Final Revision Flashcards
Inferior Alveolar Nerve Block:
drug:
onset:
duration:
max and recommended dose:
• 2% Lidocaine and 1:100 000 epinephrine • objective: onset within 15 minutes, duration for 60 minutes (pulpal anaesthesia) • profound lip numbness DOES NOT predict pulpal anaesthesia • perform vitality test (cold) -maximal dose : 500mg for adult patients -recommended dose : 6.6 - 7mg/kg
Absolute contraindication for epinephrine :
uncontrolled hyperthyroidism
Alternative Anaesthetic solutions for Inferior Alveolar Nerve Block:
- Plain solution : 3% Mepivacaine or 4% Prilocaine
- alternative when no epinephrine is used
- unstable angina, cardiac arythmia, history of myocardial Infarction, hypertension, uncontrolled diabetes, tricyclic antidepressants
- 4% Prilocaine and 1:200 000 epinephrine
- 2% Mepivacaine with 1:20 000 Levonordefrin
- Articaine with 1:100 000 or 1:200 000 epinephrine
Maxilla
Infiltration Buccal and Palatal
drug:
onset:
duration:
- 2% Lidocaine and 1:100 000 epinephrine
- objective: onset within 3-5 minutes, duration for 40-45 minutes for posterior teeth and for 30 minutes for anterior teeth (pulpal anaesthesia)
Alternative Anaesthetic solutions for Buccal and Palatal Infiltrations
- Plain solution 3% Mepivacaine
- alternative when no epinephrine is used
- unstable angina, cardiac arythmia, history of myocardial Infarction, hypertension, uncontrolled diabetes, tricyclic antidepressants
- 4% Prilocaine and 1:200 000 epinephrine
- 2% Mepivacaine with 1:20 000 Levonordefrin
- Articaine with 1:100 000 or 1:200 000 epinephrine
Supplemental Anaesthesia for Symptomatic Irreversible Pulpitis
- Intraligamental
- Intraosseous
- Intrapulpal
Intraligamental anaesthesia
= Periodontal Ligament injection
deposit anaesthetic directly into the periodontal ligament space
• specialized/pressure syringe
• small needle placed between root and crestal alveolar bone
• back-pressure developed to force the solution into the marrow spaces to contact and block the dental nerves
• mesial, distal and lingual surface
-the adjacent tooth will become whiter because of vasoconstrictor
The PDL injection or Intraosseous anaesthesia should not be used with:
Why?
Should be used with?
necrotic pulps and periapical pathosis or with cellulitis or abscess formation
This would be very painful and likely not provide profound anesthesia
Symptomatic Irreversible pulpitis
Intraosseous anaesthesia:
specialized equipment examples:
onset:
deposit anaesthetic directly into the cancellous bone around the root apex / apices
- specialized equipment examples: X-Tip (Dentsply), Stabident
- mesial or distal infiltration prior to cortical bone perforation
- rapid onset
Intrapulpal anaesthesia
What is the mode of action?
What you should always do for this type?
techniques used:
• Mode of action: strong back-pressure
• ALWAYS inform patient before administration
• techniques:
a) small hole in pulp chamber
b) use stoppers in the pulp chamber like cotton pellet or gutta-percha
c) apply the solution directly into the root canals
Management of the “Hot” pulp
Symptomatic Irreversible pulpitis
type of anaesthesia:
Premedication:
when do you give that?
- anxiety, fear
- fatigue
- tissue inflammation
- Increase dose of anaesthetic solution
- Supplemental anaesthesia: Intraligamental, Intraosseous, Intrapulpal
- Premedication 1 hour or 30minutes before anaesthetic administration: (if they had pain and they needed it)
- ibuprofen (400mg)
- paracetamol (1000mg)
Endodontic Lesion =
Endodontic lesions can be:
a change detected in the periradicular area (the surrounding bone), that is caused by an endodontic disease
1.Radiolucent 2.Radiopaque
Which is the most frequently seen radiolucent endodontic lesion?
Apical Periodontitis
SOS
Which conditions may develop without any changes in the bone seen on a radiograph?
On what information you should rely on then?
- Acute symptomatic Apical Periodontitis
- Apical Abscess
- Pulp Necrosis (without infection)
-Acute inflammation may develop without much
change in the surrounding bone. Thus may not be detected on a radiograph
- Dental History
- Clinical findings (percussion, palpation vitality tests, etc)
On which cases can you see any radiographic change in Chronic asymptomatic Apical Periodontitis?
