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Endodontics II > Lecture 1: Working Length & Access > Flashcards

Lecture 1: Working Length & Access Flashcards

1
Q

When, why, & how to refer your potential problems describes:

A

Case selection

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2
Q

Most non-complicated cases follow:

A

one basic RCT technique

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3
Q

LEO:

A

lesion of endodontic origin

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4
Q

What are our three objectives with endo cases?

A
  1. correctly DIAGNOSE disease as LEO
  2. PERFORM quality NS endodontic therapy
  3. RESTORE & DOCUMENT healed outcome
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5
Q

What will cause your endodontic treatment to fracture and fail?

A

lack of placing mandatory crown

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6
Q

Endo treatment is considered an extreme service to the patient as we:

A
  1. relieve acute pain
  2. retain otherwise lost natural tooth
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7
Q

More points are lost in lab to ____ than anything else.

A

poor access

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8
Q

Most failures on WREBs & ADEC are due to:

A

poor access

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9
Q

What is the first step in access procedure?

A

Outline (draw outline form on tooth)

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10
Q

The shape of the outline form of the tooth is dependent on:

A

anatomy of the pulp chamber

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11
Q

After drawing the outline form on the tooth, what step is next?

A

create outline form just through the enamel with number 2 round or 330 bur on high speed

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12
Q

What layer should be drilled through when creating the outline form?

A

just through the enamel

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13
Q

What burs and what speed may be used when creating the outline form?

A

2 round bur or #330 on high speed

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14
Q

When creating the outline form, the bur is somewhat ____ to the ____ surface of the tooth

A

perpendicular; lingual

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15
Q

When creating the outline form, its important to stay ___ at this point, just through the enamel at less than ____mm

A

shallow; 1mm

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16
Q

after the outline form is created, the next step to the access procedure is:

A

penetration

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17
Q

During the penetration step of the access procedure, penetrate the pulp chamber roof with ____ approaching ____ in center of outline form.

A

bur angled; parallel to long axis of root

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18
Q

During the penetration step of access procedure, penetration the ___ with the bur angled approaching parallel to long axis of the root in the ___ of outline form.

A

pulp chamber roof; center

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19
Q

During the penetration step of the access procedure you should reach the pulp in most cases by:

A

7mm

(if not ask for help- never go beyond 7mm)

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20
Q

During the penetration step of the access procedure, how should you confirm pulp canal entry?

A

with endodontic explorer; DG16 (push)

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21
Q

To confirm pulp canal entry, during the penetration step of the access procedure, you should NEVER look for canals with:

A

a bur

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22
Q

What step of access procedure follows penetration?

A

un-roofing

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23
Q

Un-roof pulp chamber with:

A

brushing out-strokes

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24
Q

When un-roofing the pulp chamber with brushing out-strokes, be careful not to:

A

gouge axial walls

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25
Q

When un-roofing the pulp chamber, remove ____ & smooth ____

A

obstructions; walls

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26
Q

When un-roofing, irrigate well with:

A

NaOCl

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27
Q

When un-roofing, irrigate well with NaOCl for:

A
  1. vision
  2. removal of debris
  3. begin disinfection
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28
Q

Following the unroofing step of the access procedure we:

A

refine

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29
Q

Refine the access prep with _____ or ____ to help provide straight-line access to mid-root. (Mostly in molar access)

A

Safe ended diamond bur or Endo-Z bur

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30
Q

The Endo-Z bur is the ___ one

A

gold one

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31
Q

Why do we use the Safe ended diamond bur or Endo-Z bur during the refining step of the access procedure?

A

to help provide straight-line access to mid-root

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32
Q

During the refining step of access procedure, the non-cutting tip of the bur (Safe ended diamond bur or Endo-Z bur) is simply a:

A

pilot

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33
Q

Do NOT JAM the Endo-Z bur INTO the canal. This is a:

A

Side-cutting instrument only!

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34
Q

After ACCESS, your next big task is:

A

working length

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35
Q

The correct working length =

A

1 mm short of the canal exit

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36
Q

If you do NOT get the ___ right; you will likely result in a poor outcome

A

WL

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37
Q

Incorrect WL may instigate:

A

apical periodontitis

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38
Q

How do you find the canal exit in your hand?

A
  1. Look at the canal exit
  2. Measure BEFORE you mount the tooth
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39
Q

How do you find the canal exit in the mouth?

