ENDODONTICS/ Restorative PP Flashcards
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?
- Extraction
- Re-rct
Fractured MOD with exposed GP for 6 months , what would be your treatment and why?
- Re-rct , because the root canal system has been exposed for more than 3 months to the oral environment (bacteria)
Name 3 features of the Nayyar core?
- 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
Name 2 restorative materials in dentistry that can bond amalgam to tooth?
RMGIC , GIC
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?
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
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?
- 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
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?
- 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
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
- 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
What are the signs and symptoms of reversible pulpitis?
- 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
How is reversible pulpitis managed?
- Removal of cause such as caries and restoration
What are the signs and symptoms of irreversible pulpitis?
- 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
How can irreversible pulpitis be managed?
- RCT
- XLA
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?
- Canal must be asymptomatic
- Root canals must be able to be dried
- Full biomechanical cleaning should have taken place
Give 3 consistuents of GP other than GP ?
- Zinc oxide
- Radio-pacifiers
- Plasticisers
- Wax
Give the functions of a sealer?
- Fill the space between the GP and the root canal walls
- Lubrication of the canal
- Provide a tight seal
Give 3 common sealers used in the root canal system?
- Epoxy resin
- Calcium hydroxide
- Zinc oxide eugenol
- Glass ionomer cement
How do you assess obturation on a radiograph?
- Check correct length
- Check there is no voids and well compacted
- Check all canals are filled
What is the reason for obturation? (3)
- Seal remaining bacteria
- Provide apical and coronal seal
- Prevent reinfection
Give 4 methods of obturation?
- Cold lateral compaction
- Warm vertical compaction
- Carrier based (GP)
- Warm lateral compaction
- Continuous wave compaction
What percentage of maxillary first molars have an MB2 canal?
93%
What are the 3 design objectives of endodontics?
- Continuously tapering funnel shape
- Maintain apical foramen in original position
- Keep apical opening as small as possible
What are the advantages of the crown down technique?
- 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
Name 3 laws of pulpal floor anatomy?
- 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
Give 3 rules for locating orifices in the pulpal floor?
- Always at junction of floor and wall
- Always at the angle of floor and wall junction
- Always at terminus of developmental fusion lines
