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Endodontics > Endo Test 2 > Flashcards

Endo Test 2 Flashcards

1
Q

Endo infections are…

A

polymicrobial

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2
Q

Bacterial profile changes in endo disease as the…

A

disease progresses

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3
Q

Debridement relies on..

A

chemical and mechanical action (cleaning and shaping)

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4
Q

Successful root canal therapy depends on a lot of things

A

Correct Diagnosis
Adequate Access
Adequate working length determination
Adequate Progressive Disinfection of the Root Canal System(Cleaning)
Adequate Shaping (minimal deviation from the original anatomy)
Adequate Obturation (bacterial-tight seal)
Adequate Coronal Seal (bacterial-tight seal)

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5
Q

Poor access leads to

A

proceudral accidents and poor chemomechanical debridement

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6
Q

Poor chemomechanical debridement leads to

A

persistent infections and poor obturation

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7
Q

What is the BEST way to decrease bacterial load

A

Mechanical + Chemical + Ca(OH)2 decreases the bacterial load the most

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8
Q

Order of best irrigants

A

4%, 2.5% NaOCl > Chlorhexidine > EDTA > Citric Acid > 0.5% NaOCl

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9
Q

Properites of the ideal irrigant

A 
Removal of particulate debris
Antimicrobial 
Dissolves organic tissue 
Removes smear layer
Disinfects areas not accessible to files
Lubrication of files (reduces separation)
Non-toxic
Not altered by dentin
Organic tissue solvent
Inorganic tissue solvent
Antimicrobial action
Nontoxic
Low surface tension
Lubricant
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10
Q

What are the BIOLOGIC objectives of cleaninga nd shaping

A

Progressively reduce the number of viable bacteria
Remove all tissues and debris
Avoid irritation of the periradicular tissues
Keep instruments and irrigants inside the tooth
Never bind the needle in the canal or you will push the Clorox through the foramen

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11
Q

What are the MECHANICAL objectives of cleaning and shaping

A

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

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12
Q

What are the 3 steps to cleaninga nd shaping

A

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

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13
Q

Describe the K3 instruments

A

same tip size (25) different taper (note differences in thickness)

same tip size (25) different taper (note differences in thickness)

used in preliminary and final crown down

Size at D0=25
Different Taper (0.12 to 0.02)
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14
Q

what RPM do you use

A

280-300

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15
Q

What is recapitulation

A

Hand files (K-files) should always be used in between rotary instruments

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16
Q

What are the goals of PRELIMINARY CROWN DOWN

A

Enlarge canal orifice - Allows for easier access of subsequent instruments and irrigants

Achieve Straight Line Access to the Apical 1/3
Decreases procedural accidents (ledges, broken instruments and etc)
Increases accuracy of working length determination

Gross-debridement of the Coronal 1/3
Avoids extrusion bacteria and their toxins into the periapical region

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17
Q

What are the goagls of the FINAL CROWN DOWN

A

Improves Line Access to the Apical 1/3
Decreases procedural accidents (ledges, broken instruments and etc)
Increases accuracy of working length determination

Maintains a glide-path into the apical 1/3

Gross-debridement of the whole root canal system

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18
Q

What are the goals for the FINAL APICAL PREP

A

Final debridement of the apical 1/3

Creation of an apical stop (matrix)

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19
Q

What instruments do you use in step 3 (final apical prep

A

Use Profile Instruments

Refer to the apical size table in your manual for the most adequate final apical size preparation for the tooth being treated

Profiles are ALL THE SAME TAPE (0.4) but different lengths

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20
Q

What taper must you reach on step 2

A

0.04 because the profiles are all this taper

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21
Q

Instrumentation goal is?

A

continuous taper from coronal access to apical foramaen

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22
Q

what is the apical matrix

A

Narrowest Portion of the Preparation

Artificial Barrier Ideally Created at the CDJ

Barrier / Stop Beyond Which Smaller Files Cannot Pass

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23
Q

3 things to evaluate cleaning and shaping

A

smooth walls

positival apical matrix

adequately enlarged while maintaining original shape and giving an even taper

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24
Q

Ideal filling material

A 
Easily introduced into the canal.
Seal laterally and apically.
No shrinkage after insertion.
Impervious to moisture.
Bacteriocidal or discourage growth.
Radiopaque.
Non-staining to tooth structure.
Non-irritating to periapical tissue.
Sterile or easily sterilized.
Easily removed from canal.
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25
Q

What are the four things in GP

A

GP
Zinc oxide
heavy meal salts
wax or resin

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26
Q

What is GP soluble in?

