Janes' Wiggs Chapter 15 and 16 - Endodontics Flashcards
According to Wiggs Chapter 15 (endodontics)
What is contained within a normal dentinal tubule?
- Tubules contain tomes fibre, nerve ending, and fluid
- Tomes fibres are the odontoblast processes which perforate the dentin
N.B. Tomes process is something different - involved in enamel secretion by ameloblast
According to Wiggs Chapter 15 (endodontics)
What is the difference between reversible and irreversible pulpitis?
With reversible pulpitis, pulp can return to a non-inflamed state.
With irreversible pulpitis, tooth will progress to pulp necrosis.
Reversible pulpitis is generally a symptom of
pulpal inflammation caused by some form of short-term
irritation such as caries, dental treatment, or trauma.
According to Wiggs Chapter 15 (endodontics)
Describe anachoresis:
Anachoresis – infection of a tooth via bloodstream or regional lymphatics,
According to Wiggs Chapter 15 (endodontics)
Describe how trauma without pulp contamination may result in non vital tooth?
Trauma causes inflammation within the pulp.
Since it is in a confined space, as inflammation progresses, rather than classical swelling (enlargement of tissue) pressure within the pulp chamber develops
Leads to collapse of venules.
This prevents blood from draining away, and leads to pulp strangulation,
According to Wiggs Chapter 15 (endodontics)
How often does sterile pulp necrosis cause periapical periodontitis
in the absence of bacterial contamination this necrosis does not cause periapical periodontitis
According to Wiggs Chapter 15 (endodontics)
Describe this pathology:
CCF 108, hyperplastic pulpitis
According to Wiggs Chapter 15 (endodontics)
How is periapaical pathology definitively diagosed?
Histopathology
According to Wiggs Chapter 15 (endodontics)
What are the 5 categories of periapical pathology?
- acute apical periodontitis of pulpal origin,
- chronic apical periodontitis,
- periapical abscess with sinus,
- periapical abscess without sinus,
- radicular cysts
According to Wiggs Chapter 15 (endodontics)
What are the radiographic and clinical signs of acute apical periodontitis?
Rads may be normal, or slight widening of PDL at apex
Clinical signs are tenderness, pain on palpation/percussion (tough to see in our pts)
According to Wiggs Chapter 15 (endodontics)
What is the classic radiographic sign of Chronic Apical Periodontitis?
produces the classical periapical lucency seen on radiographs
According to Wiggs Chapter 15 (endodontics)
What are the radiographic signs of a periapical abscess?
May be no signs if acute
may be chronic signs of endodontic disease if an acute flare of a chronic process
According to Wiggs Chapter 15 (endodontics)
What is a phoenix abscess?
A periapical abscess which has arisen from a chronic apical periodontitis.
According to Wiggs Chapter 15 (endodontics)
What is a periapical abscess with sinus?
endodontic disease which has progressed and made a draining tract (sinus)
sinus tracts may be seen facially or suborbital, ventral‐mandibular, or within the oral mucosa, either gingival or at the mucogingival line
According to Wiggs Chapter 15 (endodontics)
What is a radicular cyst?
What are the two types?
What are radiographic features?
proliferation of cell rests of mallasez, which create an apical epithelium lined cyst cavity at the apex.
Pocket cyst is if it communicates with the pulp
true cyst is when cavity lining is complete and does not communicate with the pulp
appears as a classic radiolucency.
According to Wiggs Chapter 15 (endodontics)
How is a radicular cyst differentiated from a periapical granuloma?
On the basis of histopathology.
cysts are sack-like structures with a complete epithelial lining whereas granulomas only contain a mixed cell population including epithelial tissue
will both appear as a lucency on rads
According to Wiggs Chapter 15 (endodontics)
How does condensing osteitis appear radiographically and what is it’s cause?
Reactive bone formation and increased radiodensity of periradicular alveolar bone.
Pulp inflammation stimulates osteoblast activity
According to Wiggs Chapter 15 (endodontics)
How can condensing osteitis (pathological) be differentiated on radiographs from periapical osteosclerosis (non-pathological) seen in hard chewing dogs?
Can’t be differentiated on rads
According to Wiggs Chapter 15 (endodontics)
What are 4 signs of endodontic disease on radiographs?
Condensing osteitis
Radicular ankylosis
external root resorption occurs in some endodontic disease
Periradicular osteomyelitis (alveolar bone expansion) appears as osteopenia and expansion of the alveolus
According to Wiggs Chapter 15 (endodontics)
what are the most common radiographic findings in endodontic disease?
