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4th Year Revision > Endodontics > Flashcards

Endodontics Flashcards

1
Q

What are the problems with the apical coronal approach “step back”? (3)

A
  • acute exacerbation of chronic inflammation
  • post operative pain
  • infection of periradicular tissues
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2
Q

What are the drawbacks of conventional hand stainless steel preparation techniques? (4)

A
  • mishaps
  • debris extrusion with filing motion
  • time consuming
  • less predictable shapes in curved canals
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3
Q

What are the advantages of rotary NiTi techniques? (4)

A
  • less canal transportation
  • less debris extrusion
  • faster than hand preparation
  • more predictable results
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4
Q

What are the ideal requirements of root canal irritants? (5)

A
  • eliminate microbes
  • inactivate endotoxins
  • dissolve necrotic pulp tissue remnants
  • systemically non toxic
  • remove the smear layer and biofilm
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5
Q

What are the irritants used in RCT? (4)

A
  • sodium hypochlorite
  • citric acid
  • EDTA
  • 2% chlorohexidine
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6
Q

What are the disadvantages of sodium hypochlorite? (3)

A
  • unpleasant taste
  • high toxicity
  • inability to remove smear layer when used alone
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7
Q

What are the symptoms of injecting sodium hypochlorite beyond the apex of the root? (4)

A
  • extreme pain
  • haematoma
  • swelling
  • profuse haemorrhage from the root canal
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8
Q

What is the treatment for when sodium hypochlorite is injected beyond the apex of the tooth? (3)

A
  • analgesics
  • external compression with cold pack
  • antibiotics to prevent secondary infection
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9
Q

What chelating agents are used to react with calcium ions in dentine to form soluble calcium chelates to dissolve the organic components? (2)

A
  • EDTA

- 40% citric acid

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10
Q

Name 3 paste lubricants

A
  • file eze
  • glide
  • hibiscrub
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11
Q

What is the anti-inflammatory corticosteroid found in odontopaste that causes rapid pain relief?

A

Triamcinolone 1%

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12
Q

What can iodine do?

A

Penetrate into microorganisms and attack cell molecules such as proteins, nucleotides and fatty acids resulting in cell death

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13
Q

What are the properties of iodine? (4)

A
  • bactericidal
  • fungicidal
  • virucidal
  • sporicidal
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14
Q

What does povidone iodine do?

A

Induce cell death nonspecifically due to oxidising effects of free iodine

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15
Q

What are the ideal biological properties of obdurating materials? (2)

A
  • no allergy for patient or dental staff

- antimicrobial

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16
Q

What are the ideal handling properties of obdurating materials? (2)

A
  • radiopaque

- sets in adequate time

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17
Q

What is the composition of gutta percha? (3)

A
  • 19-22% gutta percha
  • 59-75% zinc oxide
  • waxes, colouring agents, antioxidants and metallic salts
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18
Q

What are the types of pastes? (2)

A
  • zinc oxide and eugenol with the addition of toxic materials such as formaldehyde
  • plastics resin based
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19
Q

What are the alternative obturation techniques? (2)

A
  • thermoplastic gutta percha (continuous wave of obturation)

- obturators (thermafil, gutta core)

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20
Q

What are stainless steel hand files made from?

A

Iron alloys with a minimum 10.5% chromium

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21
Q

What are the advantages of stainless steel hand files?

A

They do not easily corrode, rust or stain

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22
Q

What are the disadvantages of stainless steel hand files? (2)

A
  • poor flexibility

- leads to many procedural errors during canal shaping

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23
Q

What are small instruments manufactured from?

A

Square blocks as they are more resistant to torque fractures

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24
Q

What are the types of stainless steel files? (3)

A
  • barbed broaches
  • reamers
  • files (k file, flexofile, hedstrom file)
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25
Q

What are the advantages of flexofiles? (3)

A
  • they have a non aggressive tip
  • good flexibility
  • efficient at cutting dentine with a low risk of transportation and ledge formation
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26
Q

What are hedstroem files used for?

A

Used in retreatment cases to help remove gutta percha or an overfilling of the root canal

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27
Q

What are the problems with stainless steel root canal preparation? (4)

A
  • mishaps (ledges, blockages, transportation)
  • debris extrusion with a filing motion
  • time consuming
  • less predictable shapes in curved canals
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28
Q

What are the components of NiTi? (2)

A
  • 56% nickel

- 44% titanium

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29
Q

What are the disadvantages of NiTi? (4)

A
  • instrument fracture
  • expende
  • access can be difficult in posterior teeth
  • unsuitable for complex canal anatomy
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30
Q

What are the advantages of using CaOH as a medicament? (3)

A
  • kills bacteria and inactivates endotoxins
  • reduces inflammation
  • helps eliminate apical exudate
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31
Q

What is CaOH effect on bacterial cells? (3)

A
  • damage to bacterial cytoplasmic membrane by chemical injury
  • protein denaturation
  • damage to DNA
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32
Q

What is apexification?

