Guide to Clinical Endodontics Flashcards
why do we need to examine and diagnose endodontic problems
to determine diagnosis and treatment need
determine cases too complex for level of training
determine if wise to consult with others
what is apexogenesis
vital pulp therapy performed to allow continued physiological development and formation of the root
remove portion of pulp and apply medicament
what are the indications for apexogenesis
deep caries - pulp exposure
no pretreatment symptoms
controlled bleeding
what are the aims of apexogenesis
prevent adverse clinical signs
prevent breakdown of periradicular tissues
obtain radiographs of root development
what is a pulpotomy
surgical removal of coronal portion of vital pulp tissue and biological material placed in pulp chamber and restored
when is a pulpotomy indicated
exposed vital pulps
irreversible pulpitis of primary teeth
emergency treatment for permanent if cannot start RCT
for permanent teeth with immature roots before RCT can happen
what are the aims of a pulpotomy
prevent adverse clinical signs
get radiograph of root for endo treatment
prevent breakdown of periradicular tissues
prevent resorption or canal calcification
what is pulpal debridement (pulpectomy/extirpation)
surgical removal of entire pulp tissue
what are the indications for pulpectomy
relief for acute pain before conventional RCT when RCT cannot be accomplished at that appointment
what is the aim of a pulpectomy
relief of acute pain until complete treatment can happen
what is indirect pulp capping
2 visits 6 months apart
remove caries but leave some over pulp and place CaOH and restore
next visit remove all caries and CaOH and then restore
what are the indications for indirect pulp capping
deep caries - pulp exposure
no pretreatment subjective symptoms
no periradicular pathology
what are the aims of indirect pulp capping
prevent clinical signs
obtain radiographs for root development
prevent breakdown of periradicular tissues
prevent resorption or canal calcification
what is direct pulp capping
material placed onto surface of vital pulp at exposure site and restored
what are the indications for direct pulp capping
mechanical exposure of pulp
controlled bleeding
material can be in direct contact with pulp
exposure when tooth is under dam
coronal seal can be maintained
what are the aims of direct pulp capping
prevent clinical signs
develop contact of biocompatible radiopaque capping material with pulpal tissue
maintain normal responsiveness to electrical and thermal pulp tests
prevent breakdown of periradicular supporting tissues
what are the benefits of using dental dam for endodontics
minimise risk of contamination of root canal by indigenous oral bacteria
aid visualisation by providing clean operating field
prevent aspiration/ingestion of materials
when would RCT be indicated on primary teeth
irreversible pulpitis or necrosis with no permanent successor
necrosis with/without periradicular disease
treatment will not damage permanent successor
what do you obturate with when there is a permanent successor present
a material which will resorb at similar rate to tooth (not GP)
if there is no permanent successor present what do you obturate primary teeth with
GP and sealer
what are the aims of RCT in primary teeth
alleviate symptoms
create well obturated canal
prevent breakdown of periradicular tissues
allow resorption of root structures and material when successor erupts
what are the indications for RCT for permanent teeth
irreversible pulpitis
necrotic pulp
compromising pulp due to dental procedures
placement of a post
fractured teeth with pulpal involvement
thermal hypersensitivity
what is pulp regeneration
remove pulp
place antimicrobial in canal and temporise
bring patient back
open canal and irrigate
overinstrumentation to induce bleeding
clot in canal
place MTA (3-4mm)
close canal permanently
reassess root development
what are the indications for pulp regeneration
incomplete root development and incomplete apical closure
when you cant use apexogenesis due to necrotic pulp
what are the aims of pulpal regeneration
treat apical periodontitis
induce radiograph of apical closure without breakdown of supporting tissues
retain dentition during craniofacial development
promote root development
what is apexification
clean and shape canal and pack with biologically appropriate material to create an apical barrier
what is the indication for recalcification
treating external and internal resorptive defects perforating to external surface
what is the aim of recalcification
encourage biological root repair
what is the procedure for recalcification
clean and shape canals and pack with material promoting resorptive repair
what are the indications for re-root treatment
continued periradicular pathosis
defiecient RCF quality
persistent symptoms
restorative procedures requiring re-RCT
what are the aims of re-root treatment
alleviate symptoms
create well obturated canal
maintain health of periradicular tissues
what is incise and drain
make a surgical opening in soft tissue to release exudate or decompress area of swelling
what are the indications for incise and drain
if pathway is needed to soft tissue with swelling to provide necessary drainage
when pain due to accumulation of exudate in soft tissues
when need to collect samples
what are the aims of incise and drain
alleviate symptoms
reduce localised soft tissue swellings
promote repair of soft tissues
prevent damage to teeth or anatomical structures
what do you do for an enamel fracture
smooth or resin bond or bond fragment back
what do you do for uncomplicated crown fracture
repair with bonded resin or bonding fragment back
composite bandage
what do you do for complicated fracture of immature tooth
pulp capping or partial pulpotomy
what do you do for complicated fracture of mature tooth
if doesnt need a crown then vital pulp therapy
if needs a crown then RCT
what is the treatment for crown-root fracture of immature tooth
pulp capping then wait until mature to do RCT
what is the treatment for crown-root fracture of mature teeth
RCT
what is the definitive care of avulsion with less than one hour of dry time
for immature - apexification then RCT
for mature - RCT within 7-10 days of reimplantation
what is the definitive care of avulsion with more than one hour dry time
RCT
what teeth are not suitable for re-implantation after avulsion
teeth with immature apices and extra-oral dry time greater than one hour
primary teeth
what is the emergency care for alveolar fracture involving teeth
reduction of alveolar segment and splint for 4-6 weeks
what is the definitive care for alveolar fracture involving teeth
RCT after evaluating pulpal status of teeth
what are the indications for a post
remaining coronal tooth structure is inadequate for retention of restoration
sufficient root length to accommodate the post
adequate ferrule
what are the aims of placing a post
retain core
place along long axis of tooth
avoid perforations or root fractures
preserve apical seal
eliminate space between post and surrounding tooth structure
place post in root structure that is supported by bone
minimise contamination of root canal system
what is the indications for a core
replacing coronal tooth structure
enhanced retention and resistance to displacement is necessary
what are the aims of a core
provide retention for final restoration
occupy entire pulp chamber
core does not perforate pulp chamber floor
eliminate space between core and root canal filling material
what type of restoration should be on a posterior tooth after RCT
full cuspal coverage
when is it indicated to remove a post/post and core
loss of retention
recurrent caries
fracture of post/core
access for RCT is necessary
what are the aims of post and core removal
minimise damage to tooth/adjacent teeth
alleviate symptoms
remove entire post
avoid root fractures or perforations
