Endodontics /(docmicks) Flashcards
1
Q
Dental pulp is made up of
A
Loose connective tissue
2
Q
‼️📌BE
Surveillance cell of the pulp
A
Histiocytes
3
Q
Cells of the Pulp
A
- Fibroblast
- Odontoblast
- Odontoclast
- Histiocytes / Wandering cells
- Undifferentiated mesenchymal cells/ Progenitor cell
4
Q
most numerous, secretes collagen fibers
A
Fibroblasts
5
Q
produces dentin, found the periphery of the pulp
A
Odontoblast
6
Q
cell resorbing dentin
A
Odontoclast
7
Q
macrophages
A
Histiocytes or wandering cells
8
Q
reservoir of stem cells
A
Undifferentiated mesenchymal cell
9
Q
Pulp becomes more fibrous when aging
A
True
10
Q
Internal root resorption
Deciduous
A
Observe, asymptomatic
Painful extraction
Pulpal therapy
11
Q
Internal root resorption
Permanent
A
Exo
RCT
12
Q
When do we declare definitive diagnosis
A
After access preparation
13
Q
test to determine if the tooth is vital or non vital
A
Vitality test
14
Q
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
A
Electric Pulp Test
15
Q
to differentiate reversible & irreversible pulpitis
Most common test
A
Thermal Test
16
Q
Cold test
A
air blasts
ice
difluorochloromethane / Endo ice
Ethyl chloride or CO2 stick
17
Q
gutta percha or hot water
A
Heat test
18
Q
used when other tests are inconclusive
Sensitive: Vital
Non sensitive- non vital
Last resort
A
Test Cavity
19
Q
Most accurate test to determine the pulpal vitality
A
Laser Doppler Test
20
Q
for diffuse or vague pain
A
Anesthetic test
21
Q
to determine necrotic pulp or fractured teeth using fiberoptic light source
A
Transillumination
22
Q
Symptomatic (provoked pain - lasts for <2seconds after removal of the stimulus
Has exposed dentin no pulp exposure
+ vitality test
A
Reversible Pulpitis / Hyperemia
23
Q
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
A
Symptomatic Irreversible Pulpitis
24
Q
Asymptomatic
Large tooth defect or carious lesion (possibly with pulpal exposure)
+ vitality test
Most difficult to diagnose
A
Asymptomatic Irreversible Pulpitis
25
Asymptomatic
(-) vitality test
has large tooth defect or carious lesion
Pulp necrosis
26
Rx. No changes (intact lamina dura)
| (-) percussion / palpation
Normal Apical Tissues
27
Rx. With or without widening of periodental space
| (+) PP
SAP/ Acute Apical Periodontitis
28
RX. Widening of Periodontal Space
| (-) PP
Chronic Apical Periordontitis / Asymptomatic Apical Periodontitis
29
```
Rx. With or without widening of Periodontal space
spontaneous pain
evidence pf pus
Malaise fever
Lymphadenopathy/ Lymphadenitis
(+) percussion
```
Acute Apical Abscess
30
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Widening of periodontal space
If + to percussiom patient has little discomfort
Evidence of pus
chronic fistula
(+) / (-)
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Chronic Apical Abscess
31
Increase radioapacity of adjacent bone tissues
(+) (-)
due to low grade infection
good immunity
Condensing Osteitis
32
1st
| 2nd
Endo
| Perio
33
‼️‼️REMEMBER‼️
How can you differentiate Acute Apical Abscess from Lateral Periodontal Abscess
Vitality Testing
| Probing
34
Chronic Focal Sclerosing Osteomyelitis
Condensing Osteitis
35
Inflammatiom of the periosteum adjacent to the area of an infected tootj with periapical lesion is called
Proliferative Periostitis / Garre's Osteitis
36
Exophytic overgrowth of pulpal tissue with a present epithelial surface
Pulp Polyp ( Chronic Hyperplastic Pulpitis)
37
Starts apically & progresses coronal
associate with endodonticallt tx tooth
J-shape or teardrop rdl area
Cause : Iatrogenic
Vertical Root Fracture
38
Tx for monorooted
Extraction
39
Multirooted
Root Amputation
40
If extend coronally
Hemisection
41
‼️📌
| splitting of mand. molar & removal of affected root
Hemisection
42
removal portion of a root without involving the crown
Root Amputation
43
Types of Horizontal Fracture
1. Coronal root fracture
2. Middle root fracture
3. Apical root fracture
44
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
45
Tx. Usually stabilization & observe
Pulpal necrosis- RCT
Optional: Apicoectomy
Middle Root Fracture
46
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
47
Ideally leave the MTA
6mos. / 1-2mos.
48
preserve pulp vitality under deep lesion
Indirect pulp capping
49
To preseve pulpal vitality after pinpoint mechanical exposure of asymptomatic pulp in a clean dry field
Direct Pulp capping
50
Procedure pulp capping
CaOH2/ MTA - Base- Final Restoration
51
removal of coronal pulp , presevation of radicular pulp
Pulpotomy / Partial Pulpectomy
52
Indications of Pulpotomy
1. Vital tooth with PROVOKED PAIN
2. 1.8mm of dentin thickness between PULP & CARIOUS LESION
3. Root Length is NOT <2/3 of total length (for deciduous)
53
Type of Medicament Used : Partial Pulpotomy
Indication for Deciduous
Contraindicated in young permanent tooth
* Gold standard for Deciduous pulpotomy
Formocresol
54
Partial Pulpotomy
Indicated for Permanent tooth
Contraindicated : Deciduous- why?
