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Endodontics > Endo Test 1 > Flashcards

Endo Test 1 Flashcards

1
Q

Endo is concerned with…

A

MORPHOLOGY, PHYSIOLOGY, PATHOLOGY of PULP and PERI-RADICULAR TISSUE

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2
Q

Apical periodontitis

A

Detected by peri-radicular radiolucency – INCREASED OSTEOCLAST ACTIVITY

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3
Q

NSRCT is to remove the __ and __ of microorganisms to pulpal and periradicular space

A

presence and access

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4
Q

What three factors determine how fast Apical Perio heals?

A

Chemomechanical debridement and restoration, endo pathogens, host factors

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5
Q

What two cytokines released by macrophages play an important role in bone resorption

A

IL1 beta and PGs

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6
Q

5 things in NSRCT

A 
Diagnosis
coronal access
instrumentation
obturation
final restoration
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7
Q

Diagnosis is made up of 3 things

A

history (med and dent)
classification of pulpal and periradicular disease
treatment plan

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8
Q

how many positive signs or symptoms do you need before starting RC treatment?

A

TWO

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9
Q

What are the 3 goals of coronal access

A

straight line access
conserving tooth structure
unroof pulp chamber and remove pulp horns

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10
Q

law of centrality

A

pulp chamber is always in the CENTER of the tooth

it is at the level of the CEJ

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11
Q

Law of concentricity

A

walls of pulp chamber are concentric to the external surface of the tooth at the CEJ
Same amount of tooth lies between the outside and the pulp chamber

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12
Q

Law of CEJ

A

CEJ is the most consistent, reproducible landmark for locating the pulp chamber
CEJ is easy to see, even on heavily restored teeth
roof of pulp chamber at CEJ usually

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13
Q

law of symmetry I

A

EXCEPT FOR MAX MOLARS – orifices are equdistant from MD drawn on camber floor

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14
Q

Law of Symmetry II

A

Except for MAX MOLARS – the orifices lie on a line PERPENDICULAR to the MD line

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15
Q

Law of color change

A

Color of the floor of the pulp chambers is darker than the walls

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16
Q

Law of orifice location I

A

orifices located at junction of wall and floor

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17
Q

Law of orifice location II

A

Orifices are located at the terminus of the developmental fusion lines
**Champagne bubble test - helps you locate orifice

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18
Q

what are the 2 major goals of instrumentations

A

cleaning and shaping

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19
Q

what are some chemicals you can use to clean

A

NaOCL - irrigation

Ca(OH)2 - between appointments

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20
Q

What kind of shape do you want to achieve through the shaping stage

A

continuously tapering conical shape from apical to coronal ends of the RC system

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21
Q

What is the goal of obturation

A

create a fluid-tight seal int he entire length of the RD system and to entomb any residual pathogens

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22
Q

Coronal seal

A

temporary and final restoration

prevent microleakage

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23
Q

What are some indications for NSRCT

A 
Irreversible pulpitis
pulpal necrosis
hyperplastic pulp
prosthetics
excessive supraeruption
interna/eternal resortpion
endo --> perio
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24
Q

CONTRAINDICATIONS to NSRCT

A 
tooth is unrestorable
insufficient perio support
massive root resorption
non-strategic tooth
canal instrumentation not practical
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25
Q

When do you evaluate NSRCT after you do it

A

6 months after

then yearly after that

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26
Q

how do you know you were successful?

