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NBDE II Board Busters > Endodontics > Flashcards

Endodontics Flashcards

1
Q

4 ways to dx vertical root fracture

A
  • transillumination
  • wedge and x-ray
  • perio defect
  • tooth slooth
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2
Q

vertical fracture through ROOT has __ prognosis unless you can remove the segment and ___ and ___ are performed

A

HOPELESS prognosis unless GINGIVOPLASTY and ALVEOLOPLASTY

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3
Q

tooth with vertical root fracture has ___ prognosis

A

POOR prognosis

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4
Q

most vertical root fractures are caused by?

A

using too much CONDENSATION FORCE during OBTURATION

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5
Q

anterior tooth fractures are usually caused by

A

accidental trauma

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6
Q

cracked tooth syndrome is characterized by

A

sharp, brief pain occurring unexpectedly when pt is chewing

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7
Q

3 types of flaps

A
  1. submarginal curved (semilunar)
  2. submarginal triangular and rectangular (ochsenbein-leubke)
  3. full mucoperiosteal (full thickness)
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8
Q

submarginal curved flap (semilunar)

A

half moon shaped, curved horizontal incision in mucosa or attached gingiva with concavity towards apex

NOT for anterior tooth root-end surgery

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9
Q

disadvantages of submarginal curved flap (semilunar) (4)

A
  1. limited access and visibility
  2. tearing of incision corners
  3. incision over bony defect -> scars
  4. incision limited by attachments (frenum muscles)
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10
Q

submarginal triangular and rectangular flap (ochsenbein-leubke)

A

requires 4 mm attached gingiva, healthy periodontium

scalloped incision in attached gingiva with 1 or 2 vertical incisions

LESS risk of incising over bony defects
no post-surgery gingival recession

CAN be indicated for root end surgery on anterior tooth

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11
Q

disadvantages of submarginal triangular and rectangular flap (O-L)

A

hemorrhage and scarring

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12
Q

advantages of submarginal triangular and rectangular flap (O-L)

A

better access and visibility > semilunar flap

NOT better than full mucoperiosteal flap

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13
Q

full mucoperiosteal (full thickness)

A

allows max. access and visibility

raised from gingival sulcus (elevating gingival crest + interdental gingiva)

outline precludes incisions over bony defects -> allows perio tx (curettage, SRP, bone re-shaping)

CAN be indicated for root-end surgery on anterior teeth

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14
Q

disadvantage of full thickness flap

A

difficult to reposition, suture, alter

gingival recession possible

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15
Q

electric pulp tester has HIGHER current if

A

tooth has CHRONIC PULPITIS

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16
Q

EPT checks vitality by

A

stimulating nerve endings with a LOW CURRENT and HIGH POTENTIAL DIFFERENCE in voltage

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17
Q

EPT results

  1. acute pulpitis = ___ current
  2. chronic pulpitis = ___ current
  3. hyperemia = ___ current
  4. pulp necrosis/abscess = ___ current
A
  1. acute = LOWER than normal (acute inflammation lowers pain threshold)
  2. chronic = HIGHER than normal
  3. hyperemia = LOWER than normal, but HIGHER than (1) acute pulpitis
  4. necrosis/abscess = NO response
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18
Q

EPT gives false (+) in these circumstances

A
  1. pus-filled canal

2. nervous pt

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19
Q

EPT gives false (-) in these circumstances

A
  1. recent trauma
  2. insulating restoration
  3. gloves
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20
Q

EPT also not reliable in these circumstances

A
  1. secondary dentin deposits
  2. moisture contamination
  3. immature tooth (open apex)
  4. pt taking analgesics
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21
Q

SLOB rule

A

lingual CLOSEST to cone

buccal FARTHER from cone

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22
Q

if xray taken from MESIAL, the lingual surface (ML canal) will appear more ___ than the buccal surface (MB canal) which appears ___

A

ML canal more MESIAL

MB canal appears farther DISTALLY

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23
Q

if xray taken from DISTAL, the lingual surface (ML canal) will appear more ___ than the buccal surface (MB canal) which appears ___

A

ML more DISTAL

MB more MESIALLY

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24
Q

Dx tests for recently traumatized teeth (4)

A
  1. soft tissue exam
  2. hard tissue exam
  3. xray
  4. observe adj. and opposing teeth for injury
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25
Q

Dx tests CONTRAINDICATED for recently traumatized teeth (2)

A
  1. EPT - pulp undergoes temp. paresthesia

2. percussion - painful

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26
Q

radiation safety

A
  1. stand 6 ft away, 90-135 deg. to beam
  2. FAST E-speed film
  3. 70 kVp or higher (higher = lower dose)
  4. collimation < 2.5 in.
  5. use lead apron and thyroid collar
  6. max. dose = 50 mSv/yr
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27
Q

PULPOTOMY indicated for (4)

A
  1. cariously exposed primary teeth with healthy pulp
  2. trauma or carious exposure of immature permanent teeth
  3. instead of EXT when you can’t RCT
  4. emergency for permanent teeth with acute pulpitis
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28
Q

can you do pulpotomy on fully developed permanent teeth?

