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FINALS!!! > Endo revision notes > Flashcards

Endo revision notes Flashcards

1
Q

Purpose of dental dam

A

tp retract and protect soft tossues
to reduce operator stress
prevent the pt from rinsing
prevent bacterial contamination
to prevent inhlation of insturments and materials

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2
Q

Ideal end point in RCT

A

CEJ/apical constirction

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3
Q

Recapitualtion

A

the introduction of smaller instruments into the canal to remove any debris present and to keep the canal clean

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4
Q

Pre op radiograph

A

to assess for peri-raiducalr pathology
canal calficiation
root -size, shape, number
pulp horns
the pulp chamber
the localtion of canals

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5
Q

Patency

A

communication between the root canal and peri-radicular tissues by passing small files beyond the apical constriction

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6
Q

Design objects in endo

A

create a continusally funnellnig shape
maintain the apical foramen
keep the apical opening as small as possible

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7
Q

Radigraphs used in rct

A

cwl radiograph
ppre and post radioraphs
maf rafigraph

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8
Q

eastimated working length

A

measured from a radiograph and is taken from a conronal refernce point to the apex of the tooth

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9
Q

Corrected working length

A

it is from a predefined coronal point to the apical terimnus of a tooth 1. radipgraph, 2. apex locator, 3. papper point length

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10
Q

Master apical file

A

the final file that is used in the apical portion of the canal to working length and is shaped and ready for obturation

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11
Q

GP consisits

A

GP (15%)
Radiopacifier (5%0
Plasticieser (15%)
zinc oxide (65%)

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12
Q

MTA

A

mineral trioxdie aggerate
used - root tips for apicectomy, root fracture repairs, internal root reosprtion, pulp capping

advantages - biocompatible, relases ca, alkaline ph, antibacterial
disadvangtages - long setting time, high cost, discolouration

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13
Q

Aims of NaoCl

A

disinfect the canal
to dissolve oragnic debris
to flush out debris
to lubricate insturments during root canal treamtnet

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14
Q

Factors for NaoCl function

A

volume
contact
exchange
chemical agigitation
concentration

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15
Q

NaoCl conc

A

0.5-6% - 3% the best

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16
Q

Problems with NaoCl

A

does not remove the smear layer
discolouration of fabrics
allergies
can cause eye damage
apical extrusion leading to tissue necrosis

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17
Q

Smear layer

A

a layer of inorganic debris and rganic material formed during cancl prep
it prevent sealer penetration

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18
Q

How to remove smear layer

A

17% EDTA - chealating agent that removes smear layer and opens dentinal tubules

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19
Q

Guidance for use for naocl

A

use a pt bib to prevent disoclouration of fabric
eye protection for pt
pass the syring behind the pts head
label all syrings correctly
test the naocl site with chx before using to ensure correct seal
use rubber dam
use side vented 27mm gauage 3ml syringe
depress plunger wtith finger rather than thumb
ensure only fill the syring 2/3rd full
correct concentration of naocl
use a rubber stop 2mm short of working length
avoid in tight canals and have a good opening

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20
Q

Symptoms of naocl extrusion

A

pain, swelling, neurological signs, heamoragge, airway obstuction, brusing

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21
Q

Risk factors for extrusion of naocl

A

concentration
needle locked in the canal
excessive pressure
loss of control of working length
proximity to sinus

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22
Q

NaOCl extrusion what to do

A

stop what you are doing imeediately and inform the pt of what has just occured
acheive heamostatis in the tooth and canal and place an intermedicament dressing
do not obturate or seal the canal
if small then advice pt cold compresses for first 24hrs, warm compressers thereafter, anaglesics for pain, anibiotics if only necorsis and spreading infeciton
review pt in 24hrs
if larger then may require advice and trasnfer to local max fax unit
document the incident in the pt notes and the accident incidicent book

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23
Q

Function of selaers

A

to lubricate during condesation
to fill voids and irregularies between GP and the canal
seals between dentinal walls and core

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24
Q

Properties of a sealer

A

biomcompatible
radiopaque
dimensially stable
does not dissolve in oral tissue fluids
can easily be removed from root canal if required
slow setting
no shrinkage
no staining
antibacterial
insoluble

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25
Q

ZOE sealer

A

antimicrobial but realses free eugenol which can be an irritant

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26
Q

GI sealer

A

minimal antibacterial activity
diffierlt to remove if required
increased solubility

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27
Q

Resin sealers

A

slow setting
good flow

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28
Q

Calcium silicate sealer

A

biocompatible
easy to use
quick set
non resosorbale
excelleing selaing abilities

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29
Q

Aims of root canal fillng

A

prevents the intrioduction of microgoransisma dnfluids into the canal
blocks any remaining micro-ogranisms in the canal
blocks the apical formaina, dentinal tubules and accessory canals

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30
Q

Anti - microbial paste

A

odontopaste/ledermix
contains both tertracyline and corotocosteriod
aids in reduction of pulpal inflammation

