endo2 Flashcards
Niti Vs SS K Files 10 points
- Flexibility:
NiTi Files: High flexibility and superelasticity, ideal for navigating curved canals without creating procedural errors like ledging or transportation.
Stainless Steel Files: Less flexible, higher risk of procedural errors such as ledging in curved canals. - Cutting Efficiency:
NiTi Files: Enhanced cutting efficiency with variable tapers and flute designs for effective debris removal.
SS Files: Requires more effort to achieve similar cutting efficiency; < effective in debris removal. - Resistance to Cyclic Fatigue:
NiTi Files: Increased resistance to cyclic fatigue, less likely to fracture within stress limitations.
Stainless Steel Files: More prone to cyclic fatigue and breaking under excessive use. - Memory:
NiTi Files: Exhibits supermemory, return to original shp w/o distortion after used in curved canal
SS Files: Tends to straighten in curved canals- if not pre curved, potentially altering the canal’s anatomy. - Torsional Limits:
NiTi Files: Specific torsional limits, used with automated low-torque handpieces to avoid overloading and fracture.
SS Files: requires careful manual manipulation to prevent fracture. - Instrumentation Technique:
NiTi Files: Suitable for a crown-down approach, enhancing efficiency and reducing apical transportation risk.
Stainless Steel Files: Typically employed with step-back or watch-winding techniques, more technique-sensitive and time-consuming. - Duration and armentarium:
NiTi Files: Efficient debridement and canal shaping with fewer instruments and less time.
Stainless Steel Files: Requires more instruments and time to achieve comparable debridement, especially in complex canals. - Coronal Pre-Flaring:
NiTi Files: Facilitates better access to apical parts of the canal, reducing file deflection risk; sx file
Stainless Steel Files: Needs careful handling to avoid creating ledges or excessive tooth structure removal. - Large Canal Usage:
NiTi Files: Largest size is ISO #50, F5 finishing files.
Stainless Steel Files: Size #140 used for anterior teeth. - tactile sensation+ control req : SS better
Limitations of Success Criteria evaluation of rct 3x
1 Time-Dependent Healing:
Healing may take over a year; premature evaluations might misclassify outcomes.
2 Radiographic Limitations:
Variations in image quality and interpretation-subjective.
3 Potential personal bias and missed small lesions.
4x Patient factor affecting Disease Management in rct
Patient Factors:
1Compliance with oral hygiene, follow-up visits, health status.
2Financial constraints affecting the use of CBCT.
3Disease-Specific Considerations:
Anatomical challenges like C-shape canals and Dens evaginatus common in certain demographics.
4 age:Elderly patients may have calcified tissues complicating treatment.
Factors Contributing to RCT Failures 4x
1 Anatomical Challenges:
Complex root canal anatomy and missed canals leading to untreated areas.
2 Microbial Factors:
Re-infection through coronal leakage and secondary infections from dormant bacteria.
3 Operative/Technical Factors:
Inadequate cleaning, shaping, poor obturation quality, procedural errors like ledging or canal transportation.
failure to diagnose Fractures
4 Patient Factors:
Poor oral hygiene leading to re-infection risk.
Canal Obliteration a response to.. leading to… challenges in rct: 2x
a response to previous decay or restoration/trauma , leading to calcific metamorphosis.
This can make endodontic treatment challenging due to difficulty in locating and navigating canals.
Patient-Related Factors in Endodontic Case Selection 5x
1 Medical History:
Systemic conditions (CHD, allergies, medications) that may affect treatment options.
2 Dental Anxiety:
May require special management techniques or sedation.
3 Oral Hygiene and Compliance:
Influence on post-treatment success and risk of reinfection.
Motivated to come for f/up
4 Ses- afford tx
5 Age:
Younger patients have larger pulp chambers-prone #during obt, older patients may have calcified canals.
Treatment-Related Factors in Endodontic Case Selection 9x
1 Accurate Diagnosis:for appropriate tx +mx.
2 Tooth Accessibility: Ease of isolation and visibility, especially important for posterior teeth.
3 Root Canal Anatomy:
Complexity, calcifications, number of canals. C shape, Dens invaginatus; RR(ext/int)-prognosis ⬆️ if referred
4 Restorability of the Tooth:
Structural integrity and potential for adequate coronal seal.