Chronic asymptomatic Apical Periodontitis results in a granuloma formation at the portal of exit. then the granuloma exists at the expense of bone. so radiographical changes may be visible as long as the bone resorption affects the CORTICAL BONE
What we expect to see with endodontic lesions?
origin and location:
Starting points and anatomical location of apical periodontitis: examples:
origin arise secondary to pulpal breakdown products and form next to canal portals of exit
a) apical foramen or delta
b) lateral canal
c) accessory canal at the furcal area
SOS
Portals of Exit:
Natural anatomic features:
Acquired defects:
any opening from the root canal system to the periodontal ligament space
Natural anatomic features:
• apical foramen
• lateral / accessory canals
• furcal / FURCATION FORAMINA
Acquired defects:
• perforations (root and pulpal floor)
• root fractures
Mild pain:
aspirin-like drugs indicated:
aspirin-like drugs contraindicated:
aspirin-like drugs indicated: ibuprofen 400-600mg
aspirin-like drugs contraindicated: Paracetamol 325mg
Acetaminophen=Paracetamol
Moderate pain:
aspirin-like drugs indicated:
aspirin-like drugs contraindicated:
aspirin-like drugs indicated: ibuprofen 400-600mg + Paracetamol 325mg
aspirin-like drugs contraindicated: Paracetamol 650mg
Severe pain:
aspirin-like drugs indicated:
aspirin-like drugs contraindicated:
aspirin-like drugs indicated: ibuprofen 400-600mg + Paracetamol 300mg + Hydrocodone 7.5mg
aspirin-like drugs contraindicated: Paracetamol 325mg and Oxycodone 10mg
Which radiograph is considered adequate?
1) Hard Tissues clearly visible • enamel • dentine • lamina dura • alveolar bone, alveolar crest 2) 2-3 mm of periapical area visible 3) recently taken 4) taken with the Paralleling technique so that it has MIN DISTORTION -Avoid this with patients that have/are: • intense gag reflex • low palatal vault • maxillary or mandibular torus • uncooperative
Anatomical landmarks : mandibular canal, mental foramen, incisive foramen and canal, zygomatic arch, canine fossa, nasal cavity and nasal conchae, mandibular and maxillary tori, etc
Importance of the initial radiograph(s):
- Diagnosis
- Assess Difficulty and Possible Challenges during treatment
- Prognosis of treatment
- Estimate Working Length
Estimated Working Length can differ a few mm from the actual/final working length for a few reasons:
• angulation of the radiograph
• the software that is used
• not possible to clearly locate the definitive clinical
reference point on the radiograph
When examining the pulp chamber on a radiograph we need to look for:
- dimensions
* calcifications, pulp stones
When examining the Roots and Root Canals on a radiograph we need to look for:
- Calcifications !!!!!
- Curvatures !!!!!
- Splitting of canal !!!!
- Resorption !!!!!
- C-shaped molars !!!!!
- Dimensions
- Three rooted premolar
- radix entomolaris
- radix paramolaris
When examining the Periradicular area on a radiograph we need to look for:
• Radiolucency • Radiopacity • Bone Loss -Horizontal -Vertical
SLOB rule:
Same Lingual, Opposite Buccal
- the buccal moves furthest away, the lingual moves in the direction of movement or stays in the same place
- it helps us differentiate b/w 2 canals
If the x-ray is at the distal side of the lower molar tooth which canal will be?
DB close to the xray
MB away from it
If the x-ray is at the distal side of the lower premolar tooth which canal will be?
lingual closest
buccal away
How many radiographs do we usually need for an endodontic treatment?