A

tooth is asymptomatic
tooth si functional and firmly seated in alveolus
soft tissue is normal
radiographs show normal lamina dura and no more PA radiolucency

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27
Q

How do you know NSRCT was unsuccessful

A

symptomatic tooth
soft tissue – sinus tract plus palpation
PA radiolucency still there

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28
Q

Successful endo depends on

A

effective pain control and anxiety control

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29
Q

what is endo pain secondary to

A

inflammatory mediators on nociceptors

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30
Q

What are the THREE Ds to control endo pain

A

diagnosis
definitive dental treatment
drugs – there are 3 drug classes that can act at CNS, act on axons, act on the inflammatory mediators

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31
Q

after you do NSRCT, how does the root grow back

A

SCAP – stem cells from apical papilla

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32
Q

Pulp is from what origin

A

mesenchymal

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33
Q

pulp is mostly

A

CT – highly vascularized and innervated

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34
Q

what are the functions of pulp

A 
inductive
formatie
nutritive
sensory
protective
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35
Q

Pulp horns in incisors are

A

located MD

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36
Q

pulp horns in post teeth correspond to

A

cusp tips

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37
Q

pulp chambers tend to occuppy

A

crown center

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38
Q

dimensions of pulp chamber depend on

A

shape of crown and trunk

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39
Q

“pulp cavity” is divided into what two things

A

pulp chamber and root canal

coronal part and radicular part

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40
Q

what kind of curve to most root canals have

A

FL – so a curved canal is often undetectable on a facial projection radiograph

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41
Q

wide roots tend to have

A

more than one canal

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42
Q

root canal extends from what to what

A

orifice to apical foramen

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43
Q

the shape of the pulp system reflects

A

the surface outline of the crown and root

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44
Q

Weine canal classification - TYPE 1

A

one orifice - one canal - one foramen - (1-1)

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45
Q

Weine canal classification - TYPE 2

A

two orifices - two canals - one foramen (2-1)

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46
Q

Weine canal classification - TYPE 3

A

Two orifices - two canals - two foramina (2-2)

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47
Q

Weine canal classification - TYPE 4

A

one orifice - two canals - two foramina (1-2)

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48
Q

What are somet things that can alter the internal anatomy of a root

A

age, irritants (that stimulate increased dentin formation – like caries, perio disease, etc)
calcifications
internal resorption - uncommon and not extensive

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49
Q

the apical foramen is usually…

A

NOT at the true anatomic apex of root

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50
Q

Apical constriction

A

if present, it is not radiographically visble and usually not detectable with tactile sensation

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51
Q

the apical constriction is usually how far away from the apical foramen

A

0.5 to 0.75 mm away from the apical foramen

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52
Q

the apical foramen is usually how far away from the anatomic apex?

A

3mm

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53
Q

Dens invaginatus

A

max laterals
infolding of enamel
leads to variation in root and pulp anatomy
could be a source of irritation

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54
Q

dens EVAGINATUS

A

seen in mand premolars
small tubercle on the occlusal surface – has pulp
if the tubercle fractures, there is pulp exposure and it can lead to pulp necrosis
source of where bacteria enters

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55
Q

where do you see high pulp horns

A

mesio buccal of first molars

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56
Q

where do you see lingual groove

A

max laterals

can lead to a deep narrow perio defect which can have pulpal communication

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57
Q

Dilaceration

A

complex root curves

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58
Q

info about the max central

A 
triangular access
1 canal at apex
22mm long root
root is broad BL
labial/facial curvature apically
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59
Q

max lateral

A

Triangle – oval access
1 canal at apex
Distsal curved root at apex

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60
Q

Max canine

A

oval access
LONGEST TOOTH - 26 mm
1 canal at apex
distal curved root at apex

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61
Q

Max first PM

A 
oval access -- wide FL
1 canal - 26%
2 canals - 69%
3 canals - 5% 
mesial concavity on crown and root at CEJ
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62
Q

Max 2nd PM

A

75% - 1 canal at apex*
24% - 2 canals at apex*
1% - 3 canals at apex*

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63
Q

Max 1st molar

A 
Triangle access  - base toward facial and apex toward lingual -- situated more on the mesial side of tooth
--the 2 MB canals are 1-3 mm apart 
MB root: 82% has one canal; 18% has 2
DB root - 1 canal
Palatal root - 1 canal
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64
Q

Max 2nd Molar

A

MB root - 88% has 1 canal; 12% has 2
DB root - 1 canal
Palatal root - 1 canal

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65
Q

the palatal root is facially curved in…

A

55% of first molars

37% of second molars

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66
Q

Mandibular incisors

A

centrals - 3% have 2 canals

laterals - 2% have 2 canals

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67
Q

Mandibular canine

A

oval access – widest FL access

6% have 2 canals

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68
Q

Mand 1st PM

A

oval acces - wide
74% have 1 canal
25% have 2 canals

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69
Q

what is different about mand PM crown?

