Midterm I Flashcards
Which file has a triangular cross-section?
Reamer - Reaming, balanced force, and watch-winding.
Percentages of mandibular canines having 2 canals?
2 = 3-6%
What is the definition of a prescription?
An order for medication which is dispensed to or for an ultimate user. It is not an order for medication which is dispensed for immediate administration to the ultimate user.
What are the three elements you need to cut dentin with a file?
- Force 2. Sharp 3. Rake Angle
What are the main goals for the general dentist?
- Diagnose pulpal and periapical pathosis 2. Endodontic treatment planning 3. Perform non-surgical conventional RCT on minimum difficulty cases
What is the purpose of the flute on the file?
It is the groove that catches debris between the cutting edges.
What are some ideal core material properties?
Easily manipulated, no shrinkage, seals laterally and apically, non-irrating to PA tissues, unaffected by tissue fluids, bacteriostatic, radiopaque, no staining, steril.
What are the smallest and largest dimensions of standardized K-file, H-file, and Gutta-Percha Cones?
006 and 140, and this is measuring the diameter of the very tip.
What is the difference between the standardized and the conventional sizes for Gutta Percha?
- Standardized is the normal File sizes that range from #15 to #140, with either a .02, .04, .06 taper.
- Conventional is sizes
- extra-fine,
- fine-fine,
- fine,
- fine-medium,
- medium,
- large,
- extra-large.
- The Master Cone Fit is Standardized while the accessory cones are conventional.
Where does the smear layer accumulate?
Into accessory canals, isthmuses, canal walls, and fins.
Percentages of mandibular 1st premolars having 2 canals?
2 = 25%
Step 5 of Root Canal Preparation:
- Working Length Radiograph Instrument: Use at least a #15 file for this radiograph, place file passively into canal near the estimated W.L. distance, not aggressively. Outcome: From the radiograph, determine the full length of the canal, determine the adjusted or calculated Working Length from the radiograph for each canal, and remember the Working Length is usually 1/2 to 1 mm short of the root length. Observe the canal curvatures and note the possibility of additional canals.
What does EDTA do? And what percentage do we use?
- 17%, it is a chelator and it removes the inorganic components of the canal and leaves the organic tissue intact, so we use this right before sodium hypochlorite.
- This effectively removes the smear layer, when used for at least 1 minute.
What are the characteristics of Calcium Hydroxide?
Antibacterial, non-antigenic, temporary obturant, stimulate apical root end closure. Very powerful. Inactivates biologic ac:vity of bacterial lipopolysaccharides which egress from necrotic’ pulps’into’periapical tissues’and’cause’PA’lesions
What are the 3 main groups of drugs for pain medicine?
- NSAIDS 2. Opioids/Narcotics 3. Steroids
Step 4 of Root Canal Preparation:
- Coronal Canal Preparation Instrument: Gate-Glidden Burs #2-4 (.7 - 1.1) and Orifice Opener Burs (BR 0) Outcome: Enlarge the orifice, enlarge the coronal canal to the mid-root area size of a #70, reduce the cervical triangular dentin, improve the accuracy of the working length measurement by removing any mid-root interferences, improve the depth of irrigation solution penetration.
What are the five main types of endodontic treatments and procedures?
- Conventional RCT 2. Non-surgical Retreatment 3. Surgical Retreatment 4. Traumatic Dental Injuries 5. Dental Implants
What is Azithromycin made of?
Amoxicillin and Clavulonic Acid
What are the 5 objectives of access openings?
- Remove all caries 2. Conserve sound tooth structure 3. Unroof pulp chamber and remove all coronal pulp tissue 4. Locate all canal orifices 5. Establish straight or direct line access
What are the main Aldehydes?
- Formaldehydes (Formocresol) Used for pulpectomy/pulpotomy to fix remaining pulp tissue. 2. Gluteraldehydes
What are the minimum difficulty cases for additional considerations in the AAE assessment form?
- Uncomplicated crown fracture of mature or immature tooth 2. No previous endodontic treatment history 3. None or mild periodontal disease
How do you place sealer?
Use the Master Apical File and spin in reverse with hand, then use the gutta percha point to coat the canal walls, then use paper point, or you can use the lentulo spiral which isn’t the best, and the syringe which is the single cone technique.
How does the Warm Vertical Compaction technique work for obturation?
You do a Master Cone Fit, and then apply heated plugger deep to separate the cone and heat and soften apical section, then you apply apical pressure to produce hydraulic force to softened gutta percha, moving it apically and laterally. And then additional gutta percha sections are added similarly in an incremental fashion to orifice.