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31
Q

Ns CaOH

A

alakaline ph 12.5 so antimicrobal
effective in removing tissue debris
thin so won’t reduce striength

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32
Q

Ns CaOH used for

A

inter medicament sealer
pulp capping
interal resorption
apical resoprotption
root fracture
open apex and immature tooth
larger perapical lesions

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33
Q

Beofre tx failures of endo

A

pooh oh
missed diagnosis case selection

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34
Q

during tx failures for endo

A

missed canals
iotrogenic damage
infeefftive cleaning, filling, shaping

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35
Q

after tx failures for endo

A

poor oh and caries develops
damage when placing post
leakage of conronal restoration

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36
Q

Failures of RCT

A

re infeciton
missed canals
perforation of root
loss of conoral seal
not adequate patenct
communcaiton of canal
necrotic material left

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37
Q

Extra radicular features of failure

A

radicular cyst present
root fracture

38
Q

Tx options for RCT failure

A

retreatment rct
peridaciular surgery
do nothing if aymptomatic
XLa

39
Q

Success for RCT

A

GP is withing 2mm of apex
well conensed, no voids or irregularites present
good cornoal resotration

40
Q

Radiograph follow up

A

1 year and for 4years after

41
Q

Periradicular surgery

A

apicectomy
surgery which onvovles removing only the root tip of an infected tooth - about 3mm
leaves the RCT intact

Used - when peri-radicular infection coninues, cannot retreat rct, cyst or infection present, iotrogenic damage (perofration)

42
Q

Endo retreatment

A

use protapers D1,2,3
for resin selaers - ultrasonic
for GP - protaper D and ecalptus oil
soluble paste - protaper with solvent

43
Q

Special investigations for diagnsosi

A

percussion test - positive means inflammation
mobility test
sensbility tests
occlusion - occlusal trauma intitates periadicular periododntitis
Test cavity by drilling with no la
Perio probing
transilliumniation
radiogrpahs
cusp loading test - tests for cracked tooth
sinus tract explration

44
Q

Puliptis

A

inflammation of the pulp

45
Q

Reversible pulpitis

A

inflammation of the pulp which lasts for only a few seconds and is to do with cold, sweet things, sharp quick shooting pain

46
Q

Irreversible pulpitis

A

inflammation of the pulp which lingers for a period of time onces the stimulus has been removed
the vital inflammaed pulp cannot heal
referred pain

47
Q

Pulp necrosis

A

death of the pulp - due to trauma or calcification

48
Q

Don’t pulp cap

A

non vital teeth
pa path present
irreversible pulpitis
large exposure

49
Q

Main causes of injury to pulp

A

bacteria present due to:
-caries
- perio disease (dentinal tubuls, furcal and lateral canals)
- cracked teeth
- trauma
- erossion, attrition, abrasion (dentinal tublues)
-developmental anomalies

50
Q

Apical periodontitis or periapical periodontitis

A

inflammation of the tissues surroudn the root of a tooth - casues infection in root canal system
inflammation of periradicular tissues
pressure to biting, TTP, palaption
PDL can sometimes be widening

51
Q

Chronic peripapcal abscess

A

inflammatory reaction to pulpal infection and necrosis
gradual onset, little discomfort and pus through sinus or perio pocket

52
Q

Acute periapical abscess

A

inflammatory reaction to pulpal infection and necrosis
rapid onsent, pain present, pus, swelling, maliase, fever, lymphadenopathy, TTP

53
Q

Indirect pulp cpping

A

when the pulp of the tooth is not quite exposed but close
use either calcium silcate or calcuim hydroxide with rmgic/gic and resotration

54
Q

Direct pulp capping

A

<24hrs <=2mm exposure of pulp

55
Q

Partial pulpotomy

A

pulp expose >=2mm, bleeding and inflammation cannot be stopped and acheieved

56
Q

Full pulpomty

A

large portion of pulp exposed nd bleeding cannot be achieved
if heamostasis continues may need to reusslt in pulpectomy

57
Q

Follow up in endo cases

A

6months clincially
1 year radiographically

58
Q

Obturation

A

warm vertical condensation
lateral condesation
carrier based
thermomechanical compaction

59
Q

PRevention of fractures on teeth

A

minimise internal wedging forces
minimalr removal of intraradiuclar dentine
avoid use of posts where possible

60
Q

Types of tooth fractures

A

craze lines
cracked cusp
crack tooth
split tooth
vertial root fracture

61
Q

Craze lines

A

seen on the enamel of teeth
no tx required

62
Q

Cracked cusps

A

occurs on 2 aspects of cusp by crossing the marginal ridge either buccal or lingually
fracture of crown going subinginvally

Tx -removal of the cusp and replace with onlay/crown

63
Q

Cracked tooth

A

incomplete fracture from crown subgingivally marginal rdige and proximal surfaces
more centred and apical than a cracked cusp
likley to casue PA path and pulpal issues

Tx = potential rct

64
Q

Split tooth

A

crack on tooth that extends subgingivally
complete fracture
occurs after the evoluation ofa cracked tooth