A

chloroform and xylene

Slightly soluble in eucalyptol

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27
Q

what is GP NOT soluble in

A

NOT soluble in aqueous solutions

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28
Q

what are the BIOLOGIC properties of GP

A

minimal irritation to tissue
NON-BIODEGRADEABLE
easily sterizlized

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29
Q

which is the master cone of GP

A 
standardized
named by NUMBERS
refer to MAF
first one you put in
tapered
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30
Q

which is the non-standardized GP cone

A

named by fine, med fine,fine fine etc
accessory cones
go in second
no taper

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31
Q

what are the advantages of GP

A

Can fill canal in 3 dimensions (adapts to canal walls very well)
Can be removed in retreatment or post preparation

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32
Q

what are the DISadvantages of GP

A

Doesn’t seal canal wall

Doesn’t come in precision sizes

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33
Q

ad/dis-ad of silver points

A

Advantages: they are rigid, easy to put into the right place

Disadvantages: they do not adapt to canal wall (this is why we use gutta percha – bc it adapts to the canal wall)

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34
Q

thermafil

A

combines silver points and GP

Disadvantages: bc it is so easy to place into the root canal, you may mishape or not completely clean the canal – you will have a higher instance of failure
If there is a curve, the carrier can go around the curve and it might strip the gutta percha off and lead to a source of leakage

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35
Q

why do we need sealers?

A

bc no obturation material can SEAL the canal

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36
Q

what is the IDEAL sealser

A 
Excellent seal when set.
Adheres to tooth and obturating material.
Radiopaque.
Non-staining.
Dimensionally stable.
Easily mixed and introduced into the canal.
Easily removed.
Insoluble in tissue fluid.
Bacteriocidal or discourage growth.
Non-irritating to periapical tissue.
Slow setting.
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37
Q

Kerr Sealer

A

has silver

stains tooth

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38
Q

Grossmans sealer

A

we use at UTHSCSA

non-stainign

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39
Q

What decreases working time of sealer

A

heat and humidity

over spatulation

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40
Q

what does sealer have that increases working time

A

small particle size of zinc oxide

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41
Q

What does EDTA do?

A 
Softens dentin.
Distinct antimicrobial properties.
Moderately irritating.
Suitable as irrigating agent.
Removes smear layer.
Demineralization proportional to time.
Partial demineralization.
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42
Q

properites of ideal temporary filling material

A 
Impervious to bacteria and oral fluids.
Hermetically seal.
No pressure on dressing.
Harden rapidly.
Withstand mastication.
Easy to manipulate.
Harmonious color.
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43
Q

Cavit

A

dont use on vital teeth

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44
Q

Hedstrom file

A

machined, not twisted instrument
Filing motion, more aggressively cutting than k-file
Used to prepare middle & coronal 1/3rds

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45
Q

Reamer file

A

Triangular twisted piece of stainless steel

Reaming motion = place into canal at given length, then turn clockwise ¼ turn to engage flutes, then bring out

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46
Q

K file

A

Square stainless steel wire twisted to form flutes
Used in filing motion = place in canal to given length, then apply lateral pressure against wall & bring out – do 360 deg around canal

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47
Q

what is the pulp-dentin complex highly innervated with

A

primarily pain sensing fibers

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48
Q

A mineralized encasing susceptible to damage by trauma or microbes is…

A

pulp-dentin complex

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49
Q

what is some etiology of pulpal insult

A

caries

trauma

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50
Q

what are the NON-CELLULAR defense mechanisms of the pulp

A

Outward fluid movement
Deposition of tertiary dentin (reactionary vs. reparative)
AV shunting mechanism

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51
Q

what are the CELLULAR defense mechanims of the pulp

A

Deposition of tertiary dentin (reactionary vs. reparative

Dental pulp is capable of robust immune responses.

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52
Q

in pulpal blood flow, what leads to vasoconstriction

A

sympathetic fibers

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53
Q

in pulpal blood flow, what leads to vasodilation

A 
injury
trigeminal afferent fibers
inflammatory mediators: PGs, bradykinin, free radicals
LPS and other bacterial products 
parasympatthetic fibers
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54
Q

what is the formula for pulpal blood flow

A

Pa - Pv / Rt

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55
Q

Describe outward fuid movement

A

There is a constant outward fluid movement from the dental pulp to the enamel layer.
This positive pressure is increased with edema of the dental pulp resulting in the extravasation of immunological active substances such as immunoglobulin towards the site of invasion.

Bacteria and toxin come from the carious lesion, travel down dentinal tubules, and the fluid moves in the opposite direction as the pulp becomes inflamed.

