leftovers Flashcards
1-obturation
2-endodontic obturation
3-how far into the canal
4-ideal obturant
1-use of material & techniques to fill entire root canal system in 3D manner
2-to prevent reinfection of root canals that have been clean, shaped, disinfected by instrumentation, irrigation & medication procedures
- cant cleanse & shape but can isolate & seal
- stops coronal leakage
- blocks influx of H20 & nutrients
- entombs surviving microbes
3-at termination of where you instrumented
4-easily introduced into canal
- seal canal laterally & apically
- not shrink after being inserted
- radiopaque
- bactericidal
- not stain tooth
- non toxic
- sterile
- easily removed
1-solid obturants
2-semisolid obturants
3-pastes
4-silver points
5-siglets
1-silver points
- gutta percha
- carrier based
2-pastes—
zinc oxide eugenol
plastics sargenti paste (N2)
3-lack of length control (overfills/underfills)
-unpredictable sealability—voids, shrinkage, & solubility
4-corresponds to last file size used in prep
- *contraidicated**—corrodes spontaneously w/ serum & blood
- –irreversible staining
- –lack plasticity—doesnt conform to canal
- –complicated apical surgery
- –induce inflam root resorption
5-used to remove silver points
1-gutta percha
2-does gutta percha alone seal the canals
3-good stuff about GP
1-form of rubber
-A-form—natural (brittle)
-B-form—synthetic (root canal & malleable)
-easily introduced into canal—seals canal laterally & apically
PROS= plasticity, easy to manage, inert (low toxicity), & self sterilizing (doesnt promote growth of bacteria)
CONS= lack of adhesion to dentin (doesnt seal)
can rebound & pull away from canals
2-no
3-easily introduced into canal
radiopaque
bactericidal
not staining
non toxic
be sterile
easily removed
1-sealers
2-ZnOE based
3-Plastic Epoxy
4-Glass Ionomer
5-CaOH2
6-obturation technique
1-provides a fluid tight seal between tooth & core material
functions= antimicrobial agent
filling discrepancies between material & dentin walls
binding agent between filling material & dentin walls
lubricant
gives radiopacity
2-roth selaers
-standard…but doesnt bind to dentin & is slow sletting
3-binds to dentin but it stains & is solvent insolubility
4-binds to dentin but is too hard
5-is antimicrobial but doesnt have long term stability
6-cold compaction or warm compaction
1-lateral condensation
2-warm vertical condensation
1-preselected master gutta percha cone filled into canal to WL & accessory cones are in laterally w/ spreader until filled to CEJ
-fitted (snug/tug back) to WL
-spread inserted alongside of MC 1-2 mm short of WL
-accesory cone into space made by spreader
-spreader inserted until resistance is met (repeat until filled)
ADV= length control, easy to remove, & easy techniqe
DISADV= cant obturate irregularities & insertion cant generate forces—vertical root fracture
2-preselected master gutta percha is fitted into at WL
- MC cone is seared off, compacted to make room for plasticized GP segments
- –fit GP MC
- –fit system B plugger
- –seat sealer coated MC to WL
- –sear of MC w/ system B, leaving 5 mm GP
- –condense heated MC plug w/ a cold plugger
- –condense heated MC plug w/ a cold plugger
- –back fill the canal w/ GP expressed from the obtura
- –GP back fill is condensed w/ cold plugger
verrucal papillary lesions
1-infections
2-reactive
3-idiopathic
1-squamous papilloma
verruca vulgaris
condyloma acuminatum
focal epithelial hyperplasia
2-inflammatory papillary hyperplasia
3-verruciform xanthoma
sebhorrheic keratosis
1-squamous papilloma
2-verruca vulgaris
3-condyloma acuminatum
1-benign proliferation caused by HPV 6 & 11
- 20-50 yr old…equal gender
- soft palate, tongue & lips
- some pedunculated
- koliocytes (clear cells w/ pyknotic)
- tx w/ surgical excision
2-benign prolif caused by HPV 2, 4, 6, 40
- skin & hands of kids
- vermillion border, lips & tongue
- cutaneous horn—accum of keratin on a wart
- prolif of sqamous epi finger projections
- tx= liquid N2, lactic acid, surgery
3-benign prolif epi caused by HPV 2, 6, 11, 53 & 54
- STI—genital warts
- 20% of sexually transmitted disease
- mouth & larynx, genitalia & perianal
- clustered lesion
- labial mucosa, soft palate & tongue frenum
- epi projections are broad & blunt
- surgical excision
1-focal epithelial hyperplasia
2-inflammatory papillary hyperplasia
3-verruciform xanthoma
4-seborrheic keratosis
1-benign prolif caused by HPV 13 & 32
- native americans & multiple members of family
- poor, crowded living, poor hygiene
- usually kids
- labial, buccal, & lingual mucosa
- multiple lesions, flat or papillary, usually clustered
- tx= spontaneous regression—surgical
- abrupt acanthosis of epi= koilocytes & mitosoid cells
2-bc of ill fitting denture, poor denture hygiene or always wearing denture
- candida albicans?