we need at least 4 radiographs
Steps of an endodontic treatment
1. Consultation - Diagnosis • initial radiograph(s) 2. Access Opening and Location of Root Canal Entrances -tooth isolation 3. Cleaning and Shaping • working length determination -disinfection 4. Obturation • with a gutta-percha point before obturation • final radiograph after obturation 5. Restoration -without leakage
Rotary and Reciprocal Root Canal Preparation
- Rotary files
- Reciprocating files
1.Rotary files
• they work in continuous rotation
a. Passive (less aggressive)
b. Active (more aggressive)
2.Reciprocating files
• reciprocating rotation
• clockwise and anticlockwise movement
• try to mimic the manual movement
- faster than hand files
- DISADV: higher possibility of fracture in a root
- they are used with electric motors
Endodontic Motors types:
- Electric Motors with Gear Reduction (you can change the speed of rotation using gears)
• handpiece 6:1 transmission - Speed (rpm) and Torque (Ncm) are pre-programmed so you can choose
- Rotation or Reciprocation (back and forth)
Reduction Low Speed Handpiece:
initial speed:
transmission:
preferred final speed:
- The initial speed of the dental unit can be up to 40.000 rpm
- The transmission can be 8:1 or 32:1
- The preferred final speed is usually around 250-300 rpm
Power Assisted Root Canal Instruments and Motors types:
- Passive preparation - Radial Lands
- Active cutting - Triangular cross section
- Special Cases
SOS
Common Characteristics of files and instruments:
- Assist in Straight Line Access Opening
- Flaring of the Coronal and Middle third of the root canal
- Mostly they follow the Step-Down, Crown-Down sequence or a modification. The specific technique is based on the instrument selected
- NOT in unexplored canal; should always follow hand instruments which establish a glide path
- Assist in Apical Preparation
Step-Down technique steps:
difference with crown down technique:
- Access cavity
- Check the Patency of the root canal with a small K file #10 and/or 15
- Establish the Working Length
- Shape the coronal 1/3 or 2/3 of a root canal (Coronal Flaring) with GG burs or Orifice Shapers
- Apical Instrumentation
-OPPOSITE 3 AND 4 FOR CROWN DOWN TECHNIQUE
Crown-Down technique steps:
- Access cavity
- Check the Patency of the root canal with a small K file #10 and/or 15
- Shape the coronal 1/3 or 2/3 of a root canal (Coronal Flaring) with GG burs or Orifice Shapers
- Establish Working Length
- Apical Instrumentation
-OPPOSITE 3 AND 4 FOR STEP DOWN TECHNIQUE
Lateral Compaction
Cold Lateral Condensation steps:
-Obturation technique
1.Spreader selection (placed w/in 1-2 mm of the WL)
2.Master GP Cone selection
•(GP cone to the WL)
• the size of GP should be the similar to the instrument used in the apical preparation
3.Sealer Placement
-can be done with a Master GP Cone or a hand file
-GP is removed by heat
4.Cold Lateral Compaction (steps:)
-Master Cone placement
-Spreader inserted 1-2 mm from the Working Length
-a)Spreader removed b)Accessory Cone is placed
-Repeat until the root canal is completely filled
SOS
Obturation =
procedure used to fill and seal a CLEANED AND SHAPED (without those is impossible to have a good obturation) root canal system using a root canal sealer and a core filling material
What is the biological requirement of root canal obturation?
Why?
- Hermetic seal of entire root canal
- WITHOUT EXTRUSION of obturation materials beyond the apex
B/c of bacteria remaining from crown restoration
To avoid that, is to have a good hermetic seal
SOS
Obturation prevents:
- the ingress of microorganisms into RC by coronal leakage (to prevent inflammatory rxn)
- the multiplication/growth of microorganisms remaining in RC
- in almost all of the cases we have bacteria remaining in the RC
- To avoid that is to have a good hermetic seal
SOS
Hermetic seal prevents:
PERCOLATION OF
- BACTERIA GROWTH
- TISSUE FLUID into pulp space via apical foramina/lateral canals or furcal canals, bacteria into the pulp canal space via interconnections with the gingival sulcus or periodontal pockets (into RC)
Ideal periapical healing:
- absence of periapical inflammation
- cementum deposition at the apical foramina
SOS
Evaluation of the technical quality of obturation:
Length
Density
Gutta -percha-sealer/ratio
Complete Obturation =
good density and good extension
Underfylling Obturation =
good density, but bad extension
- most often
- risk of developing apical periodontitis
Overfilling Obturation =
good density, but extension beyond apex
-risk of developing apical periodontitis
Incomplete Obturation =
not good density but good extension
Incomplete obturation with underextension =
not good density and underextension
Incomplete obturation with overextension =
not good density and overextension
-risk of developing apical periodontitis
Does technical quality of obturation influence the outcome of root canal treatment?
