Final Flashcards

Question

Removalofthesmearlayeraftercleaningandshaping does which of the following? 1. promotes coronal leakage 2. decreases dentin permeability 3. allows better adaptation of obturating materials to canal walls 4. forces bacteria into dentinal tubules

Answer 1

1. Canal negotiation 2. Canal debridement 3. Length determination 4. Canal shaping

Answer 2

Irreversible, because the cold may cause vasoconstriction, a drop in pulpal pressure, and subsequent pain relief.

Answer 3

Aspirin and Oxycodone

Answer 4

Closed, Soak in 2% NaF for 20 minutes, and do RCT in NaF soaked guaze in hand. Replant and splint for 4 weeks. It will probably ankylose. Open, May not reimplant due to very high incidence of ankylosis, but do RCT out of mouth as well.

Answer 5

1. Indirect pulp therapy 2. Hall technique (stainless crown with no caries removal) 3. Direct pulp capping (Only with small mechanical or traumatic exposures, but not with caries exposure) 4. Pulpotomy (Use **formacresol, glutaraldehyde, ferric sulfate, or MTA**)

Answer 6

They are used for the removal of pulp tissue and for removing cotton wool dressing pellets.

Answer 7

Starting the healing process/inflammation response to pulp.

Answer 8

1. Dentinal tubules (doesn't have to be direct) 2. Direct pulp exposure 3. Caries 4. Iatrogenic 5. Trauma

Answer 9

* Pen VK * Amoxicillin * Ampicillin * Clindamycin * Augmentin * Azithromycin

Answer 10

Eugenol (oil of cloves), used as an anodyne to inhibit nerve activity, and has potent antimicrobial properties.

Answer 11

1. Metal 2. Fiber 3. Ceramic

Answer 12

Use rubber dam, get WL **2-3 mm short of radiographic length**, use NiTi instruments, don't perforate, and obturate with **ZOE, iodoform paste, or CaOH, which are all resorbable, which is the key!!**

Answer 13

False negatives are more common, and no you don't wear gloves. If you get a positive response, you know you have a vital tooth.

Answer 14

* Because pulp chamber and canals provide adequate retention for core buildup

Answer 15

It is 40 nanomicrons long, right next to odontoblastic layer in coronal pulp, free of cells, traversed by blood capillaries and unmyelinated nerve fibers. This are also isn't found in young or old pulps as much, mainly middle aged.

Answer 16

Use the Master Apical File and spin in reverse with hand, then use the gutta percha point to coat the canal walls, then use paper point, or you can use the lentulo spiral which isn't the best, and the syringe which is the single cone technique.

Answer 17

1. Force 2. Sharp 3. Rake Angle

Answer 18

Reposition on splint for 2-4 weeks, and RCT later if needed.

Answer 19

You have a heat source from an electrical system like System B, and you do the same sort of technique as the warm vertical compaction or you do a softened backfilling technique, so after the apical section is placed, heated, and compacted, the softened gutta percha in an electrical gun-like device is expressed through the syringe tip, then down-packed using the Obtura.

Answer 20

Requires written prescription, no time limit to fill, refills are prohibited, multiple prescriptions (90 days) are permitted, fax prescriptions ok for prep only.

Answer 21

Benzodiazepine, along with other drugs that end in "am." The muscle relaxant drugs are Carisoprodol and cyclobenzaprine.

Answer 22

Deep pockets, extensive CAL, no pulpal disease. History of disease progression, probing, pulp test positive. Periodontal therapy only. Be cautious of the reliability of pulp testing, especially in multi-rooted teeth with severe periodontitis.

Answer 23

Making the canal near the apex way larger than it should be, so essentially taking away tooth structure.

Answer 24

Yes, but no displacement or mobility. No treatment.

Answer 25

* You get **purulence first, and then you get hemorrhage**. This has to do with the **Zones of Fisch**. If you take a periapical granuloma there are different zones within that defect. The center of that defect is usually located at the apex of the canal, and in this center is the purulence material, and around that center area is where the battle is, and blood is.

Answer 26

1. Sodium Hypochlorite 2. EDTA 3. Chlorhexidine 4. Sterile Water 5. Local Anesthetic

Answer 27

5. Working Length Radiograph Instrument: Use at least a #15 file for this radiograph, place file passively into canal near the estimated W.L. distance, not aggressively. Outcome: From the radiograph, determine the full length of the canal, determine the adjusted or calculated Working Length from the radiograph for each canal, and remember the Working Length is usually 1/2 to 1 mm short of the root length. Observe the canal curvatures and note the possibility of additional canals.

Answer 28

* Standardized is the normal File sizes that range from #15 to #140, with either a .02, .04, .06 taper. * Conventional is sizes * extra-fine, * fine-fine, * fine, * fine-medium, * medium, * large, * extra-large. * The **Master Cone Fit is Standardized while the accessory cones are conventional.**

Answer 29

T and B cells, macrophages, dendritic cells.

Answer 30

Necrotic pulp, generalized periodontitis with plaque and calculus. Pulp test negative, evidence of inflammation/necrosis, generalized increase in pocket depth, radiographic evidence of pulp and periodontal disease. First, endo treatment, evaluate in 2 months, then periodontal treatment. Avoid extensive root instrumentation during periodontal treatment that might remove cementum.

Answer 31

Closed, put in saline, milk, or saliva, irrivate socket, reimplant and splint for 2 weeks, use antibiotics, than do a RCT after one week, and CaOH 2 weeks. Open, saline to clean, doxycycline for 5 minutes, reimplant with flexible splint, use antibiotics, and follow for vitality after 2, 6, and 12 months.