5 Previous Endodontic Treatment:
Challenges with retreatment such as removing old materials.
6 Extent of Lesion:
Large periapical lesions may complicate treatment and prognosis.
7 Endo-Perio Lesions:
May require multidisciplinary approaches.
8 Procedural error - perforation, # of instruments, ledging*
9 armentarium- presence microscope
Impact of Iatrogenic Errors in Non-Surgical Endodontic Treatment Outcome: 7x
- Perforations: dt no st line access or overzealous instrumentation.Accidental creation of a hole in the tooth or root during instrumentation can lead to leakage, infection, and potentially necessitate surgical intervention or even extraction.
2 Instrument Fracture: Broken instruments within the canal can obstruct cleaning, shaping, and obturation, potentially leading to failure.
3 Over or Under-instrumentation: Extending beyond the apex (over-instrumentation) can cause post-operative pain or lead to extrusion of debris into periapical tissues, while under-instrumentation may leave infected tissue behind.
4 Over or Under-filling: Similar to instrumentation, overfilling can push material into the periapical tissues, causing irritation, while under-filling can allow for bacterial leakage and reinfection.
5 Missed Canals: Failure to identify and treat all the canals within a tooth can leave infected tissue, leading to persistent infection and failure.
6Failure to maintain asepsis, leading to cross-contamination and reinfection.
7 ledging
Reversible pulpitis, PAIN Occurs when…
When …removed, …..
vs irreversible pulpitis
when a stimulus (usually cold or sweet) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 seconds.
pain occurs spontaneously or lingers minutes after the stimulus (thermal) is removed.
Criteria for Antibiotic Use:
lOCALised abcess
Avoiding Antibiotic Resistance with:…use
it is …concern
lOCALised abcess (No Antibiotics):
If swelling is localized and no systemic symptoms (fever, malaise, lymphadenopathy), proceed with RCT-removes the source of infection, addressing the primary cause. Return if s/s, myb spread of infection
Systemic Involvement (Antibiotics Needed):
Prescribe antibiotics if signs of systemic involvement or if infection spreads (cellulitis, osteomyelitis).
Avoiding Antibiotic Resistance with:
Indiscriminate Use: significant public health concern.
Pulp Diagnosis–> ? tests
stimulates??nerve fibres
which > reliable?
Cold Test:
Purpose: Stimulates myelinated Aδ nerve fibers.
Response in Healthy Pulp: Brief, sharp pain that subsides quickly. Lingering pain suggests irreversible pulpitis. No response suggests pulp necrosis.
Electric Pulp Test (EPT):
Purpose: Delivers electrical current to stimulate myelinated Aδ nerve fibers.
Response in Vital Pulp: Tingling or slight pain to electrical stimulation. Non-Vital Pulp: No response.
Clinical Application:
Preferred Test: Cold test for reliability, especially in posterior teeth.
Adjunct Test: EPT used if cold test results are unclear.
Procedure: Test control tooth, avoid restorations or exposed dentin[false readings].
Decision Between Treatment or Referral
Considerations for Decision:
1Complexity of case[Extent of PARL; endo-perio], 2clinician’s skill [Beyond general practitioner’s expertise/procedural errors present], and3specialized equipment availability.
4Tooth anatomy, calcifications, unable to isolate 5previous treatment, and 6patient’s medical history.
Non-Vital Tooth Bleaching
Purpose:
Application Method:
prevent complication by…
Restoration of Teeth post bleaching
Restoring Root-filled Tooth -goal:2x
Aesthetic improvement of discolored teeth post-root canal treatment.
Restrict bleaching agent within the pulp chamber to protect periodontal tissues+ prevent ECresorption.
by Sealing cervical portion with glass ionomer cement.
Requires support like post and core if significant structure loss.
Needs full coverage due to increased thin cusp/ remaining tooth structure.
Restoration Goal:
Function and aesthetics with a bacteria-tight seal.
Durability and compatibility of restorative materials
Informed Consent Process:
Discuss condition, treatment options, and reasons for referral.
Obtain consent after explaining risks, benefits, and alternatives.
