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Endo Teeth Flashcards

1
Q

Treatment Planning
Considerations when deciding on restoring an endodontically treated tooth:
(5)

A

-Must have a ”global” perspective on your patient.
-How is the existing root canal? Is it sound? Does it appear adequate? PARL?
-Is the tooth restorable? How much tooth structure is left? Will you need a post?
-How important is this tooth in the patients overall treatment plan?
-How important is this tooth in the patients functioning?

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2
Q

What might be needed to properly restore this tooth beyond a crown?
(4)

A

-Post
-Core
-Crown Lengthening
-Orthodontic movement?

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3
Q

Adequacy of the Root Canal
(6)

A

-Is the tooth asymptomatic?
-Are the canals well filled?
-Does the apex appear sealed?
-Is there any suspicion of apical pathology?
-Is there a temporary restoration present?
-Is any restoration present sealed protecting the
RCT from the oral environment?

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4
Q

Adequacy of the Root Canal
-How long has the present restoration been
present?
-Long standing temporary or lack of proper seal
from restoration? Possible
-Deep caries present? Possible

A

re-treat due to bacterial contamination.

crown lengthening or even deemed nonrestorable.

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5
Q

Treatment Planning
(6)

A

Is the tooth in a useful function in the patient’s occlusion?
Is the RCT treated tooth used as an abutment for an FPD?
Are esthetics at play in restoring the RCT tooth?
What is the prognosis of the restoration you want to place
on the RCT treated tooth?
Is the patient a bruxer? Grinder?
Is the patient home care adequate?

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6
Q

Prior to the RCT, examining the remaining tooth
structure is important for —.

A

restorability

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7
Q

Just because you can do an —, doesn’t
mean you should.
Just because you could do a —, doesn’t
mean you should.
Engage your brain to put all these pieces together
to decide how best to treat a patient.

A

RCT
crown

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8
Q

Why do we need to examine RCT teeth more carefully and
consider crowning RCT teeth quickly?
-Once pulp has been removed, and nerve sensation stopped, the tooth loses its
ability to …
Meaning you can bite harder
on these teeth before you …
-In an RCT tooth, there is a loss of — from a variety of sources
(access, caries, bone loss from infection).
-The tooth now is less strong and both of the above criteria result in a higher
likelihood of —

A

monitor changes in proprioception.
feel pain or discomfort.
structural integrity
FRACTURE.

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9
Q

Favorable

A

Fracture in enamel only (crack line) or fracture in
enamel and dentin
The fracture line does not extend apical to the
cemento-enamel junction
There is no associated periodontal probing defect
The pulp may be vital requiring only a crown
If pulp has irreversible pulpitis or necrosis, root
canal treatment is indicated before the crown is
placed

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10
Q

Questionable

A

Fracture in enamel and dentin
The fracture line may extend apical to the
cemento-enamel junction but there is no
associated periodontal probing defect
There is an osseous lesion of endodontic
origin

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11
Q

Unfavorable

A

Fracture line extends apical to the
cementoenamel junction
extending onto the root with an
associated probing defect

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12
Q

Fractures:
-Posterior tooth fractures occur because:
(3)

A

-Greater occlusal forces
-Divided occlusal surface (Cusps and Fossa)
-Fillings weaken tooth ability to hold together

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13
Q

Posterior tooth –
(2)

A

Occlusal forces more inline with vertical
axis of tooth. Therefore, vertical
fractures more likely.
Cusp coverage recommended
everytime on a posterior tooth to
prevent fracture.

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14
Q

“Does every RCT treated tooth require a crown?”

A

“Crowns did NOT significantly improve the
success rates of endodontically treated
ANTERIOR teeth when ample tooth
structure remains.
Crowns significantly improved
success rates of endodontically
treated POSTERIOR teeth

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15
Q

Crowns should be placed on RCT Treated — teeth as soon as possible
with few exceptions

A

POSTERIOR

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16
Q

Crowns are only indicated on RCT Treated ANTERIOR teeth when:
(2)

A

-They are structurally weakened by large or multiple restorations
-They need substantial changes in form or color that cannot be achieved
by more conservative means

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17
Q

Crown Preparation -
Preserve and maintain
Need at least — for a ferrule.
If sufficient natural tooth structure remains, a
— are often used to help retain a core build up