Answer 32

A-fibers, which are myelinated, while C are not. The conduction velocity for A fibers (A alpha, beta, gamma, and delta) are a lot faster because of the myelination, they also have a larger diameter. C fibers are strictly for pain and found on the dorsal root and are unmyelinated. The different A fibers have different functions. A delta and C fibers are similar because they both respond to pain. A are found in region of pulp-dentin junction, and react to sharp prickling and have a low threshold, while C fibers are found throughout the pulp and are for burning, aching, less bearable sensations and have a high threshold.

Answer 33

Patients, insurance companies, and the dentist.

Answer 34

Necrotic pulp, and in following the SLA and establishing the master apical file. Probably has little benefit with vital pulps. You mix the powder with glycerin, and can use either a syringe or place it with a lentulo spiral. The research study said lentulo spiral was most effective, syringe next, and #25 K file was least effective.

Answer 35

2. Find Canal, Explore, Negotiate Instrument: K-Files, #8, #10, and #15. Watch-wind and pull out, up/down, and circumferential filing. Outcome: Identify all canals, determine canal patency, smooth the canal, and agitate irrigation solution to dissolve pulp tissue. You can use the DG16 (explorer) to feel around the orifices.

Answer 36

An acute alveolar abscess, usually from bacteria that has spread from necrotic pulp.

Answer 37

PiGPu, and then Why Your Rain Bow Green Black? Pink, Grey, Purple......White, Yellow, Red, Blue, Green, Black. These all apply to the 0.20 taper.

Answer 38

6. Apical Configuration/Gauging Instrument: Small K files #8-20. Use passively to determine apical gauging and canal size. Use a #10 file to establish apical patency. Outcome: Determine the Patency File size, determine the Initial Apical File size, which is the first file that binds at the WL. Estimate the Master Apical File size, which is the size that will be used to clean the apical canal at the working length. (The MAF is usually 3-4 file sizes larger than the IAF)

Answer 39

Deep pockets, extensive CAL, increased pain, evidence of pulpal disease. History of disease progression, probing, pulp test negative, pain, radiographic evidence. First, endo treatment, evaluate in 2 months, then periodontal treatment. Weak evidence for this condition to actually occur.

Answer 40

Splint if fracture on cervical or middle 1/3, and don't do anything if apical 1/3.

Answer 41

Because of fracture, and usually because of an improper restoration. A vertical root fracture looks like a J on a radiograph.

Answer 42

* Eliciting irritants include **irreversibe pulpitis**, inflammatory mediators from an irreversibly inflamed pulp or egress of bacterial toxins from necrotic pulps, chemicals (such as irrigants or disinfecting agents), restorations in hyperocclusion, overinstrumentation of the root canal, and extrusion of obturating materials. The pulp may be reversibly inflamed, irreversibly inflamed or necrotic.

Answer 43

1. ASA class I 2. No history of anesthesia problems 3. Cooperative and Compliant 4. No limitation in ability to open mouth 5. No gag reflex 6. No pain or swelling

Answer 44

The heading has the name, address, phone #, name and address of patient, and date of prescription. The body has the Rx symbol, name and dosage size or concentration of drug, amount or quantity, and directions to patient.

Answer 45

To wash out a body cavity or wound with water or a medicated fluid.

Answer 46

Etiologic factors present for both conditions. Generalized periodontal destruction that connects to periapical lesion. Test for root fracture. Pulp test negative. Root canal therapy, periodontal therapy. Classic case is due to a fractured or perforated root.

Answer 47

Mesial Root 2 canals = 70-80% Distal Root 2 canals = 15-30%

Answer 48

True. And they are dominated by obligatory anaerobic bacteria. The most frequent are gram-neg anaerobic rods, gram-pos anaerobic cocci, gram-pos anaerobic and facultative rods, lactobacillus, and gram-pos facultative streptococus. So mostly everything but gram-neg cocci.

Answer 49

Anxiolytic and a muscle relaxant

Answer 50

3. Pre-Flare and Tissue Debridement Instrument: Hedstrom Files #15, #20. Up/down, circumferential filing motion. Outcome: Canal debridement, enlarge the orifice, and reduce the cervical triangular dentin to improve the SLA to the mid-root canal.

Answer 51

* Condensing osteitis, a v**ariant of asymptomatic apical periodontitis**, represents an increase in trabecular bone in response to persistent irritation. The irritant diffusing from the root canal into periradicular tissues is the main cause of condensing osteitis. This lesion is usually found around the apices of mandibular posterior teeth, which show a probable cause of pulp inflammation or necrosis. However, condensing osteitis can occur in association with the apex of any tooth.

Answer 52

1. NSAIDS 2. Opioids/Narcotics 3. Steroids

Answer 53

1. Diagnose pulpal and periapical pathosis 2. Endodontic treatment planning 3. Perform non-surgical conventional RCT on minimum difficulty cases

Answer 54

Periapical bone loss, drainage through sulcus, history of extensive restorative treatment, gingival swelling, furcation bone loss. Pulp test negative, periodontal probing has narrow pockets, rapid onset, bad endo before. Endo treatment only. May be a risk factor in patient prone to periodontitis, may spread through cervical tubules into main canal systems.

Answer 55

1. Conventional RCT 2. Non-surgical Retreatment 3. Surgical Retreatment 4. Traumatic Dental Injuries 5. Dental Implants

Answer 56

Ceramic/Zirconium

Answer 57

Remove coronal pulp, and then you can do one of three things. 1) place diluted solution of formocresol for 5 minutes which produces partial tissue fixation, and then place ZOE and an intracoronal restoration over pulp stumps. 2. Place 15% ferric sulfate solution for 15 seconds which produces mechanical blockage of open cappilaries, and then place intracoronal restoration. 3. Place MTA over pulp stumps and then a intracoronal restoration.