A

crown is at 30 degree angle to root

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70
Q

Mand 2nd PM

A

oval access - wide FL
97% have 1 canal
3% have 2 canals

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71
Q

Mand 1st molar

A

81% of mesial root has 2 canal orifices and 61% of those have 2 canals that exit the apex

Distal root – 22% have 2 canal orifices and 15% of those heave 2 canals that exit the apex

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72
Q

mand 2nd molars

A

Mesial root - 64% have 2 canal orifices and of that 35% have two canals that exit the apex

distal root - 7% have 2 canal orifices and of that 5% have 2 canals at the apex

so the distal root of mand 2nd molar is usually 1 canal orifice and one canal at apex

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73
Q

what is a radix paramolaris

A

additional FACIAL root

74
Q

Radix entomolaris

A

additional LINGUAL root

75
Q

Principles of endo access are…

A

removal of all defective restorations and caries before entering the pulp
removing unsupported tooth structure
create access cavity walls that do not restrict straight or direct line passage of instruments tot he apical foramen

76
Q

where do you want your straight line access to reach

A

apical third of canal or where the initial curve of the canal begins

77
Q

proper access allows for three thing:

A

effective irrigation
cleaning and shaping
quality obturation

78
Q

what are the two safe ended burs

A

endo-z and tapered diamond

79
Q

what can you use the endo explorer to do

A

locate orifices and evaluate straight line access

80
Q

what is the major etiologic factor of pulpal disease

A

bacteria

Bacterial-induced inflammation and necrosis of pulpal tissue.

–need to remove presence and access of bacteria

81
Q

what are portals of entry for bacteria into pulp

A 
attrition or other trauma
caries
failed restoration -- microleakage
anachoresis- bacteria gather in one spot
perio--> endo connections
82
Q

what kind of bacteria invade pulp

A

polymicrobial = 5-8 diff types

the percent of obligate anaerobes increases over time

more G- than G+

83
Q

Why does necrotic pulp favor anaerobes?

A

low O2 tension
rich in Polypeptides and AA
favors commensal interactions among microbes — one bacteria’s trash is another’s treasure

84
Q

successful NSRCT involves

A

disruption and removal of bacteria

85
Q

AP is associated with what bacteria

A

Prevotella - pain and sinus tract too
Porphyromonas - pain and sinus tract too
Fusobacterium
Peptostreptococcus

86
Q

Not all infection is caused by bacteria…

A

Yeast. Herpes. HIV also involved

87
Q

if there is bacterial colonization, are you INFECTED?

A

NO. most of thse bacteria are NORMAL FLORA.

88
Q

when can you call it INFECTION

A

when there is DAMAGE to the host with emergence of clinical signs and symptoms

89
Q

where does most of the pathology of infections come from

A

release of bacterial compound ( LPS, capsules, enzymes etc)
Activation of HOST’S cytokine network
Destruction of host cells and microbes

90
Q

How does the pulp respond to infection?

A

Non-specific: PMNS –> liquefactive necrosis –> abscess - or macrophages
Specific immune response: TH > Ts > Plasma

Secondary dentin formation

Vital pulp can help stop growth of bacteria.. but necrotic pulp is not resistant to infection

91
Q

What are the major cell types in peri-radicular lesions

A

Macrophages, lymphocytes (T>B), plasma cells, PMNs, NK, eosinophils, mast cells
This infiltrate can comprise ~50% of all cells

92
Q

increased osteoclast activity leads to apical perio… through what?