A

the natural tooth structure as much as
possible as it is the strongest support of a crown.
2mm
Build up/Core will
fill the RCT access and chamber to restore the lost tooth
structure.
Pins

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18
Q

Amalgam has been as used a core material for a long time
but not as much now.
-Disadvantage –
-Advantage –

A

not retentive, does not bond, more tooth
reduction needed
strength

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19
Q

Composite resins are used much more now for core build up
-Disavantage –
-Advantage –

A

not as strong
usability, bonding, more conservative tooth
reduction

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20
Q

If tooth structure is missing, and restorability is
compromised but not condemned, a

A

post can
be used to add strength to the core build up as
you restore the lost tooth structure.

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21
Q

Why do we use a post?
(4)

A

-RCT teeth with inadequate tooth structure to retain a core
-Teeth that have lost more than 50% of coronal tooth structure
-Single rooted teeth since the anatomy of the pulp chamber
does not offer mechanical retention.
-Teeth with significant response to lateral forces of occlusion.

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22
Q

Why do we NOT use a post?
(3)

A

-The purpose of a post is to retain the core in a tooth when
there is extensive loss of coronal tooth structure.
-Preparation of a post space adds risk to the restorative
prognosis
-Higher likelihood of fracture or perforation

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23
Q

The needs for a post vary between

A

anterior and posterior.

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24
Q

Anterior Teeth –
Patient presents with an intact anterior moderate
sized lingual RCT access with a resin composite
restoration in the access
If tooth has darkened:
(2)

