased ledging/transportation

90
Q

colour of each pro taper file

A 
SX: orange
S1 purple
S2 white
F1 yellow
F2 red
F3 blue
91
Q

what file is used for alternative orifice enlargement

A

SX (orange)

92
Q

how to perform alternative orifice enlargement

A

-engage dentine (gentle clockwise turn until snug)
-disengage (45-90 degrees anticlockwise, apical pressure like balanced force)
-withdraw and turn file clockwise to dislodge debris
only do this up until curve

93
Q

what size to make apical stop and movements

A

size 20 k file
size 10,15 watch winding
size 20 balanced force

94
Q

when may F2 and F3 files be used

A

if size 20 k file not smug

95
Q

how to calculate MAP

A

first file that binds

2 file sizes up from this

96
Q

where is the canal terminus? explain

A

apical constriction

  1. 5-1mm distance between this and apical foramina
  2. 2-2mm distance between apical foramina and secondary cementum
97
Q

what properties of root canal irrigant does chlorhexidine have?

A

bacteriacidal, lubricant (hibiscrub)

98
Q

how/why to make glide path

A

using K20 file

this is just larger than pro Taper files –> leaves room for pro taper files

99
Q

what technique to use with pro taper files? describe

A

triple phase:

balanced force then rotate clockwise while withdrawing to remove debris

100
Q

3 ways pro taper does not fit to ISO standards

A
  • working part 14mm not 16mm
  • variable taper 2-16% (not 2%)
  • variable thread (so they only wind in a slight distance)
101
Q

2 things required by pro shaper files when procedure complete

A

length

tugback

102
Q

2 functions of medicament

A
  • prevent canal infection where none present

- elimate bacteria already infecting canal system

103
Q

3 types of canal medicaments

which one of these is rarely used and why

A
  • chemical antiseptics (not common now)
  • antibiotics / steroids
  • calcium hydroxide paste

chemical antiseptics: highly irritant tto periapical tissues

104
Q

2 chemical antiseptics

A
  • beechwoods creosote

- para mono chloro phenol

105
Q

2 common antibiotic/steroid pastes and their ingredients

A
  • Ledermix: demethylchlortetracycline, triamcinalone acetonide
  • odontopaste:clindamycin, triamcinalone acetonide
106
Q

which antibiotic/steroid paste should be restricted and to what 2

A

ledermix: desensitising pulpotomy
- acutely inflamed vital pulp where LA does not work
- not enough time to complete root canal after pulp exposure

107
Q

2 reasons for pulp LA failure and how steroids overcome this

A
  • inflammation –> acidic pH –> LA does not dissociate (only in neutral environment) STEROID IS ALKALINE
  • too many pain signals, LA cant handle STEROID DECREASES THIS
108
Q

3 preparations of calc hydroxide as root canal medicament

A
  • BP powder (1:8 barium sulphate) can mix to req viscosity
  • proprietry pastes: hypocal, reogan
  • life (setting calc hydroxide- use catalyst paste only so it does not set)
109
Q

pH of calc hydroxide

A

12.5

110
Q

6 functions of OH- ion of calc hydroxide, explain

A
  • bacteriacidal
  • effective solvent of organic debris
  • promotes connective tissue repair:below
  • promotes hard tissue genesis: stimulates ALKALINE PHOSPHATASE –> anabolic stages of repair in bone/ soft tissue
  • neutralise acids in areas of resorption –> stops osteoclasts etc
111
Q

function of Ca ion in calc hydroxide, why this is arguable

A

activate calcium dependent ATP reaction for hard tissue formation
BUT calcium ions in hard tissue comes from tissue fluid not CaOH paste

112
Q

3 ways to place calc hydroxide, which is not used

A
  • spiral root filler
  • hand file
  • injection syringe system
113
Q

6 uses of calc hydroxide

A
  • pulp capping/ pulpotomy
  • inter-visit medicament
  • tx of large periapical lesions
  • apexification
  • root resorption
  • root fractures/perforations
114
Q

new alternative medicament, contents and qualities 4

A

R4 root canal soln
20% chlorhexidine (only 0.02% used in perio)

4:

  • wide spectrum antibiotic
  • effective against anaerobic bacteria inc STREP FAECALIS, CANDIDA
  • substantivity
  • non-irritant
115
Q

2 temp restorations for seal over medicament

A
  • cotton wool dressing

- common temp restorations (GIC, zinc oxide-eugenol)

116
Q

stages of modified stepback technique

A
  1. access
  2. estimate WL from radiograph/ apex locator
  3. patency with number 10
  4. orifice enlargement (hedstrom files)
  5. CWL radiographs
  6. apical stop at CWL: MAF, watch wind #10,#15, balanced force #20+. irrigate and recapitulate with size below
  7. stepback: set each file after MAF to size to 1mm less than before. recapitulate with MAF
117
Q

stages of crown down technique

A
  1. access
  2. estimate WL from radiograph/ apex locator
  3. patency w #10
  4. orifice enlargement (SX file)
  5. re-establish patency #10
  6. CWL radiograph
  7. create glide path (K files up to #20)
  8. shaper ProTaper files S1, S2
  9. finisher ProTaper files F1 (F2/F3 if needed)
  10. check apical size w appropriate K file (F1=#20, F2=#25, F3=#30
118
Q

in which part of canal are bacteria mostly found

A

coronal 1/3

119
Q

5 pieces of info you need to record for every root canal

A
  • canal (which canal/tooth)
  • reference point
  • diagnostic length (est working length)
  • working length (corrected WL)
  • size of master point
120
Q

3 examples of lubricating pastes

A

glyde
canal +
fileze (file easy!)

121
Q

order of lengths of tooth roots

A

lat incisor
premolars
central incisors
canine

122
Q

how to use apex locator

A
  • access cavity, rubber dam, orifice enlargement
  • irrigation with hypochlorite
  • glide path with #10k file
  • apply lip and file electrode
  • advance #10k file until reading of 0 is achieved (watch winding)
  • set silicone stop on reference point
  • retract/ advance file to check accuracy
  • measure file length and -1mm
  • check against radiograph
123
Q

contraindications of apex locators

A
  • wet canals
  • heavily restored crown
  • poor contact of lip electrode

Restorative (5 decks)

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