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Endodontics BDS4 > Endodontic Overview > Flashcards

Endodontic Overview Flashcards

1
Q

what is endodontic disease

A

biofilm disease

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2
Q

what are the features of apical periodontitis

A

chronic polymicrobial infection
stimulation of host response
connective tissue disease

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3
Q

what is the clinical objective for RCT

A

remove canal contents
eliminate infection

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4
Q

what should obturation aim to do

A

coronal seal
timing of obturation
length
preparation

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5
Q

what are the special investigations used in endodontics

A

TTP
palpation
pockets
sensibility testing
radiographs

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6
Q

what fibres are stimulated for sharp pain

A

A fibres

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7
Q

what fibres are stimulated for dull pain

A

C fibres

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8
Q

what teeth can refer pain to the opposite arch

A

posterior teeth

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9
Q

what is normal pulp

A

symptom free and responsive to pulp testing

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10
Q

what is reversible pulpitis

A

discomfort when stimulus applied but inflammation should resolve after appropriate management

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11
Q

what is symptomatic irreversible pulpitis

A

vital inflamed pulp incapable of healing
spontaneous/lingering pain

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12
Q

what is asymptomatic irreversible pulpitis

A

vital inflamed pulp incapable of healing but no symptoms

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13
Q

what is necrosis

A

death of pulp needing RCT

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14
Q

what is previously treated

A

tooth has been endodontically treated with obturated canals

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15
Q

what is previously initiated

A

treated by pulpectomy/pulpotomy

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16
Q

what is normal apical tissues

A

not sensitive to percussion/palpation
lamina dura intact
PDL space uniform

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17
Q

what is symptomatic apical periodontitis

A

inflammation of apical periodontium presenting with pain on biting/percussion or palpation

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18
Q

what is asymptomatic apical periodontitis

A

inflammation and destruction of apical periodontium that is of pulpal origin

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19
Q

what is chronic apical abscess

A

inflammatory reaction to infection and necrosis with gradual onset and intermittent discharge of pus through associated sinus tract

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20
Q

what is acute apical abscess

A

inflammatory reaction to pulpal infection and necrosis characterised by rapid onset, spontaneous pain, pus formation and swelling of tissues

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21
Q

what is condensing osteitis

A

localised bony reaction to a low grade inflammatory stimulus seen at apex of tooth

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22
Q

what medical issues would contraindicate RCT

A

first trimester pregnancy
cardiovascular disease
cancer
diabetes

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23
Q

what dental findings would contraindicate RCT

A

periodontal problems
sub-osseous caries
unrestorable
sclerosis of canals

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24
Q

what are the treatment options for endodontics

A

no treatment with review
extraction
orthograde RCT
surgical endodontics

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25
Q

what are the success rates of orthograde RCT for irreversible and necrotic pulps over 10yrs

A

irreversible is 90%
necrotic is 80%

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26
Q

what is included in the consent obtaining process

A

treatment options and alternatives
prognosis
risks
opportunity to ask questions
agreeing on a plan

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27
Q

what are the functions of the pulp

A

nutrition
sensory
protective
formative

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28
Q

name some examples of injuries to the pulp

A

caries
cavity prep and materials
trauma
periodontal pathology
orthodontics

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29
Q

what happens to the dentine tubules as they approach the pulp and what does this mean

A

increase in number and diameter so permeability is greater

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30
Q

what are the problems with sensibility tests

A

they stimulate nerve fibres and dont indicate blood supply state
hard with multirooted teeth

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31
Q

how do you use the EPT

A

dry tooth
isolate
conducting medium
probe near pulp
patient holds handle of EPT
increase current and stimulation felt

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32
Q

what does a positive response with EPT mean

A

vital tissue in coronal chamber
no indication of reversibility

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33
Q

how do you do ethyl chloride

A

teeth dried and isolated
place cold object close to pulp horn

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34
Q

what does age do to the pulp

A

reduce size and volume due to continued dentine formation

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35
Q

how do you prevent pulpal damage

A

know tooth anatomy
avoid drilling into pulp
cavity close to pulp use sealers
cavity into pulp use direct pulp cap

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36
Q

what are the properties of CaOH

A

bacteriocidal
high pH stimulates fibroblasts
stimulates recalcification of demineralised dentine
neutralise pH from acidic restorative materials

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37
Q

what are herb schilders principles

A

create a continuously tapering funnel shape
maintain apical foramen in original position
keep apical opening as small as possible