A

-Internal bleaching
-Possible veneer or composite

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25
However, at this stage there is no need for a post due to
ample of amount of remaining tooth structure
26
Internal bleaching – (3)
In access hole, place bleaching material and seal the access with a temporary fill. May need to be repeated several times. Can last for a reasonable amount of time and may need to be touched up in the future
27
Anterior tooth – When more than 50% of coronal tooth structure has been lost - (2)
A post and core will be necessary for retention of a crown. The post and core is meant to resist lateral forces which would cause the crown to dislodge.
28
Anterior tooth – How do you decide when to place a post/core/crown versus extraction and implant? Many factors – (8)
Remaining tooth structure Patient occlusion Patient habits Ferrule? Crown lengthening needed? Esthetics Patient desires Patient details (age, meds, etc.)
29
Anterior Tooth – What is a ferrule and why does this matter in your post and core decision process? A ferrule is the Minimum ferrule = --- circumferentially uniform ferrule is the minimum height. The ferrule is desired every time a crown is done.
vertical axial wall that encircles the tooth which a crown will use to resist fracture 2mm beyond the core 2mm
30
Without the proper ferrule,
root fracture is much more l ikely on anterior teeth due to high lateral forces in mastication.
31
Posterior tooth – (3)
When remaining tooth structure has large access and a shorter clinical crown, generally a post is NOT necessary. A crown preparation with a ferrule in harmonious occlusion with a build up in the access is enough to resist fracture. Most instances a build up is adequate to aid in crown retention.
32
An “Endocrown” can be made which
fills the access with crown material.
33
Posterior tooth – If extensive coronal destruction exists, and a post is necessary to retain the core:
Use the longest and straightest root and canal
34
Use the longest and straightest root and canal --- root of Maxillary molars --- root of Mandibular molars AVOID – --- roots of Maxillary molars AVOID – --- roots of Mandibular molars
Palatal Distal Buccal Mesial
35
Premolar tooth – Significant variation in root length, curvature, bifurcation, and width. Use a post only in roots that have
ample bulk and a straight root anatomy.
36
Use a post on a premolar if: (3)
Substantial tooth structure is missing (eg –post is placed in canal to replace lost cusp). If the tooth is under substantial occlusal forces. If the height of the tooth in MI is tall
37
One possible exception: Mandibular 1st premolar. (4)
The occlusion on Mandibular first premolars is usually favorable. Patient habits and conditions need to be assessed to ensure occlusal forces are not heavy or lateral. It may be possible to avoid both a crown and post on this tooth after RCT with a conservative access fill.
38
As a general rule, it is preferred to NOT place a post unless
needed to retain the build up material.
39
Using a core build up material only is desired if it provides
adequate retention and resistance form
40
With extensive coronal destruction in premolars generally requires a
post as tooth is much smaller in relation.
41
Molars often only need a build up and then secondary retentive features such as
grooves, boxes, pins, bonding, or utilizing the access hole.
42
Likely the most important factor in clinical success…. Leave as much --- a possible. The more you take away, the more you ... Sometimes, you have to leave the tooth “ugly” as this improves (2)
tooth structure have to add, the more you weaken the tooth and restoration retention and strength
43
Retention: (4)
ability of the post to resist vertical dislodging forces Post length and taper Active or Passive design Cement used
44
Resistance: (5)
ability of the post and core to withstand lateral or rotational forces Amount of remaining tooth structure Post length and rigidity Anti-rotation features Presence of a Ferrule
45
Post Length and Diameter: --- the length of the root is ideal Minimum length at least that of the clinical crown --- of Gutta Percha left to keep the seal of the Gutta Percha
½ to 2/3 4-5mm
46
When forces are applied near the incisal, the result is ... A post too short allows the forces to act with ... These guidelines are for --- rooted teeth
stress (R) concentrated at specific points. greater stress leading to a higher incidence of root fracture. single
47
Post LengthA post that does not leave 4-5 mm at the apical for the RCT seal will compromise the tooth: (2)
The post often is too big at the apex and can cause root fracture. The apical seal is compromised and therefore, recurrent infection can occur.
48
Post LengthAs a general rule, molar post spaces greater than --- apical to canal orifice increases the potential for root perforation
7mm
49
Post LengthRoot Thickness: -Post preparation diameter should not exceed -- of the root at the CEJ -Leave at least --mm of sound dentin at mid-root -Ideal diameter of post should only be --- depending on the particulars of the tooth -Post preparation is done with instruments particular for the post and its diameter. -Stay away from canal --!!
1/3 1 0.6mm – 1.2mm curves
50
Post Length Summary Retain -- mm of Gutta Percha at the apical aspect of root -(Unless of curvatures) -Often this is not possible on molars due to root anatomy
4-5
51
Molar post measurement is -- from canal orifice in pulp chamber
7mm
52
Preserve as much root structure as possible -The diameter of the post should not be greater than -- of the root -Post space should be surrounded by at least -- of tooth structure in the mid-root and further apically.
1/3 1mm
53
Removal of Gutta Percha to create Post space --- isolation mandatory Can --- the Gutta Percha to then be able to remove it. (Heat Method) (2) Heated removal of GP can occur anytime -Years after RCT placed or immediately after obturation. ... Heated instruments are used with caution. They can overheat the tooth and cause soft tissue --- if not careful.
Rubber Dam soften/melt -System B -Flame and endo tool A heated instrument melts the GP and then a warmed plugger compacts the GP vertically. burns
54