- Condensing osteitis
- Chronic focal sclerosing osteomyelitis
According to Wiggs Chapter 15 (endodontics)
What are classic features to differentiate perio-endo disease from endo-perio disease?
- Primary endo usually have a crown fracture. If it continues to a wide PDL can be called a J lesion
- Primary perio usually have deep pockets and wedge shaped periodontal lesions
According to Wiggs Chapter 15 (endodontics)
Describe class I, II and III Perio/endo lesions
Class I - Primary endo
Class II - Primary Perio
Class III - separate endo/perio component
Memory trick: alphabetical order - Endo, Perio, Separate
According to Wiggs Chapter 15 (endodontics)
What are group I Endodontic instruments?
Hand instruments like barbed broaches, K files and H files
According to Wiggs Chapter 15 (endodontics)
What are group II endodontic instruments?
Low speed attachments, with a latch grip
like gates glidden drills and peeso reamers
According to Wiggs Chapter 15 (endodontics)
What are group III endodontic instruments?
Engine driven Ni-Ti rotary instruments which adapt to curved canals
lightspeed etc.
According to Wiggs Chapter 15 (endodontics)
What are group IV endodontic instruments?
Engine driven instruments with 3d adaptation. self adjusting file is only current one.
Included a picture because it’s so cool
According to Wiggs Chapter 15 (endodontics)
What are group V endodontic instruments?
Enging driven reciprocatin instruments.
Think endo pulse, jack-hammer, woodpecker or…
According to Wiggs Chapter 15 (endodontics)
What are group VI endodontic instruments?
Ultrasonic instruments
According to Wiggs Chapter 15 (endodontics)
What is the main cause of ledging, gouging, zipping, stripping and translation?
Ledging, gouging, zipping stripping, and translation are all caused by straight–stiff files working in curved canals and trying to regain their straight shape
According to Wiggs Chapter 15 (endodontics)
What is the name and purpose of this instrument?
Barbed broach
for removing pulp tissue whole
Insert, twist 180 and remove
Will grab tooth walls and ruin everything/break - very fragile
According to Wiggs Chapter 15 (endodontics)
What is the name and purpose of this instrument?
How are they sized?
Gates glidden drill
enlarge access and flare coronal portion of access
sized in iso sizes, but go in increments of 20 starting at 50.
so smallest is iso 50, largest is iso 150
According to Wiggs Chapter 15 (endodontics)
How are K files and reamers made?
What is the difference between the two in terms of design, cutting, carrying and use?
Reamers and files are both meade the same way, from a triangle, square or rhomboid blank. Twisted to create a spiral - Files are twisted more than reamers (more flutes per mm)
•Reamers have <1/10- <1/4 spirals per mm
They are more aggressive at cutting, but poorer carrying
Used in a clockwise turning fashion
•Files have ¼ to >1/2 spirals per mm
Tend to carry better and give better tactile sense, but don’t cut as aggressively
•Used in a push-pull or in a ¼ turn and pull fashion
According to Wiggs Chapter 15 (endodontics)
What is this instrument?
How is it made?
H-File
Made by machine cutting a round blank to remove a triangular spiral and thus leaving a continuous spiral with a thin core
According to Wiggs Chapter 15 (endodontics)
What is this instrument?
How many turns is in a ‘cutting circle’ with a square, rhomboid or triangular blank?
K file
Square makes a cutting circle in 1/4 turn (90 deg turn will bring a new cutting face the position where adjacent one started)
Triangle makes a cutting circle in 1/3 of a turn (need to rotate a triangle 120 deg to bring another cutting flute into position of the adjacent one
Rhombus needs to turn 180 degrees because it’s asymmetrical, need to go halfway around to brig a new flute to the position of the adjacent cutting flute (which is on the opposite side)
According to Wiggs Chapter 15 (endodontics)
Compare and contrast H files with K files in regards to stiffness, cutting ability and fragility?
K file is Stiffer, has a lower cutting ability, and is less prone to breakage
H file is less stiff, more aggressive cutting, and more prone to breakage
According to Wiggs Chapter 15 (endodontics)
Why are H files use ONLY in a push-pull manner?
Will thread into dentin when rotated, and dethreading it will stress or break the metal.
Baically an H file is a long, skinny screw
According to Wiggs Chapter 15 (endodontics)
What is a standard taper and what does that mean?
standard taper is 0.02.
means for every mm of length of the file, it gets 0.02 mm wider.