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56
Q

Primary dentin

A

first layer of dentin deposited during tooth development

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57
Q

Secondary dentin

A

Subsequent layer of dentin deposited with aging thoughout the life of an individual as long as the pulp is still vital

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58
Q

Tertiary dentin

A

localized layer of dentin deposited as a response to insult

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59
Q

Reparative Dentin

A

Teritiary dentin deposited by newly recruited odontoblast-like cells as result of an insult so severe that damaged the overlaying odontoblastic layer

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60
Q

So tertiary dentin can be…

A

BOTH Reactionary or Reparative

Tert dentin – body’s own restorative material – no restorative material is better than tert dentin
Tert dentin is less tubular (sometimes even Atubular) – it only accumulates in areas where it is needed.

SO the most desireable outcome as a response to injury is formation of tert dentin

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61
Q

What are the three things that can result from insult?

A

direct cellular damage
acute inflammatory response
chronic inflammatory response

62
Q

Pulpal irritants can be…

A

microbial
mechanical
chemical

63
Q

what ist he MAIN etiology of pulpal disease

A

MICROBES

they clog up the dentinal tubules

64
Q

Pulpal tissue may remain inflamed for long periods of time and may undergo eventual or rapid necrosis. This depends on several factors:

A

the virulence of bacteria,
the ability to release inflammatory fluids to avoid a marked increase in intrapulpal pressure,
the host resistance
the amount of circulation, and most importantly
the lymph drainage.

65
Q

what does direct cellular damage lead to

A

tissue destruction

Host Elicits Defense Against Invaders
May be Overwhelming to the Pulp

66
Q

what are the cardinal signs of inflammation

A 
Redness (Rubor)
Heat (Calor)
Pain (Dolor)
Swelling (Tumor)
Loss of Function
67
Q

what are the normal immune cells in the normal pulp

A

Dendritic cells
Macrophages (more centrally positioned)
Circulating T cells
Other resident immune cells

68
Q

what are the cells in INFLAMED pulp

A

Activated Dendritic cells and macrophages

Increasing numbers of PMNs

T, B, NK cells

Plasma cells (IgG, IgA specific against invading microroganisms)

69
Q

what do PMNs do during acute inflammation

A

Polymorphonuclear Leukocytes (aka PMNs):

Move towards a chemokine concentration gradient.

Have phagocytic activity

Can squeeze though vascular endotelial cells and into dentinal tubules

70
Q

Which is the first to recognize antigen

A

dendritic cell

so it is the first to release chemokines

71
Q

Describe chronic inflammation

A

PMNs are still present in great numbers

But, more T-lymphocytes and plasma cells are now present

Immunoglobulins (IgM, IgG and IgA) are now present.

72
Q

what is the first line of defense

A

PMNs

they squeeze into tubules

73
Q

what can Mediate Immune Attachment and Migration

A

cell adhesion molecules

74
Q

which cell adhesion molecules SLOW DOWN leukocytes

A 
P selectin
E selectin
PSGL1
PNad
MAd CAM
VCAM
75
Q

which cell adhesion molecules STOP leukocytes

A

ICAM2
ICAM1
VCAM1
MAdCAM1

76
Q

Allodynia

A

reduced nociceptive threshold. Non-noxious stimulus evoke pain – like when you tap a tooth (it shouldn’t hurt) but if there is a lesion/inflammation in a tooth, tapping the tooth would hurt. Stimulus causes pain when it shouldn’t

77
Q

Hyperalgesia

A

increased nociceptive signaling. Amplifies the noxious stimulus = more pain – elevated response to a painful stimulus – pulp test to test vitality of tooth – it is cold and sharp and hurts the PT – if the tooth is inflamed, it will hurt more than usual.

78
Q

Reduced firiing threshold

A

Sensitization occurs in both peripheral and central sites

79
Q

when the dentin exposed

A

infward flow of noxious agents –> inflammation
leads to increased intra pulpal tissue pressure
leads to outward flow of dentinal fluid
leads to reduced inward flow of noxious agents

80
Q

what is the results of the barthel experiment

A

Do not perform a direct pulp cap of a carious exposure!!

