Endodontics Flashcards
What is the Basrani classification of fractured teeth?
Class A1, A2a, A2b
Holstroms Veterinary Dental Techniques 3rd edition
A1: enamel fracture of crown
A2a: crown enamel and dentin fracture
A2b: crown enamel, dentin and pulp exposed
What is the Basrani classification of fractured teeth?
Class B
Class C
Holstroms Veterinary Dental Techniques 3rd edition
Class B: root fracture
Class C: crown and root fracture
According to Holstrom’s Veterinary Dental Techniques, what is the time of fracture cut off for performing vital pulp therapy on pulp-dentin fracture on a patient older than 18 months?
48 hours
According to Holstrom’s Veterinary Dental Techniques, what are the timing cut offs for vital pulp therapy for patients younger and older than 18 months?
Younger than 18 months: 2 weeks or less
Older than 18 months: 48 hours or less
According to Holstrom’s Veterinary Dental Techniques, the ideal working length is located where in relation to the apex?
1mm short of the apex
According to Holstrom’s Veterinary Dental Techniques, what rpm should rotary instruments be run at?
350rpm
Most low speed handpieces turn at 3000rpm
What fibers in the dentin pulp complex are you testing when performing sensibility tests (i.e. thermal or electrical conduction)?
A-delta fibers
In the study “Reliability of Electric Pulp Test, Cold Pulp Test
or Tooth Transillumination to Assess Pulpal
Health in Permanent Dog Teeth” what was considered the most and least reliable diagnostic test to evaluate pulp health in dogs?
- Most reliable - EPT (electric pulp test)
- Least reliable - TTI (tooth transillumination)
According to Zacher’s 2021 review “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” indirect pulp capping includes placement of what agent(s) as a base layer?
Manfra Marreta JVD 2021, Issue 2
Hard setting calcium hydroxide
MTA
newer generation bioceramic materials
Followed by glass ionomer or resin-modified glass ionomer then composite
According to Zacher’s 2021 review “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” how many millimeters of calcium hydroxide or MTA should be applied to the pulp during VPT?
JVD 2021, Issue 2
2-3mm
In the study “Reliability of Electric Pulp Test, Cold Pulp Test
or Tooth Transillumination to Assess Pulpal
Health in Permanent Dog Teeth” EPT identified what percentage of nonvital and vital teeth respectively?
96% nonvital, 100% vital
According to Zacher’s 2021 review “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” for apexification the working length should be how many millimiters short of the apex and how many millimeters of the apex should be filled with MTA?
1-2mm short of the apex
fill the apical most 4-5mm
Accoding to Zacher’s “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” what are appropriate techniques for treating fractured teeth with vital pulps?
JVD 2021
Bonding and sealing
Indirect pulp capping
Pulpotomy with direct pulp capping/vital pulp therapy
Accoding to Zacher’s “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” what are appropriate techniques for treating fractured teeth with nonvital pulps?
JVD 2021
Regenerative endodontic therapy
Apexification followed by conventional root canal therapy
What intraoperative findings are consistent with irreversible pulpitis?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Excessive or deep pulpal hemorrhage from exposed or amputated pulp
Persistent hemorrhage for greater than 5 minutes following partial coronal pulpotomy
When immature teeth sustain crown fractures when is extraction indicated?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Extensive alveolar bone loss that cannot be reversed
Insufficient crown structure for restoration
owners unable to pursue ongoing treatment
When the pinkish hue of a near pulp exposure is observed how many millimeters of pulp remains?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
~0.5mm
Indirect pulp capping indicated
In the study “Reliability of Electric Pulp Test, Cold Pulp Test
or Tooth Transillumination to Assess Pulpal
Health in Permanent Dog Teeth” TTI identified what percentage of nonvital and vital teeth respectively?
Nonvital 59% and Vital 95%
What does thermal testing rely on?
Rapid temperature change of the tooth causes a sudden fluid flow within the tubules which stimulates the A-delta fiber nociceptors in the dentin-pulp complex.
In Luotonen’s 2014 article “Vital pulp therapy in dogs: 190 cases (2001–2011),” what was the range in hours of time since exposure to treatment and what was the correlation between time of exposure and treatment success?
