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NBDE Pt 2 Mosbeys > Endo Pt 2 > Flashcards

Endo Pt 2 Flashcards

1
Q

Describe K files

A

Twisted square or triangular metal blanks along their axis; partially horizontal cutting blades

Can be used with the watch winding or balanced force techniques

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2
Q

Describe hedstrom files

A

Spiraling flutes cut into the shaft of round, tapered, stainless steel wire; very positive rake angle

Cut in only one direction - retraction

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3
Q

Describe barbed broaches

A

Sharp, coronally angulated barbs in metal wire blanks

Used to remove vital pulp from root canals, sever pulp at constriction level, and remove materials from canals.

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4
Q

Describe nickel-titanium rotary instruments

A

Designs vary in tip sizing, taper, cross section, helix angle, and pitch.

Important properties - superelasticity and high resistance to cyclic fatigue, which allows continuously rotating instruments to be used in curved root canals.

Nickel-titanium instruments have reduced incidence of blocks, ledges, transportation, and perforation but are believed to fracture more easily than hand instruments

Endosequence, lightspeed, proFile, proTaper

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5
Q

Describe how to determine working length

A

Select a point that is table and easily visualized for reference point selection.

Estimate working length with diagnostic film taken using a paralleling technique with a no. 10 or 15 K-file.

If necessary, correct the working length by measuring the discrepancy between the radiographic apex and tip of file . Adjust to 1mm short of radiographic apex

Use an apex locater - an electronic instrument used to assist in determining the root canal working length or perforation; operates on the principles of resistance, frequency, or impedance

Feel for the apical constriction, however in many cases this can be unreliable

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6
Q

The best indicator of clean walls is the ____. It shaping, it is best to __ ___ files because essentially all canals are curved.

A

Smoothness obtained

Precurve inflexible

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7
Q

____ of canal permits debridement of apical canal, reduces overinstrumentation of the foramen, and improves ability to obdurate

A

Taper

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8
Q

Name and describe 3 different techniques for cleaning and shaping.

A

Crown-down: clinician passively inserts a large instrument into the canal up to a depth that allows easy progress. The next smaller instrument is used to progress deeper into the canal; the third instrument follows, this continues until the apex is reached. Hand and rotary instruments may be used in this technique.

Step-back: working lengths decrease in a stepwise manner with increasing instrument size.

Hybrid technique - combining these two techniques to achieve the best outcome

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9
Q

Describe how to do the apical preparation

A

Apical stop helps confine instruments, materials, and chemicals to the canal space and create a barrier against which gutta-percha can be condensed.

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10
Q

What is a D1 file dimension?

A

File size at the tip of the file (.08mm for a size 8 file. 0.15mm for a size 15 file size)

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11
Q

What is the D2 or D16 file dimension?

A

The diameter of the file where the cutting flutes end (16mm)

It is the diameter at the tip plus 0.32mm (if the taper was 0.02)

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12
Q

True or false… sodium hypochlorite dissolves organic material and removes the smear layer.

A

False. It does dissolve organic matter (its a proteolytic material) but it does not remove the smear layer)

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13
Q

What are the signs and symptoms of a NaOCl accident?

A

Instant extreme pain

Excessive bleeding from teh tooth

Rapid swelling

Rapid spread of erythema

Later-bruising and sensory and motor nerve deficits

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14
Q

What are treatment options for a NaOCl accident?

A

Long-lasting local anesthetic

Encourage drainage

Steroids

Cold compresses

Antibiotics

Analgesics

Daily follow-up

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15
Q

What is EDTA?

A

Ethylenediamine tetraacetic acid

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16
Q

What does EDTA do?

A

Removes inorganic material

Removes smear layer

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17
Q

Chlorhexidine is a _____ and ___ molecule that interacts with ___ and ___ on the ___ of bacteria and enters the cell by changing ____ equilibrium and is effective at the concentration of __%

A

Synthetic cationic hydrophobic and lipophilic

Phospholipids and lipopolysaccharides on the cell membrane

Osmotic

2%

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18
Q

The combination of __ and ___ forms an undesirable precipitate, ___, which is believed to affect the seal of root canal filling.

A

Chlorhexidine

NaOCl

Parachloroaniline

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19
Q

What is the best intracanal medicament available?

A

Calcium hydroxide

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20
Q

Calcium hydroxide’s high pH causes an antibacterial effect at pH of ___. It inactivated ____. It has a ___ capacity.