Answer 58

True. Revascularization may occur in immature teeth with wide-open apexes, but it is unpredictable and must be monitored carefully.

Answer 59

**• Localized or diffuse liquefaction lesion of pulpal origin** * Destroys periapical tissues * Disintegrating PMNs **• Necrotic pulp** • Abcess within a granuloma

Answer 60

True. Can disrupt apical seal. But later in his slides it says to use rotary if the gutta percha is really old and has lost its thermoplasticity.

Answer 61

1) Increased blood flow leads to vasodilation and an increased capillary pressure, which leads to 2) increased capillary filtration, which leads to 3) increased tissue pressure, resulting in pulpal pain because it is acting on sensory nerve receptors! Pain also happens because a release of mediators of inflammation by directly lowering the sensory nerve threshold. And it is this increased pressure that compresses the thin-walled venous vessels, which leads to decreased blood flow, strangulating the pulpal vessels, and if this goes on for a while, will lead to pulpal necrosis.

Answer 62

Pulpal, acute. Periodontal, chronic.

Answer 63

* • Preserve Remaining Tooth Structure * • Protect Remaining Tooth Structure * • Provide Coronal Seal * • Satisfy Function and Esthetics

Answer 64

* **• Generally asymptomatic** * **• Not sensitive to biting** * • May feel different to percussion * **• No response to pulp vitality tests** * **• Apical radiolucency** * **• Mucosal or facial sinus tract** * **If the abscesses are huge, they are generally in the chronic stage, so Chronic Apical Abscess**

Answer 65

1. Uncomplicated crown fracture of mature or immature tooth 2. No previous endodontic treatment history 3. None or mild periodontal disease

Answer 66

-If a tooth has been out of the alveolar socket for more than 1 hour (and not kept moist in a suitable medium), periodontal ligament cells and fibers will not survive, regardless of the stage of root development. Replacement resorption (ankylosis) will probably be the eventual sequela after replantation. Therefore, treatment efforts before replantation include treating the root surface with fluoride to slow the resorptive process. -When mature avulsed teeth are replanted, they cannot be expected to reestablish pulpal blood supply.37 Revas- cularization may occur in immature teeth with wide-open apexes, but it is unpredictable and must be monitored carefully. These teeth must be monitored radiographi- cally over a period of time to watch for evidence of pulp necrosis. In the mature replanted tooth, root canal treatment is definitely indicated and should ideally be started 7 to 10 days after replantation. The splint may remain during treatment for stability. The use of calcium hydroxide as an antimicrobial intracanal interappointment medica- ment may be helpful.43,45 It is particularly beneficial if the root canal is infected, a condition that would be likely to occur when root canal treatment is delayed more than a few weeks after replantation.

Answer 67

1. Remove all caries 2. Conserve sound tooth structure 3. Unroof pulp chamber and remove all coronal pulp tissue 4. Locate all canal orifices 5. Establish straight or direct line access

Answer 68

On slide, they placed ZOE down the canals instead of gutta percha.

Answer 69

* post length * diameter * taper * luting cement * passive or active

Answer 70

K-file - filing, circumferential, balanced force, and watch-winding.

Answer 71

7. Glide Path Preparation Instrument: Starting with IAF, increase the size to at least a #20 K file to be used as the Glide Path file. Work them in sequence in watch-wind, 1/4 turn-pull, circumferential, step-back, balance-force, or crown-down. Outcome: Prepare a path that removes all interferences from the orifice to the apical terminus of the canal, smooth the canal, clear pulp tissue by irrigant agitation, at least a #20 should have a smooth glide to the WL.

Answer 72

1. Gutta Percha 2. Silver Cones (oxidizes if exposed to water, and stains tissue) 3. Paste Fillers (Calcium Hydroxide for temporary purposes), Sargenti (paraformaldehyde), Russian Red. 4. Hot dog on a stick (Thermafil, Gutta-Core)

Answer 73

* Use the narrowest, longest, smoothest, parallel post that one can fit into the post space

Answer 74

1. Outline form 2. Convenience Form 3. Caries Removal 4. Toilet of Canal (prevent blockage, clean it out)

Answer 75

1. Apical pathosis - the presence of perradicular lesions and larger lesions 2. Bacterial status of canal - presence of bacteria in canal prior to obturation (CaOH) 3. Extent and quality of obturation - short, long, voids, density 4. Quality of restoration - Coronal Seal is Huge

Answer 76

This involves enamel and dentin and has a 1-7% chance. You treat it by applying CaOH cement or VitraBond to exposed dentin and then you can restore it if it less than 1/2mm of dentine, and reattach separated tooth fragment with bonding agent.

Answer 77

1. • Active—threaded and engage dentinal walls, more retentive, **increase stress** 2. • Passive—retained strictly by luting agent, less retentive, **less stress** 3. • Parallel—more retentive than tapered, **less stress** 4. • Tapered—require less dentin removal, **increased wedge effect**

Answer 78

1. Cold 2. Heat 3. Electric 4. Test Cavity 5. Selective Anesthesia

Answer 79

10. Final MAF Radiograph & Rinse Instrument: Radiograph with the MAF at working length, final rinse with EDTA - Alcohol - NaOCl - Alcohol. Outcome: Confirm of full WL canal preparation with the MAF, confirmation of a thoroughly clean and rinsed canal.

Answer 80

Thermal - CO2 testing specifically.