A
  1. Start with average length
  2. Chart
  3. Apex Locator (if possible)
  4. Radiograph (with #15 file in canal)
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40
Q

Average root length central incisor:

A

maxillary: 22.5
mandibular: 20.7

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41
Q

Average root length lateral incisor:

A

maxillary: 22.0
mandibular: 21.1

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42
Q

Average root length canine:

A

maxillary: 26.5
mandibular: 25.6

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43
Q

Average root length 1st PM:

A

maxillary: 20.6
mandibular: 21.6

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44
Q

Average root length 2nd PM:

A

maxillary: 21.5
mandibular: 22.3

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45
Q

Average root length 1st molar:

A

maxillary: 20.8
mandibular 21.0

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46
Q

Average root length 2nd molar:

A

maxillary: 20.0
mandibular: 19.8

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47
Q

Usual # of roots & canals for maxillary incisors: (Teeth #7,#8, #9, #10)

A

one root; one canal

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48
Q

Usual # of roots & canals for maxillary canines: ( Teeth #6, & #11)

A

one root; one canal

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49
Q

Usual # of roots & canals for maxillary first premolars (Teeth #5 & #12)

A

two roots; two canals

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50
Q

Usual # of roots & canals for maxillary 2nd premolars: (Teeth #4 & #13)

A

Usually 1 root; one 1 canal

(possibly two on both)

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51
Q

Usual # of roots & canals for maxillary molars: (Teeth #1,2,3,14,15,16)

A

usually 3 roots and 3 canals (probably 4 or more)

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52
Q

Usual # of roots & canals for mandibular incisors (Teeth #,23,24,,25,26)

A

Usually 1 root: 1 canal (potentially 2 canals)

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53
Q

Usual # of roots & canals for mandibular canines (Teeth # 22, 27)

A

Usually 1 root; 1 canal

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54
Q

Usual # of roots & canals for mandibular premolars (Teeth #20, 21, 28,29)

A

usually 1 root; 1 canal (possibly 2 canals)

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55
Q

Usual # of roots & canals for mandibular molars: (teeth #17,18, 19, 30, 31, 32)

A

Usually 2 roots; 3 or possibly 4 or more canal

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56
Q

In clinic, how do we determine the correct working length?

A

apex locator

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57
Q

To determine the correct working length, place a ____ hand file in the access and extend it into the canal to the estimated canal length

A

15 hand file

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58
Q

Everything you do following an inaccurate working length is:

A

wrong

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59
Q

The goal for WL is:

A

1.0 mm short of the canal exit

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60
Q

The goal for WL is 1.0 mm short of the canal exit. This places WL in close proximately to the:

A

natural apical constriction

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61
Q

What happens if your working length is too short?

A

The canal is NOT well cleaned

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62
Q

What happens if your working length is too long?

A

Results in “blow out” which guarantees:
1. incomplete compaction at the apex
2. an explosion of sealer in the PA tissues

63
Q

In regards to working length, your reference point should be: (2)

A
  1. easy to see
  2. easy to reproduce
64
Q

When selecting a reliable reference point for anterior teeth, you should use:

A

tip of incisal edge

65
Q

When selecting a reliable reference point for posterior teeth, you should use:

A

tip of cusp for which the canal is named

66
Q

T/F: It is okay to reduce your reference point after working length is determined

A

false- don’t reduce it after working length is determined

67
Q

What is the first step after diagnosis?

A

access

68
Q

Access to the pulp chamber facilitates: (6)

A
  1. locating the canals
  2. negotiating the canals
  3. gaining patency
  4. establishing working length
  5. maintaining apical constriction
  6. a good outcome
69
Q

Arguably the single most important requisite contributing to routine endodontic success:

A

proper access

70
Q

Poor access yields problems such as: (5)

A
  1. No predictable result
  2. Routinely missed canals
  3. Unable to properly clean
  4. Unable to shape completely
  5. Unable to fill adequately
71
Q

Access involves:

A

drilling a hole through coronal structure to gain entrance into the pulp chamber

72
Q

The objective of access is to create effective shape, this include: (4)

A
  1. smooth
  2. constantly tapering
  3. respecting shape of natural canal
  4. constricting near terminus of root
73
Q

What is the “coke bottle” effect with access?

A

Canal is bigger than the cervical access at some more apical point in the canal

74
Q

List the requirements of access: (4)

A
  1. Visibility of pulp chamber and ALL canal offices from a SINGLE vantage point
  2. Straight-line access to mid-root for instrument placement
  3. Complete removal of pulpal roof and pulp horns
  4. Avoidance of unecessary weakening of tooth
75
Q

What do we mean when referring to “visibility” as a requirement of access?