J Am Vet Med Assoc. 2014
3 to 250 hours
Time since exposure had no significant correlation with success of treatment
In the human literature, what factor is most important overall for success of vital pulp therapy?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Removal of all inflamed superficial pulp
More necessary for success than timing
What intraoperative error can lead to VPT failure?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Deep penetration of pulp dressing material into pulp
In Luotonen’s 2014 article “Vital pulp therapy in dogs: 190 cases (2001–2011),” what the overall failure rate of VPT with calcium hydroxide vs MTA?
Overall failure rate for VPT with calcium hydroxide was 5 times greater than with MTA
MTA: 92%
Calcium hydroxide: 58%
In Luotonen’s 2014 article “Vital pulp therapy in dogs: 190 cases (2001–2011),” what was the association between antibiotic use and outcome?
No significant correlation with antibiotic usage and outcome when multivariate analysis used
What is the definition of apexification?
a method to induce a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulps
When MTA is used for apexification when is the apical barrier created?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Created immediately upon placement at apex
May perform apexification in 1 or 2 step procedures with MTA vs multiple procedures and months for apical hard tissue barrier to form when calcium hydroxide used
The 2012 human Mahidol study found that regenerative endodontics vs apexification with calcium hydroxide or MTA increases dentinal wall thickness and root length by what percent?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Regenerative endodontics:
Increased dentinal wall thickness by 28%
Root length by 15%
Calcium hydroxide, MTA dentinal wall thickness: 1.5%, 0.0%
Calcium hydroxide, MTA root length: 0.4%, 6.1%
The 2012 human Mahidol study found tooth survival rates following regenerative endodontics and apexification with MTA and calcium hydroxide to what percent respectively?
Zacher “Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals - A Review,” JVD 2021
Regenerative endodontics: 100%
Apexification MTA: 95%
Apexification calcium hydroxide: 77%
What are the components of MTA?
Thorne “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” JVD 2020
Portland cement and bismuth oxide
What does EPT (electrical pulp testing) rely on?
It relies on an ionic shift within the dentinal tubules. By applying an electrical current to the tooth surface, the ionic movement in the dentinal fluid causes a local depolarization and impulse propagation through the A-delta fibers.
What are the components of MTA Fillapex?
Thorne “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” JVD 2020
salicylate resin, fluent resin, natural resin, bismuth oxide, nanoparticulated silica, titanium dioxide
A GRADUAL change in tooth temperature excites what type of fibers and elicits a diffuse ache over a sharp sudden pain?
C fibers
What are the characteristics of MTA that make it an ideal root sealant and pulp capping material?
Thorne “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” JVD 2020
Biocompatible
Bactericidal effects
Noncytotoxic, radiopaque
Impervious durable seal, dimensionally stable
Good marginal adaption
Can promote osteogenesis, odontogenesis, regeneration of periradicular tissues
MTA is the material of choice for what endodontic procedures?
Thorne “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” JVD 2020
Repair of root perforations
Root end filling
Pulp capping
Pulpotomy
Apexification
Root filling material
What are the advantages of MTA Fillapex as a root canal filling material?
Thorne “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” JVD 2020
Good sealing → slight expansion on setting
Good dentinal tubule, accessory and lateral canal penetration due to presence of nanoparticles
In Thorne’s 2020 study “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” what were the outcome success rates for successful RCT, NEF and failure?
JVD 2020, Issue 2
Success: 64%
NEF: 28%
Failure: 8%
Success based off of 1 6 month recheck RAD
What type of sealer is AH Plus?
An epoxy resin sealer
In Thorne’s 2020 study “Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats,” was presence of preop periapical lucency, preop external root resorption, sealant extrusion or type of treatment performed statistically significantly associated with outcome?
Type of treatment: crown reduction + RCT stat sig more likely to fail
Pre-op PA lucency not associated with outcome (in agreement with previous cat RCT study Strom 2018)
Preop external root resorption not stat sig associated with outcome –> in contrast to previous studies
In Strom’s 2018 study “Radiographic outcome of root canal treatment of canine teeth in cats: 32 cases (1998-2016),” what were the outcome success rates for successful RCT, NEF and failure?
JAVMA 2018
Successful: 49% (18/37)
NEF: 32%
(12/37)
Failure: 19% (7/37)
Overall success rate 81%
In Strom’s 2018 study “Radiographic outcome of root canal treatment of canine teeth in cats: 32 cases (1998-2016),” what variables were stat sig associated with outcome?
JAVMA 2018
Periapical EIRR prior to RCT 10 fold increase in rate of failure
Patient age greater or equal to 5 years increased rate of failure
How many dentinal tubules do dogs have per square millimeter of dentin?