Answer 81

1. Pink 2. Grey 3. Purple **PiGPu**

Answer 82

1. Sodium Hypochlorite (Bleach) 2. Iodine -These are potent bacterial or viral killers.

Answer 83

* If a painful response is obtained by **pressing or by tapping on the crown**, this indicates the presence of **periapical inflammation**. If a painful response is obtained by tapping on the **facial surface but not the occlusal/incisal surface, periodontal inflammation is suspected**. The pain related to periodontal inflammation is likely to be in the mild-to-moderate range. Periapical inflammation is more often a sharp pain. An additional approach, useful if the patient complains of pain on chewing, is the biting test in which the patient bites down on a cotton swab between each tooth in turn.

Answer 84

They are not normally found in normal healthy pulp, but they can appear and release histamine, leukotrienes, and other platelet-activating factors, and their presence in blood vessel walls indicate their importance in pulpal inflammation.

Answer 85

No, but a heat test can sometimes because it exacerbates pain due to expansion of gases or fluids.

Answer 86

It starts at a 0.06 and 0.38 (at the D16 level, **if you know it is a 0.02 taper, than it should just be .32 above it**). 1. And it goes 0.06 2. 0.08 3. 0.10 4. 0.15 5. 0.20..... etc..... and then starts adding 0.1 between each at 0.60 6. 0.60 7. 0.70 8. 0.80, all the way to 9. 1.40

Answer 87

* Remove all internal and external undercuts

Answer 88

* -He does this one the most, and you will either do the cotton and cavit alone, or put in a medicament and then put in cotton and cavit, you always put in cotton and cavit. * -Intermediate Restorative Material, which is usually mixed with eugenol, helps inhibit nerve activity

Answer 89

1. Deep cavity preps 2. Lack of cooling 3. Impact trauma 4. Occlusal trauma 5. Deep perio curettage 6. Orthodontic movement

Answer 90

Distal Root 2 canals = 5-8%

Answer 91

**• Rapid onset of acute spontaneous pain to percussion and biting and palpation** * **Moderate to severe discomfort and swelling**—intra and sometimes extraoral * **Purulence (pus),** sinus tract sometimes * Surrounding the abscess is granulomatous tissue (an abscess within a granuloma) * Lymphadenophy—submandibular and cervical * **Periapical Radiolucency** * **No response to Pulp Vitality Tests** * Varying degree of **mobility** * Frequently **febrile**

Answer 92

* **Treatment—removal of as much pulpal tissue as time allows (pulpectomy/pulpotomy) or clean and shape** * Cotton pellet (as good as anything) * Relieve occlusion (so not sore between appointments) * It’s not infected yet, but is just inflamed, but the longer you wait, it will become infected

Answer 93

1. Chief Complaint 2. Medical and Dental History (subjective) 3. Oral Examination and Tests (objective) 4. Correlate findings to reach differential diagnosis 5. Formulate definitive diagnosis and treatment plan

Answer 94

* 1. CMCP (Camphorated Monoparachlorophenol) Less toxic * 2. Cresatin (Metacresylacetate) Even less toxic. Used for vital pulpectomy. -These are antibacterial, and act by binding to cell membrane and lipids

Answer 95

False. It is not. Bone loss must extend to junction of cortical and cancellous bone to be observed usually. The location of root apices in correlation to this junction affects how early a PA lesion can be detected, and most anterior and pre-molar teeth apices are located closer to the cortical/cancellous junction than molar roots.

Answer 96

1. Virulence of bacteria 2. Ability to release inflammatory fluids to avoid intrapulpal pressure 3. Host resistance 4. Amount of circulation 5. Most importantly, lymph drainage

Answer 97

Deep dentin

Answer 98

-Treatment of intrusive luxation injuries depends on root maturity. If the tooth is incompletely formed with an open apex, it may reposition spontaneously. If it is fully developed, active extrusion will be necessary soon after the injury, either orthodontically or surgically. Root canal treatment is indicated for intruded teeth with the exception of those with immature roots, in which case the pulp may revascularize.

Answer 99

D, that is with CaOH

Answer 100

1. Lamina dura is lost apically 2. Lucency remains at the apex in radiographs made at different cone angles 3. Lucency tends to resemble a hanging drop 4. The lesion is usually seen with a necrotic pulp

Answer 101

Periapical inflammation. This is more often a sharp pain.

Answer 102

4. Coronal Canal Preparation Instrument: Gate-Glidden Burs #2-4 (.7 - 1.1) and Orifice Opener Burs (BR 0) Outcome: Enlarge the orifice, enlarge the coronal canal to the mid-root area size of a #70, reduce the cervical triangular dentin, improve the accuracy of the working length measurement by removing any mid-root interferences, improve the depth of irrigation solution penetration.

Answer 103

False. It is intrusion that does that.

Answer 104

Periodontal inflammation

Answer 105

Periapical Disease. Specifically, to prevent or treat apical periodontitis.

Answer 106

Use a small-tip aspirator (saliva ejector with large gauge needle tip), then coarse paper point, and then fine paper point (use for final WL check). But do not do direct air spray, that is how you get an air embolism.

Answer 107

1. Stem cells (pulpal mesenchymal stem cells located in cell-rich zone of Hohl. Stem cells of apical papilla SCAP) 2. Growth factors/Morphogens 3. Scaffold (collagen or glycosaminoglycans)

Answer 108

Triangular

Answer 109

* These are rigid and are used to removed old rootfillings, and sometimes to plane the canal walls. * The instruments are used only in a filing or rasping mo\>on. They should never be rotated or engaged into den\>n as they are weak instruments and prone to fracture.