A

12.5

Lipopolysaccharides

Tissue-dissolving

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21
Q

What are the purposes of obturation?

A

To eliminate all avenues of leakage from the oral cavity or the apical tissues into the root canal system

To seal within the system any irritants that cannot be fully removed during canal cleaning and shaping procedures

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22
Q

What are 5 advantages of gutta-percha?

A

Plasticity - adapts with compaction to irregularities

Easy to manage

Little toxicity

Easy to remove

Self-sterilizing (does not support bacterial growth)

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23
Q

What are 4 disadvantages of gutta percha?

A

Gutta-percha without sealer does not seal

Lack of adhesion to dentin

Elasticity causes rebound to dentin

Shrinkage after cooling

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24
Q

The best treatment for swelling from acute apical abscess is to _____

A

Establish drainage and to clean and shape the canal

25
Q

What are three indications for incision and drainage of soft tissues?

A

If a pathway is needed in soft tissue with localized fluctuation swelling that can provide necessary drainage

When pain is caused by accumulation of exudates in tissues

When necessary to obtain samples for bacteriological analysis

26
Q

What are three indications for trephination of hard tissues?

A

If a pathway is need from hard tissue to obtain necessary drainage

When pain is caused by accumulation of exudate within the alveolar bone

To obtain samples fro bacteriological analysis

27
Q

What is trephination?

A

Refers to surgical perforation of the alveolar cortical bone to release accumulated tissue exudates

28
Q

Why is profound anesthesia difficult to achieve for I and D or trephination procedures?

A

The acidic pH of the abscess and hyperalgesia

29
Q

How deep should the incision be made for an I and D procedure?

A

Made firmly through periosteum to bone

Vertical incisions are parallel with major blood vessels and nerves and leave very little scarring

These procedures may include the placement and subsequent timely removal of a drain

30
Q

Antibiotics may be indicated in which cases?

A

Patients with diffuse swelling (cellulitis)

Patients with systemic symptoms

Patients who are immunocompromised

31
Q

When is root end resection (apical surgery/apicoectomy) indicated?

A

Persistent or enlarging apical pathosis after nonsurgical endodontic treatment

Nonsurgical endodontics is not feasible

Marked overextension of obturating materials interfering with healing

Biopsy is necessary

Access for root-end preparation and root-end filling is necessary

The apical portion of the root canal system with apical pathosis cannot be cleaned, shaped, and obturated

32
Q

What are 4 contraindications to root-end resection?

A

Anatomic factors - thick external oblique ridge or proximity to the neurovascular bundle

Medical or systemic complications

Nonrestorability

Poor root/crown ratio

33
Q

What is the procedure for root end resection?

A

Root end resection is the preparation of a flat surface by the excision of the apical portion of the root and any subsequent removal of attached soft tissues

Lay flap

Bone is removed to allow direct visualization of and access to the affected area

Root end is respected

Root end is filled.

34
Q

What are 3 disadvantages to a submarginal curved flap (semilunar flap) for a root end resection procedure?

A

Restricted access with limited visibility

Leaving the incision directly over the lesion

Often healing with scarring

35
Q

In root end resection, resection of __mm of diseased root tip is performed. The traditional __-degree bevel has been replaced with a lesser bevel of 0-10 degrees.

A

3mm

45

36
Q

In root end resection, __mm should be left for root end cavity preparation and root end filling. Prepare __mm of the root end with ultrasonic instrumentation. __ the depth of the root end filling significantly decreases apical leakage. Increasing the bevel ___ leakage.

A

3mm

3mm

Increasing

Increases

37
Q

In root end filling (retrofilling), a biologically acceptable filling material, such as ___ is placed into the ___ root end preparation to seal the root canal system.

A

MTA (mineral trioxide aggregate)

3mm

38
Q

What is root hemisection?

A

Surgical division (in approximately equal halves) of a multirooted tooth. A vertical cut is made through the crown into the furcation. The defective half of the tooth is extracted.

39
Q

What are the indications of hemisection?

A

Class3 or 4 periodontal furcation defect

Infrabony defect of one root of a multirooted tooth that cannot be successfully treated periodontally

Coronal fracture extending into the furcation

Vertical root fracture confined to the root to be separated and removed

Carious, resorptive root or perforation defects that are inoperable or cannot be corrected without root removal

Persistent apical pathosis in which nonsurgical treatment or apical surgery is impossible and the problem is confined to one root.