A

NO. Not successful - it’s only temporary tx

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29
Q

if doing pulpotomy on immature permanent tooth and bleeding isnt controlled you:

A

amputate at more apical level

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30
Q

uncontrolled bleeding is a sign of

A

inflamed pulp tissue

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31
Q

for successful pulpotomy radicular pulp must be

A

uninflamed (can always go more apical)

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32
Q

if apical amputation in pulpotomy can’t control bleeding then:

A

use hemostatic agents and monitor

if vitality lost -> APEXIFICATION (pulpectomy)

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33
Q

pulpotomy is removal of ___ contents

A

pulp chamber only

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34
Q

APEXIFICATION goal

A

induce further root development in pulpless (dead) tooth by stimulating formation of hard substance at apex to allow obturation of root canal space

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35
Q

apex closes ___ yrs after eruption

A

2-3

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36
Q

apexification procedure

A
  1. isolate, access, remove all pulp
  2. calcium hydroxid-methylcellulose paste (ex. pulpdent), double cement seal
  3. recall 3 mo. (if no apexification, new paste)
  4. RCT
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37
Q

CaOH action

A

promotes formation of hard substance at root apex by creating ALKALINE environment

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38
Q

permanent tooth fractures, has fully formed root, LARGE exposure

what tx?

A

RCT

don’t need apexification because root is formed

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39
Q

permanent tooth fractures, has fully formed root, SMALL exposure, SHORT TIME (30 min. - 1 hr.)

what tx?

A

DIRECT PULP CAP with CaOH

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40
Q

what is a PULP CAP?

most common dressing for pulp cap is?

A

sedative and antiseptic dressing on exposed HEALTHY pulp; allows recovery and maintain normal fxn and vitality

Dycal = calcium hydroxide

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41
Q

2 situations where pulp cap has better success

A
  1. accidental exposure of pulp (NOT carious)

2. pulp of young child (NOT older ppl)

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42
Q

young pulps are more/less vascularized?

A

MORE, so more amenable to repair

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43
Q

pulp cap repair occurs when ____ forms at the exposure site

A

dentin bridge

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44
Q

pulp capping not recommended in primary teeth with CARIOUS exposures because

A
  • high failure rate

- pulpotomy very successful

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45
Q

if pulp cap fails and tooth becomes symptomatic, might not be able to RCT because of

___ can also cause pulp space calcification and cause a ___ color

A

severe calcifications in root canal -> perf

trauma; yellow

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46
Q

INDIRECT PULP CAP is

procedure is

A

calcium hydroxide base on thin layer of questionable dentin remaining over pulp

  1. 3-4 mo. wait then reopen tooth
  2. remove remaining decay
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47
Q

if indirect pulp cap and SYMPTOMATIC (heat, percussion) and exposure

A

eventually RCT

in meantime, EUGENOL + IRM

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48
Q

DIRECT PULP CAP is

A

calcium hydroxide base directly on SMALL (< 1 mm) exposure

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49
Q

favorable factors for direct pulp cap

A
  • uninflamed pink pulp
  • no excess bleeding
  • no symptoms of pulpitis
  • small non-carious exposure (mechanical)
  • clean cavity
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50
Q

direct pulp capping very successful in __ teeth

A

immature

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51
Q

direct pulp cap goal

A

stimulate DENTIN BRIDGE; preserve underlying pulp tissue in healthy condition

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52
Q

don’t do direct pulp cap on teeth with

A

hx of pain, percussion (+), periapical radiolucency

—> RCT

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53
Q

failure of direct pulp cap indicated by

A

symptoms of pulpitis or no vitality

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54
Q

adverse responses after direct pulp cap (3)

A
  1. necrosis
  2. calcification
  3. internal resorption
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55
Q

criteria before canal is obturated (4)

A
  1. good preparation to allow debridement and access to apex
  2. asymptomatic tooth; dry
  3. negative bacteria culture
  4. no nerve (shouldn’t respond to thermal test)
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56
Q

ACCESS PREP objectives (4)

A
  1. straight line access
  2. conserve tooth
  3. unroof pulp chamber
  4. remove pulp horns
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57
Q

what kind of access for maxillary primary incisors?

A

facial

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58
Q

common access istakes

A

1 Md molars - mesial under marginal ridge, lingual under lingual cusps
2. Md incisors - perf
3 Mx 1st PMs - perf

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59
Q

DEBRIDEMENT is

A

removal of foreign material and contaminated/devitalized tissue

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60
Q

most crucial aspect of RCT is

A

CHEMOMECHANICAL debridement

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61
Q

best/most reliable indicator of good debridement is

A

glassy, smooth walls

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62
Q

clean shavings on file or clean irrigant can measure good debridement, T/F?

