Intro to endo

Question 1

What is Endodontics?

Answer 1

Branch of clinical dentistry concerned with the prevention, diagnosis and treatment of endodontic disease

Question 2

Which tissues are affected by endodontic disease?

Answer 2

Enamel, dentine, pulp, periapical tissues.

Pulp and PA tissues in advanced cases.

Question 3

List 5 constituents of the pulp.

Answer 3

Cells, ECM, blood vessels, Nerves, Lymphatics

Question 4

Which types of collagen are found in the pulp?

Answer 4

Types I and III

Question 5

Which cell types are found in the pulp?

Answer 5

Odontoblasts, fibroblasts, undifferentiated mesenchymal cells, white blood cells

Question 6

Which part of the pulp has the greatest concentration of collagen fibres?

Answer 6

Apical 1/3

Question 7

How should a barbed broach be used?

Answer 7

At the apical third of pulp (collagenous part) to remove the pulp as one

Question 8

What innervates the pulp?

Answer 8

Maxillary and mandibular division of trigeminal nerve

Question 9

How are pulpal fibres split?

Answer 9

80% C fibres

If A fibres, 90% are Aδ.

Question 10

Differences between Aδ and C fibres?

Answer 10

Aδ - myelinated, good localisation of pain, sharp quick pain, stimulated by hydrodynamic fluid movement; C - unmyelinated, poor localisation of pain, dull lingering pain, stimulated by intense thermal or mechanical sensation.

Question 11

What can cause pulpal injury?

Answer 11

Caries, perio, restorative treatment, trauma

Question 12

What happens in Pulpal inflammation?

Answer 12

Increased blood flow, increased inflammatory infiltrate, increased release of lysozymal enzymes, increased hydrolysis of collagen, increased vascular permeability, increased fluid in pulpal interstitial space, increased pulpal pressure, decreased lymphatic drainage.

Question 13

What is average intra Pulpal pressure?

Answer 13

10mmHg

Question 14

What is the intra Pulpal pressure during reversible pulpitis?

Answer 14

Up to 13mmHg

Question 15

What is intra Pulpal pressure during irreversible pulpitis?

Answer 15

Up to 35mmHg

Question 16

How does supine position affect intra Pulpal pressure?

Answer 16

Increases it

Question 17

How can epinephrine affect Pulpal pressure?

Answer 17

Decreases blood flow so can reduce it

Question 18

What are the three general types of endodontic pathology?

Answer 18

Pulpal pathology, radicular pathology, periradicular pathology

Question 19

What are the different types of pulpal pathology?

Answer 19

Pulpitis, chronic hyperplasia / pulp polyp, pulpal degeneration, necrosis

Question 20

What are the different types of radicular pathology?

Answer 20

Fracture, resorption (inflammatory, replacement, internal, external, cervical, apical)

Question 21

What are the different types of peri radicular pathology?

Answer 21

Periapical periodontitis, granuloma, radicular cyst, PA abscess (+/- sinus), condensing osteitis

Question 22

How can pulpal pathology be described?

Answer 22

Reversible/irreversible, Symptomatic/asymptomatic, Partial/complete

Question 23

How can periapical pathology be described?

Answer 23

Acute/chronic, Symptomatic/asymptomatic

Question 24

What is Pulpitis?

Answer 24

Inflammation of the dental pulp due to injury or infection

Question 25

What is Apical periodontitis?

Answer 25

Inflammation and destruction of the periradicular tissues caused by aetiologic agents of endodontic origin often as a result of pulpal necrosis

Question 26

What is apical periodontitis more common with?

Answer 26

Increased age, Decreased education, Reduced dental access, Heavily restored dentitions, Previously root filled teeth

Question 27

What are the two types of radicular cyst?

Answer 27

Bay cyst - connects directly to apical tissues - no epithelium over apical tissues; True cyst - epithelium barrier over apical tissues / foramen

Question 28

Briefly, what happens during a root canal treatment?

Answer 28

LA, access, pulpal extirpation, canal shaping, decontamination, obturation, coronal seal

Question 29

What are the two types of vital pulp treatment?

Answer 29

Direct pulp cap, Pulpotomy

Question 30

What do we use to cap the pulp in pulp caps or pulpotomy?

Answer 30

Mineral trioxide aggregate (MTA) NOT calcium hydroxide anymore

Question 31

What are some different types of vital pulp treatment?

Answer 31

Indirect pulp cap, Selective carious tissue removal, Stepwise excavation, Direct pulp cap, Partial pulpotomy, Full pulpotomy

Question 32

What is Indirect pulp cap?

Answer 32

Single stage caries removal to hard dentine; Biomaterial placement over thin layer of remaining dentine

Question 33

What is Selective carious tissue removal?

Answer 33

Selective caries removal to soft or firm dentine on pulpal wall; Biomaterial placement on pulpal wall of cavity

Question 34

What is Stepwise excavation?

Answer 34

First stage removal of caries to soft dentine on pulpal wall and temporisation; 6-12m later caries removal to firm dentine, biomaterial and permanent restoration

Question 35

What is Class I direct pulp cap?

Answer 35

No pre-op deep caries i.e. pulpal exposure due to trauma or iatrogenic damage

Question 36

What is Class II direct pulp cap?

Answer 36

Carious exposure, disinfectant and calcium silicate used

Question 37

What is Partial pulpotomy?

Answer 37

Removal of small portion of coronal pulp; Placement of biomaterial and restoration

Question 38

What is Full pulpotomy?

Answer 38

Removal of all coronal pulp; Placement of biomaterial and restoration

Question 39

What is Orthograde re-root treatment?

Answer 39

No surgical re-root treatment where access is gained coronally, through the original access cavity

Question 40

What is Retrograde (surgical) re-root treatment?

Answer 40

Flap raised, access gained apically

Question 41

What is Apexification?

Answer 41

The treatment of the apex of the root canal in a tooth that is necrotic to induce closure so a root filling can be achieved; Can create a false apex with MTA

Question 42

What is Apexogenesis?

Answer 42

Treatment for a tooth with an open apex to preserve the apical pulp tissue to encourage the completion of the formation of the apex

Question 43

What is Root resection?

Answer 43

The removal of a portion of diseased root structure, but retaining the remaining natural tooth; Tooth is root treated first.