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BDS4 > ENDODONTICS/ Restorative PP > Flashcards

ENDODONTICS/ Restorative PP Flashcards

1
Q

Two PA radiographs showing lower anteriors 42,41,31 and 32. Which all treated endodontically with a post and core.

Parient is referred for per-radicular surgery , name two other treatment options?

A
  • Extraction
  • Re-rct
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2
Q

Fractured MOD with exposed GP for 6 months , what would be your treatment and why?

A
  • Re-rct , because the root canal system has been exposed for more than 3 months to the oral environment (bacteria)
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3
Q

Name 3 features of the Nayyar core?

A
  • Retention obtained from the undercuts in the divergent canals and pulp chamber
  • 2-4mm GP removed from the canal and replaced with amalgam
  • Coronal restoration can be done at the same appointment
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4
Q

Name 2 restorative materials in dentistry that can bond amalgam to tooth?

A

RMGIC , GIC

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5
Q

You are carrying out a root canal preparation of an upper right canine under local anesthesia , you are irrigating the canal with a dilute solution of sodium hypochlorite when the patient suddenly feels intense pain, within minutes you notice facial swelling in the area and bleeding into the root canal from peri-radicular tissues
* What is the most likely cause for these signs and symptoms and why?

A

Extrusion on sodium hypochlorite through the root canal apex which can be due to
* high pressure injection
* Injecting too deep (to wrong working length)
* locking the syringe into the canal

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6
Q

preparation of an upper right canine under local anesthesia , you are irrigating the canal with a dilute solution of sodium hypochlorite when the patient suddenly feels intense pain, within minutes you notice facial swelling in the area and bleeding into the root canal from peri-radicular tissues

What would be your immediate action?

A
  • Reassure patient that this is a complication that can happen and that it can be managed
  • LA for pain relief
  • Irrigate canal with copious amounts of saline
  • Dress tooth with non setting calcium hydroxide
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7
Q

preparation of an upper right canine under local anesthesia , you are irrigating the canal with a dilute solution of sodium hypochlorite when the patient suddenly feels intense pain, within minutes you notice facial swelling in the area and bleeding into the root canal from peri-radicular tissues

  • What would be your management after immediate management?
A
  • Priority must be given to pain relief and prevention of secondary infection
  • Advise patient to use cold packs for the first days and then warm packs on the area of the swelling to prevent haematoma
  • Prescribe analgesics (ibuprofen or paracetamol)
  • Review patient within 24h
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8
Q

preparation of an upper right canine under local anesthesia , you are irrigating the canal with a dilute solution of sodium hypochlorite when the patient suddenly feels intense pain, within minutes you notice facial swelling in the area and bleeding into the root canal from peri-radicular tissues

The prognosis of the tooth involved is not negatively affected by the NaoCL accident , you decide to continue with the established treatment after 4 weeks, how you would prevent what has happened

A
  • Careful pre-operative radiographic assessment to ensure no open apices
  • Provide bib and eyewear for the patient and use rubber dam
  • Use chlorhexidine or saline first to irrigate the canal to test the integrity of rubber dam seal
  • Ensure all syringes are labelled carefully
  • Do not wedge the needle in the canal
  • Set rubber stop of the needle 2mm short of the working length
  • Depress syringe plunger with index finger rather than thumb
  • Do not fill the syringe too much to make easier to handle
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9
Q

What are the signs and symptoms of reversible pulpitis?

A
  • Short sharp pain that last only few seconds after stimulus is removed
  • TTP negative
  • Pain on cold and sweet stimuli
  • Localised pain that does not radiate
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10
Q

How is reversible pulpitis managed?

A
  • Removal of cause such as caries and restoration
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11
Q

What are the signs and symptoms of irreversible pulpitis?

A
  • Lingering pain after removal of stimuli
  • TTP positive
  • Dull aching pain that may radiate
  • Spontaneous pain that keeps the patient awake at night
  • Analgesics do not work
  • Poorly localised
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12
Q

How can irreversible pulpitis be managed?

A
  • RCT
  • XLA
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13
Q

You are endodontically treating tooth 16 , you have prepared the canals , and now you are planning to obturate the root canal system , what 3 criteria must be fulfilled before obturation?

A
  • Canal must be asymptomatic
  • Root canals must be able to be dried
  • Full biomechanical cleaning should have taken place
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14
Q

Give 3 consistuents of GP other than GP ?

A
  • Zinc oxide
  • Radio-pacifiers
  • Plasticisers
  • Wax
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15
Q

Give the functions of a sealer?

A
  • Fill the space between the GP and the root canal walls
  • Lubrication of the canal
  • Provide a tight seal
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16
Q

Give 3 common sealers used in the root canal system?