CaOH
| Lead to internal root resorption/ Pink tooth of Mummery
55
*‼️📌 what do you call partial pulpotomy
Cvek Pulpotomy
56
removal of entire pulp
Pulpectomy
57
Indications Pulpectomy
| Deciduous only
- Infected pulp with Spontaneous pain/ Nocturnal pain
- Non-vital pulp with Periradicular lesion
- Root length is NOT <2/3 of total length (for deciduous)
58
Obturation material for pulpectomy of deciduous?
ZOE , CaOH - Vitapex
59
RCT
| ,
1. access prep
2. Biomechanical preparatipm
3. Obturation
60
Incisors
Ovoid/ Triangular
61
Canines & PM
Ovoid
62
Maxillary Molars
Triangular / Rhomboidal
63
Mandibular Molars
Trapezoidal
64
```
All incisors
All PM (except Max. 1st PM)
```
1
65
Max. 1st PM
2
66
Max. 2nd molar
| Mand. 1st & 2nd molar
3
67
Max. 1st Molar
4 orifice
68
Most common ant. tooth associated with 2 orifices
Mand.Lateral Incisors
69
The Canal orifice that is most difficult to locate?
MB2 Of Max. 1st Molar
70
Posterior tooth with highest endodontic failure rate?
Max. 1st Molar
71
MB2 of Maxillary 1st molar is usually located
Palatal in relation MB1
72
what is the goal of access prep
Straigjt Line Access
73
Types of Apex
1. Anatomical Apex
2. Apical Foramen
3. Apical Constriction
74
most apical end of root
Anatomical apex
75
0.5mm from anatomical apex
Apical Foramen
76
0.5mm from the apical foramen in the region of DCH
| Natural stop during RCT
Apical Constriction
77
‼️📌BE
| If you want to expose lingual orifice of 2nd Mand. Lateral Incisor you must reduce
Lingual side
78
📌‼️BE
| DB orifice approach it must be opposite
ML
DB-ML
MB-DL
79
Proper approach orifice
Avoid inserting multiple files
80
Ideally, the apical point where canal preparation is to end, is loacted in
Apical Constriction- 0.5mm - 1.0mm
81
detach pulp
Smooth Broaches
82
remove pulp
Barbed broach
83
push & pull motion in clockwise-counterclockwise motion
Files
84
for shaving dentin
removal of old fillng
half turn twist (clockwise) & pull
Reamers
85
cuts only during pulling
Hedstrom
86
6
Pink
87
8
Gray
88
10
Purple
89
15-45-90
White
90
20-50-100
Yellow
91
25/55/110
Red
92
30/60/120
Blue
93
35/70/130
Green
94
40/80/140
Black
95
#12
Orange
96
irrigating solution
| bactericidal, dissolves pulpal contents, softens dentin
```
Sodium Hypochlorite (0.5% - 5.25%
ideal 5.25%
```
97
Irrigating solution
```
Hydrogen Peroxide (3%)- Bleaching agent
NSS (0.9% NaCl)
```
98
Chelating Agent. Remove smear layer
EDTA
99
Irrigating solution, Bactericidal
Chlorhexidine (0.12%)
100
Disinfection of root canal (medicament)
```
Ca (OH) 2
Camphor monochlorophenol (CMCP)
```
101
‼️📌BE
Root perforation
best prognosis
difficult to repair
Apex
102
Poorest prognosis in root perforation
| easy to repair
CEJ
103
CaOH
3-14 days
| 7 days
104
filling the canal in all dimensions
Obturation
105
NaOCI by product
Para- chloroaniline- brownish pigment clog the root canal cavity
106
Main materials used for Obturation
Gutta percha- common
107
Principal component of Gutta Percha
Zinc Oxide
108
conventional
| - not good filing properties
Silver Cones
109
to fill discrepancies , act as a lubricant to fill accessory canals
Sealers
110
main component sealers
Zinc Oxide
111
Most common sealer
ZOE
112
Solution used to soften gutta percha during tx
Chloroform, xylene (xylol), eucalyptol
113
Most predominant bacteria in an infected root canal cavity
Streptococcus & Enterococcus
114
After obturation the microorganisms at the periapex are eliminated by
Natural defenses of the body
115
Recall the px afte root canal tx should be
6mos.
116
‼️📌BE
| Open Apex- Funnel Wide Shaped
Blunderbuss Apex
117
chemically induced apical closure
| Non vital young permanent with open apex
Apexification
118
Procedure of Apexification
Canal filled with CaOhH or MTA (gold standard)
| After apical closure or formation of calcific barrier or apical stop , proceed to RCT
119
physiologic development of apex after successful vital pulp therapy (preservation of the pulp)
Apexogenesis- DPC, IPC, Pulpotomy
120
for discolored teeth after RCT
Endodontic Bleaching
121
localized, fluctuant intraoral swelling due to abscess
I& D
122
Periapical Microsurgery
| Procedure
1. Flap
2. Trephination
3. Apicoectomy
4. Retrograde filling
123
semilunar flap/ triangular flap/ trapezoidal flap
Flap- Periapical Microsurgery
124
drilling a hole in a bone )surgical window)
Trephination
125
Retrograde filling
best
prevent excessive amalgam expansion
MTA
| Zinc Free Amalgam
126
root end surgery
Apicoectomy
127
```
250 F (121c) for 20-30 mins
15 psi
```
Autoclave
128
```
‼️📌
320 F (160 C' for 1 hour
```
Dry Heat
129
not used as primary sterilization method
Chairside Sterilization
130
uses 1mm metal cup glass beads , 450 F (232 C) for 10 sec.
Glass Bead
131
uses table salt
Salt sterilizers
132
Heat- Sensitive Materials
```
Quaternary Ammonium Compounds-- Best solution
Alcohol
NSS
chlorhexidine
NaOCI
```