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38
Q

what does mechanical preparation allow

A

create space to allow irrigating solutions and medicaments into the root canal space

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39
Q

what is the mechanical debridement process

A

preparation of tooth
access cavity
straight line access
initial negotiation
coronal flaring
working length determination
apical preparation

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40
Q

what size ISO file is needed for apical preparation

A

minimum ISO 25

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41
Q

what are the ideal properties of an irrigant

A

killing of biofilm microbes
detachment of biofilm

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42
Q

what are the properties of NaOCl

A

antimicrobial
dissolve pulp remnants and collagen
dissolves necrotic and vital tissue

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43
Q

what are the factors important for function of NaOCl

A

concentration
volume
contact
agitation
exchange

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44
Q

what concentration should NaOCl be

A

between 0.5-6%

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45
Q

what are the problems with NaOCl

A

effect on dentine properties
inability to remove smear layer
discolouration
ophthalmic injuries
apical extrusion
allergic reactions

46
Q

what are the problems with chlorhexidine

A

cannot disrupt biofilms
risk of interaction with NaOCl
anaphylaxis

47
Q

what is the cleaning and shaping protocol for the final rinsing sequence

A

3% NaOCl (30ml) for 10mins
17% EDTA 1 min
3% NaOCl final rinse

48
Q

what are the symptoms of sodium hypochlorite extrusion

A

pain
swelling
ecchymosis
haemorrhage
neurological complications
airway obstruction

49
Q

what is the classic presentation of sodium hypochlorite extrusion

A

bruising along course of superficial venous vasculature

50
Q

what are the risk factors for sodium hypochlorite extrusion

A

excessive pressure during irrigation
needle locked in canal
loss of control of working length
larger apical diameters
anatomical factors
higher NaOCl concentration

51
Q

what is the flow rate to avoid sodium hypochlorite extrusion

A

1ml per 15seconds

52
Q

what is the management for sodium hypochlorite extrusion

A

stop treatment
keep calm
advise patient
explain material left canal
administer LA
get haemostasis
steroid medicament to reduce inflammation
cold/warm compress over next few days
review within 24hrs
advise analgesia
if deteriorating then OS or A&E

53
Q

what are the guidelines for NaOCl use

A

pre-op radiograph
bib
eyewear
dam with oraseal
test with chlorhexidine
label syringes
side vented needle
dont fill it full
use index finger
use stopper
pass syringe behind patient

54
Q

what do intracanal medicaments do

A

reduce inflammation or exudate and control root resorption

55
Q

what is an antimicrobial paste and what is it used for

A

corticosteroid and tetracycline mix
for hot pulps
reduce pulpal inflammation

56
Q

what does CaOH do in the canal

A

antibacterial activity
remove tissue debris

57
Q

what is used for inter-appointment disinfection

A

CaOH paste

58
Q

what is used for temporary dressings

A

GI cements

CaOH, small cotton wool, coltosol then GI

59
Q

what is estimated working length

A

estimated length at which instrumentation should be limited
measure to apex and subtract 1mm

60
Q

what is corrected working length

A

length at which instrumentation and obturation should be limited
apex locator for this

61
Q

what is master apical file

A

largest diameter file taken to working length representing final prepared size of apical portion of canal

62
Q

what are the different types of instrument movement

A

filing/reaming/watch-winding/balanced force/envelope of motion

63
Q

what is watch winding

A

back and forward between 30-60 degrees

64
Q

what is the modified flare technique made of

A

balanced force and step back

65
Q

what is barbed broach good for

A

grabbing pulp

66
Q

what is hedstrom file good for

A

re-RCT

67
Q

how do you create a glide path

A

confirm straight line access
explore anatomy
coronal flare
irrigate and repeat

68
Q

what is instrument separation due to

A

torsional stress
flexural stress

69
Q

what is torsional stress

A

extensive instrument surface encounters excessive friction on canal walls

70
Q

what is flexural stress

A

repeated cyclic metal fatigue

71
Q

what is the cold lateral compaction procedure

A

place GP master cone to working length
some tug back
remove cone
dry with paper points
coat in sealer
place to working length
finger spreader
accessory cone
endo alpha to sever GP
endo plugger to plug coronal GP

72
Q

when should obturation be undertaken

A

pain free
signs resolved

73
Q

what is GP made of

A

GP
zinc oxide
radiopacifiers
plasticisers

74
Q

what is the problem with cold lateral compaction

A

inability to obturate laterally and close voids between cones

75
Q

what is warm vertical compaction

A

cone of GP in root canal and sever coronal bit
sealer passes into lateral anatomy
keep doing this until get to top

