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4th Year - Module 7 > Endodontics > Flashcards

Endodontics Flashcards

1
Q

When should an RCT be followed up?

A
  • clinical and radiographic follow-up at least 1 year after treatment
  • further follow up for up to 4 years
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2
Q

When is RCT retreatment indicated?

A
  • persistent periapical pathology following RCT
  • new periapical pathology associated with a root-filled tooth
  • new restoration for tooth planned and radiographic assessment shows inadequate root canal filling or periapical radiolucency
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3
Q

What can be seen radiographically in the presence of a persistent periapical pathology following RCT?

A

No radiographic signs of bony healing after 4 years

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4
Q

What is considered new periapical pathology associated with a root-filled tooth?

A
  • initial healing but a new radiolucency develops some time later.
  • Root canal system has become infected subsequent to previous treatment
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5
Q

What are the estimated success rates of primary and secondary RCT?

A

Primary 83%
Secondary 80%

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6
Q

What are three main prognostic factors for RCT pretreatment?

A

1) pre-operative periapical lesion
2) apical extent of coronal restoration
3) quality of coronal restoration

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7
Q

What does the term “healed” indicate with RCT?

A
  • clinically - no signs/symptoms
  • radiological - no residual radiolucency or scarring after surgery
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8
Q

What does the term “healing” indicate with RCT?

A
  • clinical - no signs/symptoms
  • radiological - reduced radiolucency in follow up <4yrs
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9
Q

What does the term “asymptomatic function” indicate with RCT?

A
  • clinical - no signs/symptoms combined with no or persistent radiolucency, reduced in size or unchanged
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10
Q

What does the term “persistent/recurrent/emerged disease” indicate with RCT?

A
  • clinical - with or without symptoms
  • radiological - new, increased, unchanged or reduced after >4yrs
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11
Q

What guidelines are there in the prevention of post-treatment disease regarding quality of RCT?

A
  • rubber dam isolation
  • proximity of preparation to AC
  • sufficient taper of preparation
  • adequate irrigation and placement of interappointment medicament
  • correct extension of obturation without extrusion
  • adequate coronal seal to prevent re-infection
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12
Q

What are the four indications for root canal retreatment?

A

1) previous treatment failed - signs of inflammation/infection
2) persistent symptoms, sinus tract (chronic abscess), swelling, pain
3) failure of previous treatment due to technical reasons
4) existing pathology and new restoration planned for tooth

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13
Q

What are four different types of periapical pathology?

A

1) intraradicular microbes
2) extraradicular microbes
3) foreign body reaction
4) true cyst

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14
Q

What are five examples of microbial causes of post-treatment disease?

A

1) intraradicular microbes - either persistent or secondary to major cause of endo failure
2) extraradicular microbes
3) radicular cyst
4) cracked teeth, vertical root fracture
5) coronal leakage

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15
Q

What are two examples of non-microbial causes of post-treatment disease?

A

1) cholesterol crystals
2) foreign body reactions in periapical tissues

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16
Q

What are the two causes of intraradicular infection root canal treated teeth?

A

1) persisting infection - inadequate isolation/disinfection during RCT
2) new/secondary infection through leakage

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17
Q

Do radiographs indicate the biological status of the root canal?

A

no

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18
Q

What are “persistent bacteria”?

A

those that remain in the root canal system after root canal disinfection and interappointment dressing

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19
Q

What type of bacteria is commonly considered a “persistent bacteria”?

A

Gram positive bacteria - appears to be more resistant to antimicrobial treatment and has the ability to adapt to harsh environmental conditions in instrumented canals

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20
Q

How many species of bacteria usually exist in “apparently well treated canals”?

A

1-5 species

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21
Q

How many species of bacteria usually exist in “inadequately treated” canals?

A

10-20 species, similar to untreated canals

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22
Q

What are the microbes commonly found in retreatment cases? 6

A

1) E faecalis
2) streptococcus
3) lactobacillus
4) actinomycetes
5) propionobacterium
6) candida albicans

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23
Q

What are three possible origins of microbes in retreatment cases?

A

1) contamination during initial treatment
2) leaving a tooth on open drainage
3) coronal leakage post-treatment

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24
Q

What forms can bacterial colonies exist in extraradicularly?

A
  • biofilms on external root surface
  • inside periapical granulomas
  • establish periradicular infection e.g. acute apical abscess
25
Q

What is a radicular cyst?

A
  • most common odontogenic cyst of inflammatory origin
26
Q

What does a radicular cyst arise from?

A

epithelial cell rests in the PDL

27
Q

What are the two types of radicular cyst?

A
  • true cyst
  • pocket cyst
28
Q

What is a true cyst?

A

lesion enclosed by an epithelial lining

29
Q

What is a pocket cyst?

A

epithelial sac communicates with the root canal system

30
Q

What kind of cyst will heal following RCT?

A

a pocket cyst will normally heal following endodontic treatment whereas a true cyst won’t

31
Q

What are cholesterol crystals formed of?

