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CSB- SS sheets questions > endodontics > Flashcards

endodontics Flashcards

1
Q

what is the cause of endodontic disease

A

bugs fungi archaea

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2
Q

what do we need for a PA lesion

A

bugs aka bacteria

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3
Q

what are the three things needed for endodontic problems

A

microorganisms
host response
time

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4
Q

why do we study endodontic microbiology

A

We can identify which bacteria play a key role in progression of disease
Helps develop a treatment strategy in terms of microbial eradication – present/future
To see how the microbes interact (tackling biofilm is diff to planktonic)

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5
Q

what type of bacteria do we find in the apical region

A

lower oxygen
less number of species
less accessible to tx
nutrients form the peri radicular tissues

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6
Q

what type of bacteria do we find in the coronal region

A

higher oxygen count
nutrients from carbs in oral cavity
higher bacteria count
easier to treat

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7
Q

how does the root canal microflora act

A

in a biofilm or planktonic

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8
Q

what do we see in the biofilm

A

calcium in the protective layer that can denature the sodium hypochlorite and makes it difficult to remove

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9
Q

state some resistance of biofilms to eradication

A 
physical barrier 
mechanical 
shape 
metabolism 
transfer
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10
Q

issues with diagnosing endo

A

We are reliant on the pt. description of symptoms which may be confusing
There is a poor correlation between symptoms & histological status of the pulp
SOCRATES always tends to help
Character is most important part of SOCRATES for endo
When a pt. describes character of pain THINK about it, don’t just write it down
Other tests are available to aid diagnosis such as speciality tests & radiographs
Unless cortical plate has been lost, lesion may not be visible with conventional radiograph
We may need to use CBCT imaging to take slices of the lesion

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11
Q

what do we need to consider with multi rooted teeth

A

Pt’s may have one dead tooth and other teeth are vital

A positive result will be seen with EPT & TTP but tooth is partly necrotic & needs RCT

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12
Q

what is the first stage of RCT

A

isolation

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13
Q

why is isolation so important

A

stress for their comfort and improve prognosis of tx

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14
Q

what are some key facts for chemo mechanical prep

A

Instruments shape, irrigants clean

We aim to achieve a shape that optimises irrigation & simplifies obturation

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15
Q

what does the canal look like in CS

A

narrower at every point apically

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16
Q

where do we find the apical foramen

A

emain in its original position & we clean as much as poss. up to there
The apical opening should be kept as small as possible

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17
Q

what are some hand instrumentation techniques

A

step back
modified double flare
balanced force
stem winding

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18
Q

what is the step back technique

A

Coronal flare, file all way down to apex and step back from there

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19
Q

describe modified double flare

A

Crown down first, step back from apex & blend coronal with apex

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20
Q

describe balanced force

A

60 degrees clockwise to engage dentine & 180 anticlockwise to cut it

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21
Q

describe stem winding

A

Simple rotation & pull , slower than balanced force but safer

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22
Q

define patency filing

A

taking a file K10/15 all the way to the apex to clear out any debris

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23
Q

define recapitulation

A

taking the MAP all the way to full working length to check

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24
Q

give some examples of rotary instruments

A 
rotary files( pro taper gold) 
wave one
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25
Q

what type of instrument is the pro taper gold

A

it is a rotary instrument in one direction only

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26
Q

what type of instrument is a wave one

A

reciprocating- rotates in one direction and then in the other direction

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27
Q

what are automated instruments made form

A

Ni-TI

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28
Q

what is the advantages with Ni-Ti

A

less likely to cause procedural errors

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29
Q

what are some procedural errors we can get

A

dentine debris
transportation
ledge
perforation

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30
Q

what are some types of file fracture we can get

A

torsional failure

cyclic fatigue

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31
Q

what is an apical granuloma

A

formation of tissue that forms at root tip

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32
Q

what is periapical periodontist

A

disease you have when you have an apical granuloma

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33
Q

how do we measure success of endo

A

should be measured 1 year cost op and subsequently for a minimum of four years

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34
Q

what do we look for in cases where the rct has succeeded

A 
no abscess 
no pain
no swelling
no loss of function 
no sinus tract involvement 
normal radiographic PDL space around the root
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35
Q

give some examples of definitions of outcome

A

the strict criteria -

the loose criteria

survival

failure

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36
Q

explain the strict criteria

A

The length of review should be for at least 4 years

Strict criteria we generally use for research purposes

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37
Q

explain the loose criteria

A

Tooth is functional, pain free, no signs of swelling, lesion has only reduce din size