Step 6 of Root Canal Preparation:
- Apical Configuration/Gauging Instrument: Small K files #8-20. Use passively to determine apical gauging and canal size. Use a #10 file to establish apical patency. Outcome: Determine the Patency File size, determine the Initial Apical File size, which is the first file that binds at the WL. Estimate the Master Apical File size, which is the size that will be used to clean the apical canal at the working length. (The MAF is usually 3-4 file sizes larger than the IAF)
What are some of the irrigation techniques with removing the smear layer?
Every 2-3 files you should change, agitate with small file like a #10 or #15, endoactivator, use small side-vented needle, keep chamber wet, alternate NaOCl with 17% Aqueous EDTA.
Which file has a teardrop cross-section?
Hedstrom - Filing, circumferential, and watch-winding.
Percentages of maxillary 1st premolars having 2 canals? 3 canals?
2 = 60-80% 3 = 6%
Why do we remove the smear layer?
So filling material adapts better to the canal wall, to get better adhesion of sealer to dentin, and to get better tubular penetration of sealer.
What does taper mean?
It means that the file diameter is getting 0.02 mm wider per millimeter increase at D0 towards D16.
Percentages of mandibular 2nd molar root canals
Distal Root 2 canals = 5-8%
What are the main Halides?
- Sodium Hypochlorite (Bleach) 2. Iodine -These are potent bacterial or viral killers.
What are K-files used for?
They are like reamers, but have spirals much closer together. They are used to plane and smooth the walls of the root canal.
Important characteristics of Schedule III-V controlled substances?
These may be oral, written, or faxed. Refills are ok and by call-in.
Percentages of maxillary 2nd premolars having 2 canals?
2 = 10-20%
What does the smear layer mainly consist of?
Organic and inorganic substances as well as fragments of odontoblastic processes, various species of bacteria, and necrotic debris.
What are the main 4 categories that medications are prescribed for?
- Pain 2. Infection 3. Anxiety 4. Muscle Relaxant
What are the teeth with almost always 1 canal only?
Maxillary anteriors, palatal and distobuccal roots of maxillary molars.
What is the acronym for the colors of the file sizes?
PiGPu, and then Why Your Rain Bow Green Black? Pink, Grey, Purple……White, Yellow, Red, Blue, Green, Black. These all apply to the 0.20 taper.
What is the process/technique for placing gutta percha?
The Master Cone Fit (usually same as MAF) is fit to within .05-1mm of WL. Or you can take a little larger size, dip the tip in chlorophorm, dip it in the sealer, and push it the last 1.5mm. Some radiographically firm after this, most don’t. Then for the lateral condensation technique, you place the Master, use the spreader to create space for accessory points, and this is all to within 2-3mm of WL. You have about 6 seconds to place the accessory points to fill space, and you repeat this to coronal 1/3. Then you sear excess with heated plugger (glick). Then you vertically compact with double-ended plugger (5/7) and then you clean the chamber with alcohol-soaked cotton pellet.
What are the 4 main types of core material?
- Gutta Percha
- Silver Cones (oxidizes if exposed to water, and stains tissue)
- Paste Fillers (Calcium Hydroxide for temporary purposes), Sargenti (paraformaldehyde), Russian Red.
- Hot dog on a stick (Thermafil, Gutta-Core)
What is the best way to clear apical debris?
Use the Master Apical File to working length, and do apical patency with a #10 K file 0.5mm-1mm away one more time.
What are the 4 main endodontic access principles?
- Outline form 2. Convenience Form 3. Caries Removal 4. Toilet of Canal (prevent blockage, clean it out)
What are the minimum difficulty cases for patient considerations in the AAE assessment form?
- ASA class I 2. No history of anesthesia problems 3. Cooperative and Compliant 4. No limitation in ability to open mouth 5. No gag reflex 6. No pain or swelling
What are the names of the two diameters near the apex?
The minor apical diameter and the major apical diameter.
What are the 5 main uses for intracanal medicaments?
- Antibacterial
- Enhance anesthesia
- Render canal contents inert
- Control persistent inflammation
- Control post-treatment pain
Step 2 of Root Canal Preparation:
- Find Canal, Explore, Negotiate Instrument: K-Files, #8, #10, and #15. Watch-wind and pull out, up/down, and circumferential filing. Outcome: Identify all canals, determine canal patency, smooth the canal, and agitate irrigation solution to dissolve pulp tissue. You can use the DG16 (explorer) to feel around the orifices.
