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BDS Finals > Endodontics > Flashcards

Endodontics Flashcards

1
Q

Maxillary incisor access cavity

A

Triangular

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2
Q

Mandibular anterior access cavity

A

Ovoid

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3
Q

Maxillary molar access cavity

A

Trapezoid - mesial

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4
Q

Mandibular molar access cavity

A

Trapezoid - central

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5
Q

Sclerotic Canal

A

Calcification in the root canal system

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6
Q

What helps a sclerotic canal

A

EDTA chelating agent 17%

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7
Q

Which material is used in the canal between visits

A

Non setting calcium hydroxide

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8
Q

Pulpal Diagnoses (7)

A
  1. Normal pulp
  2. Reversible pulpitis
  3. Symptomatic irreversible pulpitis
  4. Asymptomatic irreversible pulpitis
  5. Pulpal necrosis
  6. Previously treated
  7. Previously untreated
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9
Q

Problems with sensibility testing multi rooted teeth

A

1 canal could be necroded while the others are fine

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10
Q

Temperature of ethyl chloride

A

-50

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11
Q

Temperature of frozen carbon dioxide

A

-78

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12
Q

EPT

A

Electric Pulp Test

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13
Q

Electric Pulp Test (2)

A
  1. Electric current used to stimulate A delta fibres
  2. Negative response reliable indicator
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14
Q

Issues with EPT (3)

A
  1. No indication of reversibility of inflammation
  2. No correlation between threshold and pulp condition
  3. Immature apices unreliable
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15
Q

Apical Diagnoses (6)

A
  1. Normal
  2. Symptomatic apical periodontitis
  3. Asymptomatic apical periodontitis
  4. Chronic apical abscess
  5. Acute apical abscess
  6. Condensing osteitis
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16
Q

Cells found in the pulp

A

Odontoblasts

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17
Q

What do odontoblasts generate

A

Tertiary dentine

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18
Q

RDT

A

Remaining Dentine Thickness

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19
Q

Dentine permeability and cavity depth

A

The deeper the cavity the greater the dentine permeability

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20
Q

Condensing osteitis (2)

A
  1. Diffuse radiopaque lesion
  2. Localised bony reaction to low grade inflammation
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21
Q

Temperature of endo ice

A

-27.2

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22
Q

Periodontitis impact on pulp

A

Prematurely ages pulp

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23
Q

Pulp ability to respond to inflammation with age

A

Less resistant to inflammation as age increases

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24
Q

Sodium Hypochlorite properties (4)