Removal of Gutta Percha to create Post space Mechanical Method Canal is instrumented with -Pink GP should be visualized being removed during the entire use of these instruments. -This should be done --- There is a safety tip on the Gates Glidden and the Peaso. Correct --- is CRITICAL -Do not force bur into --- A slow speed handpiece is used. Gates used at --- with Electric handpiece Peaso used at --- with Electric handpiece No HARD pressure is used. The GP is soft and should guide the instrument.
Gates Glidden and/or Peazo Reamer rotary instrument. SLOWLY angulation hard dentin surfaces. 800RPM 1200RPM
55
Treatment Planning - Post Mechanical GP Removal Follow the pink GP with gentle --- movements. Press in. Pull back. Repeat You may need to start with a Watch your ---!!!
vertical small drill and step up to a larger one depending on the size of the canal. angulation
56
Active posts
engage the surrounding root material usually via threads or a serrated edge.
57
Passive posts
fit into the canal without engaging the surrounding root material.
58
Threaded Parallel posts are the most retentive
-Create higher stress on the root and therefore have a higher incidence of root fracture
59
Serrated Parallel are close behind in retentiveness.
-High stress at apex and therefore higher incidence of root fracture
60
Tapered Passive Posts are least retentive (2)
-Less incidence of root fracture due to least amount of stress on root -Can be adequate.
61
Most to least retentive
Threaded Parallel Post Serrated Parallel Post Threaded Tapered Post Serrated Tapered Post Parallel Passive Post Tapered Passive Post
62
Active posts are often
screwed into the teeth with a handpiece or special tool to engage the surrounding root surface
63
Passive Posts gain their retention and support through
cementation
64
Passive Posts sit in close proximity to --- and rely on cement for rentention.
post space walls
65
Custom Passive Post – Custom Post
-Resin pattern sent to lab to be cast in metal alloy
66
Pre-Fabricated Posts –
Cemented in root with core build up of composite or amalgam
67
Pre-Fabricated Posts – Cemented in root with core build up of composite or amalgam Shapes are (3) Some are --- Can be (2)
parallel, tapered, or a combo serrated Metal or Fiber
68
Custom Cast Post Advantages: (3)
Anti-Rotational properties Core is part of post Can be preservative of tooth structure as the post fits the space
69
Custom Cast Post Disadvantages: (4)
Multiple appointments needed Tapered design is not as retentive Dark un-esthetic core Higher incidence of root fracture as post is harder material than root and if occlusion is off, post will not break, root will
70
Pre-Fabricated Post Advantages: (4)
Increased retention within root Ease of placement More versatile to a wider range of tooth root shapes Post will often break before root will
71
Pre-Fabricated Post Disadvantages: (4)
Post space needs to be slightly larger than cast Core retention to post can be a problem Possible rotation Metal posts still have un-esthetic color
72
Pre-Fabricated Post Caution--
Parallel posts have difficulties at times with narrowing of tooth root and can lead to root tip fracture.
73
Clinical Treatment Decision: A premolar with a canal shape that is ovoid presents a dilemma. A pre-fab post is not stable on its own as the canal shape allows the post to rock back and forth so: (3)
-A cast post can be made -A Pre-Fab post can used and cemented -A Two Pre-Fab post technique can be used to stabilize the Pre-Fab Post
74
Two Post Technique
One major post goes to length and height for Core build up, but canal orifice allows post to wobble. A minor (smaller) post can be placed into the canal as far down as it can go to stabilize the major post. This reduces the stress on the major post which would have been supported only by cement. Then the two posts are cemented in the canal together and core build up placed. Primarily for Anterior and select premolars
75
Cast Post Technique (4)
A red Duralay resin impression is made of the post space. Tooth is temporized while Duralay is sent to the lab. Post is tried in and cemented. Cast post is used as build up as well.
76
With a tapered post, how do you keep it from being able to rotate? (3)
Small grooves in canal can allow cement to fill those spaces decreasing rotation Using multiple posts A Cast post that includes a slight fill in a neighboring canal.
77
Once posts are in, concerns for re-treatment arise due to preparations of the
canals. Often too wide, too much tooth removed to be able to remove post cement, and then re-treat.
78
The post should extend to the height of your --- so that the build up has the full support of the post.
build up
79
Challenging occlusion? Little occlusal room? Significant vertical overlap? Bruxer/Grinder? If so, a --- post is the first choice as it will not break or separate. The risk is root facture however if the forces on the tooth are still too strong.
Cast
80
Post Materials: Metal Posts: (4)
-Cast Metal (type 3 Gold with Gold and Palladium) -Stainless Steel – very rigid, used most often -Titanium alloy – biocompatible but weaker -Brass – not used, corrosion occurs
81
Post Materials: Non-Metal Posts: (3)
-Fiber-Reinforced composite (glass/quartz) -Ceramic (zirconia) post / composite core -Possible other ceramic post/core (milled or pressed in lab). Not enough data to recommend.
82
-Ceramic (zirconia) post / composite core (2)
-Difficult to remove -increased fracture potential
83
Fiber reinforced Posts: -Main advantage is better --- -Modulus of --- is similar to dentin -Must use --- cement (self-adhesive) -Less --- than metal posts Post will usually break before post does -Failures typically occur in teeth with ---
esthetics Elasticity Resin Root fractures little coronal tooth structure.
84
Pre-Fab Post summary: Used by a majority of clinicians Can be used in (2) situations Either (3) in cross section Can be (2)
immediate or emergency parallel or taper and round fiber reinforced or metal alloy -Usually stainless steel or titanium alloy
85
Cementation: ---- cements do not increase post retention in a significant way -Better to use --- -Showed to improve retention. -A pre-treatment of the dentin prior to cementation can have significant increase in --- of bond.
Luting Dual or Self cure Resin cement. strength

Fixed Prostodontics 2 (13 decks)

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