Endodontics Flashcards
Prognosis of broken rotary files
The issue is whether the canal was debrided to the apex. A broken file, of itself, does not have an adverse effect on prognosis – no significant difference between GP and sealer vs. GP, sealer, and file in apical third if the tissue is removed and canal is adequately irrigated. (Compendium, May 2013, 324-326)
Steps to prevent breakage of NiTi files
- Hand file to the apex before introducing rotary files (#20-#30)
- Hen-peck motion. Do not force file beyond the point at which it meets resistance
- Pre-flare the canal (open up the coronal portion)
- Modified crown-down: prepare apical third by going smaller to larger
- Properly clean file after each use in canal
(Compendium, May 2013, 324-326)
Success rates indirect pulp cap
survival rates: 97%, 93%, and 80% at 1.5-, 5-, and 10-year follow-ups. Technique in Evernote.
Success rates direct pulp cap (MTA & GI—in Evernote)
3-year: 70%
2-year: 80%
1-year: 90%
Cracked tooth diagnostics and treatment planning
Tooth Slooth: close slowly and firmly, then a sudden release.
Good prognosis with just crown: If pain is intense, sharp, and brief and limited to one cusp, the cusp is fractured. If more than one cusp, try a temporary crown. If symptoms improve, good prognosis with just crown.
RCT and crown: If TS is dull, prolonged or throbby, it’s periapical. If symptoms of pulpitis with or without TS, RCT. If symptoms do not ameliorate with temp crown, RCT.
Extraction: Cracked necrotic tooth. If crack extends below pulp chamber, even if vital. (methylene blue)
Which has higher bacterial levels: caries under a perfectly sealed filling or all caries removed before a perfectly sealed filling is placed?
Surprisingly, the bacterial levels are higher where all caries is removed. This is one more study that suggests that leaving decay (they left soft decay) over the pulp is better than exposing it. (EN “Do you have to remove all the decay?”)