Which bug is Chlorhexidine specifically effective against compared to other irrigants?
- Enterococcus faecali. Clorhexidine is mainly just antimicrobial, doesn’t do much else, but it does form an ill-wanted precipitate when combined with bleach.
- Chlorhexidine is similar to NaOCl but unable to dissolve necrotic tissue nor remove smear layer
What is Percocet made of?
Tylenol and Oxycodone
What type of drug is a valium?
Benzodiazepine, along with other drugs that end in “am.” The muscle relaxant drugs are Carisoprodol and cyclobenzaprine.
What are the main phenols?
- CMCP (Camphorated Monoparachlorophenol) Less toxic
- Cresatin (Metacresylacetate) Even less toxic. Used for vital pulpectomy. -These are antibacterial, and act by binding to cell membrane and lipids
What is the overall outline form of anterior tooth including premolars?
Oval. They start out as triangular and become more oval.
Step 10 of Root Canal Preparation:
- Final MAF Radiograph & Rinse Instrument: Radiograph with the MAF at working length, final rinse with EDTA - Alcohol - NaOCl - Alcohol. Outcome: Confirm of full WL canal preparation with the MAF, confirmation of a thoroughly clean and rinsed canal.
Step 3 of Root Canal Preparation:
- Pre-Flare and Tissue Debridement Instrument: Hedstrom Files #15, #20. Up/down, circumferential filing motion. Outcome: Canal debridement, enlarge the orifice, and reduce the cervical triangular dentin to improve the SLA to the mid-root canal.
What is the composition of Gutta Percha?
- 20% gutta percha
- 65% zinc oxide
- 10% radiopacifiers
- 5% plasticizers
How does the smear layer accumulate?
During cleaning and shaping, we push debris against the canal wall.
Step 1 of Root Canal Preparation:
- Access Cavity Preparation Instrument: #330, #557 Outcome: Get straight line access (SLA) to canal orifices, mid-root, or first canal curvature. De-roof the complete pulp chamber, remove pulp chamber tissue, and conserve tooth structure.
What are the 5 main commonly used irrigants?
- Sodium Hypochlorite 2. EDTA 3. Chlorhexidine 4. Sterile Water 5. Local Anesthetic
What are the 5 main types of sealer?
- Zinc-Oxide and Eugenol (ZOE, Roth’s) (We use Roth’s/Grossman in the clinic)
- Resin-based
- CaOH-base
- Glass Ionomer
- Bioceramic
How far can the smear layer pack into dentinal tubules?
Up to 1 to 5 microns
Which file has a square cross-section?
K-file - filing, circumferential, balanced force, and watch-winding.
How many different sized files are there and what are they?
There are 21, and they are 006, 008, 010, 015, 020, 025, 030, 035, 040, 045, 050, 055, 060, 070, 080, 090, 100, 110, 120, 130, 140.
What are the 4 main uses of files?
- Canal negotiation 2. Canal debridement 3. Length determination 4. Canal shaping
What is the overall outline form of mandibular molars?
Rhomboid
What are Hedstrom files used for?
- These are rigid and are used to removed old rootfillings, and sometimes to plane the canal walls.
- The instruments are used only in a filing or rasping mo>on. They should never be rotated or engaged into den>n as they are weak instruments and prone to fracture.
Important characteristics of a controlled substance?
Must be dated and signed on day of issue, manually signed, ink, indelible pencil, or typewritten. The physician has to be registered with DEA, but military, public health, FBI are exempt.
What is the overall outline form of maxillary molars?
Triangular
Step 8 of Root Canal Preparation:
- Mid-Root Preparation & Gauging Instrument: Use the MAF and at least two larger files in a passive Balance Force method to enlarge the mid-root portion of the canal. The mid-root preparation will be even more defined with the next step. Outcome: Enlarge the mid-root canal, and continue to agitate the irrigant and disinfect the canal.
What is apical transportation?
Making the canal near the apex way larger than it should be, so essentially taking away tooth structure.
What are the 4 main cleaning & shaping objectives of root canals?
- Remove infected hard and soft tissue
- Give disinfecting solutions access to the apical canal space
- Create space for the delivery of medicaments and subsequent obturation
- Retain the integrity of radicular structures
Percentages of mandibular incisors having 2 canals?
2 = 30-40%
We know that the number sizes match the diameter of the tip, but what are the diameter numbers at D16?
It starts at 0.38 and ends at 1.72
What are the main access burs and their categories?
