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NBDE 2 > Endodontics > Flashcards

Endodontics Flashcards

1
Q

function and use of NaOCl (sodium Hypochlorite)

A

irrigant used during cleaning and shaping
tissue solvent with antimicrobial effect
typically used at 5.25%w

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2
Q

hydrogen peroxide function and use

A

used for canal irrigation
antimicrobial and effervescent effect (bubbling out debris)
3%

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3
Q

EDTA function and use

A

used to remove calcium, dimineralize and soften dentin, remove smear layer
chelating agent with antimicrobial effect

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4
Q

what is a chelating agent

A

agent with the ability to comine with metalls ion and thereby inactivate it

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5
Q

Chlorhexadine

A

intracanal cleansing agent

substantivity

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6
Q

why should chlorhexadine and NaOCl not be placed in the canal simultaneously

A

because it forms a precipitate that can block the canal

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7
Q

What is placed in a sealer to make it radioopaque

A

metallic salts

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8
Q

calcium hydroxide (CaOH) use and function

A

placed in the canal as antibacterial agent,
placed between appointments
increases pH in the canal

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9
Q

gutta percha contents

A

59-75% zinc oxide
19-22% gutta percha
1-17% metal sulfates
1-4% plasticizing wax and resin

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10
Q

Mineral Trioxide Aggregate (MTA) uses and function

A

cement like material used as root end filling, perforation repair, and pulp capping

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11
Q

Iodine Potassium Iodide uses and function

A

intracanal medicament/irrigant

antimicrobial action with little toxicity or irritation

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12
Q

Eugenol and eucalyptol uses and function

A

intracanal medicaments

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13
Q

lubricants function

A

decreases friction, decrease risk of file separation

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14
Q

How should reamers be rotated

A

no more that 1/2 turn at a time

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15
Q

D type files

A

rhomboid bland alternating large and small flutes

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16
Q

rubber dam function

A
  1. prevent irrigants from aspiration
  2. prevents aspiration of files and such
  3. prevent bacterial contamination
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17
Q

H type (Hedstrom)

A

spiral edges like a screw, cuts only on pulling stroke

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18
Q

K type

A

tightly spiraled, cuts on push, pull, rotation

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19
Q

NiTi (Nickle titanium)

A

elastic nickle titanium

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20
Q

What colors are the files (by size)

A 
#10 purple
#15 White
#20 Yellow
#25 Red
#30 Blue
#35 Green
#40 Black
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21
Q

Objectives of Access Preparation

A
  1. Straight line access (prevent ledging, stripping, perforation)
  2. Preservation of tooth structure
  3. Unroofing pulp chamber to expose canal orifices
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22
Q

Maxillary central incisor access and canal

A

triangular (from lingual)

canal is large, conical and confluent with pulp chamber

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23
Q

Maxillary lateral incisor access and canal

A

triangular (from lingual)
smaller than central, concical
root tip is palatal or distal

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24
Q

Maxillary canine access and canal

A

canal is larger than max incisors, oval in shape
Wider BL than MD
rarely has divided canal at apex

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25
Q

Max 1st premolar access and canal

A

generally has 2 roots and 2 canals (palatal is larger) sometimes merge
Access is oval in shape (wider BL than MD)

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26
Q

Max 2nd premolar access and canal

A

Access is oval in shape (wider BL than MD)
60% have 1 canal (40% 2 canals)
typically 1 root

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27
Q

Maxillary Molars

A

Access in Triangular in shape (maintain oblique ridge)
3-4 canals (MB, P, DB, MB2)
P canal is straight, wide, tapered
DB is small and tapered
MB smallest, splits into 2 canals, difficult

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28
Q

Mandibular Incisors

A

Access circular in shape

single canal that may divide into B and L canals

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29
Q

Mandibular Canine

A

Access is oval (wider BL than MD)

common to have canal separate into 2

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30
Q

Mandibular premolars

A

Access is oval (Wider BL than MD)

cone shaped canal (70-80% have single canal)

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31
Q

Mandibular Molars

A

Access is blunted triangle (apex at D)
typically 3 canals (ML, MB, D) 4 canals = DL, DB
D canal is bisector of ML and MB

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32
Q

How to determine Working Length

A
  1. Select Stable reference point
  2. estimate with #10 or #15 hand file and X-Ray
  3. Use apex locator on #10 or #15 File and X-Ray
  4. correct X-ray discrepancy
  5. 1 mm short of radiographic apex
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33
Q

goals of instrumentation

A
  1. removal of pulpal tissue
  2. remove infected dentin (houses bacteria)
  3. Shape canal
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34
Q