- usually in palatal vault
- papillary growths hyperkeratosis inflammation
- tx= removal of denture to help w/ early lesions
- –antifungals help, excision for larger/older lesions
3-hyperplastic condition of mouth, skin & genitalia
-unknown etiology
-soft, painless, sessile mass w/ white & yellow/papillary surface
surgical excision
4-skin of face, trunk & extremities
patients >40
macules that become fissured= verrucous plaques
-no oral lesions
-stuck on appearance
-dermatosis papulosa nigra on black ppl
-no tx needed
-horn cysts= keratin filled invaginations
1-goals of perio therapy
2-intial therapy goals
3-summary of initial therapy goals
1-to alter/eliminate microbial etiology & contributing risk factors for perio…stopping progression of disease & perserving dentition in state of health, comfort & function w/ appropriate esthetics & prevent recurrence of perio
-regeneration of perio attachment apparatus where needed
2-arrest/attenuate progress of perio disease
induce positive changes in subg bacterial flora
resolving inflammation
create environ that permits gingival tissue to heal
improving/maintaining attachment level
dec pocket depth
prep tissues for surgical procedures
3-dec bioburden mass to tissues
- minimize impact of systemic factors
- eliminate/control local risk factors
1-dec bioburden challenge to tissues
2-minimize impact of systemic factors
3-elim/control local risk factors
1-intensive training of patient in appropriate tecniques for self-care & professional removal of calc deposits & bacterial products from tooth surface
- calc deposits always are covered w/ living bacterial biofilms that are associated w/ continuing inflammation if not removed
- facilitating oral hygiene procedures
2-certain systemic diseases can inc risk of periodontitis & severity—systemic & glycemic control
3-plaque development & retention
- –oral hygiene (dec bioburden mass)
- –calculus (maintains bioburden mass)
- –overcontoured restorations (plaque rention)
- occlusal trauma factors
- local environmental risk factors that can inc risk of developing periodontitis in sites
- plaque rention in a site allow damage over time to periodontium
1-anticipated outcomes w/ initial therapy
2-phase 1 therapy
3-initial therapy/hygenic phase
1-reducing/eliminating inflammation
- reducing probing depths
- improving clinical attachment
2-management of acute problems (perio abscess, NUG, endo-perio)
- control of local etiology (plaque, 2ndary factors & occlusal forces)
- –dec bacterial load & improve bacterial flora
- prep teeth for biologically healthy root surfaces
- minimize plaque harboring factors
- re-eval 4-6 wks after completion of initial therapy
3-plaque removal/control
scaling/root planing—calc debridement
minimize plaque retentive areas (restorations)
selective extraction
adjust occlusal discrepancies
re-eval 4-6 wks
1-patients role
2-effects of oral hygiene
3-effects of oral hygiene by professional cleanings on subg
4-effects of personal oral hygiene on subg
5-effect of adv perio therapy w/o personal hygiene
6-why Scaling/root planing
1-cotherapist in treatment…train for self care
2-daily deplaquing will improve superficial gingival health (reduce inflammation)
- toothbrushing can reach up to 1 mm subg, but can alter up to depth of 3 mm
- remocal of supraging plaque= limited response
- in pockets over 5 mm oral hygiene alone isnt effective in altering subg biofilm
3-dec # of spirochetes & bacteriodes after 3 wks of professional daily plaque control
4-no impact when probing depth >5 mm
5-ineffective
6-dec quantitiy of organisms below a critical mass & composition of remaining bacterial flora to one associated w/ health
- removal of root surface elements (calc-plaque-endotoxin)
- biologically acceptable root surface
1-microbial shift
2-scaling root planing
3-scaling
4-root planing
1-effected by removal of bacterial by scaling root planing ===smooth root surface, supports effective oral hygiene & removal of toxins