Answer 110

* It is long term low grade pulpal irritation, dentin formation obliterates canals, and is usually not pathosis. A **yellowish discoloration of the crown is often a manifestation**, and the **pain threshold to thermal and electrical stimuli usually increases. Does not require treatment.** * Book says = Another type of calcification is the extensive formation of hard tissue on dentin walls, often in response to irritation or death and replacement of odontoblasts. This process is called **calcific metamorphosis**. As irritation increases, the amount of calcification may also increase, leading to partial or complete radiographic (but not histologic) obliteration of the pulp chamber and root canal. A yellowish discoloration of the crown is often a manifestation of calcific metamorphosis. The pain threshold to thermal and electrical stimuli usually increases; often the teeth are unresponsive.

Answer 111

A normal taper is 0.02 For example, for a 050 file, the D16 is 0.82 and the D0 is 0.50. So we take **(0.82-0.50) and divide that by 16mm, to give us = 0.02 taper**

Answer 112

Antibacterial, non-antigenic, temporary obturant, stimulate apical root end closure. Very powerful. Inactivates biologic ac:vity of bacterial lipopolysaccharides which egress from necrotic' pulps'into'periapical tissues'and'cause'PA'lesions

Answer 113

1. Signs and symptoms consistent with recognized conditions 2. Minimum difficulty in obtaining radiographs 3. Anterior/Premolar teeth with slight inclination 4. routine rubber dam placement 5. normal crown morphology 6. Slight or no curvature (

Answer 114

There are 6 of them. The smallest is 0.50 mm and the largest is 1.50 mm. It goes 1. 0.50 (#1) - 2. 0.70 (#2) - 3. 0.90 (#3).. 4. 1.10 (#4) 5. 1.30 (#5) 6. 1.50 (#6)

Answer 115

Tackiness, air tight seal, radiopaque, fine powder, no shrinkage, no staining, slow setting time, bacteriostatic, insoluble in tissue fluids, non-irritating to periradicular tissue, soluble in common solvent for removal.

Answer 116

Every 2-3 files you should change, agitate with small file like a #10 or #15, endoactivator, use small side-vented needle, keep chamber wet, alternate NaOCl with 17% Aqueous EDTA.

Answer 117

* They are extremely percussion sensitive * Treatment—complete pulpectomy or clean and shape (RCT without the obturation) * Cotton/cavit * Relieve occlusion

Answer 118

* **Spontaneous pain** * **Acute pain to biting or percussion** * **Hot, cold, electric sensitivity (pulpitis)** * May or may not respond to Pulp Vitality Tests * May or may not have PA radiolucency (yet) * **Widened (thickened) PDL** * Histology—PMNs and macrophages * May have liquefaction necrosis

Answer 119

* Inflammatory lesion of pulpal origin * Long standing lesion * Same histology as AAA * CAA has a pathogenesis similar to that of AAA. **It also results from pulpal necrosis and is usually associated with chronic (asymptomatic) apical periodontitis that has formed an abscess.** The abscess has “burrowed” through bone and soft tissue to form a sinus tract stoma on the oral mucosa or sometimes onto the facial dermis. CAA may also drain through the periodontium into the sulcus and may mimic a periodontal abscess or pocket

Answer 120

We have CO2.

Answer 121

Use the Master Apical File to working length, and do apical patency with a #10 K file 0.5mm-1mm away one more time.

Answer 122

1. Pain 2. Infection 3. Anxiety 4. Muscle Relaxant

Answer 123

9. Apical Canal Preparation Instrument: use the #10 to carefully maintain apical patency. Use file sizes from the IAF to the MAF to enlarge the apical canal, and use watch-wind, step-back, or balance-force. Outcome: Maintain canal patency. Maintain working length. Maintain apical position. No canal ledging, zipping, or apical transportation.

Answer 124

True. Replacement resorption (ankylosis) will probably be the eventual sequela after replantation.

Answer 125

It is an exotic metal, superelastic metal. It can accommodate greater stress without increasing the strain, and has the ability to return to its original shape after being deformed. We don’t leave Nickel Titanium rotary instruments in the canal for more than a couple of seconds because it will cause damage, but they are extremely helpful because they can curve and adapt to the shape of the canal.

Answer 126

Organic and inorganic substances as well as fragments of odontoblastic processes, various species of bacteria, and necrotic debris.

Answer 127

* It is inflamed pulp with dentinoclastic activity. **The tooth needs to be vital in order for this to happen**. Most of these cases are asymptomatic, but you can end up getting **pink spots** on the crown if it is advanced. **You need to do a root canal on these.** * Book says = The pulp is transformed into a vascularized inflammatory tissue with dentinoclastic activity; this condition leads to the resorption of the dentinal walls, advancing from its center to the periphery. Most cases of intracanal resorption are asymptomatic. Advanced internal resorption involving the pulp chamber is often associated with pink spots in the crown. **Teeth with intracanal resorptive lesions usually respond within normal limits to pulpal and periapical tests.** Radiographs reveal presence of radiolucency with irregular enlargement of the root canal compartment. Immediate removal of the inflamed tissue and completion of root canal treatment are recommended; these lesions tend to be progressive and eventually perforate to the lateral periodontium. When this occurs, pulp necrosis ensues and treatment of the tooth becomes more difficult.

Answer 128

An order for medication which is dispensed to or for an ultimate user. It is not an order for medication which is dispensed for immediate administration to the ultimate user.