A

F

inaccurate! need glassy, smooth walls

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63
Q

most common cause of root canal failure is

A

incomplete/inadequate disinfecting the root canal

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64
Q

2nd most common cause of root canal failure is

__%?

A

leakage from badly filled canal

40%

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65
Q

most effective way to reduce canal microorganisms is

A

complete canal debridement

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66
Q

objectives of root canal OBTURATION (3)

A
  1. fluid tight seal at apical foramen
  2. filling of root canal space
  3. favorable biologic environ. for tissue healing
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67
Q

if accessory/lateral canal not filled during obturation, the tx is:

A

eval every 3 mo.

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68
Q

after endo, takes ___ mo. before you see radiolucency get smaller on xray

A

6-12 mo.

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69
Q

after RCT, desirable changes are (3)

A
  1. regeneration of alveolar bone
  2. deposition of apical cementum
  3. PDL re-establishment
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70
Q

indications for solvent-softened custom GP cones (3)

A
  1. no apical stop
  2. abnormally big apical portion of canal
  3. irregular apical portion of canal
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71
Q

solvent softened custom cones not used if __ is achieved

A

TUGBACK

it doesn’t result in a better apical seal; should have a APICAL SEAT

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72
Q

master cone should reach how far

A

to apical position of prep or 1 mm short of foramen

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73
Q

why do you recapitulate?

A

clean apical segment of DENTIN filings not removed by irrigation

use your MAF after each increase in file size

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74
Q

regaining canal patency

A
  • crown down (large to small)
  • rotary > heated instruments
  • light pressure with NiTi rotatry files
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75
Q

glass bead sterilizer sterilizeds files in __ sec at __ temp

A 
15 sec
200 C (428 F)
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76
Q

techniques to remove GP

A
  • rotary
  • ultrasonic
  • heat
  • heat + instrument
  • file
  • chemical
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77
Q

reagent to dissolve GP

A

chloroform

others - xylol, halothane, benzene, carbon disulfide, essential oils, methyl chloroform, white rectified turpentine

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78
Q

irrigants (3)

A
  1. sodium hypochlorite (NaOCl)
  2. hydrogen peroxide (3%)
  3. urea peroxide (gly-oxide)
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79
Q

irrigant bactericidal action better than ___

A

intracanal meds

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80
Q

NaOCl

A
  • most common
  • conc. in 1%, 2.6%, 5.25% (not agreed which is best, all OK)
  • good tissue solvent, antimicrobial, lubricant
  • toxic to vital tissue
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81
Q

can disinfect GP points in __ solution for how long?

A

5.25% NaOCl, 1 min.

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82
Q

2 modes of action of hydrogen peroxide (H2O2)

A
  1. BUBBLING - foams debris from canal, an EFFERVESCENT effect
  2. liberation of OXYGEN - kills anaerobic bacteria
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83
Q

Urea peroxide (gly-oxide)

A
  • avail. in anhydrous glycerol base (gly-oxide) to prevent decomposition
  • better tolerated by tissue than NaOCl
  • has BETTER solvent action and MORE germicidal than H2O2
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84
Q

good irrigant for canals with normal PA tissue and WIDE apices

A

urea peroxide (gly-oxide)

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85
Q

best use for gly-oxide is ___ canals

A

narrow, curved

utilize slippery effect

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86
Q

chelating agents (3)

A
  1. ethylene diamine tetra-acetic acid (EDTA)
  2. EDTAC (EDTA + Cetavlon)
  3. RC-Prep
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87
Q

chelating agents act on ___ tissues with little effect on ___ tissues

A

work on CALCIFIED tissues with little effect on PERIAPICAL tissue

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88
Q

action of chelating agents

A

act by substituting Na+ ions that combine with dentin to form soluble salts for Ca+ ions that are bound in a less soluble combination

canal edges become softer

helps prepare sclerotic canals after apex is reached with a fine instrument

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89
Q

EDTA

A
  • removes mineralized portion of smear layer
  • self-limiting, decalcifies up to 50 mm of root canal wall, stops as soon as chelator is used up
  • 17% conc.
  • active in canal 5 days
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90
Q

EDTAC (EDTA + Cetavlon)

A
  • greater antimicrobial action than EDTA
  • more inflammatory potential
  • inactivated by NaOCl
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91
Q

RC Prep

A
  • foamy solution
  • combines EDTA and urea peroxide
  • provides chelation and irrigation
  • natural effervescense increased by irrigation with NaOCl
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92
Q

zinc oxide eugenol

A
  • based root canal sealer

- fill discrepancies between core filling material and dentin walls (more important than core filling)

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93
Q

ZOE functions (3)

A
  1. lubricant for gutta percha
  2. forms bond btw gutta percha and dentin
  3. antibacterial
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94
Q

ZOE disadvantages

A
  • staining
  • slow setting time
  • non-adhesion
  • solubility
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95
Q

radiopacity in sealers are from

A

metallic salts

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96
Q

after filling canal with gutta percha, if there is a horizontal line of material (gp or sealer) extending mesially and distally from canal to PDL space -> indicates ___

