Intro to endo Flashcards
What is Endodontics?
Branch of clinical dentistry concerned with the prevention, diagnosis and treatment of endodontic disease
Which tissues are affected by endodontic disease?
Enamel, dentine, pulp, periapical tissues.
Pulp and PA tissues in advanced cases.
List 5 constituents of the pulp.
Cells, ECM, blood vessels, Nerves, Lymphatics
Which types of collagen are found in the pulp?
Types I and III
Which cell types are found in the pulp?
Odontoblasts, fibroblasts, undifferentiated mesenchymal cells, white blood cells
Which part of the pulp has the greatest concentration of collagen fibres?
Apical 1/3
How should a barbed broach be used?
At the apical third of pulp (collagenous part) to remove the pulp as one
What innervates the pulp?
Maxillary and mandibular division of trigeminal nerve
How are pulpal fibres split?
80% C fibres
If A fibres, 90% are Aδ.
Differences between Aδ and C fibres?
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.
What can cause pulpal injury?
Caries, perio, restorative treatment, trauma
What happens in Pulpal inflammation?
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.
What is average intra Pulpal pressure?
10mmHg
What is the intra Pulpal pressure during reversible pulpitis?
Up to 13mmHg
What is intra Pulpal pressure during irreversible pulpitis?
Up to 35mmHg
How does supine position affect intra Pulpal pressure?
Increases it
How can epinephrine affect Pulpal pressure?
Decreases blood flow so can reduce it
What are the three general types of endodontic pathology?
Pulpal pathology, radicular pathology, periradicular pathology
What are the different types of pulpal pathology?
Pulpitis, chronic hyperplasia / pulp polyp, pulpal degeneration, necrosis
What are the different types of radicular pathology?
Fracture, resorption (inflammatory, replacement, internal, external, cervical, apical)
What are the different types of peri radicular pathology?
Periapical periodontitis, granuloma, radicular cyst, PA abscess (+/- sinus), condensing osteitis
How can pulpal pathology be described?
Reversible/irreversible, Symptomatic/asymptomatic, Partial/complete
How can periapical pathology be described?
Acute/chronic, Symptomatic/asymptomatic
What is Pulpitis?
Inflammation of the dental pulp due to injury or infection
What is Apical periodontitis?
Inflammation and destruction of the periradicular tissues caused by aetiologic agents of endodontic origin often as a result of pulpal necrosis
What is apical periodontitis more common with?
Increased age, Decreased education, Reduced dental access, Heavily restored dentitions, Previously root filled teeth
What are the two types of radicular cyst?
Bay cyst - connects directly to apical tissues - no epithelium over apical tissues; True cyst - epithelium barrier over apical tissues / foramen
Briefly, what happens during a root canal treatment?
LA, access, pulpal extirpation, canal shaping, decontamination, obturation, coronal seal
What are the two types of vital pulp treatment?
Direct pulp cap, Pulpotomy
What do we use to cap the pulp in pulp caps or pulpotomy?
Mineral trioxide aggregate (MTA) NOT calcium hydroxide anymore
What are some different types of vital pulp treatment?
Indirect pulp cap, Selective carious tissue removal, Stepwise excavation, Direct pulp cap, Partial pulpotomy, Full pulpotomy
What is Indirect pulp cap?
Single stage caries removal to hard dentine; Biomaterial placement over thin layer of remaining dentine
What is Selective carious tissue removal?
Selective caries removal to soft or firm dentine on pulpal wall; Biomaterial placement on pulpal wall of cavity
What is Stepwise excavation?
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
What is Class I direct pulp cap?
No pre-op deep caries i.e. pulpal exposure due to trauma or iatrogenic damage
What is Class II direct pulp cap?
Carious exposure, disinfectant and calcium silicate used
What is Partial pulpotomy?
Removal of small portion of coronal pulp; Placement of biomaterial and restoration
What is Full pulpotomy?
Removal of all coronal pulp; Placement of biomaterial and restoration
What is Orthograde re-root treatment?
No surgical re-root treatment where access is gained coronally, through the original access cavity
What is Retrograde (surgical) re-root treatment?
Flap raised, access gained apically
What is Apexification?
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
What is Apexogenesis?
Treatment for a tooth with an open apex to preserve the apical pulp tissue to encourage the completion of the formation of the apex
What is Root resection?
The removal of a portion of diseased root structure, but retaining the remaining natural tooth; Tooth is root treated first.