A

visibility of pulp chamber and ALL canal offices from a SINGLE vantage point

76
Q

visibility of pulp chamber and ALL canal offices from a SINGLE vantage point =

A

draw

77
Q

Why is straight-line access to mid-root a requirement or access?

A

straight-line access to mid-root is requirement for instruments & obturating materials (without regard to long axis of the tooth)

78
Q

Cross-hatched area of secondary dentin that should be removed to create better access to the mesial root:

A

dentin triangle

79
Q

What may be used to remove the dentin triangle to create better access to the mesial root?

A

.25/.12 rotary file

80
Q

Why is it important to preserve tooth structure during access?

A

to avoid unnecessary weakening of tooth

81
Q

What are the 3 main steps to access?

A
  1. Outline form (2D surface shape)
  2. Coronal access (extending into pulp)
  3. Radicular acesso (adjustments to allow easy straight-line entry to mid-root of each canal)
82
Q

The 2D plan for the initial opening (could be traced onto crown)

A

outline form

83
Q

To allow unobstructed visualization of the pulpal floor and ALL canna offices from a single vantage point:

A

Coronal access

84
Q

During coronal access, you should reach the pulp at ____ mm or less

A

7mm

85
Q

T/F: The pulpal floor should NOT be touched by access bur

A

True

86
Q

Walls of the coronal access should ____ to the occlusal

A

diverge

87
Q

Walls of the coronal access should DIVERGE to the occlusal because: (3)

A
  1. better light
  2. better visualization
  3. Temp restoration placed between visits will not be easily dislodged to leak & contaminate
88
Q

To allow straight-line access to mid-root for all shaping instruments and obturation materials (observe canal path - not long axis of tooth)

A

Radicular access

89
Q

Facilitates “crown-down” procedure:

A

radicular access

90
Q

T/F: Hand files generally require 10 strokes/file before going to the next larger size file

A

False- generally require 100 strokes/file

91
Q

Common canal configurations:

One canal from pulp chamber to apex

A

Type 1

92
Q

Common canal configurations:

2 canals from pulps chamber, join prior to apex

A

Type 2

93
Q

Common canal configurations:

2 canals from pulp chamber to apex

A

Type 3

94
Q

Common canal configurations:

One canal from pulp chamber divides prior to apex

A

Type 4

95
Q

Which type of canal configuration is the most difficult to treat?

A

Type 4

96
Q

Label the type of canal configuration seen below:

A

Type 1

97
Q

Label the type of canal configuration seen below:

A

Type 2

98
Q

Label the type of canal configuration seen below:

A

Type 3

99
Q

Label the type of canal configuration seen below:

A

Type 4

100
Q

What is the shape of access for a maxillary central incisor?

A

triangular access (base of triangle at incisal)

101
Q

T/F: For access with a maxillary central incisor, the angles of the triangle are slightly rounded

A

true

102
Q

For access with maxillary central incisor what is the measurement of the triangle on all sides?

A

About 3 mm

103
Q

Total straight-line access on anteriors would involve access from the facial and create a weakening of the incisal edge and an esthetic issue, this is called:

A

incisal compromise

104
Q

“Incisal compromise” is when total straight-line access on anteriors would involve access from the facial and create a:

A

weakening of the incisal edge and an esthetic issue

105
Q

What is the shape of access for a maxillary lateral incisor?

A

triangular/oval

106
Q

The maxillary lateral incisor has a thinner root than the central incisor meaning:

A

narrower access M-D and narrower pulp horns

107
Q

When accessing a maxillary lateral incisor, its important to note that the root curves to the _____ and the apex tips to the ____

A

distal; palatal

108
Q

Due to the apex tipping to the palatal, what is the most difficult maxillary anterior tooth to access?

A

lateral incisor

109
Q

Phenomenon on all anterior teeth in regard to access:

A

incisal compromise

110
Q

What is the shape of access for a mandibular canine?

A

oval

111
Q

If the mandibular canine has one root, its usually vey wide:

A

F-L

112
Q

What type of canals can be seen in a mandibular canine? What type do we see most often?

A

Type I, II, or IV; Type I most common

113
Q

According to vertucci, ____% of mandibular canines have 1 canal, whereas ____% have 2 canals

A

78%; 22%

114
Q

T/F: It is more common for a mandibular canal to have 2 canals, than 1 canal.