A

from dying cells during chronic inflammation

32
Q

What are four examples of things that can cause a foreign body reaction (non-microbial cause of post treatment disease)?

A
  • gutta percha
  • sealers
  • paper points
  • cotton pellets
33
Q

What radiographic techniques can be used to detect apical periodontitis and which is highly sensitive?

A
  • panoramic radiographs 0.28
  • periapical radiographs 0.55
  • CBCT 1.00 (very high sensitivity)
34
Q

Accessing a root canal treated tooth through an existing crown risks what?

A

higher risk of perforation due to reduced visibility and tooth alignment may be altered by the crown

35
Q

When should a pre-existing crown be removed for re-treatment and what are the advantages?

A
  • when a crown is defective/caries
  • to allow assessment of remaining tooth structure
  • to improve visibility and access to canals
  • avoid perforation risk
36
Q

What does sectioning involve?

A
  • take sectional putty impression first
  • section crown into two halves taking care not to cut through core, then remove with excavator
37
Q

What kind of bur should be used to section a porcelain crown?

A

diamond bur

38
Q

What kind of bur should be used to section a metal crown?

A

tungsten carbide

39
Q

What is the WAMkey technique for removing a metal or MCC?

A

1) estimation of access point
2) incision of crown
3) horizontal extension of cavity
4) shaping of cavity
5) insertion of WAMkey instrument
6) slight rotation movement of shaft

40
Q

What are two examples of crown removers?

A

1) crown tapper
2) KaVo Coronaflex

41
Q

What are the two main techniques of post removal?

A
  • post removal with ultrasonic energy
  • post removal with post pulling devices
42
Q

What kind of ultrasonics are used for post removal using ultrasonic energy?

A

Piezoelectric ultrasonics - 30-40kHz
tips for post removal have a blunt end

43
Q

How do you remove a screw type active post?

A

-remove core material from around post with high speed burs and ultrasonics
- use wrench supplied by manufacturer for insertion
- ultrasonics can aid process by breaking up cement

44
Q

How do you remove a cast post and core?

A
  • usually involves removal of coronal restoration
  • may require cutback of core using tungsten carbide bur prior to ultrasonics
  • if post extremely well fitting then removal can be very difficult
45
Q

What are four examples of post pulling devices?

A

1) Egglers post pulling device
2) Ruddle post pulling kit
3) Massarann Kit
4) ivory miniature post puller

46
Q

What makes a post more difficult to retrieve?

A

adhesive resin cements

47
Q

What is used to remove a quartz fibre post?

A

RTD quartz fibre post removal kit

48
Q

What four techniques can be used for the removal of gutta percha?

A

1) rotary endodontic files
2) ultrasonics
3) heat
4) solvents

49
Q

How is GP removed using PTG?

A

1) measure estimated WL for radiograph
2) depending on diameter select either F2 or F3, length 21mm
3) rpm to 600
4) use in coronal 2/3 - work from F3-F2-F1 if required
5) go down in 1mm increments checking EAL until WL and patency achieved
6) if apical section underprepared/not obdurated negotiate with size 10 file, establish WL and patency and complete prep using normal PTG sequence at 300rpm (S1, S2 etc)

50
Q

What is the Hedstrom files and solvent approach to removing GP?

A
  • traditional technique
  • files are SS therefore less flexible, not effective in narrow, curved canals
  • useful if a single cone obturation or poorly compacted GP
  • engage loose GP with file and pull to remove
  • do not engage canal wall
51
Q

Are solvents required for retreatment with rotary NiTi instruments?

A

no definitive answer

52
Q

What are 5 types of solvent?

A

1) chloroform
2) turpentine
3) DMS IV (Eugenol)
4) Endosolv R (resin)
5) Endosolv E (eugenol)

53
Q

How can heat be used to remove GP?

A
  • softens and removes GO
  • useful when removing coronal GP for post placement
  • remaining GP soft and requires vertical compaction
54
Q

What are the two types of carrier-based GP removal?

A

1) thermafil
2) guttacore

55
Q

What is thermafil?

A
  • carrier based GP removal
  • plastic carrier covered in alpha phase GP
  • plastic sprue difficult to remove esp in underprepared canals
  • care must be taken as very easy to deflect and perforate
56
Q

What is guttacore?

A
  • carrier based GP removal
  • carrier made of cross-linked GP
  • allows easier removal in re-treatment cases
57
Q

What are silver points?

A
  • technique for removal of RCT filling
  • care not to cut coronal end
  • remove with Stieglitz forceps or gently trough with fine ultrasonic tip
  • when micro leakage occurs, cement fails and cone corrodes
58
Q

Why are endodontic pastes mainly banned now?

A
  • technique for removal of RCT filling
  • shrinkage and poor seal made of toxic materials
  • often contain paraformaldehyde which is mutagenic, carcinogenic
  • endomethasone
  • resorcinol-formalin (Red Russian) - sets very hard, not radiopaque, difficult to remove and often discolours tooth pink/red

4th Year - Module 7 (16 decks)

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