401 carious exposures capped:
Asymptomatic
Exposure less than 1mm2
Rubber dam isolation
Calcium Hydroxide dressing
Permanent restoration
81
Q

what happened if there is chemical etiology

A

iatrogenic

hypochlorite by dentist

82
Q

Periradicular pathosis: ACUTE

A

Etiology: microbial (early), trauma (e.g. occlusion), chemical (accidental injection of chemical into the periradicular tissues)
No radiographic lesion seen, perhaps just widening of the PDL
Same inflammatory infiltrate profile as seen in the pulp

83
Q

Periradicular Pathosis: CHRONIC

A

Etiology: Microbial (well-established infection)
Lesion is evident on the radiograph
Chronic inflammatory infiltrate as seen in the dental pulp is observed
There is activation of osteoclasts

84
Q

which periradicular pathosis is evident on radiograph

A

chronic

85
Q

Which periradicular pathosis has activation of osteoclasts

A

chronic

86
Q

what is present in chronic periapical pathosis

A

canal-periodontium communication

87
Q

What is obliterating the root canal space in three dimensions

A

obturation

88
Q

What are the proper cleaning and shaping characterisitcs

A

SMOOTH WALLS –WITHOUT ROUGHNESS, BLENDING FROM APICAL CONSTRICTION TO THE ACCESS PREP

POSITIVE APICAL MATRIX-TESTED WITH THE MASTER APICAL INSTRUMENT, SOMETIMES ONE SIZE SMALLER

ADQUATELY ENLARGED-ESTIMATED FROM THE DIAGNOSTIC RADIOGRAPH FOR ORIGINAL CANAL SIZE

89
Q

What are the criteria of fitting a GP master cone

A

THE MASTER CONE MUST FIT IN A DRY CANAL
Master cone must extend to WL
Have slight resistance to withdrawal
Radiographic confirmation to verify

90
Q

how many drops of eugenol when mixing sealer

A

2 dropos

91
Q

how much powder when mixing sealer?

A

size of quarter

92
Q

how do you know you’ve mixed the sealer correctly?

A

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

93
Q

How do you coat the canal walls?

A

Select a Profile instrument 2 sizes smaller set it to WL and coat it with sealer

94
Q

If you have a curved canal, how do you coat the walls with sealer?

A

A wiggling motion

95
Q

What is indicated when coating the canal walls on a straight canal

A

a counterclockwise rotation into the straight canal

96
Q

what is lateral condensation

A

a technique which involves the use of spreaders and pluggers(condensers) to fill the root canal system.

97
Q

What does the spreader do in lateral condensation?

A

is used to force the master cone laterally against the canal wall to make room for accessory cones by insertion with apical force

98
Q

The spreader makes space for what?

A

accessory cone

99
Q

When kind of force is used when you compact the GP?

A

both lateral and vertical

100
Q

what is the smallest size spreader

A

FF yellow

101
Q

what is a medium spreader

A

MF Red

102
Q

what is the largest spreader

A

F blue

103
Q

Accessory cones need to reach how far from WL?

A

1 - 2 mm

104
Q

how much cavit is needed for a good seal

A

4mm

105
Q

can you use cavit on a vital tooth

A

NO!
cavit needs water to set
it will dehydrate the dentin

106
Q

what happens if you over extend the sealer

A

it is an irritant

so usually cause transient discomfort

107
Q

What happens if you over extend GP

A

it is usually more irritating than if you over extend sealer and is not desirable

108
Q

5 criteria that are essential to proper obturation of the root canal

A

PROPERLY CLEANED & SHAPED CANAL
A GOOD APICAL MATRIX
A CONTINUOSLY TAPERING CANAL PREPARATION FROM ORIFICE TO APICAL FORAMEN
A SOLID CORE FILLING MATERIAL SUCH AS GP THAT OBTURATES THE CANAL SPACE IN ALL DIMENSIONS AND A FILM OF SEALER BETWEEN THE CANAL WALL AND GUTTA PERCHA MASS

SKILL OF THE OPERATOR

109
Q

always remember

Regardless of the type of obturation technique used, the quality of the obturation will be no better than the ________.

A

canal prep

110
Q

what are the 5 diagnostic components

A 
CC
History
Extra and Intraoral exams
Pulp tests
Radiographic exam
111
Q

what does physical tapping reveal

A

periapical irritation

indicated by a painful response to physical tapping

112
Q

what can palpation pick up

A

incipient swelling

determines tenderness

113
Q

when assessing mobility… getting a 1 means?

A

barely and perceptible horizontal movement

114
Q

when assessing mobility… getting a 2 means?

A

LESS THAN 1mm of horizontal movement

115
Q

when assessing mobility… getting a 3

means?

A

MORE THAN 1mm of horizontal movement

116
Q

what is the purpose of doing a peril exam

A

may discover a vertical root fracture or sinus tract
establish periodontal prognosis

make sure to explore the entire sulcus

117
Q

how can lighting up a tooth help see a fracture?

