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Restorative > Managing Endo Problems > Flashcards

Managing Endo Problems Flashcards

0
Q

What are the reasons for re treating a tooth?

A

Symptoms
Increasing radiolucency
Coronal restoration needs replacement with inadequate root filling in situ

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1
Q

What Endodontic problems may you come across?

A

Canals difficult to access
Retreatment
Perio endo lesion
Resorption

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2
Q

How do you manage re treatment?

A

Establish the possible cause for failure
Identify the type of root filling material
Consider the alternatives: accept,surgery , extrication

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3
Q

What are the resins for failure?

A 
Unfilled canal
Loss of coronal or apical seal 
Root fracture/perforation
Periodontal pathology
Other pathology
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4
Q

What are the errors relating to canal prep?

A 
Incomplete deridement
Lateral perforations
Apical perforation 
Blocked canal
Ledging
Apical zipping
Elbow formation
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5
Q

What causes an apical zip?

A

Inappropriate rotation of instruments

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6
Q

WHat causes an elbow to form?

A

Inappropriate pre curving of instruments

Hour glass shape

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7
Q

What are the advantages of orifice enlargement?

A

Straighter access to apical region
Improved flow of irrigant within the canal
Reduces likelihood of apical extrusion since the bulk of bacteria are removed coronally and Inorganic debris is reduced

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8
Q

What can go wrong during access?

A

Crown in situ: loss of directional sense

Obstruction: post or fractured instrument

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9
Q

What can you use to get GP out of the canal?

A

Oil of eucalyptus or chloroform
Use a probe to create a small space down the side of the GP and remove GP using
1. Hedstrom files
2. Specialised files eg. XGP remover and Deep star files

MUST AVOID SPREAD TO APOCAL REGION

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10
Q

How can you remove metal points from the canal? What material are they usually made from?

A

Silver

  1. Grip with forceps
  2. By pass with a file or pathfinder
  3. use EDTA
  4. Use a sonic hand piece
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11
Q

When are metal points easier to be removed?

A

When leakage has occurred and the corrosion products have leached away

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12
Q

What instrument kit can you use remove posts and instruments?

A

Masserann kit.

  1. Ultrasonic
  2. Trepan: which has a diameter of 1.1-2.4mm: this is a hollow tube which is designed to cut troughs around the post/fragrant to be removed.
  3. Extractor: grip the fragment to allow withdrawal
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13
Q

How can you remove cement fillings ?

A

This can be very difficult

  1. Solvent may help eg oil of eucalyptus
  2. Small round headed burr
  3. Hedstrom files
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14
Q

How can you identify if a paste or cement has been used the obturate a canal?

A

Paste Much easier than cement

Cements tend to be much more radiopque

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15
Q

What do you do if you cannot remove all the blockage?

A

Need to accept before causing any more damage

Fill the patent canal to coronally of blockage and then keep under review

16
Q

What can Endodontic lesions cause in the periodontium?

A

Pulpitis: minimal effect on periodontium
Periapal periodontitis: inflammatory lesion may destroy pdl, bone and root. Lesion may occur laterally or in furcation which is associated with lateral canals or associated with a root instrument perforation and this seen anywhere.
Periapical abscess: May discharge through pocket or perforate the PDL and discharge through buccal sinus.

17
Q

How can periodontal lesions affect the pulp?

A

Root surface plaque: with an intact cementum this will have little affect on healthy pulp
Exposed dentine: hypersensitivity and loss of attachment to apex of the tooth may cause retrograde pulpitis

18
Q

How can you diagnose perio endo lesions?

A
  1. Radiographs
  2. Vitality tst
  3. Tracking sinus
  4. Colour, mobility, signs and symptoms
19
Q

What do you do first on a combined perio endo lesions?

A

Root treat and perio surgery may be required

20
Q

When is root resorption initiated?now can it be arrested?

A

Then there has been stimulation of osteoclasts like cells which are in contact with dentine surface

When the stimulus which is activating these CDs is removed

21
Q

What is internal root resorption? How does it appear radiographically?

A

This is initiated by bacterial endotoxins

See a symmetrical bubble in the chamber

22
Q

What is happening to the pulp in internal root resorption?

A

The pulp is inflamed but vital

23
Q

What happens when the pulp dies with internal resorption?

A

This type of reception will cease

24
Q

What must be done as soon as you notice IRR?

A

Extirpate pulp and fill with CaOH

25
Q

What is cervial resorption?

A

This is a special type of external root resorption which is initiated by damage of the root surface at the cervical portion

26
Q

What propagates cervical root resorption?

A

Damage to the root surface and probated by Infected root canal or periodontal micro flora

27
Q

How can the damage to the root surface occur in CR?

A

Trauma eg following ortho and non vital internal bleaching

28
Q

How do you manage cervical resorption?

A

Surgical exposure
Deridement and curettage all inflammation tissue
Restore external resorption defect
Root canal therapy

29
Q

What is the success of treating cervical resorption dependant upon?

A

The degree of resorption that has already taken place and the degree to which the osteoclasts like cells have been eliminated

30
Q

When does external inflammatory resorption occur?

A
  1. Usually following serious injury eg Avulsion and trauma

2. Micro organisms may infect the canal and stimulate osteoclasts like cells

31
Q

Which tissue initiates the damage in external inflam resorption?

A

Pdl which is then propagated by an infected root canal seeping to the external surface

Destruction can be very rapid!!!

32
Q

What is the treatment for EIR?

A

Protracted CaOH to eliminate osteoclasts like cells

33
Q

What is replacement resorption?

A
  1. This is when there has been necrosis of pdl which has been caused by a dried out tooth
  2. Tooth them becomes ankylosed and root is replaced by bone
34
Q

What is the treatment for replacement resorption?

A

No successful treatment

35
Q

Which material can be used in resorptife defects?

A
  1. CaOH

2. MTA

36
Q

What is MTA?

A

Powder which contains hydrophilic particles and sets in presence of water

37
Q

What is the action of MTA?

A

Prevents micro leakage
Biocompatible
Promotes regen of the original tissues

38
Q

What are the uses of MTA?

A 
Furcal repair 
Perforation repair
Pulp Cap
Root resorption
Apexificatjon 
Root end filling

Restorative (45 decks)

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