A
  • Epoxy resin
  • Calcium hydroxide
  • Zinc oxide eugenol
  • Glass ionomer cement
17
Q

How do you assess obturation on a radiograph?

A
  • Check correct length
  • Check there is no voids and well compacted
  • Check all canals are filled
18
Q

What is the reason for obturation? (3)

A
  • Seal remaining bacteria
  • Provide apical and coronal seal
  • Prevent reinfection
19
Q

Give 4 methods of obturation?

A
  • Cold lateral compaction
  • Warm vertical compaction
  • Carrier based (GP)
  • Warm lateral compaction
  • Continuous wave compaction
20
Q

What percentage of maxillary first molars have an MB2 canal?

A

93%

21
Q

What are the 3 design objectives of endodontics?

A
  • Continuously tapering funnel shape
  • Maintain apical foramen in original position
  • Keep apical opening as small as possible
22
Q

What are the advantages of the crown down technique?

A
  • Removes bulk of infected tissue
  • Creates a reservoir for irrigant
  • Keeps reference point for working length which makes straight line access easier
  • Limit spread of infected material at apical foramen
23
Q

Name 3 laws of pulpal floor anatomy?

A
  • Law of colour - always darker
  • Law of symmetry 1 - orifices lie equidistant from a line drawn in a mesio-distally through the pulp chamber except for maxillary molars
  • Law of symmetry 2 - orifices lie perpendicular to a line drawn mesiodistally through the pulp chamber floor except for upper molars
24
Q

Give 3 rules for locating orifices in the pulpal floor?

A
  • Always at junction of floor and wall
  • Always at the angle of floor and wall junction
  • Always at terminus of developmental fusion lines
25
Q

Give 4 reasons for irrigation during endodontic treatment?

A
  • Mechanical preparation alone does not remove all bacteria
  • Irrigation reaches areas that files cannot reach
  • To flush out debris
  • To dissolve organic and non organic content
  • Remove the smear layer
  • Lubrication
26
Q

Why is sodium hypochlorite a good irrigant?

A
  • High antimicrobial activity
  • Dissolve organic and non organic content ( collagen and necrotic tissue)
27
Q

What strength of NaOCl is used?

A

3%

28
Q

Name other common irrigant other than NaICl?

A

Chlorhexidine

29
Q

How is the smear layer removed?

A
  • EDTA 17% which is chelating agent
30
Q

Name 2 intracanal medicaments?

A
  • Corticosteroid and tetracyline paste (antimicrobial paste 5-7d ) - reduce pulpal inflammation
  • Non setting calcium hydroxide - Antibacterial with low PH
31
Q

What are the landmarks for an inferior alveolar nerve block?

A
  • Pterygomandibular raphe and coronoid notch and posterior border of the ramus - insert needle from contalateral premolar area in pterygomandibular space until contacting bone then retract
32
Q

Give 3 reasons for instrumentation of the root canal system?

A
  • Remove infected tissue
  • Allow irrigant access
  • Make space for medicaments and obturation
  • Create an environment for periradicular healing
33
Q

What advantages do protaper files have over K files?

A
  • Shape memory
  • Elasticity
  • Decreased lateral pressure reducing the risk of ledges
  • Decreased number of intruments needed
  • increased cutting efficiency
  • Easier to use
34
Q

Name 2 rotary endodontic systems?

A
  • Reciproc
  • Protaper
35
Q

Describe 2 other techniques other than reaming and filing?

A
  • Watch winding - back and forth oscillation 30-60 degrees with light apical pressure
  • Balanced force technique - Clockwise motion (1/4) then counterclockwise motion to (1/2) wit apical pressure
36
Q

Name 3 reasons why a file may separate ?

A
  • Flexural stress due to repeated cyclic fatigue
  • Torsional stress due to binding to canal walls
  • Complicated curved canal anatomy
37
Q

Give 6 reasons why a patient with newly placed composite may be experiencing pain on biting ?

A
  • High occlusion
  • Polymerisation contraction stress
  • Soggy bottom
  • Cracked tooth syndrome
  • Deep restoration close to the pulp without lining
  • Debonded composite causing sensitivity
38
Q

5 restorative management techniques to minimise the problems in the previous question?

A
  • Check occlusion with articulating paper
  • Place composite in increments to one surface only to avoid polymerisations contraction stress
  • Place composite in 2mm increments and ensure light curing to avoid soggy bottom
  • Careful caries removal at pulpal floor with excavator or slow speed to avoid pulp irritation and ensure to place lining
  • Cracket tooth syndrome - make sure good cuspal coverage
  • Debonding of restoration - ensure good moisture control
39
Q

Give 3 reasons anterior guidance is preferred over posterior guidance?

A
  • Easier to reproduce
  • Protect teeth and restorations on posteriors
  • Easy on muscles

BDS4 (69 decks)

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