Underfilling with or without good density is:
Overfilling or overextension with or without good density is:
yes
Underfilling with or without good density is
- a risk for developing apical periodontitis in vital teeth
- a certain maintenance of apical periodontitis in necrotic teeth
Overfilling or overextension with or without good density is:
- a risk for developing apical periodontitis in vital teeth
- a long-term delay in healing of apical periodontitis in necrotic teeth
SOS
Cold Lateral Vs Warm Vertical Condensation Techniques:
ADV Vs DISADV:
Cold Lateral ADV: Working length control DISADV: Nonhomogeneous filling with separate cones
Warm Vertical
ADV:
Obturation of RC irregularities & accesssory canals
DISADV:
Less length control and potential apical extrusion
Techniques of RC obturation:
Contra-indications:
CLC technique:
WVC technique:
CLC technique:
- RC of oval shape and incompletely instrumented
- RC with internal root resorption
WVC technique:
- Apices which have been MOVED from their normal position
- Open apices without apical plug
- Apices which have opened due to root resorption
Teeth with Pulp inflammation have:
Increased BP
Increased tissue pressure
Inability of pulp to expand
Lack of collateral blood circulation
-leads to pain of all nerves and spread of inflammation
Pulp Inflammation can lead to:
Reversible pulpitis -> Generized pulpitis -> Pulp necrosis -> RC infection -> Apical periodontitis -> Bone destruction, Pain/swelling, Odontogenic infection
-Pulp necrosis does not mean that vital pulp is totally absent in the whole canal or in all canals of a multi-rooted tooth
Indications for pulpectomy/RCT:
- painful pulpitis
- pulp exposure
- elective treatment in periodontal and prosthodontic therapy
Pulpectomy is carried out to prevent the destructive course of pulpitis which may result in RC infection and associated apical periodontits
Critical measures for a predictable outcome:
Anesthesia
Aseptic technique
Access cavity preparation, entire pulp removal
Root canal cleaning and shaping in the whole working length
Effective root canal disinfection protocols
Hermetic obturation
Follow-up
How to control aseptic conditions?
Avoid contaminating the pulp space with:
remove caries with complete excavation
eliminate restorations
rubber dam tightened to tooth structure
tooth DISINFECTION before cavity access prep
Infected debris
Saliva or gingival exudate
Non-sterile instruments
How to disinfect the operating field?
NaOCl or CLX or Iodine
Pulp tissue extirpation:
By performing a pulp extirpation, your dentist can remove the infected or damaged soft tissue inside your toot
Instruments:
- Barbed broach or rotary files in large canals
- K-files in narrow canals
Barbed broach: insertion-rotation-withdrawal
Use of reamers/files: insertion-reaming-withdrawal
Operation:
- The wound healing level should ideally be placed slightly short of the apical constriction
- WL determination !!!!!! (need to know this before the pulp tissue extripation)
- Shaping at least up to MAF and irrigation of root canal for control of bleeding
A common complication after pulp extripation:
Reasons of bleeding in the root canal:
Inappropriate WL
Pulp remnants at the apical part of the canal
Bleeding from PDL
If RCT will be completed in 1 visit, the tissue reorganization depends on: / Reasons to postpone obturation are:
- Injury from cleaning and shaping
- Potential toxicity of the sealer
Treatment of non-infected cases is a prophylactic strategy to prevent:
- contamination and growth of microbes in the RCT
- development of symptomatic/asymptomatic apical periodontitis
Aim of RCT in necrotic teeth:
to impede RC infection spread and their products to periapical area and their metastasis to distant organs
Pathogenesis of apical periodontitis requires:
infection of the apical end of root canal
-main difference with vital teeth
The egress of microorganisms and their products from infected RC through:
-apical, or lateral foramina
-dentinal tubules
-iatrogenic root perforations
can directly affect the surrounding periodontal tissues and give rise to pathologic changes in these tissues
Routes by which the microorganisms reach the pulp:
Direct communication with oral environment
- Exposed pulp undergoes inflammation, necrosis and infection
- Pre-requirement for apical pulp infection is the necrosis of coronal root pulp
- As long as the pulp is vital, dentinal exposure to oral environment does not represent a significant route of endodontic infection
- However if the vitality of pulp is compromised and the defense mechanisms are impaired, very few days are needed to initiate infection
Dentinal tubules