76
Q

what is continuous wave obturation

A

fitted cone inserted and sever coronal part and then insert heated plugger into mass of GP in one continuous motion and remove which will leave an apical stop

77
Q

what are the functions of a sealer

A

seals space between dentinal wall and core
fills voids and irregularities in canal, lateral canals and between points
lubricates during obturation

78
Q

what are the properties of an ideal sealer

A

radiopacity
non-staining
no shrinkage on setting

79
Q

advantage of ZOE based sealer

A

antimicrobial

80
Q

advantage of GI sealer

A

dentine bonding

81
Q

advantage of resin sealers

A

slow setting
good sealing ability
good flow

82
Q

advantage of calcium silicate sealers

A

high pH
hydrophilic
biocompatible
no shrinking on setting
excellent seal

83
Q

what is looked at on post obturation radiograph

A

length
taper
density
GP removed to CEJ
errors

84
Q

what should be placed over the top of GP

A

ZOE
CaOH
RMGI
flowable composite

85
Q

what is success defined as by ESE

A

RCT assessed after 1 year and absence of pain, swelling and other symptoms. no sinus tract. no loss of function. normal PDL

86
Q

what is an uncertain outcome

A

radiographic changes remain same size or has only diminished in size

87
Q

what is unfavourable outcome of RCT

A

signs and symptoms of infection
lesion appeared after treatment or pre-existing lesion increased in size
root resorption

88
Q

what are the pre-op factors affecting success

A

non-vital with or without periapical lesion

89
Q

what are the operative factors affecting success

A

filling extending to within 2mm of apex
no extrusion of obturation
good coronal restoration
patency
no perforation
EDTA rinse
no mixing of CHX and NaOCl

90
Q

what are the biological reasons for failure

A

persistent intra-radicular infection
extra-radicular bacteria
non-microbial agents
cholesterol crystals
foreign body reactions
scar tissue healing

91
Q

how do you assess restorative prognosis

A

check for fractures
assess remaining amount of tooth structure
get good seal

92
Q

how do you remove insoluble resin

A

ultrasonics

93
Q

how do you remove GP

A

hand files and solvent
reciproc

94
Q

what is the protaper retreatment protocol

A

lowest speed that effectively engages material
D1 into GP until obturation material removed from coronal third
auger obturation from middle with D2
remove from apical third with D3

95
Q

what is the reciproc retreatment protocol

A

remove bulk of obturation material in coronal third with heat
remove obturation material in body of canal with R25
determine working length and remove obturation material in apical third
increased apical enlargement with R40 and R50

96
Q

what do solvents do to tubules

A

leaves smear of GP on them and obstructs them

97
Q

how do you avoid perforations

A

inspect external surfaces
think where you8 are in tooth
knowledge of anatomy
measure radiograph
Dg16 and rubber stopper as depth gauge

98
Q

what are the complications of instrumentation

A

blockage
ledges
apical damage
perforation
fractured instrument

99
Q

what is blockage

A

dentine debris getting packed into apical portion of root

100
Q

what is a ledge

A

internal transportation of canal when working length too short

101
Q

what is apical zipping

A

over-enlargement on outer side of curvature and under-enlargement of inner aspect at apical end point

102
Q

what is apical transportation

A

transportation of apical foramen fails to provide resistance for packing of GP so it is overextended and poorly filled

103
Q

how do you diagnose a perforation

A

persistent bleeding into canal
multiple radiographs
electronic apex locators
dental operating microscope

104
Q

what does the prognosis of perforation depend on

A

location
time elapsed
size
periodontal irritation
material used for repair

105
Q

what are the issues with access

A

too big/small
roof of pulp chamber not removed properly
perforation

106
Q

what are the issues with mechanical preparation

A

blockage
separated file
ledge

107
Q

how do you avoid blockage

A

dont skip files, dont force files, ensure file is passive prior to moving to bigger file
recapitulate and patency file and irrigate

108
Q

what are the issues with obturation

A

too short/long
voids
too much GP in pulp chamber
GP in other canals

109
Q

how do you avoid separating instruments

A

know limits of instrument
pay attention to rotation degrees
stay focused
lubricate canal

110
Q

how do you avoid obturation not being the right length

A

pre-op radiograph
apex locator and reference point

Endodontics BDS4 (1 decks)

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