What are the two ways canals are cleaned

A

biomechanical

Chemomechanical

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35
Q

What is the crown down technique

A

early flaring with rotary instruments
incremental removal of canals debris from orifice to apex
files used in a large to small sequence
Coronal portion cleaned and shaped before apical portion

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36
Q

What is the step back technizque

A

use smaller flexible files in the apical third
use sequentially larger files at incremental lengths
stay .5-1mm short of WL
apical portion prepared before coronal portion

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37
Q

gutta percha properties

A

flexible at room temp, plastic at 60 degrees C (140 F)
opaque (barium salts)
soluble in chloroform, ether, xylol

38
Q

Lateral compaction technique

A

master apical cone selected at 1mm short of apex
walls coated with sealer
cone compacted against wall, another cone placed and compacted until canal is filled

39
Q

warm vertical compaction

A

master cone selected, walls coated with sealer
cone pushed in and cut with hot instrument
hot instruement placed halfway down the canal melting apical gutta percha
condenser pushes GP apically
repeat until obturated

40
Q

chloropercha technique

A

same technique as warm vertical compaction except chloroform is used to make GP plastic

41
Q

Carrier based obturation

A

sealer is placed in the canal

warm coated GP is placed into the canal

42
Q

continuous wave compaction

A

warm vertical compaction performed with a tip heated electrical plugger

43
Q

problems with silver point obturation

A

post and core buildups became impossible
apical surgery is complicated
may cause inflammatory root resorption

44
Q

should we remove asymptomatic, non problem causing silver points

A

nope

45
Q

When to do surgical endodontics

A 
obstructed canal
wide apex
inaccesible canal
persistant apical periodontitis in well filled canal
internal or external root resorption
post and core in tooth
46
Q

Root amputation or apioectomy

A

flap, bone removed, apex removed,

area curetted, retrograde filling

47
Q

retrograde amalagam or MTA filling

A

apioectomy, followed by opening of apex and filling with MTA or amalgam
Used when retrograde filling isn’t likely to succeed

48
Q

I&D and trephination

A

cleaning to relieve pressure and give the infection a path to drain

49
Q

Hemisection

A

multirooted tooth cut vertically in half, defective half of the tooth is EXTd, RCT on the remaining half
(makes two teeth, EXT bad one)

50
Q

Root amputation

A

removing infected root, leave entire crown

51
Q

Intentional reimplantation

A

EXT tooth, perform RCT outside of mouth, Reimplant

poor prognosis

52
Q

Preventing ledging

A

(straighter canals)
straight line access
good lubrication
flexible files

53
Q

Ledging Treatment

A

relocate and renogotiate canal to WL (reverify) then filled and sealed
if ledge isnt removed
instrument to new WL, fill and seal (inform pt)

54
Q

signs of perforation

A 
sudden hemorrhage
sudden pain
radiograph
apex locator not functioning right
deviant file course
severe post op pain
55
Q

better prognosis of tooth with perforation if

A 
its located above bone
smaller than 1 mm
occurs later in treatment
easily accessable and treated
good isolation
well sealed after repair
56
Q

Perforation treatment

A 
repair with MTA
extrusion and restoration
crown lengthening and restoration
root amputation or hemisection
intentional reimplantation
57
Q

prevention of instrument separation

A 
use of the right instrument
adequate lubrication and irrigation
examine instruments for fatigue
replace files often
dont use larger files until small files don't bind
58
Q

treating canals with separated files

A

remove instrument if accessable and loose
navagate around the instrument, leave it there
prepare and instument to WL above separated file (needs adequate seal)

59
Q

prognosis of tooth with separated file better if…

A

minimal debris apical to file
separation occurs later in procedure
larger size file

60
Q

Causes of Vertical Root fracture

A

excessive filling or condensation forces
wedge effect during post cementation
over preparation of the canal (thin dentin/cementum)

61
Q

Symptoms of Vertical Root Fracture

A

serve perio pocketing
sinus tract development
pain with chewing
lateral root radiolucencies

62
Q

Treatment of vertical root fracture

A

EXT of single rooted tooth

root amputation if possible (multi rooted tooth)