Answer 129

* • Treatment—Complete pulpectomy or clean and shape (apical penetration) * • Copious irrigation * • CaOH after drying * • **Mucosal I & D (It can get dangerous if the swelling is diffuse and is low on the mandible because it can block the airway and they can die in the middle of the night. That is why drainage if super important)** * • Cotton/cavit * • Antibiotics/Pain Management

Answer 130

* Do RCT unless it is a hyperocclusion and pulp is vital, reduce occlusion, give it a couple of days, and if not, do RCT

Answer 131

8. Mid-Root Preparation & Gauging Instrument: Use the MAF and at least two larger files in a passive Balance Force method to enlarge the mid-root portion of the canal. The mid-root preparation will be even more defined with the next step. Outcome: Enlarge the mid-root canal, and continue to agitate the irrigant and disinfect the canal.

Answer 132

It has a high proportion of fibroblasts, immune cells like macrophages, dendritic cells, undifferentiated mesenchymal cells. Also known as subodontoblastic area.

Answer 133

Smaller in all dimensions, primary crowns are wider M-D relative to crown length. Primary have have narrower and longer roots and are more slender. More constricted at DEJ. Enamel and dentin are thinner.

Answer 134

It is when microbes are transported in blood to areas of tissue damage. Traumatized teeth become infected thru this pathway, and thru enamel cracks.

Answer 135

Hand Nickel-Titanium files

Answer 136

There are 21, and they are 006, 008, 010, 015, 020, 025, 030, 035, 040, 045, 050, 055, 060, 070, 080, 090, 100, 110, 120, 130, 140.

Answer 137

* Infectious agents cause liquefactive necrosis * Blood loss causes ischemia or coagulative necrosis * As stated before, pulp is encased in rigid walls, it has no collateral blood circulation, and its venules and lymphatics collapse under increased tissue pressure. Therefore irreversible pulpitis leads to liquefaction necrosis. If exudate produced during irreversible pulpitis is absorbed or drains through caries or through a pulp exposure into the oral cavity, necrosis is delayed; the radicular pulp may remain vital for long periods of time. In contrast, closure or sealing of an inflamed pulp induces rapid and total pulpal necrosis and periradicular pathosis. In addition to liquefaction necrosis, ischemic necrosis of the pulp occurs as a result of traumatic injury from disruption of the blood supply. Necrotic pulp is a clinical condition associated with subjective and objective findings indicat- ing death of the dental pulp.

Answer 138

* 17%, it is a chelator and it removes the inorganic components of the canal and leaves the organic tissue intact, so we use this right before sodium hypochlorite. * This effectively removes the smear layer, when used for at least 1 minute.

Answer 139

It is a two way street and microbes in subgingival biofilms could reach the pulp through canals. Pulpal necrosis only occurs if periodontal disease/pocket reaches the apical foramen due to damage of blood vessels that penetrate the apical foramen.

Answer 140

* A pulp polyp, and it is when pulp cavity opens and instead of necrosis, pulp tissue proliferates and comes out the top to form a surface epithelium from oral epithelial cell implantation. Usually seen in the younger crowd, and is asymptomatic. * **Treat this with a root canal**

Answer 141

You do a Master Cone Fit, and then apply heated plugger deep to separate the cone and heat and soften apical section, then you apply apical pressure to produce hydraulic force to softened gutta percha, moving it apically and laterally. And then additional gutta percha sections are added similarly in an incremental fashion to orifice.

Answer 142

Reposition with splint for 2-4 weeks, RCT later if needed.

Answer 143

2 = 60-80% 3 = 6%

Answer 144

Up to 1 to 5 microns

Answer 145

006 and 140, and this is measuring the diameter of the very tip.

Answer 146

1. Make the post about 3/4th the length of the root when treating long-rooted teeth 2. With average root length, just stick to the 4 or 5 mm rule of gutta percha 3. Should extend at least 4 mm apical to bone crest 4. Molar posts shouldn't extend more than 7 mm down the canal from the pulp chamber 5. **The post should be as long as the clinical crown is going to be**

Answer 147

Reamer - Reaming, balanced force, and watch-winding.

Answer 148

It starts at 0.38 and ends at 1.72

Answer 149

These may be oral, written, or faxed. Refills are ok and by call-in.

Answer 150

Most teeth have just one. The exceptions are: Maxillary 1st premolar = 2 roots Maxillary 1st molar = 3 roots Mandibular molars = 2 roots

Answer 151

It is the groove that catches debris between the cutting edges.

Answer 152

* If the leading edge of the blade is ahead of the perpendicular, the angle is, by definition, negative. * Examples of negative rake instruments are reamers, K-files, K-Flex files, diamond burs, most NiTi-files, and burnishing burs or regular burs run backwards.

Answer 153

Toothpaste for electric and petroleum jelly for heat.

Answer 154

4 mm. Another study says 5 mm, because 95% of accessory canals are within that 5 mm range that go out to the periodontium.

Answer 155

Caries, **exposed dentin (most common)**, recent dental treatment, defective restorations, trauma. RCT's are not needed. Pain on testing will be sharp.

Answer 156

* It is a natural host defense mechanism associated with pathological changes in the periapical tissues. * Resorption provides a separation between the irritants and the bone preventing osteomyelitis

Answer 157

1. Necrotic pulp 2. Immature root apex (young patient) 3. Pulp space not to be utilized by a post or any restorative purposes 4. Coronal seal

Answer 158

It means that the file diameter is getting 0.02 mm wider per millimeter increase at D0 towards D16.

Answer 159

* Caused by pulpal necrosis * Chronic * Generally asymptomatic * Sometimes patients don’t respond to SAP and it turns into this which won’t cause pain, they forget about it, and it becomes bad.

Answer 160

1. Phenolic compounds (essential oils, aldehydes, halogens) 2. Calcium Hydroxide 3. Steroids 4. Antibiotics

Answer 161

False. It weakens it actually.