A

IL 1 - beta

PGs

93
Q

What if bacteria are present during obturation/

A

success drops from 94% to 68%

94
Q

What is so special about Enterococcus faecalis

A

33-60% of NSRCTs have E. Faecalis

95
Q

How far can microbes grow into dentinal tubules in 14-21 days?

A

300-400um

this is why uthscsa does a “crown down”

96
Q

what is the best method of cleaning?

A

cleaning and shaping (instrumentation)
with 0.5% NaOCL and
Ca(OH)2 for 1 week

97
Q

If there is pulpal necrosis with AP present, there is…

A

> 90% chance of intraradicular infection

98
Q

what are some techniques to reduce bacteria

A

Rubber dam
Chemomechanical debridement (modified crown-down, larger file size, copious NaOCl irrigation)
Inter-appointment medicament (Ca(OH)2 has best antibacterial effectiveness)
Quality of obturation
Seal of temporary and final restoration

99
Q

what are some properties of an ideal irrigant

A 
removes debris
antimicrobial
dissovles organic tissue
removes smear layer
disinfects areas not accessible to files
lubcricates files -- so you don't have separation 
non-toxic
not altered by dentin
100
Q

Rank the irrigants from most to least useful

A 
4% NaOCl > 
2.5% NaOCl >
2% chlorhexidine >
0.2% chlorhex >
EDTA >
citric acid >
0.5% NaOCl

do EDTA to remove smear layer

101
Q

When do you prescribe abx?

A

systemic involvement: lymphadenopath, fever, malaise etc

Pt has compromised immune system: disease or drugs

if the signs/symptoms are rapidly increasing

if there is involvement of an anatomic danger zone

102
Q

when you do use abx.. you should

A

check up on PT every 24 hrs

use loading doses

103
Q

Thee are 3 most common strains of pathogens

A

eubacterium (91 strains)
peptostreptococus (65 strains)
black-pigmented bacteroids (30 strains)

ALL ARE SUSCEPTIBLE TO PENICILLINS

104
Q

what percent of the bacteria are susceptible to amoxicillin + clavulanic acid

A

99% – it is the BEST

augmentin

105
Q

what is the worst abx?

A

metronidzole – only 42% are susceptible

106
Q

list the abx in order of best to worst

A 
amox + clavulanic acid >
clindo >
amox = clarithromycin >
penicilin >
metronidzole
107
Q

3 stages of odontogenesis

A

Bud –> cap –> bell –> eruption

108
Q

when is the enamel knot seen?

A

starts proliferating at cap stage – it is where the CUSPS or incisal edge will be

109
Q

where are the number of cusps defined

A

bell stage

110
Q

As the tooth erupts, there are NO MORE AMELOBLASTS.. only…?

A

odontoblasts which persist though life

111
Q

Hertwigs epithelial root sheath

A

epithelial origin

communicates with the mesenchymal stem cells

112
Q

enamel knot determines crown shape

what determines root shape

A

hertwig’s epithelial root sheath

113
Q

what are some cells found in the pulp

A 
Fibroblasts
Odontoblasts
Dendritic Cells
PMNs (neutrophils and macrophages)
Lymphocytes
Endothelial Cells and Neurons
Mesenchymal (Stem) Cells
114
Q

what is the most numerous cell in the pulp

A

fibroblasts
what does fibroblasts make>
type 1 and 3 collagen

it degrades collagen fibrils (turnover)
and has secretory function – growth factors

115
Q

what is the most specialized cell in dental pulp

A

odontoblasts
– make and sescrete DENTIN

makes type 1 collagen and proteoglycans for the ECM

secretes growth factors

believed to be able to detect antigens

116
Q

what growth factors do fibroblasts secrete

A

NGF and NPY

117
Q

what growth factors do odontoblasts secrete

A

dentin sialoprotein

DPP

118
Q

what is the ultimate APC>

A

dendritic cell
highly specialized immune cell
similar to Langerhans cell in skin
class 2 APC

presents it to T cells via MHC II

119
Q

Macrohpages and neutrophils

A

move toward a chemokine [] gradient
has APC activity
can squeeze into dentinal tubules
releases inflammatory mediators – IL1 and TNF alpha

