Isolation and File ID Flashcards
1
Q
what does the rubber dam protect from
A
patient from swallowing or aspirating instruments and materials
2
Q
the dental dam is defined as:
A
standard of care
3
Q
effective isolation crucial to:
A
- RCT success
- patient protection
- provider protection
4
Q
what is one of the basic objective of successful contemporary RCT
A
the elimination of micro orgranisms within pulpal spaces
5
Q
can you eliminate micro organisms in the presence of saliva
A
no it is impossible
6
Q
what can ensure the absense of saliva in the surgical field
A
only a properly applied dental dam
7
Q
failure to eliminate salivary leakage by proper placement of the rubber dam creates:
A
salivary contamination
8
Q
what can salivary contamination cause and how
A
life threatening cellulitis by introducing additional micro- organisms which can greatly complicate the infection
9
Q
what will cause NaOCl to leak into the mouth as you irrigate
A
if saliva is not effectively sealed by dam placement
10
Q
what is 8.3% NaOCl commonly used for
A
flushing out debris and cleaning the prepared canal system
11
Q
what are latex dams available in
A
black, white, blue, green color in various weights and thickness
- non latex dams also available in the clinic
12
Q
which type of rubber dam frame should you select
A
one which is radiolucent so you can leave it in place when taking radiographs
13
Q
how many teeth should be isolated with the rubber dam
A
isolate only the tooth to be treated
14
Q
should you take the rubber dam off and frame off when taking radiographs
A
no
15
Q
what is the “butterfly” labial clamp useful for
A
most anterior teeth and even some premolars
16
Q
how are clamps without wings used
A
placed first on the tooth with the RD later stretched over the clamp and tooth
17
Q
what tooth is rubber dam clamp #212 designed for
A
anterior tooth
18
Q
how do you place the clamp
A
- once dam is securely placed below the height of contour of the tooth, push the dam off the wings of the clamp
19
Q
where should the clamp rest
A
at the cervical line below the height of contour to be adequately retained
20
Q
when is it difficult to retain clamps over the height of contour
A
with young or partially erupted teeth
21
Q
what happens when the dam has not been released from the wings of the clamp
A
leaks
22
Q
even after the dam is released from the wings of the clamp, it may be necessary to use some type of ________ around the tooth to ensure isolation
A
sealing agent to caulk
23
Q
what sealing agent can be used to caulk around the tooth
A
Oraseal by Ultradent
24
Q
when would you use a caulk- seal agent
A
if you have any idea that leakage might occur
25
what do you do if you are unable to achieve 100% effective isolation of the tooth to be treated
- provisionally restore tooth to obtain isolation base
- clinical crown lengthening procedure
- refer to endo specialist
- if still cant treat, consider alternate treatment modality
26
if you cannot place an effective rubber dam:
you cannot do a RCT on the tooth
27
a badly broken tooth requiring RCT is covered with ____
hyperplastic gingiva
28
what must you do to a badly broken tooth before RCT
build up
29
how can you excise the gingiva to cover the badly broken tooth
electrosurgery, laser, or conventional surgery
30
what may excision of gingiva do
expose sufficient tooth structure to be able to place a clamp and isolate with dental dam to allow for RCT
31
what is the split dam technique
cant place a clamp on the tooth so the dam is stretched over neighboring teeth and the rubber dam over the tooth of interest is sealed by the use of oraseal
32
what are the types of endo files
- hand files
- reciprocal files
- vortex file .25/.12
- vortex blue files
33
why are there different types of files
- each file type has unique attributes
- each file type can benefit us in a specific way when used correctly
- each type is important to consistent RCT success
34
describe the stainless steel hand file
- takes a sharper edge
- is fairly flexible up to #20
- can be pre- curved easily to negotiate very curved canals- retains the shape
- increases geometrically in stiffness as diameter increases
- efficient when used by hand
- separates if overused or abused usually with some warning
35
describe nickel- titanium motor driven
- edge not as sharp- motor driven for efficient shaping
- is extremely flexible - super elastic but difficult to pre curve
- has nearly perfect shape memory - will not hold a curve
- works efficiently in engine driven handpieces
- separates if overused or abused usually with NO warning
36
what are SS K- type hand files made of
twisted tapered stainless steel wire having a square, triangular, or diamond shaped cross section
37
basically SSK hand files are:
screws
38
continual clockwise rotation will cause an SSK hand file to:
-screw itself to and out the end of the root or
- become locked in dentin and fracture
39
what are hand files essential for:
- scouting the canal - #10 or #8
- creating a glide path (#10 to patency and #15 to WL only
- bypassing a ledge, blockage or separated instrument
- gaining length
40
what hand files will be used for most cases
#10 and #15
41
when would you use larger sized files
serial step back
42
what sizes to hand files come in
0.08 - 0.14
43
what are the measurements of hand files
the tip of the diameter in hundredths of a mm
44
what is the sequence of hand files
white,yellow,red,blue,green,black
from .45 to 0.80 and again 0.90 to 1.40
45
what is the last file size before the increments of sizes go up 0.1
0.60
46
what mnemonic helps you remember the sequence of hand files
"Will You Really Be Going Back"
47
hand files are supplied in ________ lengths,
21,25, and 31mm
48
no matter which length is supplied, the fluted portion of the file is ____ long
16mm
49
all standardized K-type hand files are
0.02 taper
50
what does 0.02 taper mean
from D0 to D16 the diameter increases regularly by 0.02mm in diameter for each 1mm that one travels from D0 to D16
51
what is the color sequence of hand files starting at #15
white, yellow, red, blue, green, black
52
how much greater does the diameter become on a file every 1mm back
0.02mm
53
what happens to a SS K hand file if bent too sharply in an angular fashion or distorted in any way