50,000 to 100,000
What type of sealer is GuttaFlow 2?
Silicone sealer
In Goodman’s 2020 study “The Incidence of Radiographic Lesions of Endodontic Origin Associated With Uncomplicated Crown Fractures of the Maxillary Fourth Premolar in Canine Patients,” what was the overal incidence?
Neimic, JVD 2020
24.3%
In Goodman’s 2020 study “The Incidence of Radiographic Lesions of Endodontic Origin Associated With Uncomplicated Crown Fractures of the Maxillary Fourth Premolar in Canine Patients,” what factors were not associated with increased LEOs?
Neimic JVD 2020
Right vs left side
Age
Sex
Working status
In Goodman’s 2020 study “The Incidence of Radiographic Lesions of Endodontic Origin Associated With Uncomplicated Crown Fractures of the Maxillary Fourth Premolar in Canine Patients,” what factor was stat sig associated with fractured teeth?
Weight
For each kg increase in wt, 3.8% increase chance of having a fractured tooth
Association of weight with LEO not stat sig
What is the working time and curing time of AH plus compared to GuttaFlow 2?
AH plus: working time 4 hours, setting time 8 hours
GuttaFlow 2: working time 10-15 minutes, setting time 30 min
Do AH Plus and Gutta Flow 2 shrink or expand on setting?
AH plus shrinks (1.76%)
Gutta Flow 2 expands (0.2%)
Lothamer’s 2017 article, “Apical Microleakage in Root Canals Obturated with 2 Different Endodontic Sealer Systems in Canine Teeth of Dogs,” what were the differences in microleakage between the Gutta Flow 2 and AH plus groups?
Snyder, Goldschimdt, Soukup. JVD 2017
No stat sig difference in prevalence of microleakage between groups
Magnitude of dye penetration between groups not significant
In Adrian’s study, “Radiographic Outcome of the Endodontic Treatment of 55 Fractured Canine Teeth in 43 Dogs (2013-2018),” what were the outcome success rates for successful RCT, NEF and failure?
JVD 2022
Success: 93% (51/55)
NEF: 5.5% (3/55)
Failure: 2% (1/55)
Overall success rate 98%
In Adrian’s study, “Radiographic Outcome of the Endodontic Treatment of 55 Fractured Canine Teeth in 43 Dogs (2013-2018),” what variables influenced success in regards to presence of a preoperative periapical lucency?
JVD 2022
Teeth with preop PAL were more likely to fail (40% success rate)
Obturation material: teeth obturated with GP cone + flowable GP had higher success rates when preop PAL present
Teeth with crowns had higher success rates when PAL present
How is a periapical lucency typically defined via imaging for root canal outcome papers?
Widening of the periapical periodontal ligament space greater than double the width of the PDL space in other areas surrounding the root
In humans after what time point if a periapical lucency has not decreased in size is root canal therapy considered to have failed?
4 years
Kuntsi-VaattavaaraVerstraete, Kass. “Results of root canal treatment in dogs: 127 cases (1995-2000) JAVMA 2002
In Kuntsi-Vaattavaara and Verstraete’s 2002 paper “Results of root canal treatment in dogs: 127 cases (1995-2000),” what were the outcome success rates for successful RCT, NEF and failure?
JAVMA 2002
Successful: 69% (87/127)
NEF: 26% (33/127)
Failure: 6% (7/127)
Overall success rate 94%
In Kuntsi-Vaattavaara and Verstraete’s 2002 paper “Results of root canal treatment in dogs: 127 cases (1995-2000),” perioperative periapical lucencies and EIRR increased the risk of failure by how much respectively?
JAVMA 2002
Periapical lucency 9.5x more likely to fail
EIRR 2.3x
Nonvital pulps also had lower success rates
In Kuntsi-Vaattavaara and Verstraete’s 2002 paper “Results of root canal treatment in dogs: 127 cases (1995-2000),” what teeth had an increased risk of failure compared to the maxillary fourth premolar?
JAVMA 2002
mandibular fourth premolars and first molars
Canines
In Kuntsi-Vaattavaara and Verstraete’s 2002 paper “Results of root canal treatment in dogs: 127 cases (1995-2000),” what variables were not associated with root canal outcome?
Age
Sex
Small vs large breed dogs not associated with outcome
Voids and obturation method not associated with outcome
In Lee and Verstraete’s 2022 study ““Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018),”what were the outcome success rates for successful RCT, NEF and failure?