120
Q

which is the regulatory T cell

A

CD 4

T HELPER

121
Q

which is the effector t cell

A

CD 8

CYTOTOXIC T CELL

122
Q

what makes up the ECM

A 
water
GAGs
Type 1 and 3 collagen
Non-collagenous proteins
----tenascin and fibronectin
123
Q

what does fibronectin do

A

Substrate adhesion glycoproteins

Involved in the attachment, spreading and migration of cells

124
Q

why is the pulp considered MICROvascularized

A

the biggest artery that enters is an arteriole

the biggest vein that exits is a venule

125
Q

what is a C fiber

A

low conducting
THROBBING PAIN
dull ache
typical linflammatory pain

126
Q

what is an A-delta fiber

A

sharp and quick pain
dentinal HSR
fluid moving up and down to cause a delta to go off

127
Q

describe the pathosis in periradicular tissue

A

Breakdown of bone, PDL and possibly cementum
Loss of cementum may lead the root susceptible to resorptive processes
Periradicular lesion heals with successful Endo TX, if lesion is of endodontic origin.

128
Q

what are the biologic objectives of cleaning and shaping

A

Progressively reduce the number of viable bacteria
Remove all tissues and debris
Avoid irritation of the periradicular tissues

129
Q

what are the MECHANICAL objectives of cleaning and shpaing

A

Achieve a continuously Tapering Cone Shape
Smooth Canal Walls
Development of an apical stop (matrix)
Avoid Iatrogenic Preparation Errors

130
Q

what are the 3 steps to cleaning and shaping

A

Preliminary Crown-Down (pre-flaring of the initial 2/3)
Final Crown-Down
Apical Preparation

131
Q

what do you use when you crown down

A

shape root canal system
use different TAPER but SAME SZE

k3

25mm at tip – but various tapers

132
Q

what are the goals of PRELIMINARY CROWN DOWN === step 1

A

enlarge canal orifice
achieve straight line access to apical 1/3
gross debridgement of coronal 1/3

133
Q

What are the goals for the FINAL crown down —— step 2

A

improve line access to apical 1/3
maintains a glide path into the apical 1/3
gross debridement of the whole root canal system

134
Q

3rd step - final apical prep

A

final debridement of apical 1/3

creation of an apical stop (matrix)

135
Q

how do you get the EWL?

A

subtract 1mm from the canal length

136
Q

in the final crown down, what taper K3 file do you have to reach the working length with?

A

0.04 taper

137
Q

what provides sensation to pulp

A

V2 and V3

138
Q

what are the chemical properties of gutta percha

A

Soluble in chloroform and xylene
Slightly soluble in eucalyptol
Insoluble in aqueous solutions

139
Q

what are the biologic properties of gutta percha

A

Minimally irritating to tissue
Non-biodegradable
Easily sterilized

140
Q

the master cone is..

A

tapered

ID’d by numbers - 30, 35, 40 etc

141
Q

the non-standardized cone is

A

not tapered – ID’d by name: fine, extra fine, med fine etc

142
Q

why is gutta percha better than silver tips?

A

gutta percha adapts to canal walls

143
Q

what does the thermafill carrier do

A

combines the properties of gutta percha and silver tips

144
Q

WHAT ARE THE EFFECTS OF EDTA

A 
Softens dentin.
Distinct antimicrobial properties.
Moderately irritating.
Suitable as irrigating agent.
Removes smear layer.
Demineralization proportional to time.
Partial demineralization.
145
Q

what is cavit

A

most commonly used temporary sealer
but don’t use in vital teeth because it needs water to set??
it dehydrates the dentin and causes more pain to PT

use only on non vitals

146
Q

intermediate restorative material (IRM)

