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Clinic > Endodontics > Flashcards

Endodontics Flashcards

1
Q

Assessment criteria for a RCT

A

Full MH + Clinical Exam

C/O+HPC

I/O: buccal + lingual ST, colour, palpation, restoration, swelling, sinus, palpation, TTP, mobility, periodontal exam, sensibility testing, radiographic findings

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2
Q

Pregnancy importance in case selection

A

Within 1st trimester as emergency only

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3
Q

CVD importance in case selection

A

Contraindicated if MI within last 6 mths

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4
Q

Cancer importance in case selection

A

XLa preferred if poor prognosis, liaise

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5
Q

Diabetes importance in case selection

A

Appts shouldn’t interfere with insulin/meal schedule + minimise stress

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6
Q

MRONJ importance in case selection

A

Liaise

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7
Q

Allergies importance in case selection

A

GP is safe, possible NiTi or latex allergy

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8
Q

Name 5 clinical factors important for case selection

A
  1. Pulpal
    - sinus/abscess/TTP/EPT/ECL
  2. Caries status
    - consider XLa if insufficient tooth tissue remains
  3. Periodontal status
    - deep pocket >4mm, pus, tooth mobility, furcation involvement
  4. Restorative status
    - remaining coronal tooth structure, pre existing crown status
  5. Adjacent teeth
    - sound periodontal apical status
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9
Q

Name 6 radiographic factors important for case selection

A
  1. Endodontic status if previously retx
    - apical + coronal seal quality
    - obturation not within 2mm of apex
    - poorly condensed
  2. PA status
    - PDL widening
    - apical radiolucency
    - immature root apex
  3. Root anatomy
    - no of root canals/large curvatures
    - calcifications
    - dilacerations/resorption
  4. Restorative
    - crown:root ratio
    - pre-existing crown status
  5. Bone levels
    - perio with significant bone loss
  6. Caries status
    - subcrestal caries non restorable
    - significant caries may prevent isolation
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10
Q

What is a root canal tx?

A
  • RCT is used to tx infection at the centre of the tooth
  • The infection can be due to decay, leaky fillings/trauma
  • The centre of the tooth = pulp which contains BVS,nerves and connective tissue
  • RCT is necessary when the pulp (soft tissues) become inflamed/infected and is irreversible
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11
Q

Signs/symptoms of a tooth requiring RCT

A
  • Severe pain when eating/drinking or biting
  • Keeps up at night
  • Lingering sensitivity to hot/cold
  • Abscess
  • Deep decay or darkening of gums
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12
Q

What does RCT tx involve?

A

Removing the tooth pulp (nerve)
Disinfecting (cleaning)
Shaping of the RC systems to remove bacteria and create space for obturation (filling of biocompatible material) to prevent reinfection
Crown may be required to protect the tooth

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13
Q

Indications for RCT

A

Irreversible plural damage
Apical periodontitis
Elective devitalisation prior to further tx (over denture)

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14
Q

Contraindications for RCT

A

Non functional
Non restorable
Insufficient perio support
MI last 6mths

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15
Q

Risks for Endo Tx

A
  • Post op pain/swelling/trismus
  • Instrument separation
  • Perforation/ root fracture
  • Failure to negotiate WL
  • Hypochlorite incident
  • Continued symptoms - reRCT
  • Missed canals
  • Damage to existing restos
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16
Q

Design objectives for endo

A
  • Maintain apical foramen in original position
  • Keep apical opening as small as possible
  • Continuously tapering funnel shape
17
Q

Shape objectives for endo

A
  • Make ideal shape + space for irrigant + filling
  • Remove pulpal debris
18
Q

Cleaning aims for endo (4)

A
  • Remove smear layer
  • Flush out debris
  • Lubricate instruments
  • Dissolve organic debris
19
Q

3 laws of pulpal floor anatomy

A
  1. Orifices lie perpendicular to imaginary line drawn M–>D
  2. Pulpal floor darker than pulpal walls
  3. Orifices lie at equidistant from each other to imaginary line drawn M–>D
20
Q

3 laws for locating orifices on plural floor

A
  1. Orifices lie at junction between pulpal floor and walls
  2. Orifices lie at angles of pulpal floor + walls
  3. Orifices always at terminals of developmental fusion lines
21
Q

Protaper hand files steps

A
  1. Access cavity + straight line access with DG16
  2. 10k set at 2/3rds EWL to create glide path
  3. Establish CWL with 10k + apex locator /PA + 15k
  4. 10K CWL (balanced force)
  5. 15K CWL (balanced force)
    Irrigate + recapitulate between
  6. S1 purple CWL for coronal 3rd
  7. S2 white CWL for mid 3rd

FINISHING FILES
8. F1 yellow CWL
9. F2 orange CWL
10. Irrigation protocol, dry + try MAF25 , obturate

22
Q

Proper hand file sequence

A

S1,S2,(SX),F1,F2,F3

23
Q

Radiograph follow up for endo

A

Annual for 4yrs
Look for: absence of pain swelling +sinus tract, normal PDL

24
Q

Modified Double Flare steps (GG+K)

A
  1. Access cavity + straight line access with DG16
  2. 10k set at 2/3rds EWL to create glide path
  3. GG for coronal flare (set at 2/3rds)
    Size 4 , Size 3, Size 2
  4. Establish CWL with 10k + apex locator/PA + 15k
  5. Apical prep:
    15k CWL watch winding
    20k CWL balanced force
    25k CWL
    30k CWL until file binds then take next 2 file sizes to CWL to create apical stop, last file used = MAF
  6. Apical taper: joins apical + coronal prep

STEPBACK TECHNIQUE
7. Take 1 size larger file than MAF, set rubber stopper 1mm less than CWL
E.g 30k - 14mm, 35k - 13mm, 40k - 12mm,
8. Irrigation protocol, dry, obturate

25
Q

Reciproc steps

A
  1. Access cavity + straight line access with DG16
  2. 10k EWL set at 2/3rds to create glide path (watch winding)
  3. 15k to 2/3rds EWL
  4. R25 to 2/3rds EWL - 3pecks (coronal prep)
  5. Irrigate + recapitulate
  6. Establish CWL with 15k PA or EAL+10k (0 reading -1mm)
  7. R25 to CWL (apical prep)
    Irrigate + recapitulate
  8. Try 25k and make sure it goes down to CWL with tug back (apical gauging) Try MAF 25
  9. Irrigation protocol, dry, obturate
26
Q

Reciproc protocol for deciding what size file

A

R25 - if canal narrow/completely invisible on PA/ iso 20 not passively to WL
R40 - if canal medium/iso 20 passively to WL
R50 - if large canals/iso 30 passively to WL

27
Q

Irrigation protocol

A

3% NaOCl at least 30ml for 10mins
17% EDTA 1 min rinse (remove smear layer)
3% NaOCl final rinse
Dry with paper points

28
Q

Obturation protol

A

Master GP25 cone lathered in AH+ (1:1)
B finger spreader +/- accessory cones
Severe off with heated endo alpha at level of orifice + plug with endo plugger
Clean coronally
Remove all unsupported enamel

29
Q

4 methods of removing GP for a previously tx tooth

A
  1. GG
  2. 15c+ file then 10c+ file
  3. Proper retx - D1,D2,D3
  4. Reciproc

Clinic (4 decks)

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