40
Q

Hemisection is most often performed on ___ teeth. Hemisection requires root canal treatment on all retained ___. When possible, it is preferable to complete the root canal treatment and place a permanent restoration into the canal orifices [before/after] the hemisection.

A

Mandibular molar

Root segments

Before

41
Q

What is bicuspidization?

A

A surgical division (as in hemisection, usually a mandibular molar), but the crown and root of both halves are retained.

The procedure results in complete separation of the roots and creation of two separate crowns.

42
Q

What is the difference between root end resection and root resection?

A

Root end resection is amputating just the tip of a root whereas root resection is complete removal of one or more roots of a multirooted tooth (root amputation)

43
Q

What are 7 indications for root resection (root amputation)?

A

Class 3 or 4 periodontal furcation defect

Infrabony defect of one root of a multirooted tooth that cannot be successfully treated periodontally

Existing fixed prosthesis

Vertical root fracture confined to the root to be resected

Carious, resorptive root or perforation defects that are inoperable or cannot be corrected without root removal

Persistent apical pathosis in which nonsurgical root canal treatment or apical surgery is impossible

At least one root is structurally sound

44
Q

In root resection, amputation of an entire root is performed leaving the crown in tact. Root resection requires ___ on all ___. When possible, it is preferable to complete root canal treatment and place a permanent restoration into the canal orifices.

A

Root canal treatment

Retained root segments

45
Q

What is intentional reimplantation?

A

Insertion of a tooth into its alveolus after the tooth has been extracted for the purpose of accomplishing a root end filling procedure.

46
Q

True or false… in intentional reimplantation stabilization of the reimplanted tooth is always needed.

A

False. It may or may not be needed.

47
Q

True or false… RCT is typically performed before intentional reimplantation

A

True

48
Q

What are 5 indications of intentional reimplantation?

A

Persistent apical pathosis after endodontic treatment

Nonsurgical retreatment is impossible or has an unfavorable prognosis

Apical surgery is impossible or involves a high degree of risk to anatomic structures

The tooth presents a reasonable opportunity for removal without fracture

The tooth has an acceptable periodontal status before the reimplantation procedure

49
Q

When is surgical removal of the apical segment of a fractured root indicated?

A

When a root fracture occurs in the apical portion and pulpal necrosis results

50
Q

In surgical removal of the apical segment of a fractured root, a ___ flap is surgically elevated, and when necessary ___ is removed to allow direct visualization and acces to the affected site. The __ portion of the affected root and all of the targeted tissue are removed.

A

Mucoperiosteal

Bone

Apical

51
Q

Endodontic emergencies are usually associated with __ or __ or both and require immediate __ and ___

A

Pain or swelling

Diagnosis and treatment

52
Q

Emergencies are usually caused by pathoses in the __ or ___ tissues. Emergencies include ___, ___or __

A

Pulp or periapical

Luxation, alvulsion, or fractures of the hard tissues

53
Q

Radiographic examination of emergency cases are helpful but has limitations because…

A

Periapical radiolucencies may not be present in acute periapical periodontitis

54
Q

What is the preferred treatment for management of painful irreversible pulpitis?

A

Complete cleaning and shaping of the root canals

Pulpectomy provides the greatest pain relief but pulpotomy is usually effective in the absence of percussion sensitivity

55
Q

True or false.. chemical medicaments sealed in chambers do not help control or prevent addional pain in painful irreversible pulpitis

A

True

56
Q

True or false… antibiotics are indicated in painful irreversible pulpitis

A

False.

57
Q

When localized swelling exists, the abscess has invaded ___. Compete debridement should be performed as well as ___ to relieve pressure and purulence. Patients with localized swelling [often/seldom] have elevated temperatures or systemic signs, so systemic antibiotics are [unnecessary/necessary]

A

Soft tissues

Drainage

Seldom

Unnecessary

58
Q

When diffuse swelling exists, the swelling has dissected into ___ spaces. Most important is the removal of the irritant via __ or ___. Swelling may be incised and drained followed by ___ insertion. Systemic antibiotics are [indicated/contraindicated] for diffuse, rapid swelling.

A

Fascial

Canal debridement or extraction

Drain

Indicated

59
Q

A history of preoperative pain or swelling is the best predictor of ___ emergencies

A

Flare-up

NBDE Pt 2 Mosbeys (2 decks)

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