A
  1. Antimicrobial
  2. Dissolves pulp remnants and collagen
  3. Dissolves necrotic and vital tissue
  4. Disrupts smear layer
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25
Concentration of sodium hypochlorite
0.5 - 5.25%
26
Problems with sodium hypochlorite (3)
1. Possible effect on dentine properties 2. Inability to remove smell layer by itself 3. Effect on organic material
27
Sodium hypochlorite complications (4)
1. Discolouration of fabrics 2. Eye injury if contact 3. Apical extrusion leading to tissue necrosis 4. Allergic reactions
28
Antifungal activity of chlorhexidine
Less than NaOCl
29
Chlorhexidine impact on biofilms
Unable to disrupt biofilms but somewhat active against them
30
Chlorhexidine absorption
Prevents microbial colonisation for time beyond time of application
31
Can canal irritants be used at the same time
No
32
Order of canal irrigation after instrumentation (3)
1. NaOCl 30ml (at least 10 mins pre obturate) 2. EDTA 1 min 3. NaOCl final rinse
33
Endodontics during pregnancy (3)
1. Not a contraindication 2. First trimester emergency only 3. Pain/infection managed alongside obstetrician
34
Endodontics and CV disease (3)
1. Myocardial infarction within 6 months - contraindication 2. Emergency tx provided w/consultation from cardiologist 3. Minimise stress
35
Endodontics and cancer (2)
1. Chemo and radiotherapy can compromise healing 2. Consult oncologist
36
Endodontics and diabetes (4)
1. Pts carefully monitored 2. Appointments don't interfere with normal insulin/meal schedule 3. Minmise stress 4. Higher rate of RCT failure
37
Endodontics and Bisphosphonates (2)
1. Non-surgical endo preferential to extraction 2. Use entire health care team when developing tx plan
38
Endo - restorative considerations for restorability (4)
1. Sub-osseous caries 2. Poor crown/root ratio 3. Misalignment of teeth 4. Pre-existing full coverage restorations
39
Why should front surface mirrors be used
Rear surface mirrors increase distortion
40
Internal resorption radiographic appearance
Continuous with the canal
41
External resorption radiographic appearance
Appears superimposed on canal
42
Alternatives to non-surgical endodontic tx for difficult cases (3)
1. Extraction 2. Orthograde root canal treatment 3. Surgical endodontics
43
How to assess endodontic case difficulty
AAE Endodontic Case Difficulty Assessment Form
44
Why is protaper used for re root treatment
Active tip allows initial penetration into material
45
Protaper D1
Coronal filling removal
46
Protaper D2
Middle filling removal
47
Protaper D3
Apical filling removal
48
Protaper speed for retreatment (2)
Slowest speed that engages obturation material 500-700rpm
49
How far away from the apex should you stop for retreatment
2-3mm
50
How can you bypass ledges in endo
Pre curved C+ files
51
Solvent for gutta percha removal (2)
1. Chloroform 2. Eucalyptus oil
52
Assessment of endodontic tx (5)
1. 1 year later 2. Absence of pain, swelling etc. 3. No sinus tract 4. No loss of function 5. Radiological evidence of normal PDL
53
Irregularly mineralised tissue on post endodontic assessment (3)
Scar tissue Not necessarily persisting apical periodontitis Continue to monitor
54
Types of success - endo (2)
Technical success Biological success
55
Operative factors contributing to endodontic success (4)
1. Filling extended to within 2mm of radiographic apex 2. Not extruded 3. Well condensed root filling with no voids 4. Good quality coronal restoration
56
Law of centrality
Pulp chamber always in the middle If 1 canal - in the middle If canal off to one side - more canals
57
Colour of pulp chamber floor
Always darker than the walls
58
Where do canal orifices lie
At the junction of the walls and the floor
59
What should be established before retreatment - endo
Cause of the failure
60
PRD
Periradicular Disease
61
Purpose of intra-canal medicaments (3)
1. Destry microorganisms and prevent reinfection 2. Reduce inflammation and exudate 3. Control of root resorption
62
Anti-microbial paste - endo (3)
1. Mix of corticosteroid and tetracycline 2. Used in management of hot pulps to reduce inflammation 3. Effective for 5-7 days
63
Non-setting calcium hydroxide (2)
1. High pH contributes to antibacterial activity 2. Prolonged antibacterial activity
64
pH of non-setting calcium hydroxide
12.5
65
How to use non-setting calcium hydroxide
Fill canal completely with disposable syringe tip
66
Design objectives for RCT (3)
1. Create a continuously tapering funnel shape 2. Maintain apical foramen in original position 3. Keep apical opening as small as possible
67
Bur that has cutting sides but will not cut any deeper
Endo Z bur
68
Hand file motions (4)
1. Filing 2. Reaming 3. Watch-winding 4. Balanced force
69
Describe watch winding
Back and forward oscillation of 30-60 degrees with light apical pressure
70
Describe balanced force (3)
1/4 turn clockwise With continued pressure turn 1/2 turn counterclockwise Do this 1-3 times then irrigate and repeat
71
Syringe used for endo
Luer lock syringe
72
Reason for early coronal flare (3)
1. Avoids hydrostatic pressure in canal 2. Removal of heavily contaminated contents 3. Improved straight line access to apical 1/3
73
Distance between apical constriction and radiographic apex
Greater in older teeth with secondary cementum
74
Paper point working length determination
If the point touches blood or tissue fluid it will be red
75
Gauging
Passive exploration
76
How long does AH plus take to set
8 hours
77
Purpose of obturation (4)
1. Prevent microorganisms from reentering 2. Block apical foramina 3. Block dentinal tubules 4. Block accessory canals
78
Main obturation technique
Cold lateral compaction
79
Other obturation techniques (3)
1. Warm vertical compaction 2. Continuous wave obturation 3. Carrier based obturation
80
RCT Sealer function (3)
1. Seals space 2. Fills voids 3. Lubrication
81
Root Resorption Definition
Non-bacterial destruction of the dental hard and soft tissue due to interaction of clastic cells