it cannot be bent back to a useful shape and must be discarded before placing in a tooth
54
when can hand files break/separate within the canal
excessive engagement during clockwise rotation especially in smaller sizes
55
what are the safest intra- canal instruments
hand files
56
hand files give us the greatest ______ of all intra canal shaping instruments and serve as _____ and basic instrumentation to negotiate _______
greatest tactile sense; pathfinder, canal curves and blockages
57
what motion are hand files used in
watch winding motion
58
what motion is used to remove hand files
circumferential filing from length
- press against alternate walls of canals and pull back for a filing motion
59
dont go to the next larger file until:
you have worked the smaller file to the point that the next larger file goes to the desired length without pushing
60
never place a ____ file in a curved canal
straight
61
what percent of canals are curved
all of them to some degree
62
what should you do when entering canal
gently curve all hand files
63
try to _________ the greatest curve you observe in the radiograph of the canal
match or slightly exceed the greatest curve
64
what will happen if you slightly exceed the curvature of the canal
the file will track the inner wall of the curve and be conformed to the actual curve of the canal
65
if you place a straight file in a curved canal what happens
the file will track the outer wall of the the curve and gouge the canal at that point creating what we call a ledge
66
what happens if you create a ledge
it may be difficult or impossible to regain the true canal as subsequent file insertions tend to more easily follow the path of the ledge
67
forcing a file from a ledge will lead to:
a root perforation or separated instrument and probable failure of the case
68
when a scouting file fails to advance but is loose in the canal:
do not push but realize that the canal takes a bend at this point
- remove the scouting file and place a 45 degree bend in most terminal flutes
- use this in a light probing motion to indicate
-the path of the curve as in picking a lock
- once the path is discovered to patency it may be smoothed and carefully enlarged to #15 as a glide path
69
what are the only way to scout a canal
hand files
70
what are the only way to bypass a ledge or separated instrument
hand files
71
what are the only way to negotiate and smooth a tight curve to smooth the glide path or to regain lost length
hand files
72
what are most engine driven reciprocal and rotary files made of
nickel titanium and related alloys
73
what are engine driven reciprocal and rotary files used for
the ability to stay centered in the canal was basic in their introduction
- based on their quality of performing in a super elastic manner
- easily follow a smoothyl created glide path and immediately return to their designed shape when stress is removed
74
what are wave one gold files
motor driven reciprocal files
75
what do motor driven reciprocal files do
push material ahead of the file
- used in 3 passes to prevent pushing debris out the end of the root where it would cause inflammation
76
what size is the small wave one gold files
0.20/.07
77
what do 6 black bands indicate on the .25/.12 vortex Ni-Ti rotary file
12 taper
78
what is the maximum flute diameterin the .25/.12 vortex rotary file
1.20mm size #129
79
the .25/.12 may not be appropriate to enlarge a smaller canal and may need to be carefully used to a depth less than the maximum flute diameter to avoid:
excessive root structure or possible strip perforation of the root
- about the depth of 12-14mm only
80
what are the sizes of the vortex blue rotary files
.25/0.04 through .45/.04
81
what size is the vortex rotary file
.25/.12
82
what is the size of the patency file
.10/.02
83
what is the size of the glide path file
.15/.02
84
we will be using vortex blue files of the following sizes
-.25/.04
- .30/.04
- .35/0.4
- .40/.04
- .45/.04
- .50/.04
85
larger than #50 we will do ____ with _____
serial step back; hand files
86
vortex blue files tip sizes are identified by:
the color of the ring
87
the taper of the file is identified by the number of:
black bands x 2
88
what sequence are the vortex blue files used in
25-30-35-40-45
89
what is the intended use of the barbed broach
rotated in canal to entangle and remove vital pulp organ
90
describe the barbed broach
- SS hand instrument with plastic handle
- a round wire which is barbed by scoring and prying a tag of metal away from the long axis of the wire
- if broach becomes bound within the canal or forced around a canal curvature, it will routinely break upon removal attempt
91
when are barbed broach instruments recommended
large, straight canals
92
when is the reamer useful
by advancement and rotation in straight canals
93
why are reamer instruments dangerous in curved canal
ledging is the usual result
94
the tip of the reamer is ____ in nature
cutting
95
how is the reamer made
by twisting a square or triangular wire but the angle between the long axis of the instrument and the cutting blade is small so it is ineffective when used in a filing motion
96
describe the hedstroem file
- a ground round wire
- cuts aggressively on pull stroke
- vulnerable to rotation
- prone to fracture
- used by faculty
97
how are reamers manufactured
by twisting a tapered triangular SS blank
98
fewer flutes are created than _____
K type files
99
reamers cut only upon ____
rotation
100
reamers are ineffective with a ____ motion
filing
101
why are reamers dangerous
they tend to stray away from natural canal
102
how are K type files manufactured
by twisting a tapered square or rhomboidal SS blank
103
how are K type files effective
when used with a rasping (pulling) motion
104
K type files are _____ prone to fracture
less
105
K type files tend to follow natural canal when ____
pre-curved
106
what type of files do we use: Reamers, K-type files, Hedstrom files
K-type files
107
how are hedstrom files manufactured
by machining (grinding) tapered round SS blank
108
hedstrom files have a ________ when used in a filing motion
aggressive dentin removal
109
why are hedstrom files weaker
due to machining
110
if hedstrom files are used in a rotational manner:
they are very easily broken
111
