Endo Summary Flashcards
Maxillary roots+canals
Central 1 (1)
Lateral 1 (1)
Canine 1 (1)
1st premolar 2 (2)
2nd premolar 1(1)
First molar 3 (4)
2nd molar 3 (3)
Mandibular roots+canals
Central 1 (1)
Lateral 1 (1)
Canine 1 (1)
1st premolar 1 (1)
2nd premolar 1 (1)
1st molar 2-3 (3)
2nd molar 2 (3)
Endo Assessment
Sinus
Colour
Swelling
TTP
EPT/ECL
Mobility
Pockets
Radiographs
Endo contraindications
Preg 1st trimester - emergency only
CVD within last 6mths
Cancer - XLa preffered
Endo medical indication
Pt on bisphosphonates currently RCT>XLa
Success rates for 1st endo to 2nd
90% - 1st RCT
80% - 2nd RCT
Functions of pulp
Nutrition, sensation
Design objects for RCT (3)
- Create a continuously tapering funnel shape
- Maintain apical foramen in original position
- Keep apical opening as small as possible
Function of mechanical prep
Creates space for irrigate + shape to obturate
NaOCl advantages
Antimicrobial activity
Dissolves necrotic + vital tissue
Disrupts smear layer
Important factors for NaOCl (5)
Concentration
Volume
Contact
Mechanical agitation
Exchange
Disadvantages of NaOCl
Effect on dentine
Inability to remove smear layer itself
Sodium hypo incidents - eye/fabrics
Apical extrusion –> tissue necrosis
Allergic reactions
Define the smear layer
Layer of organic+inorganic material found on dentinal walls after instrumentation
What is the disinfectant protocol (3)
NaOCl 3% 30ml for 10mins
17% EDTA 1 min
NaOCL final rinse
Function of EDTA
Chelating agent removes smear layer
CHX function
Antibacterial but unable to disrupt biofilms
Anaphylaxis risk
What is EWL
PreOp PA - 1mm
What is CWL
Confirmed with EAL,length for prep+obturation
What is a MAF
Largest diameter file to WL
Represents final prep size of apical portion of canal
List different file movements
Filing
Reaming
Watch winding
Balanced force
Envelope of motion
Function of barbed broach
Extirpation
What motion do we use K files in
Filing
Function of Hedstroem files
GP removal or fractured instruments
NiTi files advantages
Superelasticity
Greater taper + cutting efficiency over SS (K files
Filing motion
1/4 turn clockwise
Watch winding motion
Back and forth 30-60
Balanced force motion
1/4 turn clockwise, 1/2 turn counter clockwise
Envelope of motion
360 degrees
Reasons for instrument separation
Torsional stress/flexural stress
Properties of materials that fill RC
Biocompatible
Unaffected by tissue fluid
Insoluble
Non supportive of bacterial growth
Radiopaque
Removable
List different obturation techniques
Cold lateral compaction
Warm vertical compaction
Continuous wave
GP constituents (4)
Gutta Percha
Zinc Oxide
Radiopacifiers
Plasticisers
Function of sealers (3)
Seal space between dentinal wall
Lubricate
Fill voids
Common sealers
ZOE
GI
Resin - AH+ (hydrophilic)
Calcium Silicate (hydrophilic)
RCT favourable assessment of outcome criteria
Absence of pain, swelling other symptoms
No sinus tract
No loss of function
Radiological normal pDL
RCT unfavourable assessment of outcome criteria
Signs/symptoms of infection
PAP, or PAP same size or increased
Factors contributing to RCT success (4)
Patency
Well condensed no voids
Within 2mm of apex
Good quality restoration
Factors contributing to RCT failure (6)
Missed canals
Ledges
Perforations
Sinus
Size of PAP
Iatrogenic damage
Laws of Symmetry
Orifies lie equidistant from line drawn MD across pulp chamber
Orifies lie perpendicular to each other
Law of colour change
Pulpal floor darker than walls
Law of Orifice location
Located at junction of walls + floor
Located at angles in floor - wall junction
Lie at terminus of root development fusion lines
Symptoms of NaOCl extrusion
Pain, bleeding, bruising, swelling, airway obstruction
RFs for NaOCl extrusion (6)
Excessive pressure during irrigation
Needle locked within canal
Loss of control of WL
Larger apical diameters - immature apex
RR
Proximity to sinus
Management of NaOCl extrusion
Stop tx, alert pt
Consider LA if in pain
Achieve haemostats
Place a steroid containing medicament - ODONTOPASTE
Dress tooth + document/datix + give POI
Post op instruction for NaOCl extrusion
Pain + swelling relief
Cold compress first few days
Warm compresses
Analgesia
Review within 24hrs
Abx?
Refer if severe
NaOCl guidelines
Careful preop: open apices/perf
Always pass syringe behind head
Silicone stopper set 2mm short of WL
Syringe 3/4 full
Build up if isolation compromised
Depress with index finger
Bib + eye protection
Dental dam + check seal
Clearly label syringes
Irrigating needle should not bind in canal
Use LeurLok 27G needle