- After a carious lesion or during dental procedures, microorganisms may use the transdentinal pathway in a direction to reach the pulp
- Dentin permeability is not uniform
- Bacteria gain access to the pulp when the dentin distance between the border of carious lesion and the pulp is <0.2 mm in absence of tertiary dentin zone
Periodontal membrane
- Microorganisms from infected root canals directly affect the periodontal tissues and induce periodontal disease
- Theoretically, microorganisms from gingival sulcus may reach the pulp chamber through the periodontal membrane, exposed dentinal tubules, lateral canals or the apical exit
- Once the pulp becomes necrotic bacteria can reach the RC
Blood stream
Leaking restoration
Ecological conditions in different areas of the RC of a necrotic pulp:
Coronal Region Vs Apical Region
oxygen:
bacterial counts:
accessible to treatment:
-nutrients from periradicular tissues:
Apical Region:
- lower oxygen
- lower bacterial counts
- less accessible to treatment
- nutrients from periradicular tissues: proteins and glycoproteins
Coronal Region:
- more oxygen
- more bacterial counts
- more accessible to treatment
- nutrients from periradicular tissues: carbohydrates
Intraradicular endodontic infections:
Definitions:
Primary infections:
Secondary infections:
Persisting infections:
Primary infections:
Bacteria that invade the NECROTIC PULP and they are responsible for apical periodontitis
Secondary infections:
Bacteria that invade the RC as a result of LEAKAGE in the coronal restoration or during the RCT
Persisting infections:
Bacteria that resist the intracanal antimicrobial procedures during RCT and are responsible for failures or post-treatment apical periodontits
-caused by bacteria that survived in treated canal
-involved microorganisms are remnants of primary and secondary infections
-microorganisms entering the RC secondary to professional intervention
Asepsis is maintained in RCT of infected teeth. Why?
To exclude contamination of bacteria that have greater resistance to disinfection protocols of RCT
(facultatively anaerobic gram-positive bacteria- enterococci)
SOS
In what type of infection are these two microbes involved?
Actinomyces
- primary and persistent infection
- A short-term course of antibiotics is often insufficient to control actinomycotic infections
E. faecalis
-persistent infection
SOS
Basic measures to maintain asepsis in RCT of infected teeth.
Removal of caries, old fillings
Disinfection of the operative field and rubber dam with an antiseptic
After access cavity preparation and before any search for root canal openings the access cavity is filled with a biocompatible antiseptic irrigant, e.g., sodium hypochlorite
Don’t leave the tooth with open cavity to the environment to prevent contamination of infected teeth with other bacteria in the interappointment !!!
SOS
Critical measures in cleaning and shaping for a predictable outcome:
-started with ENLARGEMENT OF CORONAL PART of RC and thin instruments to avoid pushing necrotic, infected material through the apical foramen
-by continuous using copious amounts of irrigation solution (STANDARD IRRIGATION PROTOCOL)
When the cleaning and shaping is finished, the canal is DRIED and FILLED with a CaOH PASTE
-The canal can be filled during the next visit if there are no symptoms, no exudate
SOS
Aim of the diagnosis in endodontics:
The clinical examination, but with limited impact in diagnosis of pulp diseases
SOS
Dental history of pulpal diseases - Focus on:
Discomfort (characteristics of pain)
Swelling (indicates pulp necrosis)
History of trauma
History of recent dental work
Endodontic diseases are likely to have a history
SOS
Useful information from clinical/radiographic examination
Deep carious lesion (characteristics) Positive percussion (indicates pulpal necrosis) Radiographic findings from apical tissues (indicate pulpal necrosis)
SOS
Cases with Thermal tests:
- for cold test use:
- for hot test use:
Case 1:
Case 2:
Case 3:
for a healthy pulp: heat and cold rxn times:
- hot or cold stimulus (hot is a risk)
- for cold test use: ice pellets, CO2 sticks, skin refridgerant
- for hot test use: cotton pellets with metal forcepts
Case 1: If control(+) and testing tooth(+) the only conclusion should be: pulp is vital
Case 2: If control(+) and testing tooth(-) the conclusion should be: pulp necrosis
Case 3: If control(-) repeat it with another control
for a healthy pulp:
Heat – The initial response is delayed and pain intensity tends to increases as the stimulus is maintained
Cold – The initial response is immediate and pain intensity tents to decrease as the stimulus is maintained
Electrical pulp test:
when is it used? when it's not used? what materials do you use for it? results: what correlation must be done?