A

root fracture

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97
Q

MTA

A
  • best retro filling material

- seals APICAL portion of canal

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98
Q

___ must be placed when an apical seal may be faulty

A

reverse filling (MTA)

ex. calcified root canal

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99
Q

advantages of MTA (5)

disadvantages of MTA (2)

A

pros

  1. radiopaque
  2. hydrophilic
  3. biocompatible
  4. non-toxic
  5. induces hard tissue formation

cons

  1. hard to manipulate
  2. long-setting time
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100
Q

apicoectomy

A

oblique resection of most apical portion of root

flap tissue, buccal bone around root apex removed, area curetted

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101
Q

indications for apicoectomy

A
  • reverse filling placed, need to gain access to area of pathosis
  • poorly filled apical portion removed to level of canal obturated
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102
Q

most common reason for apicoectomy and retrograde filling

A

retreating teeth with posts

103
Q

indications for periradicular surgery

A
  1. non-negotiable canal, blockage, severe root curvature
  2. complications from accidents ex. instrument separation, ledge, perf
  3. failed tx from irretrievable posts or root fillings
  4. horizontal apical fractures where apical end of pulp becomes necrotic
  5. biopsy to dx non-odontogenic causes of symptoms
104
Q

periapical curettage

A

same as apicoectomy but does NOT remove root apex

objective: remove and examin diseased tissue and determining extent of lesion

105
Q

most common bleaching agent for endo tx teeth

A

superoxol

106
Q

superoxol

A

30% aqueous solution by weight of H2O2 in distilled water

potent oxidizing agent whose bleaching effect is from direct oxidation of stain-producing substances

107
Q

superoxol technique

A

apply heat to superoxol-saturated cotton pellets in tooth chamber; repeat until tooth is lighter

heat liberates oxygen in the bleaching agent

108
Q

most probable post-op complication of bleaching is

A

acute apical periodontitis

109
Q

acute apical periodontitis (AAP)

A
  • pain triggered by chewing or percussion

- alone does not indicate irreversible pulpitis

110
Q

AAP indicates

A

irritated apical tissues assoc. with a vital pulp with potential reversible pulpitis

111
Q

walking bleach technique

A

place thick paste of sodium perborate and 203 drops of superoxol in tooth chamber with temporary restoration

112
Q

broken instrument past apex -> what tx?

A

surgery

easier if wedged coronal or at curvature of canal but difficult if passed canal curvature

113
Q

if instrument breaks in canal and periapical radiolucency present with minimal canal enlargement before the accident -> what tx?

A

surgery because periapical tissues had little opportunity for healing

obturate to block then apicoectomy sand retrofilling

114
Q

if instrument breaks in canal’s APICAL 1/3 and lodged tightly and no radiolucency

A

remaining space filled with gutta percha, eval. 3-6 mo. recall

115
Q

prognosis of tooth with broken instrument is best if

A

vital pulp

no periapical lesion

116
Q

nickel titanium methods

A
  1. push and pull stroke
  2. reaming motion
  3. engine-driven rotary (only reaming)
117
Q

what determines canal preparation’s shape

A

instrument’s ACTION

not type of instrument

118
Q

filing

A

push-pull with emphasis on withdrawal troke

  • more efficient than reamers
  • greater number of flutes in contact with walls
  • produces canal IRREGULAR in shape -> must be filled with gutta percha
119
Q

reaming

A

clockwise rotation especially in insertion

  • canal is ROUND in shape
  • most efficient if using a silver cone to fill
120
Q

circumferential filling

A

push-pull filing that scrapes walls to create smooth, tapered prep

-enhances prep when flaring method used

121
Q

canal’s widest diameter should be at ___; narrowest diameter at ___

A

widest at ORIFICE

narrowest at dentinocemental junction (0.5-1.0 mm from radiographic apex)

122
Q

___ mm from apex is where teeth should be filed to and filled

A

0.5-1.0 mm

123
Q

barbed broaches are for

A

removing pulp tissue, cotton, other soft materials

NOT for canal enlargement

barbs represent a weakened point

124
Q

hedstrom files are an effective ___ instrument

A

H-Type stainless steel

made using a sharp, rotating cutter to gauge triangular segments out of round blank shaft to make a sharp edge

125
Q

hedstrom files should be used only with a ___ action

A

FILING

-> planes dentin walls faster than K-files or reamers

126
Q

S-file is a modified ___ file

A

Hedstrom

127
Q

K files are best for removing

A

hard tissue to ENLARGE canals

made by twisting a blank (SQUARE stainless steel rod)

128
Q

K-file action in canal is in what direction?

directs pressure in what direction?

A

clockwise-counterclockwise

direct pressure apically (filing or reaming action)

129
Q

what type of file is the strongest and cuts least aggressively?