Carbide high speed #330 and #557, Diamound round and round end taper, and specialty burs like the Endo-Z FG and LA Axxess Kit, as well as slow speed round burs.
What is Percodan made of?
Aspirin and Oxycodone
What is the definition of irrigation?
To wash out a body cavity or wound with water or a medicated fluid.
Step 7 of Root Canal Preparation:
- Glide Path Preparation Instrument: Starting with IAF, increase the size to at least a #20 K file to be used as the Glide Path file. Work them in sequence in watch-wind, 1/4 turn-pull, circumferential, step-back, balance-force, or crown-down. Outcome: Prepare a path that removes all interferences from the orifice to the apical terminus of the canal, smooth the canal, clear pulp tissue by irrigant agitation, at least a #20 should have a smooth glide to the WL.
Step 9 of Root Canal Preparation:
- Apical Canal Preparation Instrument: use the #10 to carefully maintain apical patency. Use file sizes from the IAF to the MAF to enlarge the apical canal, and use watch-wind, step-back, or balance-force. Outcome: Maintain canal patency. Maintain working length. Maintain apical position. No canal ledging, zipping, or apical transportation.
What are the sizes for the Gates Glidden Drills?
There are 6 of them. The smallest is 0.50 mm and the largest is 1.50 mm. It goes
- 0.50 (#1) -
- 0.70 (#2) -
- 0.90 (#3)..
- 1.10 (#4)
- 1.30 (#5)
- 1.50 (#6)
Important characteristics of a Schedule II controlled substance?
Requires written prescription, no time limit to fill, refills are prohibited, multiple prescriptions (90 days) are permitted, fax prescriptions ok for prep only.
At what percentage is bleach usually worked with?
2.5-5.25%
Why is the smear layer potentially harmful?
It may be contaminated with bacteria and their metabolic by-products, it may prevent sealer contact with the canal wall, permitting leakage, and it may disintegrate then cause obturation leakage.
What is the main essential oil?
Eugenol (oil of cloves), used as an anodyne to inhibit nerve activity, and has potent antimicrobial properties.
What is the name of the 3rd root found in Asians on their mandibular 1st molars?
Radix Entomolaris
What is the process for drying the canal?
Use a small-tip aspirator (saliva ejector with large gauge needle tip), then coarse paper point, and then fine paper point (use for final WL check). But do not do direct air spray, that is how you get an air embolism.
What does a modern prescription have on it?
The heading has the name, address, phone #, name and address of patient, and date of prescription. The body has the Rx symbol, name and dosage size or concentration of drug, amount or quantity, and directions to patient.
What is zipping?
It is when you completely miss the apex at the bottom and form your own apex.
What are some characteristics of Sodium Hypochlorite?
- NaOCl—2.5=5.25% (full strength) Bleach
- Best Proteolytic Agent
- Breaks Down Proteins into Amino Acids Through Free Chlorine
- Chelator
- Removes Debris and Wets Canal Walls
- Antimicrobial
- Dissolves Organic and Inorganic Debris
- Opens Dentinal Tubules (Smear Layer Removal)
- Disinfects and Cleans Areas Inaccessible to Instruments
What are some ideal sealer properties?
Tackiness, air tight seal, radiopaque, fine powder, no shrinkage, no staining, slow setting time, bacteriostatic, insoluble in tissue fluids, non-irritating to periradicular tissue, soluble in common solvent for removal.
What type of files should you establish and finalize the Master Apical File with?
Hand Nickel-Titanium files
What are the main 4 types of Medicaments?
- Phenolic compounds (essential oils, aldehydes, halogens) 2. Calcium Hydroxide 3. Steroids 4. Antibiotics
What is and what is a downside to the Lentulo spiral (low speed latch)?
-A Lentulo spiral is a dental instrument used to properly distribute root canal sealer and cement evenly throughout the root canal system, as when performing endodontic therapy or a post and core cementation. They can cause damage because they catch a lot on the walls.
What are Reamers used for?
They are miniature hand-operated twist drills used to enlarge the size of the root canal and to negotiate the canals to their apices.
What is Flexeril used for?
Anxiolytic and a muscle relaxant
What is Lortab/Norco made of?
Tylenol and Hydrocodone
What are the minimum difficulty cases for diagnostic and treatment considerations in the AAE assessment form?
- Signs and symptoms consistent with recognized conditions 2. Minimum difficulty in obtaining radiographs 3. Anterior/Premolar teeth with slight inclination 4. routine rubber dam placement 5. normal crown morphology 6. Slight or no curvature (<10 degrees) 7. Closed apex (Less than 1 mm) 8. Canal visible and not reduced 9. No resorption evident
Percentages of maxillary 1st molar root canals?