- when natural tooth structure is available and the results of the thermal tests are inconclusive
- topical anesthetic gel or toothpaste, should be used
- cannot be used on restorations and is not reliable when placed too close to the gingiva
- The presence of a response indicates that the pulp is vital, whereas the absence of response indicates pulp necrosis
results:
- A response before the maximum of the scale means that there is some vital pulp tissue inside the tooth
- No response at the maximum number means that there is not vital tissue
- false +ve and false -ve may occur
-correlation b/w findings of cold and EPT
Reversible pulpitis:
It is usually asymptomatic and responds normally to vitality tests
No history of continuous or spontaneous pain
When present symptoms follow the pattern:
Application of hot, cold, produce sharp TRANSIENT pain
Removal of the stimulus results in immediate relief
Irreversible pulpitis:
It may be usually symptomatic
Episodes of continuous spontaneous pain in current or past dental history !!
The pain may be sharp, dull, localized or diffused lasting from few minutes up to a few hours
Different response to thermal stimuli from those in normal pulp: heat produces an immediate pulp response cold produces immediate response or may cause transient relief of a continuous dental pain
Pulp necrosis:
- It is asymptomatic with no response to sensibility tests
- May be associated with spontaneous pain in presence of apical heperemia (initial phase of apical periodontitis)
- Does NOT mean that the vital pulp is totally absent in the whole canal or in all canals of a multi-rooted tooth
SOS
Root resorption:
=
classified based on:
is the NON BACTERIAL DESTRUCTION of the mineralized cementum or dentine due to the interaction of clastic cells and dental hard and soft tissues
- pathologic nature
- classified based on histology, aetiology or origin
SOS
Which 2 things prevent the resorption of the roots?
from internal root resorption:
from external root resorption:
from internal root resorption: predentin
from external root resorption: unmineralised organic cementoid
-odontoclasts cause resorption
SOS
Classification of root resorption - examples:
Internal:
External:
Internal:
inflammatory and replacement
External:
inflammatory, replacement, cervical, surface and transient apical breakdown
Internal inflammatory resorption:
=
how is it caused?
how is the diagnosis made?
a result of damage to the predentin by:
-physical tooth trauma (partial ischemia) or pulpitis
- If the tooth loses pulp vitality, resorption will end
- diagnosis is made radiographically
External inflammatory resorption:
on which cases it occurs?
characteristic:
progression dictated by:
how is it stopped?
- It occurs in teeth with infected necrotic root canals or teeth with apical periodontis
- The roots may appear shorter than normally expected
- can cause difficulties in determining the working length and complete preparation and obturation of root canals
- due to trauma or injuries of tissues
- progression dictated by the pulp status
- after control of pulp infection resorption stops
Transient apical breakdown (TAB):
characteristic:
associated with:
radiographical findings:
- is a non-infected transient resorption of the apical portion of the root and the adjacent bone
- associated with dental injuries
- Radiographically, there is initial widening of the PDL space and loss of apical LD (after a year they restore)
External replacement resorption:
how is it caused?
treatment:
results in:
- severe dental injuries
- occurred after dental trauma in a developing dentition resulting in infra-occlusion
- may degenerate due necrosis of PDL cells
- no available treatment
- PDL, cementum and root dentin, become resorbed via osteoclasts and replaced with alveolar bone laid down by osteoblasts as part of the repair process
SOS
External cervical resorption:
caused by:
location:
associated with:
- in cervical area of tooth
- It may be misdiagnosed as caries in the radiographic examination
- A pink spot in the cervical aspect of the tooth can be rarely seen !!!
- Pink spots: differential diagnosis based on radiographic examination is required
- associated with maintenance of pulp vitality
SOS
Differential diagnostic procedure is a systematic diagnostic method used to identify the:
The intermediate step in the identification of final diagnosis is the:
final disease entity (NOT final diagnosis)
tentative diagnosis
SOS
Treatment planning in endodontics:
No treatment –wait and see (in tentative diagnosis)
Vital pulp therapy and pulp protection (in normal pulp or reversible pulpitis)
RCT (in irreversible pulpitis or apical periodontitis or abscess)
Surgery (in repeated root canal treatments, persisting infections)
SOS
Pulpal conditions:
- Normal pulp
- Reversible pulpitis
- Irreversible pulpitis
- Pulp necrosis
- Differential diagnosis: 2 from 3:
- Differential diagnosis: 1 from 2:
- Differential diagnosis: 1 from 4:
Differential diagnosis: 1 from 2 (dental history)
Differential diagnosis: 2 from 3 (dental history, percussion)
Differential diagnosis: 1 from 4 (sensibility testing)
dental history = type of pain
SOS
Periapical conditions: A. Normal periapical tissues B. Symptomatic apical periodontitis C. Asymptomatic apical periodontitis D. Condensing osteitis E. Acute apical abscess F. Chronic apical abscess
- Differential diagnosis: B from C
- Differential diagnosis: B from D
- Differential diagnosis: B from E
- Differential diagnosis: B from F
- Differential diagnosis: C from E
- Differential diagnosis: E from F
Differential diagnosis: B from C (dental history, x-ray, percussion)
Differential diagnosis: B from D (dental history)
Differential diagnosis: B from E (dental history, x-ray)
Differential diagnosis: B from F (dental history, sinus tract, percusssion)
Differential diagnosis: C from E (dental history, swelling, percussion) !!!!