A

K-file

K-flex file is a modified K-file

130
Q

2 types of K isntruments

A
  1. K files

2. Reamers

131
Q

reamers have more/less flutes than k-files?

A

FEWER

132
Q

reamers are used in canals to ___ in only a ___ action to enlarge canals

remove debris using clockwise/counterclockwise reaming action?

place materials in apical portion using clockwise/counterclockwise rotation?

A

SHAVE DENTIN in reaming action

CLOCKWISE for debris

COUNTERCLOCKWISE for materials

133
Q

5 critical factors to manage traumatic avulsions

A
  1. time
  2. storage media
  3. tooth socket - don’t curette
  4. root surface - don’t scrape, dry
    5 splint stabilization - up to 2 wks to allow reattachment of PDL
134
Q

teeth replanted by __ min show little resorption

teeth replanted after ___ hrs have extensive root resorption

A

30

2 hrs

135
Q

best storage media

A

MILK

because of neutral pH 6.5-6.8 and osmolality (for cell survival)

136
Q

mgmt of avulsed permanent tooth replanted within 2 hrs of trauma

A

10-14 days after replant - clean and shape + CaOH

replace every 3 months for 1 yr

if resorption stopped, fill with gp

137
Q

mgmt of avulsed permanent tooth > 2 hrs of trauma

A

ankylosis and ext root resorption probably after 2 yrs

RCT BEFORE replantation
soak tooth in 2.4% fluoride solution at 5.5pH for 20 min.
curette blood clot, irrigate with saline
rinse tooth with saline, replant

splint 4-6 wks

138
Q

in re: avulsed tooth out > 2hrs

ankylosis gives better/worse prognosis than ext root resorption

A

BETTER

ext root resorption leads to failure

139
Q

PDL cells die after __ min

A

60 min. of dry storage

tap water is just as bad!

140
Q

saliva has storage up to __ hrs

milk has storage up to __ hrs

A 
saliva = 2
milk = 6
141
Q

when do you RCT teeth with complete roots after avulsion?

A

asap!

142
Q

teeth with incomplete roots might not need RCT if replanted within ___ min

A

30

143
Q

what is the most frequent sequela to avulsed tooth replantation?

A

root resorption

144
Q

external root resorption is caused by

A
  • periradicular inflammation
  • dental trauma
  • ortho
  • impacted teeth
  • bleaching of non-vital teeth
145
Q

external root resorption is always accompanied by __ and is the chief cause of failure of replantation of permanent teeth

A

bone resorption

146
Q

3 types of external root resorption

A
  1. surface
  2. external inflammatory resorption
  3. replacement resorption
147
Q

surface resorption (1)

A
  • caused by ACUTE INJURY to PDL and root surface
  • healing forms new cementum and PDL
  • root resorption limited to cementum, can heal, can’t see on xray
148
Q

external inflammatory resorption (2)

A

infected pulp complicates resorptive process; BOWL-SHAPED resorption areas

  • involves cementum and dentin
  • need necrotic pulp and bacteria
  • immediate RCT stops it
149
Q

replacement (ankylotic) resorption (3)

A

substituted by bone

150
Q

causes of internal (inflammatory) root resorption

A

dental trauma, partial removal of pulp (pulpotomy), caries, pulp capping with calcium hydroxide, cracked tooth

151
Q

INTERNAL (inflammatory) ROOT RESORPTION

A
  • causes loss of vitality

- inflammation from infected CORONAL PULP is usually the cause

152
Q

teeth with internal resorption have hx of

A

trauma, crown prep, pulpotomy

153
Q

undifferentiated reserve C.T. pulp cells are activated to form ___ that resorb tooth structure in contact with pulp

A

dentinoclasts

154
Q

in internal resorption, what does the root canal look like

A

anatomy is altered and increases in size, appears as irregular radiolucency, the canal “disappears” into the lesion

155
Q

tx of choice when internal resorption is detected

A

PULPECTOMY so resorption stops

156
Q

internal resorption can only occur when

A

some pulp tissue is VITAL

note: negative does not rule out this etiology

157
Q

pink tooth is a sign of ____

pink cause of ___

A

pathognomonic sign of internal resorption;
sometimes a sign of cervical root resorption

pink cause of granulation growth undermining coronal dentin

158
Q

INTENTIONAL REPLANTATION (replant sx) and its indications (4)

A

-tooth that needs endo is removed, prepped, and returned

Indications

  1. routine endo is impossible
  2. canal blocked and periapical sx impractical
  3. perf
  4. previous tx failed, but non-sx tx or sx impractical

*only consider when no other alternative tx to maintain

159
Q

how should the socket wall be treated during replantation?

A

don’t touch!

160
Q

why don’t you replant primary teeth?