Answer 162

* Reaming—Rotating clockwise as flutes engage dentin (REAMER, ROTARY) * Filing—Bind flutes and scrape out along dentinal walls ( KIFILES, HEDSTROM FILES) * Circumferential Filing—Move file from wall to wall while scraping (ALL but REAMERS) * Balanced Force—Place, cut w/pressure (force) and remove (KIFILES, REAMERS) * Watch Winding/Twiddling—Gently and repeatedly rotating instruments apically (ALL)

Answer 163

* Loss of Moisture—9% * Irrigation Materials—NaOCl, EDTA, etc interact with dentin and deplete calcium and fragilize dentin * Aging—reduces fracture resistance * Aggressive Coronal Access and Instrumentation—results in excessive tooth structure loss * Loss of Coronal Seal—reinfection leading to additional Endodontic treatment

Answer 164

6 months to 5 years

Answer 165

* By treating the endo first, the toxins and debris from the root canal could be pushed out into the periodontium and exacerbate the periodontal condition.

Answer 166

It may be contaminated with bacteria and their metabolic by-products, it may prevent sealer contact with the canal wall, permitting leakage, and it may disintegrate then cause obturation leakage.

Answer 167

Facultative bacteria initially dominate, and then anaerobes take over as oxygen is depleted from the root canal and pulp necrosis takes place.

Answer 168

Tylenol and Oxycodone

Answer 169

Pulpal, wider apically. Periodontal, wider coronally.

Answer 170

1. • Amalgam Core with/without metal post 2. • Composite Core without post 3. • Composite Core with fiber or ceramic post 4. • Composite core with prefabricated metal post 5. • Cast Gold post and core

Answer 171

Must be dated and signed on day of issue, manually signed, ink, indelible pencil, or typewritten. The physician has to be registered with DEA, but military, public health, FBI are exempt.

Answer 172

Gram negative

Answer 173

Cold sensitivity

Answer 174

False, it is diameter

Answer 175

* remaining tooth structure * post length and rigidity * antirotation features * presence of FERRULE

Answer 176

* Dries Canal, Surfactant (lowers surface tension with NaOCl)

Answer 177

False, they do not

Answer 178

-A Lentulo spiral is a dental instrument used to properly distribute root canal sealer and cement evenly throughout the root canal system, as when performing endodontic therapy or a post and core cementation. They can cause damage because they catch a lot on the walls.

Answer 179

1. Access Cavity Preparation Instrument: #330, #557 Outcome: Get straight line access (SLA) to canal orifices, mid-root, or first canal curvature. De-roof the complete pulp chamber, remove pulp chamber tissue, and conserve tooth structure.

Answer 180

Alveolar bone proper

Answer 181

Saline or anesthesia, turns into thick paste.

Answer 182

When the blade is behind the perpendicular. Hedstrom and most dental burs.

Answer 183

* NaOCl—2.5=5.25% (full strength) Bleach * Best Proteolytic Agent * Breaks Down Proteins into Amino Acids Through Free Chlorine * Chelator * Removes Debris and Wets Canal Walls * Antimicrobial * Dissolves Organic and Inorganic Debris * Opens Dentinal Tubules (Smear Layer Removal) * Disinfects and Cleans Areas Inaccessible to Instruments

Answer 184

* • They will be extremely percussion sensitive * • Treatment—complete pulpectomy or clean and * shape * • **Establish drainage if possible** * • **Copious irrigation** * • **CaOH medicament if room after drying** * • Cotton/cavit (old school—leave open) * • Relieve occlusion * **• Antibiotics/Pain Management**

Answer 185

So filling material adapts better to the canal wall, to get better adhesion of sealer to dentin, and to get better tubular penetration of sealer.

Answer 186

During cleaning and shaping, we push debris against the canal wall.

Answer 187

1. Formaldehydes (Formocresol) Used for pulpectomy/pulpotomy to fix remaining pulp tissue. 2. Gluteraldehydes

Answer 188

1. Decrease in dentin permeability 2. Tertiary dentin formation 3. Inflammatory and immune responses Pulp is the only connective tissue in the body with the ability to protect itself from certain external irritants.

Answer 189

Oval. They start out as triangular and become more oval.

Answer 190

You can have symptomatic or asymptomatic, and the pain is usually prolonged rather than sharp, but pulp will eventually become necrotic so RCT is needed. The best time to treat is when it is asymptomatic and caries possibly into pulp space.

Answer 191

Carbide high speed #330 and #557, Diamound round and round end taper, and specialty burs like the Endo-Z FG and LA Axxess Kit, as well as slow speed round burs.

Answer 192

Mandibular 2nd molar. Two towards mesial, one on distal.

Answer 193

1. Rubber prophy cup 2. Gutta Percha stick (most common) 3. Batter powered

Answer 194

Sensory innervation to pulp does not mature until later stages of root formation. Thermal testing may be more reliable.

Answer 195

They are like reamers, but have spirals much closer together. They are used to plane and smooth the walls of the root canal.