A

does NOT need water to set

147
Q

a standard K file has

A

16 mm of screw area

25 mm length total

148
Q

when do you use a barb broach

A

NOT IN A NARROW OR CURVED CANAL

only use for Gross tissue removal from the root canal space

  Pulpectomy
  Debridement
149
Q

K# profiles have a

A

onstant tip size and varying taper

150
Q

the colored ones… have

A

constant 0.04 taper but varying tip size

151
Q

what ist he largest k file we use

A

20

152
Q

what are the non-cellular defenses of pulp

A

outward fluid movement
tert dentin
AV shunts

153
Q

what are the cellular mechanisms of defense for pulp

A

tert dentin

robust immune response

154
Q

what kind of pressure is in pulp from fulid movement

A

positive pressure

outward movement

155
Q

tert dentin

A

body’s own restorative material
can be reactionary or reparative
less tubular than reg dentin
makes a hard tissue barrier – dentin bridge

156
Q

bacterial insult to pulp results in what three things

A

direct cellular damage
acute inflammatory response
chronic inflammatory response

157
Q

what is allodynia

A

reduced threshold – something that should not be painful is painful

158
Q

what is hyperalgesia

A

increased signaling – amplifies noxious stimulus

159
Q

when there is an inward flow of noxious agents…

A

there is inflammation
then increased intra-pulpal tissue pressure
then outward flow of dentinal fluid
which REDUCES ITHE INWARD FLOW OF NOXIOUS AGENTS!

160
Q

once you have carious exposure, the chances are

A

SLIM JIM.

do not perform a direct pulp cap of carious exposed teeth

161
Q

the master cone for gutta percha should be…

A

fitted in a dry canal

162
Q

the master cone of gutta percha should be what when you withdraw it

A

slightly resistant

163
Q

does the master cone extend to the working length?

A

yes

164
Q

how do you confirm that the apical fit for the master gutta percha cone is good

A

radiographic

165
Q

how do you dry the canal

A

sterile paper points

166
Q

how do you pick a master cone size

A

same size as master apical file

set it to the working length

167
Q

a correct fit gutta percha cone should

A

be at the WL

slightly resist removal

168
Q

what if the master cone does not fit

A

inser the MAF again and make sure it goes down to the correct WL
clear the apex with a 10 file
irrigate and reinsert the master gutta percha cone to the WL or select another gutta percha cone of the same esize

169
Q

what if you don’t feel resistance?

A

the final prep is larger than originally believed – operator error
test a larger cone then
only use the larger cone if it goes all the way down to the WL

170
Q

what if the new master cone feels resistant but it doesn’t reach the WL

A

you have to go back with the Profile and use one size larger than the origianl cone tested

171
Q

How does one know when the root canal sealer is properly mixed?

A 
When there is a dense, homogenous,
smooth, creamy mass which when the
spatula is raised three fourths(3/4) to 
One(1) inch from the mixing slab, the 
string of sealer holds 4-5 seconds before
breaking
172
Q

How do you coat the canal walls with sealer

A

choose a profile instrument 2 sizes smaller than what your MAF was and set it to your WL and coat it with sealer

173
Q

when do you use a counter clock wise rotation

A

straight canal when sealing canal

174
Q

when do you use a wiggle motion when sealing canal walls

A

curved canal

175
Q

WHAT DOES “LATERAL CONDENSATION” OF GUTTA PERCHA MEAN?

A

using spreaders and plungers to fill the root canal system

176
Q

when do you use a yellow FF spreader

A

small canals

177
Q

when do you use a red MF spreader

A

medium canals

178
Q

when do you use a F blue spreader

A

large cnaals

179
Q

how far from the WL do you need to be when you do lateral compaction

A

1-2 mm

choose an acessory cone that matches the spreader size you chose

180
Q

CAVIT can only be used with

A 
non vital teeth
it needs water
and it will pull water from dentin
and dehyrate it
and cause more pain
if the tooth is vital

Endodontics (3 decks)

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