A

potential danger to permanent successor

-infxn, ankylosis

161
Q

functions of PULP (3)

A
  1. dentin formation
  2. induction - forms dentin -> enamel formation
  3. nutrition - tubules (hydration, form peritubular dentin)
162
Q

first formed dentin laid before odontoblast layer is organized is ____

A

mantle dentin

163
Q

most dentin is ___ dentin

A

circumpulpal

164
Q

___ dentin forms after eruption and through life; results in gradual asymmetric rdxn in pulp size

A

secondary

165
Q

irregular and disorganized dentin layer in response to injury or irritants

A

tertiary dentin (reparative)

166
Q

as dental pulp ages, # of reticulin fibers increases/decreases

A

DECREASES
pulp is LESS CELLULAR and MORE FIBROUS

size of pulp decreases

167
Q

as pulp ages, collagen fibers and calcifications within pulp increase/decrease?

A

INCREASE

168
Q

pulp stones

A

calcifications assoc. with chronic pulpal disease

169
Q

nerves in pulp

A
  • myelinated (sensory)
  • unmyelinated (motor) = regulate lumen size of blood vessels
  • afferent sympathetic
170
Q

are proprioceptors present in pulp?

A

NO

they respond to stimuli regarding movement

171
Q

what is the only nerve ending found in pulp?

A

free nerve endings

  • it’s a SPECIFIC pain receptor
  • regardless of source of stimulation, the only response is PAIN
172
Q

cells in pulp;

cells in DISEASED pulp

A

pulp

  1. fibroblasts (mainly)
  2. odontoblasts
  3. histiocytes (macros and lymphocytes)

diseased pulp

  1. PMNs
  2. plasma cells
  3. basophils
  4. eosinophils
  5. lymphocytes
  6. mast
173
Q

during pulpal inflammation these cells are involved in response, NOT __

A

involved = plasma cells, macros, lymphocytes

NOT PMNs

because there’s no direct pulp exposure, it’s not an ACUTE response. after exp then PMNs are chemotactically attracted

174
Q

vital pulp response to microbial invasion is very resistant because after 2 wks exposure, only ___ mm of coronal pulp has given in

A

2 mm

175
Q

apical or coronal portion of pulp has more collagen?

A

apical

Type 1:3 = 55:45
Type 5, small amts

176
Q

what type of collagen predominates in dentin

A

Type 1

177
Q

fibroblasts in pulp make what types of collagen? (2)

A

Type 1 and 2

178
Q

central zone (pulp proper) contains ____

list 3 layers

A

nerves, blood vessels

  1. cell-rich zone (innermost) - fibroblasts
  2. cell-free zone (zone of Weil) - capillaries, nerves, nerve plexus of Rashkow
  3. odontoblastic layer (outermost) - odontoblasts, next to predentin & mature dentin
179
Q

absence of what layer predisposes dentin to internal resorption?

A

predentin

10-47mm of dentin matrix is unmineralized next to the odontoblastic layer

180
Q

__ wall of md teeth is most easy to perf

A

lingual wall

cause of lingual inclination

181
Q

__% of md 1st PM has 2 canals with 2 apical foramina

A

25%

23% can have 2 or 3 canals

182
Q

radiographic indication that 2 canals present

A

pulp canal disappears midroot

183
Q

referred pain to mental region of mandible might be from these teeth (3)

A

md 1st PM
md 2nd PM
md canine
md central

184
Q

__% md 2nd PM has 1 canal at apex

A

97%

  • oval access
  • close to mental foramen
185
Q

pulpitis in this tooth can refer pain to the EAR

A

md 1st molar

186
Q

md 1st molar has a ___ shape outline

__% cases, distal root has 2nd canal

A

trapezoid

40%

-pulp chamber located in mesial 2/3 of crown

187
Q

md canine, root canal wall is thin M-D/B-L? and wide M-D/B-L?

A

thin mesiodistally

wide labiolingually

188
Q

in the md central, if there are 2 canals, which one is straighter?

A

labial

access is long oval

189
Q

mx incisors, canines have __ axial inclination

A

DISTAL - angle bur to distal to avoid perf of mesial root

190
Q

referred pain to FOREHEAD can be from these teeth

A

mx central, mx lateral

191
Q

mx central/lateral is most likely to have a curved root

A

lateral

192
Q

mx central root anatomy

A

access is OVAL-TRIANGULAR (more tri)

193
Q

mx lateral root anatomy

A

access is OVAL

more slender than central, often has distal and/or lingual curvature or dilacerations

194
Q

pulpitis in mx canine can refer to what area?

A

NASOLABIAL

195
Q

how many canals for mx 1st PM?

A

2 canals

60% have 2 roots (B, palatal), usually equal in length

196
Q

which tooth has a canal cross section shaped like a figure 8 ellipse?

A

mx 1st PM
-> access is THIN OVAL

careful don’t perf on mesial (mesial concavity)

197
Q

mx 2nd PM refers pain where?

usually has how many roots?

A

temporal (more)
nasolabial

85% 1 root, 15% have 2 roots

access is THIN OVAL

198
Q

mx 1st or 2nd PM has higher incidence of accessory canals?