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38
Q

explain the survival criteria

A

We do this as it’s easy to collect data on survival studies
Difficult to follow up a lesion but easy to follow up presence of a tooth
Allows for comparison between diff treatment options

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39
Q

explain failure

A

if fails- say the disease has persisted not that the tx has failed

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40
Q

what makes the difference in improving survival rates

A

Presence or absence of a lesion
Filling should extend to within 2mm of radiographic apex but not extrude
Well condensed filling with no voids
Good quality coronal restoration

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41
Q

what are some things that decrease survival rate of rct

A 
Pre op presence of sinus
 Increases size of lesion 
Presence of a flare up 
Perforation 
Mixing CHX & NaOCl
42
Q

what are some things that increase survival rate of rct

A

Getting canal patency

Final rinse is with EDTA in retreatment

43
Q

what is tx planning

A

What you’re going to do & when you’re going to do it

44
Q

what is planning tx

A

How are you going to execute this treatment

45
Q

what do we consider looking at the radiographic assessment

A

Root length
Degree of canal sclerosis
Canal symmetry
Canal curvature

46
Q

what is some distinctive features of Vertical root fracture

A

Sinus at mid root level
Go round tooth, suddenly the probe will drop 13/14 mm (narrow isolated defect)
Circumferential bone loss will be seen on both sides of tooth

47
Q

what is the prognosis like with vertical root fracture

A

prognosis low if below the pulp chamber need extrac

48
Q

what are some differential diagnosis options

A

reversible/ irreversible pulpits
periapical periodontitis
dentine hypersensitivity

49
Q

what are some tx options for dentine hypersensitivity

A

fluoride varnish- 2x per year limit

50
Q

what are some tx options for reversible pulpits

A

removal or caries removal

51
Q

what are some tx options for irreversible pulpits

A

RCT / XLA

52
Q

what do we need to consider with RCT

A

need informed consent as patient might just find it easier to remove the tooth

53
Q

what do we need to check in reinfected teeth

A

remove the fillings to see what the leakage is like and how can we provide cuspal coverage for it

54
Q

what are the four radiographs which need to be taken

A

pre op
working length
master point
post op

55
Q

what assessments of root filled teeth do we need to do before tx

A

endo
periodontal
coronal tissue

56
Q

what does the coronal tissue assessment include

A 
quality of tooth 
position of tooth 
rests 
aesthetics 
occlusion
57
Q

advantages of restoring immediately after endo

A

good coronal seal
protection from tooth fracture
places tooth back in function

58
Q

disadvantages of restoring immediately

A

risk of tooth fracture
unsure of endodontic outcome
expensive restoration if we need to re endo

59
Q

what is the disadvtnages of delayed restoration

A

risk of endo failure
may require revision
increased risk of loss of coronal seal and tooth frac

60
Q

what is the advantages of delayed restoration

A

endodontic success confirmed

expense of new crown avoided

61
Q

what are some restoration options to build up a tooth

A

standard plastic
Nayyar core
pre fabricated post
cast post and core

62
Q

how do we do a standard plastic restoration

A

this involves cutting the GP back with hot excavator & plugging it down
The definitive restoration is placed over the top of this
Don’t forget to place an RMGIC lining over the GP to prevent coronal leakage

63
Q

how do we carry out a Nayyar core

A

good option if a whole wall is broken down

remove 2-4 mm of the GP in the canal and line with RMGIC and fill will amalgam

64
Q

advantages of Nayyar core

A 
Can be placed immediately after endo
Uses coronal tooth structure to improve retention
Reduces stresses (compared to post placement)
Usually easy to remove
65
Q

what do we do if there is not enough tissue for a core

A

we need to use a post but this weakens the tooth

66
Q

what is the principle of post design

A

Aims to maximise retention & minimise stresses within the root

67
Q

what are some types of post

A

tapered
serrated
cast

68
Q

what is the issue with tapered posts

A

as it acts like a wedge it can put pressure on the tooth and cause it to fracture

