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5th ICP - Endo > Endodontic Tx Planning > Flashcards

Endodontic Tx Planning Flashcards

1
Q

What are some indications for endodontic treatment?

A 
Irreversible pulpitis
Periapical pathology
Post retained restorations
Overdenture
Teeth doubtful pulp
Periodontal disease 
Pulp sclerosis following trauma
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2
Q

What history would you get from pt with irreversible pulpits?

A

Lingering pain
Spontaneous pain
Keep away

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3
Q

What clinic signs would indicate periapical pathology?

A

Exaggerated response sensibility testing

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4
Q

What diagnosis would you give if there was periapical pathology?

A

Symptomatic or asymptomatic apical periodontitis

OR acute/ chronic apical abscess

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5
Q

What is needed to reach diagnosis?

A

Pt hx
Clinical exam
Radiograph

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6
Q

When are post used to retain restorations?

A

When too much tooth structure has been lost and is needed to retain indirect restoration

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7
Q

What is the issue by placing posts to retain restorations?

A

Can lose vitality?

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8
Q

How much structure is needed to retain restoration?

A

4-5mm - can be made from composite core

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9
Q

What is issue w/ compostite core?

A

May not withstand lateral forces of occlusion

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10
Q

How does an over denture work?

A

Teeth decoronated to provide support as over denture abutment - need to be endo tx

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11
Q

When can teeth under overdenture not be endo tx?

A

If canals are highly sclerosed with no periapical pathology - still need to warn risk of loss vitality

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12
Q

What do pt need if having over denture?

A

Good OHI, diet and motivation

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13
Q

What instance would periodontal disease indicated endo?

A

When there is a perio-endo lesion

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14
Q

What tx can be provided with perio-endo lesion?

A

Sometime do root resection - root need to be endo prior resection

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15
Q

What happens to a tooth after trauma when they remain vital?

A

respond to trauma by laying down secondary dentine resulting in narrowing of pulp space

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16
Q

Is trauma an indicated for endo?

A

No - scelrosis/ narrowing pulp chamber is not indication

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17
Q

What is the reliable tx if pt has trauma and tooth has discoloured?

A

Endodontic treatment followed internal bleaching - warn pt can take long time

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18
Q

What are the general contraindications for endo?

A

Inadequate access
Poor OH
General medical condition

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19
Q

What are local contraindications for endo?

A 
Tooth not restorable
Insufficient periodontal support
Non-strategic tooth
Root fracture
Root resorption 
Anatomy
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20
Q

What cases by inadequate access by an issue?

A

Pt limited mouth opening
Microstomia
TMD
Previous overeruption

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21
Q

What is general rule to see is adequate opening?

A

Should be able to fit 2 fingers between incisors

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22
Q

Is there any medical specific contraindications to endo?

A

No but pt but be well enough to undergo multiple long appointments

23
Q

Why are older people more difficult to provide endo?

A

Scelrosis of canals

24
Q

How determine if tooth is restorable?

A

Finishing line of restoration MUST be supracrestal and ideally supra gingival

25
Q

Can mobile teeth be endo tx?

A

If grade 1 mobile potentially definitely not 2+

26
Q

When may teeth be mobile but suitable for endo?

A

If significance PA infection w/ loss bony tissue at apex may become mobile - hopefully resolve with RCT

27
Q

What is a non-strategic tooth?

A

One which is unopposed and non-functional

28
Q

Why may non-strategic tooth be suitable for endo?

A

Used as distal abutment for a partial denture

29
Q

What root features have poor prognosis?

A

Sub-crestal and vertical fractures

30
Q

What are clinical signs of root fracutre?

A

Isolated, narrow or deep periodontal pocket

31
Q

What are radiographic signs of root fracture?

A

J shaped radiolucency or displacement of fragment

32
Q

What are types of root fracture?

A

Internal and external

33
Q

What are sub-categories of external fractures?

A

External cervical resorption

External replacement resorption

34
Q

What causes external cervical root resorption?

A

Aetiology unknown but may be associated with trauma

35
Q

Where does external cervical root resorption start?

A

Subgingivally at cervical region

36
Q

Is external cervical root resorption symptomatic if not why?

A

Often asymptomatic

Pulp is vital and only becomes involved when lesion progressed extensively

37
Q

How diagnose external cervical root resorption?

A

Clinical and radiographic findings

CBCT may be useful to assess extend lesion

38
Q

How manage external cervical resorption?

A

Specialist treatment, referral instigated as soon as diagnosis suspected

39
Q

What is external replacement resorption?

A

Where the root surface is gradually replaced with bone - ankylosis

40
Q

Aetiology of external replacement resorption?

A

Often trauma

41
Q

How diagnosis external replacement resorption?

A

High-pitch sound on percussion

42
Q

How diagnosis external replacement resorption on children?

A

Tooth will be non-mobile and become infra-occluded

43
Q

How treat external replacement resorption?

A

RCT won’t stop process therefore not indicated

No tx will stop ankylosis

44
Q

Where does internal root resorption take place?

A

Entirely in canal system

45
Q

What is the classic appearance of internal resorption?

A

Ovoid expansion of tooth canal - inside –> out

Outline of canal will be lost

46
Q

What see in internal resorption if lesion is close to crown of tooth?

A

Pink spot lesion

47
Q

Is internal resorption symptomatic?

A

If current pulp usually partially vital so may have pulpits symptoms as often chronically inflamed

48
Q

Tx of internal resoprton?

A

Endo, obturation can be difficult due to anatomy caused resorption

49
Q

What type of obturation is required for internal resorption?

A

Thermal obturation

50
Q

What is the effect of radiotherapy on bone tissue?

A

Reduced valuation - end arteritis obliterates

51
Q

What are bisphosphoantes?

A

Osteoclast inhibitor - inhibit bone resorption

52
Q

Why are those radiotherapy on bisphosphoantes better suited RCT > XLA?

A

Increased risk of osteoradionecrosis/ medication related osteonecrosis - therefore may try endo tx teeth usually be contraindicated

53
Q

What is success rate of endo?

A

80-90%

54
Q

Why not provide implants > RCT?

A

Implant not an alternative for endo - should only be considered to replace a missing tooth once it has failed/ deemed unrestorable

5th ICP - Endo (7 decks)

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