Success: 71%
(199/281)
NEF: 25% (71/281)
Failure: 4% (11/281)
Overall success rate 96% virtually unchanged from same groups’ 2002 paper 94%
In Lee and Verstraete’s 2022 study ““Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018),” what affect did preop PAL and EIRR have on outcome?
JAVMA 2022
PAL and EIRR NOT sig associated with increased risk of failure
Opposite of 2002 study!
In Lee and Verstraete’s 2022 study ““Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018),” what factor was significantly associated with outcome?
JAVMA 2022
Mandibular first molar teeth had a stat sig higher incidence of failure
Maxillary PM4 teeth had high rates of failure but not stat sig
What is the success rate of surgical endodontics in humans?
Fulton, Arzi, Lommer. “Outcome of surgical endodontic treatment in dogs: 15 cases (1995-2011).” JAVMA 2012.
90%
In Fulton’s 2012 study “Outcome of surgical endodontic treatment in dogs: 15 cases (1995-2011),” what were the success rates?
Arzi, Lommer, Verstraete. JAVMA 2012
Success: 66% (10/15)
NEF: 33% (5/15)
Overall success rate 100%
In Fulton’s 2012 study “Outcome of surgical endodontic treatment in dogs: 15 cases (1995-2011),” did choice of root end filling material influence outcome
No influence on outcome
Vast majority MTA used
In Hernandez’s 2014 paper “Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog,” what teeth had significantly greater numbers of apical foramina?
JVD 2013
Mandibular first molars
Mandibular first molars 57 vs maxillary fourth premolars 36 and maxillary canines 38
What are the principles of the endodontic triad?
Preparation, sterilization and obturation
What were the organisms that were frequently isolated in “Microbiological Aspects of Naturally Occurring Primary Endodontic Infections in Dogs “?
Pasteurella, Bacteroides, Propionibacterium
What were the main findings of “Microbiological Aspects of Naturally Occurring Primary Endodontic Infections in Dogs” regarding associations between number of bacterial species involved and radiographic signs of endodontic disease?
There were no statistical significant associations
The number of bacterial species in root canals in the paper “Microbiological Aspects of Naturally Occurring Primary Endodontic Infections in Dogs “ were found to _____ after they were over 12 months.
Decrease
Pasteurella, Bacteroides, Propionibacterium are what kind of pathogens in the oral cavity if dogs?
Opportunistic, and have been found in subgingival plaque in dogs aka normal flora in dogs
What is the sieved plug of the apical delta?
Hernandez. “Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog. JVD 2014.
An extension of the cementum within the root canal forming the apical delta measuring 2 +/-0.4mm
In Hernandez’s 2014 paper “Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog,” what is the average apical foramen diameter in humans vs the average apical foramina in dogs?
Hernandez. “Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog. JVD 2014.
Humans average 380 micrometers
Dogs 80% < 50 micrometers
After how many days is pulp necrosis expected after the pulp has been exposed?
65 days
Of the three teeth that were observed in the paper “Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog” which tooth had the most significant amount of apical foramina?
The mandibular first molar with a mean of 57.3 +/-18.9
Maxillary fourth premolar 36 +/- 11.6
Maxillary canine 38 +/- 9.3
What is a “sieved plug”?
Cementum at the apical level of the root that separates the dental pulp from the periodontium.
In the study “The Incidence of Radiographic Lesions of
Endodontic Origin Associated With
Uncomplicated Crown Fractures of the
Maxillary Fourth Premolar in
Canine Patients” what was the percentage of UCF’s that had lesions of endodontic origin?
24.3%
In the study “The Incidence of Radiographic Lesions of
Endodontic Origin Associated With
Uncomplicated Crown Fractures of the
Maxillary Fourth Premolar in
Canine Patients” explain what parameter that was statistically significant made a dog more likely to have an UCF?
Weight was a significant factor
Average weight of control - 14.9 kg
Average weight of all UCF - 21.5 kg
Average weight of UCF with a LEO - 24 kg
Average weight of UCF without a LEO - 15 kg
In Feigin’s 2022 study ““Analysis and Assessment of Pulp Vitality of 102 Intrinsically Stained Teeth in Dogs,” what percentage of intrinsically stained teeth were nonvital?
Feigin, Bell, Shope, Snyder. JVD 2022, Issue 1
88%