2-reduce contributing factors like calc & overhanging restorations
- removal of calcified deposits, bacterial products (endotoxins) & biofilm from tooth surfaces & infected perio pockets
- outcome enhanced by patient oral hygiene
3-process by which plaque & calc are removed from suprag & subg tooth surfaces
4-process by which residual embedded calc & cementum are removed from roots to produce smooth, hard, clean surface
1-alterations in exposed cementum
2-how much to root plane
3-outcome after phase 1 therapy
1-hypermineralized surface zone
changes in organic matrix
endotoxins cytotoxic in tissue culture
2-deposits of calc on root surfaces in cementum irregularities
scaling is insufficient bc some cemetum has to be removed (planing)
-bacterial toxins dont strongly adhere to diseased root surfaces so tooth smoothness isnt required, BUT is is a clinical indicator of calc removal available at present
3-reduction of clinical inflam (erythema, edema & bleeding)
- prep of bio acceptable tooth surfaces
- microbial shift to less pathogenic flora
- reduction of probing depth
- gain of clinical attachment
1-whats a template
2-trimming
3-used for
4-shades
5-prep
1-matrix
- helps form lingual wall
- determines incisal edge: position, length, thickness & shape
- made of poly vinyl, silicone, or clear vacuform
2-trim mesio-distally
-no material overlapping facial surface
3-incisal edge restorations, diastema closure, or peg lateral build up
4-A1 Dentin & BL Light Enamel
5-bevel anterior w/ 2 mm bevel w/ an 8 bur
1-aim of pulp therapy
2-approach of pulp therapy
3-normal
4-reversible pulpitis
5-irreversible pulpitis
6-necrotic
7-clinical data
1-preserve primary teeth until normal exfoliation
maintain arch integrity & health of teeth/supporting tissues
-maintain vitality of tooth affected by caries or trauma
2-prelim data gathering & interpretation focused on determining health of pulp upon which available therapeutic options are chosen
3-symptom free & responsive to vitality testing
4-caries, cracks, restorative procedures, trauma may cause exaggerated response to thermal stimuli, diasspears on removal of stimuli
5-symptomatic/asymptomatic, spontaneous pain…exaggerated response to thermal tests that lingers on removing stimuli
6-death of pulp
7-hx of pain elicited from parent of care giver since children vary in response to reporting pain (major clinical tool)
—intentionally eliciting pain can scare the kid
1-pain
2-clinical examination
3-soft tissue changes
4-palpation
5-percussion
6-mobility
1-presence/absence
spontaneous/provoked
intermittent/prolonged
2-visual
palpation
percussion
mobility
vitality testing
3-redness of buccal mucosa
drainage through thin buccal bone
sinus tract/parulis
4-fluctations felt by palpating…swollen mucobuccal fold
-bone destruction
5-bite stick response for kids
not recommended bc have resorbing roots/furcation involvements
6-normal exfoliation vs path mobility
compare w/ contralateral
1- pulp testing
2-non vital pulp therapy
3-vital pulp therapy
4-indications for vital pulp therapy
1-heat test= unreliable…chances of pulp damage bc of highly placed pulp horns
- *cold** test= reliable…intrapulpal pressure=indicatory
- *EPT**= unreliable bc of undeveloped odontoblast nerve fibres of pulp & plexus of raschkow at pulp dentin border
2-pulpectomy, extraction & space maintainer
3-pulpotomy & indirect pulp therapy
4-large carious lesion close to pulp where exposure might result in caries removal
- absence of soft tissue path…like sinus tract, path mobility & spontaneous pain
- absence of radio changes like furcation involvement, resoprtion or PA pathology
- restorable tooth
- atleast 1/3 of root remaining
1-prim vs perm tooth morph
2-vital pulp therapy for primary teeth
3-non vital pulp for young perm teeth
1-greater molar root curvature
- inc # of accessory canals in floor of pulp chamber
- large pulp relative to crown size, w/ pulp horns coser to tooth surface (mesial more than distal)