63
Q

complicated vs uncomplicated fractures

A

complicated include the pulp, uncomplicated do not

64
Q

Complicated fracture treatments

A 
pulp capping (young teeth, pinpoint exposure, 1 hr or less)
partial pulpotomy (young teeth, large exposure, less than 24 hours, vital pulp)
pulpectomy (permanent teeth, large exposure, pain, long exposure)
65
Q

Root fracture prognosis is good if

A

fracture is in apical third of root
low mobility
tooth is vital

66
Q

root fracture treatment

A

splint tooth 4 weeks, take out of occlusion
PDL heals the fracture
vital tooth = granulation tissue, then calcified tissue
RCT if pulp necrosis occurs

67
Q

Alveolar fracture diagnosis

A

mobility of multiple teeth
occlusal discrepency
radiograph or CT

68
Q

alveolar fracture treatment

A

reposition bony segment splinted for 4 weeks

monitor teeth for vitality

69
Q

concussion definition

A

injury to tooth causing tenderness to percussion
no displacement or mobility
good prognosis

70
Q

subluxation

A

tender to percussion
slighlty mobile but not displaced
good prognosis
may need stabilization

71
Q

extrusive luxation

A

teeth displaced incisally
typically mobile
tender to percussion

72
Q

extrusive luxation treatment

A 
cleanse area with saline
reposition tooth
suture gingiva
splint for 2 weeks
monitor vitality
73
Q

lateral luxation

A

toot displaced laterally
usually fracture of facial cortical bone
sensitive to percussion
fracture is palpatable

74
Q

lateral luxation treatment

A 
cleanse area with saline
reposition tooth
suture gingiva
splint for 2 weeks (4 or more in severe cases)
monitor vitality
75
Q

Intrusive luxation

A

displacement apically
tender to palpation and percussion
may intrude into sinus or nasal cavity

76
Q

intrusive luxation treatment

A

incomplete root formation and less than 7mm of intrusion = allow re-eruption
complete root formation of greater than 7mm intrusion = surgical or orthodontic intervention

77
Q

Avulsion

A

complete separation from the socket

may have alveolar fracture

78
Q

avulsion antibiotic treatment

A

prescribe amoxicillin to 12 and under 7 days
prescribe doxycycline to 12 and older 7 days
if tooth touched soil recommend tetanus booster

79
Q

post implantation instructions

A

soft diet for 2 weeks
no contact sports for 2 weeks
brush teeth with soft brush after each meal
rinse with .12% Chlorhexadine 2x per day for 2 weeks

80
Q

avulsed tooth with closed apex already reimplanted

A

Rinse, radio, flexible splint

81
Q

avulsed tooth with closed apex kept in medium <60 min:

A

clean, irrigate, radiograph, anesthetize, reimplant, radiograph, flexible splint

82
Q

avulsed tooth with closed apex dry for > 60 min

A

remove necrotic tissue with gauze
soak in NaF 20 min
irrigate, radiograph, reimplant, radiograph, suture if needed, flexible splint (Endo prior if needed)

83
Q

avulsed tooth with open apex already reimplanted

A

rinse, radiograph, flexible splint

84
Q

avulsed tooth with open apex, in biological medium for < 60 min

A

clean, soak in doxycycline, irrigate, radiograph, anesthetize, reimplant, radiograph, flexible splint

85
Q

avulsed tooth with open apex stored dry for > 60 min

A

remove necrotic tissue with gauze

irrigate, radiograph, RCT (apexification), reimplant, radiograph, flexible splint

86
Q

External Resorption vs. inflammatory external resorption

A

external resorption from trauma, not bacterial in etiology

inflammatory ER = necrosis -> bacterial toxins leave -> ER

87
Q

Replacement External resorption

A

ankylosis - PDL replaced with bone

88
Q

internal resorption

A

inflammatory process, symmetrical RL in root canal, pulp may be vital or necrotic
Treat with prompt RCT

89
Q

components of pulp

A 
odontoblasts
fibroblasts
nerves
blood vessels
lymphatics
90
Q

Pulpotomy
What
When

A

removal of the coronal portion of the tooth

in immature teeth, vital pulp

91
Q

apexogensis

A

immature teeth, open apex, damaged coronal pulp but healthy radicular pulp.
after pulp capping or pulpotomy in immature teeth
hope that completion of the root happens so you have an apical stop for RCT

92
Q

apexification

A

done on necrotic teeth with open apex

placement of CaOH or MTA in the apical third to foster completion of root formation

NBDE 2 (6 decks)

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