82
What makes RANKL good at root resorption (3)
1. Very motile 2. Ruffled border 3. In contact with dentine
83
Molecules involved in root resorption (2)
1. RANKL 2. OPG
84
What does OPG do to RANKL
Inhibits it
85
RANKL stimulation (3)
1. PTH, B3 and interleukin 2. Trauma 3. Chronic inflammation
86
Largest protective element from root resorption from osteoclasts
Periodontal ligament
87
Types of internal root resorption (2)
1. Inflammatory 2. Replacement
88
Types of external root resorption (4)
1. Inflammatory 2. Replacement 3. Cervical 4. Surface
89
How to differentiate internal/external root resorption
Internal resorption - lines of canal widen External resorption - still see parallel lines of canal
90
Internal Inflammatory root resorption signs (4)
1. Can be unrestored 2. +ve response to sensitivity testing 3. Can have pocketing if lesions perforated 4. Can have sinus if PRD
91
Will internal resorption change position with parallax
No
92
Pathogenesis of internal inflammatory root resorption (3)
1. Coronal pulp necrotic 2. Apical pulp vital 3. Will continue to progress until apical pulp goes non vital
93
Internal inflammatory resorption treatment
Orthograde endodontics
94
Internal replacement root resorption signs (2)
1. Can be unrestored 2. +ve to sensitivity testing
95
Internal replacement root resorption radiographic signs
Pulp radiopaque
96
Treatment for internal replacement root resorption (2)
Leave tooth until it becomes symptomatic RCT difficult
97
External surface resorption signs (3)
1. Can be unrestored 2. Increased mobility 3. +ve to sensitivity testing
98
Radiographic signs of external surface resorption (2)
PDL intact Trabecular pattern where PDL used to be
99
Tx for external surface resorption (3)
If middle of ortho - stop ortho If post ortho - no tx Splint mobile teeth
100
Aetiology of external surface resorption (5)
1. 90% of teeth have some form 2. 1-5% severe ESR 3. 15% moderate 4. Usually teeth for anchorage worst affected 5. Can happen idiopathically during growth
101
What can cause external surface resorption (4)
1. Ortho 2. Ectopic teeth 3. Pathological lesions 4. Idiopathic
102
External inflammatory resorption signs (3)
1. Usually restored 2. -ve response to sensitivity testing 3. Possible sinus, swelling, TTP
103
External inflammatory resorption radiographic signs (2)
Periapical radiolucency Restoration close to pulp
104
Aetiology of external inflammatory resorption
Pulp is necrotic and inflammation precipitates resorption process
105
Tx for external inflammatory resorption
Remove cause of inflammation Usually re endodontic treatment
106
Signs of external replacement resorption (4)
1. Can be restored but infraoccluded 2. No TTP but high pitched note 3. No mobility 4. +ve to sensitivity testing
107
Radiographic signs of external replacement resorption (2)
1. No obvious PDL 2. Pulp appears normal
108
Aetiology of external root resorption (2)
Trauma Osteoclasts comes into contact with root dentine
109
Tx for external replacement resorption (2)
1. Decoronation to prevent hard and soft tissue defect 2. Allows bone to grow over root
110
External cervical resorption signs (3)
1. Can be unrestored 2. Pink spot 3. +ve to sensitivity testing
111
External cervical resorption radiographic findings (3)
1. Usually spares pulp (predentine) 2. Apple core appearance 3. CBCT useful for visualising
112
External cervical resorption class 1 (2)
1. Crestal 2. 1/4 circumference
113
External cervical resorption class 2 (2)
1. Coronal 1/3 2. 1/2 circumference
114
External cervical resorption class 3 (2)
1. Middle 1/3 2. 3/4 circumference
115
External cervical resorption class 4 (2)
1. Apical 1/3 2. More than 3/4 circumference
116
External cervical resorption potential causes (5)
1. Ortho 2. Trauma 3. Historical heated non-vital whitening 4. viral infection 5. Systemic - thyroid
117
Tx options external cervical resorption (3)
1. Monitor 2. Extraction 3. Internal repair and orthograde endodontics (less likely)
118
C file difference
Cutting tip
119
What is GP made of (4)
20% Gutta percha 65% zinc oxide 10% radiopacifiers 5% plasticisers
120
Issues with cold lateral compaction (4)
1. Voids 2. Spreader tracts 3. Incomplete fusion of GP 4. Lack of surface adaptation
121
Other obturation techniques (3)
1. Warm vertical compaction 2. Continuous wave obturation 3. Carrier based obturation
122
What can be used to create an apical seal (2)
Biodentine MTA
123
Sealer Functions (3)
1. Seals space 2. Fills voids and irregularities 3. Lubricates during obturation
124
Properties of an ideal sealer (9)
1. Radiopacity 2. Bacteriostatic 3. Easily mixed 4. Good adhesion 5. Slow set 6. Insoluble in tissue fluids 7. Soluble on re tx 8. Biocompatible 9. No shrinkage on setting
125
How long does AH Plus take to set
8 hours
126
What is AH plus
Epoxy resin
127
EndoRez (2)
1. UDMA resin based sealer 2. Good penetration into tubules
128
Resin based sealers (3)
1. AH Plus 2. EndoRez 3. Calcium silicate
129
What sealers are not recommended
Sealers containing organic material like aldehydes
130
Glass Ionomer sealers (4)
1. Good dentine bonding properties 2. Minimal antimicrobial activity 3. Removal difficult 4. Little clinical data to support use
131
What happens when GP is exposed directly to oral bascteria
Rapidly becomes infected
132
Is zinc oxide eugenol cytotoxic
Yes, it forms an effective antibacterial barrier
133
Symptoms of NaOCl extrusion (6)
1. Pain 2. Swelling 3. Ecchymosis 4. Haemorrhage 5. Neurological complications 6. Airway obstruction
134
Ecchymosis in NaOCl extrusions (2)
Manifests along the superficial venous vasculature Rare <50 cases in literature
135
Risk Factors for NaOCl extrusion (6)
1. Excessive pressure 2. Needle locked in canal 3. Loss of control of working length 4. Larger apical diameters/constriction 5. Anatomical factors/proximity to sinus 6. Higher NaOCL conc?

BDS Finals (22 decks)

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