- flat ribbon shaped canals
2-protective liner, indirect pulp treatment
direct pulp capping &&& pulpotomy
3-liner, indirect pulp treatment, direct pulp cap
partial pulpoptomy, apexo, pulpectomy & apexification
1-pulpotomy
2-indications
3-contraindications
1-involves amputation of coronal pulp which has been affected by caries/ exposure
remaining vital radicular pulp tissue surface is treated w/ clinically successful medicament
maintain asymptomatic primary tooth until exfoliation
bc of speech, mastication & space maintenance
2-deep carious lesion w/ pulp exposure
- absence of soft tissue path (sinus tract), path mobility & spontaneous pain
- absence of radio changes of furcation radiolucency, internal/external resorption, PA path
- 1/3 of root remaining
3-hx of spontaneous/ unprovoked pain
- fistula.draining sinus
- pulp hemorrhage
- PA radiolucency
- path resoprtion & mobility
1-tx success based on
2-pulpotomy medicaments/agents
1-dx of vitality status of pulp
- radiographic results
- clinical assessment of teeth to make sure they’re healthy & reversibly inflamed
2-formocresol
- *ferric sulfate**
- *mineral trioxide aggregate**
1-formocresol
2-ferric sulfate
3-MTA—mineral trioxide aggregate
1-19% diluted
-glycerine w/ H20 w/ buckleys
-treats pulp stumps & not agent for hemostasis
(get hemostasis by damp cotton pellets)
-formaldehyde makes it bactericidal & reversibly inhibits enzymes
-creates superficial layer of fixation while preserving vitality of deeper radicular pulp
—-apply: soak cotten pellet, blot pellet in dry gauze, place pellet over stumps & pack w/ dry pellet…leave for 4-5 min to stop bleeding & then remove
2-hemostatic agent= astringedent
—apply: following hemorrhage contorle, infuser is applied for 10-15 s, pulp chamber rinsed w. h20 & dried before placing ZOE
3-available as proroot as powder & then mix liquid
—-apply: powder w/ water on mixing pad
1/4th powder needed for 1 pulpotomy (can be reused), h20 cant be reused, place moist cotton pellet in there then thick mix of MTA over pulp stumps w. thickness of 2 mm. coat the MTA w/ RMGI so it gives compressive forces for restoration placement
1- indirect pulp therapy
1-if has large carious lesion
- some caries must be left behind in tooth to avoid exposure
- dont reenter tooth to remove caries
- remove superficial/peripheral caries w/ high speed & peripheral walls are cleaned, leaving caries over pulp
- large slow round removes caries over pulp
- once affected dentin is reached, stop there
- affected dentin remineralizes if theres a seal, can leave 1-2 mm over pulp
- infected dentin covered w/ base that ends on sound dentin & gives a seal over affected dentin left behing—remineralize & get harder
- reinforced ZOE like IRM or RMGI recommended for IPT
- tooth restored w/ stainless steel crown
1-follow up
2-pulpotomy
3-access pulp chamber
4-restorations
1-take PA every 6 mo
- look for uniform narrowing of canals & signs of resoprtion
- gold: no change between pre-op & followup radiograph
2-removes coronal pulp, leaving healthy pulp tissue in root canals/radicular part
-minimize contamination by removing superficial caries & cleaning walls before exposing pulp
3-wide access opening makes it possible to visualize chamber & remove rissues down to orifices, removing ledges that hide pulpal tissue
- cusps tips are ood for location & # of pulp horns
- pulp must bleed when roof is removed= vital pulp
- 1st =high speed = access opening & remove roof
- 2nd=large slow round= remove pulp tissue
- 3rd=small & moist cotton pellets= control hemorrhage & clean chamber—uncontroled= inflammation & vital pulpotomy is contraindicated
- –pack ZOE against pulp stumps w/ damp pellet
- –condense ZOE onto floor & then restore tooth w/ final restoration at same appt to avoid failure of pulpotomy
4-pulpotomized tooth has been weakened by caries & tooth removal= full coverage stainless steel crown used for protection & seal