A

mx 2nd PM

199
Q

mx molars pulp chamber outline is

A

TRIANGLE

  • line connecting mesial and palatal is longest
  • 59% 4th canal usually lingual to MB
200
Q

most missed canal in mx 1st molar

palatal canal curves to ___

A

MB cause it’s under MB cusp; access from DL position, often splits into 2 canals

curves to FACIAL

201
Q

u-shaped radiopacity overlying palatal root apex is most likely?

A

zygomatic process

202
Q

which nerves are distributed in the subnucleus caudalis of trigeminal nerve (CN V)?

A

CN VII, IX, X

creates potential of referred pain to many sites

203
Q

transplantation is

A

transfer of tooth from one socket to another in same person or another person

when root isn’t fully developed - better prognosis

204
Q

force controlled vertical tooth movement occlusally in a socket is called

A

orthodontic extrusion

INDICATIONS

  • prior to implant
  • untx subgingival pathoses
205
Q

to stablize intentionally replanted tooth

A

ask pt to close in CO for rest of the day

206
Q

disadvantage of endodontic implants is

A

lack of apical seal

207
Q

procedure to apically position gingival margin and/or reduce cervical bone is called

A

crown lengthening

-to tx subg caries, perfs, resorptions

208
Q

root submersion

A

resection of tooth roots 3 mm below alveolar crest then cover with mucoperiosteal flap

-will prevent alveolar resorption and maintain better proprioception

INDICATIONS
-rampant caries, adverse periodontal conditions, repeated failure of prosthetic cases, med complex, avoid esthetic defect

209
Q

the earliest and most common symptom of pulpal edema/inflamed pulp (acute pulpitis)

A

thermal sensitivity

usually involves increased and persistent pain to cold

210
Q

best way to test thermal response

A

rubber dam; bathe each tooth in hot/cold water

211
Q

thermal test false (-) in teeth that are

A

immature

recently traumatized

or premedicated with analgesic

212
Q

__ is the only reliable clinical evidence that 2’ dentin has formed

A

decr. tooth sensitivity (cause tubules calcified)

213
Q

conditions that DON’T require endo (3)

A
  1. cementoma (periapical cemental dysplasia) - usually anterior md, wont’ affect pulp vitality
  2. traumatic bone cyst - not true cyst cause no epithelial lining, teeth usually vital
  3. globulomaxillary cyst - jxn of globules and mx processes, btw lateral and canine, tooth vital
214
Q

conditions that DO require endo (4)

A

all NONVITAL

  1. apical scar - periapical granuloma, cyst, abscess
  2. radicular cyst
  3. chronic dental abscess
  4. chronic periapical granuloma - asymptomatic, most COMMON sequelae of pulpitis
215
Q

___ is a condition that results from a pulpal infxn that extends through the apical foramen into periapical tissues

A

periapical abscess

MOST COMMON of all abscesses

  • pus in alveolar bone at root apex after pulp dies
  • first symptom is tenderness -> throbbing with swelling
  • won’t respond to EPT or cold but maybe heat
  • ER: drain and rx abx -> RCT
216
Q

acute osteomyelitis is most commonly caused by

A

dental infection

  • occurs in jaw
  • serious sequelae of periapical infxn
  • often spreads into MEDULLARY SPACES
  • severe pain, temp/fever, lymphadenopathy
  • teeth are loose and sore
217
Q

radiographic features of acute osteomyelitis

A
  • takes 1-2 wks to see it

- diffuse lytic changes -> MOTH EATEN radiolucency

218
Q

__ is an acute abscess that develops through the periodontal pocket; involves alveolar bone loss, pocket formation, periodontal pathologic conditions

A

periodontal abscess

palpation (+)
percussion (+)
EPT responsive (UNLIKE periapical abscess)

BACTERIA = gram (-) rods ex. capnocytophaga, vibrio, fusobacterium

219
Q

__ is a rare abscess that occurs when bacteria invade thru a break in the gingival surface

A

GINGIVAL

-caused by mastication, oral hygiene procedures, dental tx

220
Q

__ is a long-standing low-grade infxn of periapical bone with the root canal being the source of infxn

A

chronic apical abscess (suppurative apical periodontitis)

  • asymptomatic
  • tx by RCT

-differential: NOT a cyst or granuloma because those are well-defined radiolucencies

221
Q

__ is an apical lesion that develops as an acute exacerbation of a chronic apical abscess

A

PHOENIX abscess (suppurative apical periodontitis - recrudescent abscess)

  • granulomatous zone gets infected
  • dx on acute symptoms and xray

percussion (+)
x-ray: big PA radiolucency

222
Q

massive invasion of pulpal contaminants will result in a __

A

acute abscess (Phoenix)

223
Q

__ to __ % of bone must be altered before you see it on an xray

A

30-50%

occurs at the jxn between the cortical and cancellous bone

224
Q

__ is a localized collection of pus inside alveolar bone at the apex after pulpal death, with infxn extending into periapical tissue