A

A fracture will disrupt the transmission of light through the tooth, exhibited by loss of illumination on the side of the fracture opposite the light source

SO… light it up… and then the part you don’t see lit up has a fracture somewhere
darkened part is on the other side of the fracture plane

118
Q

when taking radiographs, why is it imporant for correct angulation

A

you need to see the separation of multirooted teeth
come in at an angle to see
like we did 15 degreees off on max premolar

119
Q

when you do a pulp test, why do you select a control tooth

A

to establish what is “normal” to the PT

120
Q

where do you apply the thermal testing agent

A

mid facial area of facial crown surface

121
Q

what are some reasons for getting a false negative on the electric pulp tester

A 
Patient heavily premedicated
Inadequate contact with tooth
Recently traumatized tooth
Excessive calcification in the canal
Recently erupted tooth with immature apex
Partial necrosis
Dead batteries in pulp tester
122
Q

what is a reason to get a false POSITIVE on the electric pulp tester

A

Conductor / electrode in contact with a metallic restoration or gingiva
Patient very anxious
Failure to isolate and dry tooth
Liquefaction necrosis

123
Q

what are some plans of treatment?

A 
No treatment
Emergency treatment
Root canal treatment
Other
Tentative restorative plan
Extraction
124
Q

what are the clinical APICAL diagnoses?

A 
Normal
Symptomatic Apical Periodontitis
Asymptomatic Apical Periodontitis
Acute Apical Abscess
Chronic Apical Abscess
125
Q

what are the clinical PULPAP diagnosis

A 
Normal
Reversible Pulpitis
Irreversible Pulpitis
----Symptomatic
----Asymptomatic
Pulp Necrosis
Previously Treated
Previously Initiated Therapy
126
Q

What makes endo infections complex?

A

the bacteria are more ANAEROBIC as you move deeper in the canal
but the majority of the bacteria are found in the coronal 1/3 of the canal

127
Q

by how much does the taper of a file increase

A

0.02mm of taper per each 1mm length

128
Q

what are the 3 non-cellular defense mechanisms of pulp

A

AV shunting
tert/reparative dentin
outward fluid movement

129
Q

what is reparative dentin

A

Reparative dentin (3) deposited by newly recruited odontoblast like cells as a result of severe insult that has damaged the overlaying odontoblastic layer. Is it atubular dentin

130
Q

what is reactionary dentin

A

deposited by odontoblasts (they react) when there is moderate insult. It is tubular dentin continuous with other dentin layers

131
Q

what ist he difference between reparative and reactionary dentin

A

reparative dentin is ATUBULAR to a SEVERE insult

Reactionary is TUBULAR DENTIN to a MODERATE insult

132
Q

tertiary dentin can be ___ or ___.

A

reactionary or reparative

133
Q

How do we know that Microorganisms are the main etiology of pulpal disease??

A

RAT STUDY

Kakehashi, Stanley and Fitzgerald 1965

134
Q

cleaning and shaping will disrupt the bacterial _____.

A

biofilm

135
Q

how do you get the periradicular lesion?

A

bacterial invasion –> necrosis –> lesion

136
Q

PMNS follow a chemotactic gradient:

A

Detect a chemical signal (chemostasis)

Roll  Attach Migrate Attack

137
Q

how do you develop chronic apical periodontitis

A

• Cellular mediator activate osteoclasts and they destroy the surrounding apical bone

138
Q

what is central sensitization

A

when a tooth pain is around for a while and the other adjacent teeth will also feel painful

139
Q

if the PT breaks off parts of their crowns, is there a good prognosis?

A

yes.

just bond the teeth back on

140
Q

do osteoclasts get activated in acute periradicular pathosis

A

no

141
Q

in anterior teeth, where do you cut off the GP?

A

1.0 mm apical to cervical line

1mm apical to CEJ

142
Q

in posterior teeth, where do you burn off the GP?

A

at the root canal orifice

143
Q

what is central sensitization

A

when a tooth pain is around for a while and the other adjacent teeth will also feel painful

144
Q

if the PT breaks off parts of their crowns, is there a good prognosis?

A

yes.

just bond the teeth back on

145
Q

do osteoclasts get activated in acute periradicular pathosis

A

no

146
Q

do osteoclasts get activated in acute periradicular pathosis

A

no

147
Q

do osteoclasts get activated in acute periradicular pathosis

A

no

148
Q

in anterior teeth, where do you cut off the GP?

A

1.0 mm apical to cervical line

1mm apical to CEJ

149
Q

in posterior teeth, where do you burn off the GP?

A

at the root canal orifice

150
Q

surviving odontoblasts will lay down?

A

reactionary dentin

to a moderate/minor insult

151
Q

newly recruited odontoblasts will lay down?

A

reparative dentin

to a major big insult

Endodontics (3 decks)

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