Differential diagnosis: E from F (swelling, sinus tract)
SOS
The pulpal-type pain result from conditions of chronic irritation of the 5th cranial nerve:
Trigeminal neuralgia Atypical facial pain Temporomandibular disorder (TMD) Occlusal discrepancies Maxillary sinusitis Other etiologies (cardiogenic, neoplasmatic, post herpetic)
Best material for obturating a root canal of a tooth is: A. Thermoplastic GP B. Silver cone C. Resorbable paste D. GP with sealer
D. GP with sealer
Obturation of a root canal should achieve: A. Tug back B. Hermetic seal C. Fluid free seal D. All of the above
D. All of the above
The success of a root canal filling is best assessed by: A. Clinical observation B. Size of gutta percha cone used C. radiographs D. the diameter of root canal reamer
A. Clinical observation
Main cause of failure of endodontic therapy: A. Improper biomechanical preparation B. Improper access cavity preparation C. Incomplete obturation D. Over extended filling
C. Incomplete obturation
The main aim of obturation is:
A. Fill the canal and prevent apical percolation of fluids
B. Fill the canal and prevent discoloration of teeth
C. Fill the canal and give support to the restoration
D. All of the above
A. Fill the canal and prevent apical percolation of fluids
Best method of condensation is: A. Lateral condensation B. Thermoplasticized C. Vertical condensation D. None of the above
A. Lateral condensation
Most common cause of RCT failure: A. Incomplete removal of PA cyst B. Non obturation of accessory canals C. Incomplete debridement with improper obturation D. Large size of PA pathology
C. Incomplete debridement with improper obturation
Master cone is:
A. Fully snug fit with accurate working length
B. used by master of staff
C. instrument first used in taking working length
D. last file to fit loosely
A. Fully snug fit with accurate working length
Internal resorption is due to: A. Pulp Necrosis B. Acute inflammation of pulp C. Chronic inflammation of pulp D. None of the above
C. Chronic inflammation of pulp
Pain due to acute "irreversible" pulpitis is: A. Spontaneous B. Sharp C. Lasting for short time D. Both A and B
D. Both A and B
Periapical Osteosclerosis or Condensing Osteitis:
low grade response of the body to mild irritation
There is diffuseness and a concentric arrangement of increased trabeculation around the apex
-radiopaque lesion
The pulpal response ranges from transient reversible to irreversible pulpitis by which factors?
severity
duration
host response
Step down technique
When is the Shaping of coronal 1/3 or 2/3 of root canal done?
before:
after:
before apical instrumentation and after WL established
Shaping of coronal 1/3 or 2/4 of root canal done w/:
Gates glidden bur
Which is to prevent non-infected teeth? •Asepsis •Antisepsis •Disinfection •None
•Asepsis
Disinfection means that the tooth is already affect
To prevent infection aseptic techniques are used - asepsis is for living
What plays a beneficial role for stimulation of hard tissue repair?
dentinal debris during instrumentation
Surface resorption : pressure- induced resorption:
more extensive non-inflammatory root resorption is induced by the pressure of a crypt of an unerupted tooth or more commonly during orthodontic treatment
vitality and function of the pulp is maintained
often extensive and easily observable radiographically
induced by dental trauma or usually during orthodontic treatment
with the removal of the initiating “trauma”, these non-inflammatory resorptions will become inactive and partial repair will occur
Standard irrigation protocol:
Starting phase:
After shaping with MAF:
Finishing phase:
Last irrigation:
Starting phase: NaOCl 3%, sterile saline
After shaping with MAF: NaOCl 3%, saline, EDTA 17%, saline
Finishing phase: NaOCl 3%, saline
Last irrigation: CHL 2%, saline
Pulp necrosis can be seen only if:
the periodontal pocket reaches the apex