A

The process of creating an environment within the root canal and periapical tissues after pulp death that allows a calcified barrier to form across the open apex of an immature root

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33
Q

What is internal resorption as a result of?

A

Chronic pulpitis

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34
Q

What are the types of external resorption? (6)

A
  • surface resorption
  • inflammatory resorption
  • replacement resorption
  • pressure resorption
  • systemic resorption
  • idiopathic
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35
Q

What is the treatment of a non vital immature permanent incisor tooth? (3)

A
  • apexification
  • apical barrier
  • revascularisation
36
Q

How do you do revascularisation of the reticular pulp? (5)

A
  • irrigation with NaOCl
  • dressed with a mixture of ciprofloxacin, metronidazole and minocycline for 7 days
  • confirm canal is dry
  • use a size 40 flexofile to irritate tissues and cause bleeding. Leave 15 mins to form a clot
  • place MTA over clot, temporise with CW/coltosol
37
Q

What are the disadvantages of gutta percha? (3)

A
  • lack of adhesion to dentine
  • when heated shrinkage on cooling
  • cannot be heat sterilised
38
Q

What are the properties of sealers? (4)

A
  • provide a fluid tight seal
  • no shrinkage with setting
  • slow setting time
  • fill canal irregularities
39
Q

What are the types of sealers? (3)

A
  • zinc oxide eugenol
  • calcium hydroxide
  • glass ionomer
40
Q

What are the properties of bioceramic sealers? (4)

A
  • biocompatible
  • chemically stable
  • hydrophilic
  • high pH during setting
41
Q

What does the bioceramic material smart paste bio do?

A

Releases calcium hydroxide and hydroxyapatite on setting

42
Q

What are the clinical applications of MTA? (4)

A
  • pulp capping
  • perforation repair
  • apical plug
  • obturation
43
Q

What are the complications caused by poor access preparation? (7)

A
  • inadequate opening
  • mutilation of coronal tooth due to removal of too much tooth structure
  • inadequate caries removal
  • labial perforation
  • furcal perforation
  • entering the wrong tooth
  • allowing debris to clog and block the orifices of the canals
44
Q

What are the types of irritant flows within root canals? (2)

A

Laminar- removes planktonic bacteria

Turbulent- removes biofilm

45
Q

What are the treatment outcomes for primary treatment:

  • without periradicular periodontitis
  • with periradicular periodontitis
  • overall
A
  • 92%
  • 74%
  • 81%
46
Q

What are the treatment outcomes for retreatment:

  • without periradicular periodontitis
  • with apical periodontitis
A
  • 89-100%

- 56-84%

47
Q

Don’t give odontopaste to patients taking what medication?

A

Erythromycin

48
Q

What is the treatment of an acute apical abscess? (5)

A
  • removal or irritants
  • drainage
  • dress with calcium hydroxide and seal access
  • relieve the occlusion
  • review in 24 hours time
49
Q

What are the causes of failure of LA? (5)

A
  • anatomy
  • effect of inflammation of local tissue
  • pH
  • effect of inflammation on blood flow
  • effect of inflammation on nociceptors
50
Q

What is the effect of inflammation on local tissue pH?

A

Inflammation may cause ion trapping of LA in charged acid form and unable to cross cell membrane and anaesthetise the nerve

51
Q

What is the effect of inflammation on blood flow?

A

Peripheral vasodilation induced b inflammatory mediators could reduce the concentration of LA by increasing the rate of systemic absorption

52
Q

What is the effect of inflammation on nociceptors?

A

Inflamed tissues release neuropeptides that cause nerve sprouting

53
Q

What are the causes of an endodontic flare up? (4)

A
  • preparation beyond the apex
  • over instrumentation
  • pushing debris into the periapical tissues
  • incomplete removal of pulp tissue
54
Q

What are the causes of pain following canal preparation? (4)

A
  • overinstrumentation
  • undetected canal
  • apical/lateral perforation
  • temp dressing supra occlusion
55
Q

What are the causes of pain following canal obturation? (4)

A
  • restoration in supra occlusion
  • over instrumentation
  • sealers slightly toxic for first 24-48 hours
  • root fracture
56
Q

What are the causes of pain some months following RCT? (2)

A
  • tooth in traumatic occlusion

- cracked, fractured tooth

57
Q

What are the symptoms of a cracked tooth? (3)

A
  • localised pain on chewing or biting
  • unexplained sensitivity to cold
  • pain on release of pressure
58
Q

What are the conditions found to improve the outcome of primary root canal treatment? (4)

A
  • preoperative absence of periapical radiolucency
  • root canal filling with no voids
  • root canal filling to within 2mm of radiographic apex
  • satisfactory coronal restoration
59
Q

What do cholesterol crystals form from?