A

False- one canal is much more prevalent

115
Q

To avoid common errors of access, you should: (2)

A
  1. line up penetration in two planes (MD & FL)
  2. visualize cervical cross section
116
Q

A common iatrogenic error that often spell the demise of the tooth:

A

perforations

117
Q

List some common errors of access: (6)

A
  1. too large
  2. skewed to distal
  3. too small & round
  4. too cervically placed
  5. pulp horns not cleaned
  6. straight-line access to mid-root is inhibited
118
Q

Inadequate access compromises:

A

shaping

119
Q

Inadequate access induces:

A

bending of the file

120
Q

Inadequate access creates ___ of the canal

A

apical transportation

121
Q

Access is ALWAYS gained through ____ approach on ALL posterior teeth

A

occlusal

122
Q

What is the shape of access for a maxillary 1st premolar

A

Thin oval access (MD)

123
Q

The thin oval shaped access of a maxillary first premolar should be the width of:

A

4 round bur

124
Q

Most commonly in a maxillary first premolar we see ___ canals.

A

two

125
Q

List the prevalence of the following canals for a maxillary first premolar:

____% two canals
____% one canal
____% three canals

A

85% two canals
9% one canal
6% three canals

126
Q

What is the shape of access for a maxillary second premolar?

A

thin oval

127
Q

The thin oval shape of access for a maxillary second premolar should be the widget of:

A

4 round bur

128
Q

Most often we see the maxillary second premolar have a Type ___ canal, ____root & ____canal (75-85%) of the time.

Type ___, ____, & ____ are less frequent

A

Type 1; 1 root & 1 canal

Type II, III, & IV

129
Q

How often do we see two roots for a maxillary second premolar? How often do we see three roots?

A

2 roots: 15-25%; 3 roots: rare

130
Q

In a maxillary second premolar, if one canal is found but is not in the center FL, then we should assume:

A

2 canals present

131
Q

In regards to a maxillary 2nd premolar, we should be aware of type ___, because they are very hard to shape, clean & fill.

A

IV

132
Q

What is the shape of access for a mandibular first premolar?

A

Thin oval

133
Q

Mandibular first premolars usually have ___ root(s) and ___ canals ___% of the time.

A

one root one canal (73.5%)

134
Q

Mandibular first premolars usually have 1 root and 1 canal 73.5% of the time. They have type IV canals ___% of the time. They have three canals ___% of the time.

A

24%; less than 1%

135
Q

What is the shape of access for a mandibular second premolar?

A

Thin oval

136
Q

The mandibular second premolar usually has ___ roots and ___ canals ____% of the time

A

1 root; 1 canal (85.5%) Type 1

137
Q

95% of the time, the maxillary first molar has ___ canals

A

4

138
Q

What is the shape of access for a maxillary 1st molar

A

triangle: apex to palatal

139
Q

The triangular shaped access with the apex to the palatal for a maxillary first molar should NOT cross:

A

the oblique ridge

140
Q

T/F: The maxillary first molar has 4 canals most of the time but if not, has 5 canals

A

True

141
Q

The access to the maxillary second molar is similar to the ___ but more ___

A

Similar to maxillary 1st molar but more compressed MD

142
Q

What is the shape of access for a maxillary second molar?

A

triangle

143
Q

What is the shape of access for a mandibular 1st molar?

A

Trapezoid

144
Q

When accessing a mandibular first molar, the mesial and distal walls of the preparation lean toward the:

A

mesial

145
Q

The access prep for a mandibular first molar does NOT cross:

A

distal triangular ridges

146
Q

T/F: Most often , the mandibular 1st molar has 4 canals followed by 3 canals.

A

False- 3 canals most often, followed by 4 canals

147
Q

What is the shape of access for a mandibular 2nd molar?

A

Trapezoid/Triangle (similar to mandibular 1st)

148
Q

T/F: Most often, the mandibular 2nd molar has 4 canals, followed by 3 canals

A

False- 3 canals most often, followed by 4 canals

149
Q

When a mandibular 2nd molar has two centered canals, were call this ____. When this occurs, ____.

A

C-shaped; REFER

150
Q

T/F: At UMKC, all 2nd molars are done by advanced endo

A

True

151
Q

How should we line up the bur when accessing a tooth?

A

In 2 planes

152
Q

What is the WORST error you can make with access?

A

Perforation

153
Q
A

Endodontics II (9 decks)

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