69
Q

what is the issue with serrated posts

A

cuts into dentine and can break the tooth

70
Q

what is the benefit of serrated posts

A

some just passively sit in the canal (most used)

71
Q

what should the post length be

A

leave 5mm of apical Gp to stop contamination

should be greater than the crown of the tooth

72
Q

what is the width of the post

A

not exceed 1/3rd of the width of the CEJ

73
Q

where do we want the forces to be transmitted in the post

A

to the dentine then the PDL and bone to reduce the risk of root fracture

74
Q

positives of fibre posts

A

Aesthetic
Bond with dual cure resins (LC & Chemical cure)
Flex properties close to dentine (slightly less) so when force occurs, it fracs before dentine
Can be removed for revision of endo treatment
Claimed to reinforce root but evidence doesn’t confirm this

75
Q

main cause of failure of fibre posts

A

decementation

76
Q

advantages of cast post and core

A

can go sub gingival

good in oval canals

77
Q

disadvantages of cast post and core

A

extra clinical visit

temporisation is difficult

78
Q

advantages of pre fab post and core

A

immediate coronal seal
crown prep on same visit
better aesthetics
reduces number of stages

79
Q

disadvantages of pre fabricated post and core

A

core takes time to build

80
Q

what is the ferrule effect

A

360 degrees wrap around of dentine which increases strength and success of RFT

81
Q

what is the job of the ferrule

A

improves resistance ot dynamic loading
reduces potential for stress concentration
helps maintain integrity of the cement seal

82
Q

how dow e protect the tooth from fracture

A

using an extra coronal restoration

83
Q

what do we need to consider in regards to occlusion

A

eg if working on a canine we need to change to GF from canine guidance to put less stress on the tooth

84
Q

what are the three main points to success

A

preverse and protect remaining tooth tissue
establish and maintain seal
restore aesthetics and function

85
Q

what does healthy periapical tissue look like

A

healthy PDL space seen as a radiolucent white line

86
Q

what does the radiolucent white line represent

A

the lamina dura

87
Q

what is the bone pattern of the maxilla like

A

less tabular and lower density

88
Q

what is the bone pattern of the mandible

A

horizontal trabecular pattern

89
Q

what are some shadows we can see that are radiolucent

A

antrum
mental foramen
nasopalatine foramen

90
Q

what are some radiopaque shadows we can see

A

mylohyoid ridge
zygoma
sclerotic bone

91
Q

what does rarefying mean

A

radiolucent

92
Q

what does oestitis mean

A

inflammation go the bone

93
Q

why might we see hypercementosis on the x ray

A

Idiopathic cause
Stresses on the tooth
Certain systemic diseases

94
Q

what is osseous dysplasia

A

Condition with unknown aetiology

radiolucencies on apical region of teeth

95
Q

who do we see a increased prevalence of osseous dysplasia

A

ANTERIOR TEETH in afro carribean middle age females

96
Q

stages of periapical rarefying osteitis

A

ill defined
well defined
corticated Radiolucency
increased in chronicity

97
Q

early stages of periapical rarefying osteitis

A

Ill defined, symptomless, common to see pt.’s with grotty mouths and only 1 giving pain
Diagnosis of ill-defines rarefying osteitis & non-vital

This person has an abscess – pain, looks tight, shiny & pushing lip down
Clinically we can diagnose an abscess
Radiographically they have an ill-defined radiolucency associated with premolar
Diagnosis of ill-defined rarefying osteitis & non vital

98
Q

how long does ti take for radiographic appearance to catch up with symptoms

A

10 days approx

99
Q

if lesions are less than 1cm then it can be

A

2/3 are granuloma

100
Q

if lesions are 1-1.5cm then it can be

A

50% granuloma

50% cysts

101
Q

if lesions are greater than 1.5cm then it is a

A

2/3rd chance it is a radicular cysts

102
Q

describe sclerosing osteitis

A

Even more chronic still
May be no radiolucent component
May be halo of sclerosing osteitis surrounding an area of rarefying osteitis
Often seen around roots of lower first molars
Also called condensing or focal sclerosing osteitis

CSB- SS sheets questions (4 decks)

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