A

Dying cells during chronic inflammation

60
Q

What are the techniques of post removal? (2)

A
  • post removal with ultrasonic energy

- post removal with post pulling devices

61
Q

How do you remove screw type active posts? (3)

A
  • remove core material from around post using high speed burs and ultrasonics
  • use wrench supplied by manufacture for insertion
  • ultrasonics can aid process by breaking up cement
62
Q

What are the causes of fractured instruments? (2)

A
  • torsional fracture

- cyclical metal fatigue

63
Q

What do you use to remove fractured instruments? (3)

A
  • operating microscopes
  • stroke air blower
  • ultrasonic instruments
64
Q

What materials are used for haemostasis?

A

Place calcium hydroxide and leave for 4-5mins then wash out with sodium hypochlorite

65
Q

What matrix technique materials are used with composite repairs to exclude moisture?

A

Calcium sulphate and resorbing collagen

66
Q

What are the causes of pathological root resorption? (2)

A
  • injury (mechanical and chemical)

- stimulation (infection and pressure)

67
Q

What are the causes of persistent periapical radiolucencies in endodontically treated teeth? (5)

A
  • extraradicular infection
  • intraradicular infection
  • foreign body reaction
  • true cyst
  • fibrous scar tissue
68
Q

What are the disadvantages of a semi lunar flap? (4)

A
  • disruption of blood supply
  • poor wound healing
  • limited surgical access
  • scarring
69
Q

What suture material do we use in surgery?

A

Polypropylene

70
Q

What are the types of suture materials? (3)

A
  • nylon monofilament sutures
  • polyester
  • polypropylene
71
Q

What do the components of zinc oxide eugenol do? (2)

A
  • zinc competes with calcium for binding sites on the surface of hydroxyapatite
  • eugenol increases dentine micro hardness
72
Q

How is the structure of collagen in the organic matrix altered in endodontically treated teeth? (2)

A
  • there are more immature cross links present

- may cause a decrease in tensile strength and an increase in brittleness

73
Q

What are the supracrestal attached tissues?

A

This is a band of soft tissue attachment from the alveolar bone to the coronal extent of the junctional epithelium

74
Q

What is the fertile effect?

A

Bracing effect of crown going over core and tooth

75
Q

Name 3 adhesive bonding agents

A
  • all bond 2
  • amalgambond plus
  • optiond 2
76
Q

What are the contents of composite? (4)

A
  • aromatic dimethyacrylate
  • filler particles
  • quartz
  • silica
77
Q

What are the types of hybrid composite? (2)

A
  • addition of fibres, ceramic fillers, titanium and lanthanide
  • multicore flow blue
78
Q

What are the disadvantages of dentine pins? (4)

A
  • induce internal stresses
  • cause dentinal crazing
  • fracture resistance of core is reduced
  • perforation into periodontium
79
Q

What are the advantages of immediate post placement? (4)

A
  • familiarity of root canal morphology
  • less risk of post perforation
  • the apical seal will not be disrupted
  • increased apical leakage after delayed post preparation
80
Q

What is the ferrule effect provided by?

A

Bracing of the remaining tooth structure by the indirect restoration not the remaining coronal tooth structure

81
Q

What should you do if there is a insufficient coronal tooth tissue for a ferrule? (3)

A
  • orthodontically extrude tooth
  • crown lengthen
  • extract and replace with a bridge or implant
82
Q

What are the designs of passive posts? (2)

A
  • cast

- preformed/prefabricated

83
Q

What are the advantages of cast post and core passive posts?

A

Conserves tooth tissue, reducing risk of apical perforation

84
Q

What are the disadvantages of cast post and core passive posts? (3)

A
  • time consuming with lab costs
  • properties within casting can increase the risk of post fracture
  • placement of burnout posts into working models may result in shorter posts
85
Q

What are the features of parallel sided serated posts?

A
  • vertical vent to allow escape of excess cement
  • once seated the strain due to the build up of hydraulic pressure will dissipate
  • patterned interlinking recesses
86
Q

What luting cements are used for post retained restorations? (4)

A
  • zinc phosphate
  • polycarboxylate
  • glass ionomer
  • composite resins
87
Q

What are the traditional methods of restoration of compromised anterior teeth? (4)

A
  • apexification, immature teeth using calcium hydroxide
  • apical barrier
  • obturation with thermoplastic gutta percha
  • metal post to retain core and crown

4th Year Revision (12 decks)

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