A

acute apical/alveolar abscess (AA)

  • 1st symptom is tenderness -> throbbing, swelling
  • tooth might get loose, pt gets fever

EPT (-)
Cold (-)
Heat (+) maybe

Tx: drain, later RCT

225
Q

__ is a growth of granulomatous tissue continuous with the PDL due to pulpal death with diffusion of toxic products into the periapical area

A

granuloma

  • usually asymptomatic
  • xray: well defined radiolucency with some irregularity
226
Q

__ is an inflammatory response of the periapex that develops from pre-existing granulomatous tissue

central, fluid-filled, epithelium-lined cavity, surrounded by granulomatous tissue and peripheral fibrous encapsulation

A

CYST

  • asymptomatic
  • xray: well defined radiolucency
227
Q

granuloma and cyst are only differentiated by

A

HISTOLOGY

228
Q

in endo-perio lesions, what tx is first?

A

endo

perio first only if it’s primary periodontal lesion

229
Q

common clinical finding of perio prob is

A

pain to lateral percussion on a tooth with wide sulcular pocket

230
Q

probing lesions (3)

A
  1. conical-shaped
  2. blow-out (acute)
  3. narrow sinus tract
231
Q

conical shaped probing lesion

A

can’t be managed by endo alone, typical of perio problem, bone loss at crestal bone and progresses apically

232
Q

blow-out (acute) probing lesion

A

non-vital (necrotic) pulp that can completely heal after RCT, normal sulcus depth until area of swelling (drops near apex)

233
Q

narrow sinus tract lesion

A

normal probing depth, except narrow area, probe can pass down root to some distance

tooth is non-vital

234
Q

reversible pulpitis (pulpal hyperemia = pulpal inflammation)

A
  • most commonly caused by bacteria
  • pain requires external irritant to evoke painful response
  • sharp and brief pain, stops when irritant is removed
  • percussion (-)
  • pulp responds more to cold than hot
235
Q

__ is an excess accumulation of blood in the pulp due to vascular congestion

A

pulpal hyperemia

  • engorgement of pulpal vessels with blood
  • when you remove the cause -> pulp normal
236
Q

how do hyperemic teeth respond to EPT

A

lower current than normal

237
Q

best way to reduce pulp injury during tooth prep is to

A

minimize dehydration of dentin

238
Q

irreversible pulpitis (acute pulpitis) is

A

a condition characterized by SPONTANEOUS PAIN with periods of cessation, intermittent

  • LINGERS after irritant is removed
  • usually not readily localized
  • incr. by heat and relieved by cold
  • lying down or bending over intensifies the pain (incr. pressure)
  • percussion (+)
239
Q

necrotic pulp (pulp death)

A
  • may have no painful symptoms, no EPT response

- sometimes response to heat but not cold

240
Q

bacteroides involved in pulpal-periradicular infxn (2)

A

porphyromonas

prevotella

241
Q

bacteria species in infected root canals (5)

A
  1. eubacterium
  2. peptostreptococcus
  3. fusobacterium
  4. porphyromonas
  5. prevotella
242
Q

what species isnt as important in the progression of caries as it is the initiation?

A

streptococcus

243
Q

virulence factors in periradicular pathosis (4)

A
  1. LPS (gram - bacteria)
  2. enzymes - neutralize abs and complement components
  3. extracellular vesicles - bacterial adhesion, proteolytic activities, hemagglutination, hemolysis
  4. fatty acids - affect chemotaxis, phagocytosis
244
Q

if vital pulp is exposed for 2 weeks, bacteria won’t penetrate more than __ mm

A

2 mm

245
Q

endo contraindications

A
  1. non-restorable/non-strategic tooth
  2. bad peiro support
  3. vertical root fracture
  4. internal/external resorption
  5. can’t instrument canal/surgery
246
Q

is hemophilia a contraindication to endo?

A

no but check with physician

247
Q

post guidelines

A
  • leave 4 mm gutta percha
  • threaded screw posts incr. fracture -> PARALLEL and TAPERED are preferred
  • cusps adj. to lost marginal ridges should have ONLAY
248
Q

why are endo posterior teeth more prone to fracture?

A

destruction of coronal structure

249
Q

min. restoration for endo tx teeth is

A

onlay -> cuspal coverage

250
Q

pulp chamber retained amalgam, __ mm into each canal

A

3 mm

251
Q

Anterior tooth fractures are usually do to

A

Accidental trauma

252
Q

RCT for horizontal root fracture is not indicated if

A

Fracture site remains in close proximity and pulp is vital

253
Q

Symptoms of cracked tooth syndrome

A

Sharp, brief pain occurring unexpectedly when pt chews

254
Q

3 types of surgical flaps

A
  1. Submarginal curved (semilunar)
  2. Submarginal triangular and rectangular (Ochsenbein-Leubke)
  3. Full mucoperiosteal

NBDE II Board Busters (11 decks)

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