Endodontics /(docmicks) Flashcards
Dental pulp is made up of
Loose connective tissue
‼️📌BE
Surveillance cell of the pulp
Histiocytes
Cells of the Pulp
- Fibroblast
- Odontoblast
- Odontoclast
- Histiocytes / Wandering cells
- Undifferentiated mesenchymal cells/ Progenitor cell
most numerous, secretes collagen fibers
Fibroblasts
produces dentin, found the periphery of the pulp
Odontoblast
cell resorbing dentin
Odontoclast
macrophages
Histiocytes or wandering cells
reservoir of stem cells
Undifferentiated mesenchymal cell
Pulp becomes more fibrous when aging
True
Internal root resorption
Deciduous
Observe, asymptomatic
Painful extraction
Pulpal therapy
Internal root resorption
Permanent
Exo
RCT
When do we declare definitive diagnosis
After access preparation
test to determine if the tooth is vital or non vital
Vitality test
to determine the pulp is responsive or non responsive
NOT ACCURATE in determining PULPAL VITALITY
Commonly used secondary test
Commonly to produce FALSE - NEGATIVE & FALSE POSITIVE results
Electric Pulp Test
to differentiate reversible & irreversible pulpitis
Most common test
Thermal Test
Cold test
air blasts
ice
difluorochloromethane / Endo ice
Ethyl chloride or CO2 stick
gutta percha or hot water
Heat test
used when other tests are inconclusive
Sensitive: Vital
Non sensitive- non vital
Last resort
Test Cavity
Most accurate test to determine the pulpal vitality
Laser Doppler Test
for diffuse or vague pain
Anesthetic test
to determine necrotic pulp or fractured teeth using fiberoptic light source
Transillumination
Symptomatic (provoked pain - lasts for <2seconds after removal of the stimulus
Has exposed dentin no pulp exposure
+ vitality test
Reversible Pulpitis / Hyperemia
Symptomatic (spontaneous pain)
Pan id accentuated by stimulus or lying down
paindful stimulus results to lingerimg pain that pasts for more than 30sec
Has large tooth defect or carious lesion (possibly with pulpal exposure)
+ vitality test
Symptomatic Irreversible Pulpitis
Asymptomatic
Large tooth defect or carious lesion (possibly with pulpal exposure)
+ vitality test
Most difficult to diagnose
Asymptomatic Irreversible Pulpitis
Asymptomatic
(-) vitality test
has large tooth defect or carious lesion
Pulp necrosis
Rx. No changes (intact lamina dura)
(-) percussion / palpation
Normal Apical Tissues
Rx. With or without widening of periodental space
(+) PP
SAP/ Acute Apical Periodontitis
RX. Widening of Periodontal Space
(-) PP
Chronic Apical Periordontitis / Asymptomatic Apical Periodontitis
Rx. With or without widening of Periodontal space spontaneous pain evidence pf pus Malaise fever Lymphadenopathy/ Lymphadenitis (+) percussion
Acute Apical Abscess
Widening of periodontal space If + to percussiom patient has little discomfort Evidence of pus chronic fistula (+) / (-)
Chronic Apical Abscess
Increase radioapacity of adjacent bone tissues
(+) (-)
due to low grade infection
good immunity
Condensing Osteitis
1st
2nd
Endo
Perio
‼️‼️REMEMBER‼️
How can you differentiate Acute Apical Abscess from Lateral Periodontal Abscess
Vitality Testing
Probing
Chronic Focal Sclerosing Osteomyelitis
Condensing Osteitis
Inflammatiom of the periosteum adjacent to the area of an infected tootj with periapical lesion is called
Proliferative Periostitis / Garre’s Osteitis
Exophytic overgrowth of pulpal tissue with a present epithelial surface
Pulp Polyp ( Chronic Hyperplastic Pulpitis)
Starts apically & progresses coronal
associate with endodonticallt tx tooth
J-shape or teardrop rdl area
Cause : Iatrogenic
Vertical Root Fracture
Tx for monorooted
Extraction
Multirooted
Root Amputation
If extend coronally
Hemisection
‼️📌
splitting of mand. molar & removal of affected root
Hemisection
removal portion of a root without involving the crown
Root Amputation
Types of Horizontal Fracture
- Coronal root fracture
- Middle root fracture
- Apical root fracture
Tx. stabilize & observe
Poor prognosis
If there is pulp necrosis - RCT
Optional: removal of coronal portion - if there is continuation of fracture
Coronal root fracture
Tx. Usually stabilization & observe
Pulpal necrosis- RCT
Optional: Apicoectomy
Middle Root Fracture
best prognosis
Tx. Usually observe
Pulp is usually vital & fracture line heals
If there is pulpal necrosis - RCT
Optional: Apicoectomy- there is continuation of fracture
Apical Root Fracture
Ideally leave the MTA
6mos. / 1-2mos.
preserve pulp vitality under deep lesion
Indirect pulp capping
To preseve pulpal vitality after pinpoint mechanical exposure of asymptomatic pulp in a clean dry field
Direct Pulp capping
Procedure pulp capping
CaOH2/ MTA - Base- Final Restoration
removal of coronal pulp , presevation of radicular pulp
Pulpotomy / Partial Pulpectomy
Indications of Pulpotomy
- Vital tooth with PROVOKED PAIN
- 1.8mm of dentin thickness between PULP & CARIOUS LESION
- Root Length is NOT <2/3 of total length (for deciduous)