Palatal and Distobuccal root 1 canal = 100% Mesiobuccal Root 2 canals = 40-80%
How does the Modified Warm Vertical Compaction technique work for obturation?
You have a heat source from an electrical system like System B, and you do the same sort of technique as the warm vertical compaction or you do a softened backfilling technique, so after the apical section is placed, heated, and compacted, the softened gutta percha in an electrical gun-like device is expressed through the syringe tip, then down-packed using the Obtura.
What are the characteristics of Nickel Titanium rotary instruments?
It is an exotic metal, superelastic metal. It can accommodate greater stress without increasing the strain, and has the ability to return to its original shape after being deformed. We don’t leave Nickel Titanium rotary instruments in the canal for more than a couple of seconds because it will cause damage, but they are extremely helpful because they can curve and adapt to the shape of the canal.
What are barbed broaches used for?
They are used for the removal of pulp tissue and for removing cotton wool dressing pellets.
Percentages of mandibular 1st molar root canals?
Mesial Root 2 canals = 70-80% Distal Root 2 canals = 15-30%
Percentages of mandibular 2nd premolars having 2 canals?
2 = 15%
Locan Anesthetic has some antimicrobial activity. True or False?
True
How many roots do teeth have? Exceptions?
Most teeth have just one. The exceptions are: Maxillary 1st premolar = 2 roots Maxillary 1st molar = 3 roots Mandibular molars = 2 roots
Although you can use with any diagnosis, what are the indications for the placement of Calcium Hydroxide?
Necrotic pulp, and in following the SLA and establishing the master apical file. Probably has little benefit with vital pulps. You mix the powder with glycerin, and can use either a syringe or place it with a lentulo spiral. The research study said lentulo spiral was most effective, syringe next, and #25 K file was least effective.
What are the colors of 6, 8, and 10 files, the first three?
- Pink
- Grey
- Purple
PiGPu
What are the diameters at the tip and top of a 006 K file? And at what diameter of the tip does the increments change as you get all the way from a .06 diameter tip to a 1.40 diameter tip?
It starts at a 0.06 and 0.38 (at the D16 level, if you know it is a 0.02 taper, than it should just be .32 above it).
- And it goes 0.06
- 0.08
- 0.10
- 0.15
- 0.20….. etc….. and then starts adding 0.1 between each at 0.60
- 0.60
- 0.70
- 0.80, all the way to
- 1.40
What is the normal taper for a K file and how do you calculate it?
A normal taper is 0.02
For example, for a 050 file, the D16 is 0.82 and the D0 is 0.50. So we take (0.82-0.50) and divide that by 16mm, to give us = 0.02 taper
What is the definition of a positive rake angle? And which files have one?
When the blade is behind the perpendicular. Hedstrom and most dental burs.
What is the definition of a negative rake angle? And which files have one?
- If the leading edge of the blade is ahead of the perpendicular, the angle is, by definition, negative.
- Examples of negative rake instruments are reamers, K-files, K-Flex files, diamond burs, most NiTi-files, and burnishing burs or regular burs run backwards.
The pulp chamber follows the anatomy of the crown. True or False?
True
Which tooth can have the three canals in the shape of a C?
Mandibular 2nd molar. Two towards mesial, one on distal.
What are the different methods of file use for each file?
- Reaming—Rotating clockwise as flutes engage dentin (REAMER, ROTARY)
- Filing—Bind flutes and scrape out along dentinal walls ( KIFILES, HEDSTROM FILES)
- Circumferential Filing—Move file from wall to wall while scraping (ALL but REAMERS)
- Balanced Force—Place, cut w/pressure (force) and remove (KIFILES, REAMERS)
- Watch Winding/Twiddling—Gently and repeatedly rotating instruments apically (ALL)
What does MTAD do?
- (Tetraclycline, Acid, Detergent) Removes smear layer, Antimicrobial
What does Alcohol do to a canal?
- Dries Canal, Surfactant (lowers surface tension with NaOCl)
What does he say about cotton & cavit and IRM?
- -He does this one the most, and you will either do the cotton and cavit alone, or put in a medicament and then put in cotton and cavit, you always put in cotton and cavit.
- -Intermediate Restorative Material, which is usually mixed with eugenol, helps inhibit nerve activity
What are the common antibiotics used for endodontics?
- Pen VK
- Amoxicillin
- Ampicillin
- Clindamycin
- Augmentin
- Azithromycin