Answer 196

* Little or no pain, even with **percussion** * No response to Pulp Vitality Tests * Slightly sensitive to **palpation** * Widened PDL to Extensive lesion (starting lesion at least) * Granuloma—PMNS, Mast Cells, Macrophages (no epithelium) * Apical Cyst—Stratified squamus epithelium surrounded by CT containing all cellular components found in granuloma (Granuloma that contains a cavity lined with epithelium— Epithelial Cell Rests of Malessev or Hertwigs root sheath) * 59% granuloma, 22% cysts, 12% scars, 7% ? * A granuloma is your basica apical abscess * There may be slight sensitivity to palpation, indicating an alteration of the cortical plate of bone and extension of AAP into the soft tissues. Radiographic features range from interruption of the lamina dura to extensive destruction of periapical and interradicular tissues

Answer 197

1. Zinc-Oxide and Eugenol (ZOE, **Roth's) (We use Roth's/Grossman in the clinic)** 2. Resin-based 3. CaOH-base 4. Glass Ionomer 5. Bioceramic

Answer 198

Caused by bacteria and bacterial products or loss of blood supply. If exudate produced during irreversible pulpitis is absorbed or drains through caries into oral cavity, necrosis is delayed.

Answer 199

* Depending on the cause (pulpitis or pulpal necrosis), condensing osteitis may be either asymptomatic or associated with pain. Pulp tissue of teeth with condensing osteitis may or may not respond to electrical or thermal stimuli. Furthermore, these teeth may or may not be sensitive to palpation or percussion. Radiographically, the presence of a diffuse concentric arrangement of radiopacity around the root of a tooth is pathognomonic. Histologically, there is an increase in irregularly arranged trabecular bone and inflammation. * Root canal treatment, when indicated, may result in the complete resolution of condensing osteitis.

Answer 200

* To retain the core

Answer 201

Hedstrom - Filing, circumferential, and watch-winding.

Answer 202

Radix Entomolaris

Answer 203

No displacement, but **mobile and percussion sensitive with sulcular bleeding**, not treatment.

Answer 204

* 1. Antibacterial * 2. Enhance anesthesia * 3. Render canal contents inert * 4. Control persistent inflammation * 5. Control post-treatment pain

Answer 205

To put on the pulp to create an inflammatory process in order to start the healing process.

Answer 206

* Has high pH * bacteria tight seal, creates its own seal, works the best * hardens * acts as a base for permanent restoration * needs moisture to cure-two appointments * grey can't be used in anterior teeth * expensive * It comes in grey and white and white can also discolor while the temporary is on.

Answer 207

Easily manipulated, no shrinkage, seals laterally and apically, non-irrating to PA tissues, unaffected by tissue fluids, bacteriostatic, radiopaque, no staining, steril.

Answer 208

1. Lamina Dura lost apically (widened) 2. Lucency remains at apex despite angulation 3. Lucency resembles hanging drop 4. Tooth has necro;c pulp

Answer 209

* This is probably a chronic apical abscess * • Treatment—complete pulpectomy or clean and shape (apical penetration) * • Copious irrigation * • CaOH after drying * • Cotton/cavit * • Relieve occlusion * • Antibiotics/Pain Management

Answer 210

Amoxicillin and Clavulonic Acid

Answer 211

* This is idiopathic, no known cause. **Tooth is vital**, normal, shallow filling, **completely asymptomatic**. Usually you can elicit pain or you can see that there have been some heavy restorations or something.

Answer 212

* 20% gutta percha * 65% zinc oxide * 10% radiopacifiers * 5% plasticizers

Answer 213

Facultative anaerobic gram positive coccus

Answer 214

Palatal and Distobuccal root 1 canal = 100% Mesiobuccal Root 2 canals = 40-80%

Answer 215

* Palatal of maxillary and distal of mandibular

Answer 216

* (Tetraclycline, Acid, Detergent) Removes smear layer, Antimicrobial

Answer 217

* • A POST & CORE is a dental restoration used to sufficiently build-up tooth structure for future restoration, i.e. crown when there is not enough tooth structure to properly retain the crown. * • The POST is placed within the body of the root of a tooth that has already been treated with RCT * • The CORE is the part of the restoration that shows out in the mouth that helps anchor a cap or crown

Answer 218

It is when you completely miss the apex at the bottom and form your own apex.

Answer 219

1. Pain 2. Swelling 3. Broken tooth 4. Loose tooth 5. Tooth discoloration 6. Bad taste/breath

Answer 220

* Molar moderate = just a regular core and crown * Molar severe = post and amalgam core and crown * Premolar moderate = post and amalgam core and crown * Premolar severe = custom cast post and core and crown

Answer 221

False, neither is smooth. But threaded will.

Answer 222

Anesthetize, isolate, access, debridement of necrotic tissue, WL, irrigate with NaOCl diluted, dry, medicament with CaOH or Triple Antibiotic paste 1:1:1 mixture of cipro, metro, mino (which can stain). Visit in 2-4 weeks, repeat if still infected, anesthetize with 3% Mepivacaine w/o vasoconstrictore, isolate, access, irrigate NaOCL and then 17% EDTA to remove medicament, dry, then use #10 or #15 file out of apex to stimulate bleeding, place collagen matrix (colla-plug) to serve as matrix for white MTA seal, then put on permanent restoration.

Answer 223

Maxillary anteriors, palatal and distobuccal roots of maxillary molars.

Answer 224

It involves enamel, dentin, and pulp. The factors are the extent of the fracture, stage of root development, and length of time since fracture, and restorative treatment plan. Immature roots need pulp to develop. You can treat it by pulp capping with CaOH if within 1st 30 hours, otherwise do a partial or pull pulpotomy, or a pulpectomy.

Answer 225

* Gram negative are usually eliminated * Gram positive and facultative bacteria like streptococi, enterococci, lactobacilli, they all usually stay and hang around, specifically **Enterococcus faecalis.**

Answer 226

* (1) necrotic pulp tissue * (2) proteins and glycoproteins from tissue fluids and exudate that seep into the root canal system via apical and lateral foramina * (3) components of saliva that may coronally penetrate the root canal * (4) products of the metabolism of other bacteria.