Tx - mainly xla unless can remove segment

65
Q

Vertical root fracture

A

complete or incomplete fracture going subingvally and then cornally

Tx - xla or potentially hemisection

66
Q

How to prevent fracturing endo insturments

A

allow a good striaght line access
good vision and magnification and illumination
use files in correct sequence
aviod using files on numerous occasions
do not put too much force or pressure in the files

67
Q

What are the main cuases of failure of rct

A

bacterial contamination
inadequate disinfection

68
Q

Intrument fracture due to

A

small files
operator inexperience
poor root morphology/ curvatures
torsional or flexure fracutre
number of times files used
technique used

69
Q

Why carry out periradiuclar surgery

A

if failed RCT before
biopsy of a periapcal path - radicular cyst
external root resoprptioin
ramage of damage - perforation
management of peradicular infection
direct inspection of fracture
retirval of fracture insturments

70
Q

File retrield procedure

A

apical 1/3 - do not achieve retirieval - obture to fractured insutrment and monotr
middle 1/3 - try to bypass and if not obture to fractured insturment and potential for surgery
cornal 1/3 - remove fracture intrument with minimal removal of dentine

71
Q

If sepration occured before instrumentaion or disinfection

A

bypass fracture and if not then place interm ed caoh and wait 2-4weeks and then obturate adn follow up

72
Q

Internal inflammatory root resoprtion

A

non vital pulp resorbs the internal surfaces of a root
balloning appearnace intrenal and root surface intact
pink spot may be present on tooth

Tx - mechanical and chemical debrdiement, ns caoh placed for 4wks and then obturate

73
Q

External inflammatory root resoprtion

A

intiatited by PDL damage which is maintained and propgated by necortic pulp tissue
root surface indisitnct and the intact tramlines of internal canal

Tx - chemical and mechanical debridment, nscaoh placed for 4wks then obturate

74
Q

External cervical root resoprtion

A

resoortpio of root surface that occurs cervically on the root
parallel lines present and apple core appearnaced

Tx - monitor, XLA, interal repair and endo

75
Q

External replacement reosprtion (ankylosis)

A

resoprtion of tooth sutructure which inturn tunrns to bone
loss of PDL and lamina dura
occurs after trauma - avulsion, luxation, intrusion

Tx - no treament possible exepcet decorniate to ACJ if infra occlusion and monitor

76
Q

Root resoprtion occurs due to

A

truama
bleaching
bruxism
ortho
exfoliation of decidous teeth
impacted teeth

77
Q

posts indicated

A

in premolar teeth
when 1/2 marginal ridges are lost on tooth

78
Q

Choice of post

A

root morphology
internal canal antomy
remoaing coronal dentine

79
Q

Post crietira

A

4-5mm of GP present at the apex of the tooth
no more than1/3 the diameter at the root of the tooth
crown to post ratio 1:1
2/3rds the root length
2mm of ferulle present
2mm supra ging tooth remaining
1mm of coronal dentine present
avoid lower incisors and curved canals

80
Q

Ideal post

A

parallel sided - avoids wedging and reduces root fracture
cement retained
non threaded - less stress on tooth, howver is less retentive
not rotated

81
Q

Parallel sided

A

requires the removal of more dentine to be removed so risk of peroforation

82
Q

Tapered sided

A

less dentine to be removed
small tapered roots
HOWEVER
more stress into root so incrsaed root fracture

83
Q

Serrated

A

increases root surface area for retention but does not increase stress

84
Q

Post removal

A

USS
Masseran kit
Eggler post remover
Mosquuito forceps
Sonic scaler

85
Q

Failure of posts

A

fibre - decementation
carbon or metal - due to root fracture due to stress

Perio
Caries
Vertical root fracture
Root resoprtion
Decementation
Perforation
endo failure
post or core fracture

86
Q

Nayyar core

A

uses amalgam or compiste
used when loss of both marginal ridges and the pulp chamber small
2-3mm of g pis removed in the coronal portion

87
Q

Ferrule

A

2mm of ferrule remaining to increases resitance from fracture due to lateral forces

88
Q

Cores

A

composite - mainly for firbe osts, good aethetics, bonds to tooth strucuture, however mositure sens and tech sens

Amaglam - easy prep, poor aesthetics and requires retnetion as can’t bond to dentine adn takes 24hrs to set so dealy in tx

GI - bonds to dentine adn relases fluoride, but it is weak and absorbs water and expands

89
Q

Material

A

Ceramic - zirconia
Cast metal - risk of corrision, ppor aesthitcs, radiopaque, root fracture
fibre posts - glass, quartz, carbon - do not use if not enough ferrule as risk of root fracture

90
Q

Ledge

A

a step made within a canal due to stopping the file too short of the working length

91
Q

Zippeing

A

a tear drop shape created in apical 1/3 of the wall - due to overextending passed the apical forman or large files

92
Q

Transportotion

A

creation of a new pathway - due to excessive force during instrumentation

FINALS!!! (20 decks)

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