NEW MD ENDO CARDS Flashcards
what 3 types of cells are found in pulp?
Fibroblasts
Odontoblasts : primary (before root formation complete) and secondary dentin (after)
mesenchymal cells: tertiary dentin (secondary odontoblasts protect pulp from injury)
how does dentin affect pulp?
limits ability to expand
calcifcation of tubules in response to slowly advancing caries is what type of dentin ?
sclerotic dentin ( hard)
histologic zone of pulp
Inside -> out
predentin , odontoblastic layer, cell-free zone of weil, cell-rich zone, pulp core
this pulp fiber resonds to cold
A-delta fiber
structre of C vs alha-delta diber
alpha: marge myelated afference nerve
c-fiber: small unmyelinated afferent
which way do alpha and C fibers travel
alpha: coronally through pulp
C fiber: centrally om [ulp stroma
C fiber vs alpha fiber, which one is dull throbbing pain?
C fiber ( alpha is sharp transient)
a patient feels pain at a stimulus lower than they usually feel. what is this called
allodynia ( sun burn hurts when you touch skin, doesnt normally hurt)
an example of referred pain would be ?
preauricular pain from mandibular molars ( share V3 innervation)
EPT test is contraindicated in patients that have what>
cardiac pacemaker
a patient comes in no complaints of spontaneous pain. turns out symptom is coming from an irritant. what does he have?
reversible pulpitis
patient is asymtpmatic and no clinical signs. what do they have
asymtpomatic irreversible pulpitis
patient has a long term interruption of blood supply to the pulp. diagnosis ?
pulp necrosis
patient has no response to cold. what is it?
pulpal necrosis !!
patient has heightened and lingering response to pulp. what is it?
symptomatic irreversible pulpitis ( necrosis means no response)
patient has no sympts but PARL developing on radiograph. what do they have?
asymtpomatic apical periodontitis
straight line access should be to >
orifice and apex
what tooth has the highest rate of root occurrence?
maxillary canine 96% chance of 1 root
what tooth most likely to have 2 roots
max 1st pm
access shape of maxillary molars
blunted triangle/ rhomboidal
access prep shape of mandibular molars
trapezoid
file colors
why you run blu ? go Back
15 20 25 30 35 40
the SS hand files have what size taper?
.02
the niTi rotary instruments have what size
.04
.06
size 15 file is what at the tip? and what at 16 mm?
.15 mm at tip and .47 mm from tip to 16 mm from tip
.15 + .02(16mm) .47 mm
what is the irrigant that dissolves ORGANIC materials?
NaOCl sodium hypochlorite
what is the lubricant that dissolves INORGANIC material
EDTA
what dissolves GP in retreatment of RC
chloroform
primary endodontic infection bacteria?
bacteroides
failed endo treatment bacteria?
enterococcus faecalis
EF
main ingredient for GP and sealer? **
zoe !!
when condensing GP which one is warm and which is cold
vertical and lateral condensing?
Vertical: warm
Lateral : cold
what is surgical RCT?
cutting off apex tip and re instrumentation
best method for localized and fluctuant swelling?
incision and drainage
periapical microsurgery is what/
resectioning of 3 mm of diseased root tip
ways to avoid ledging in root canals
NiTI files
use smaller instruments to bypass ledge
instrument canal to full length
pre bend file
what type of perforation is through pulpal floor?
furcal perforation
what is considered danger zone in a molar in endo?
D side of M root !!!
what is better. perforating more apical or more coronal?
more apical
what is sign of perforation?
immediate hemmorrhage
sudden pain
what material do you internally repair when perforating a tooth
MTA
trauma protocol for tooth
TRAVMA
tetanus booster ( avulsion only) radiograph antibiotic ( avulsion only) vitality test more appointments
when would you need tetanus booster for tooth trauma? what about antibiotics?
avulsion only
avulsions only
what are ellis classifcation
1- enamel 2- enamel and dentin 3- e,d,p 4- traumatized tooth becomes non vital 5- luxation ( displacement of tooth) 6- avulsion ( completely out)
what is an uncomplicated fracture ?
fracture without pulp involvement
how to fix an euncomplicated fracture affected enamel only?
smooth edges
how to fix uncomplicated fracture that affects enamel and dentin?
restore
a patient fractures his tooth with pulp involvement. it has been less than 24 hrs. what should we do?
direct pulp cap
a patient fractures his tooth to the pulp and it has been 24 hours. what should clinician do?
CVEK ( partial pulpotomy
patient fractures his tooth with pulp involved and it has been 72 hours. what to do?
pulpotomy
patient has a horizontal root fracture on the coronal portion. what should treatment be>
RIGID splint 6-12 weeks ( WORST KIND)
patient has a horizontal root fracture on the midroot portion. what should treatment be>
FLEXIBLE splint for 3 weeks
patient has a horizontal root fracture on the APICAL portion. what should treatment be>
flexible splint for 2 weeks max to avoid ankylosis
if a tooth is concussed, what is the tx option?
let tooth rest
this is when a tooth does not displace, but mobilits is increased. PDL rips and bleeds
what is tx?
avulsion
lateral luxation
sub luxation
extrusion
subluxation (tooth loose in socket)
flexible spling 1-2 weeks
tooth is partially extruded from the socket
tx?
avulsion
lateral luxation
luxation
extrusion
extrusion ( tooth out coronally)
open apex: reposition, flexible splint, monitor
closed: resp. flexible splint,RCT
displacement of tooth in any direction except axially. usually crown displaced palatally and root displaced labially tx? avulsion lateral luxation luxation extrusion
lateral luxation
open: reposition, flexible splint, monitor
closed: rep. flex sp. RCT if needed
80% necrosis closed apex
complete seperation of tooth from its alveolus
tx?
closed / open apex
>60 and <60
avulsion lateral luxation luxation intrusion extrusion
depends on EDT ( extra dry time)
closed:
<60 : reimplant, splint
>60: reimplant, splint, RCT
Open:
<60: reimplant, splint , specification first sign of pulp infection
>60: may or maynot implant, spling, rct, plan for implant
apical displacement of tooth
tx?
avulsion lateral luxation luxation intrusion extrusion
intrusion: tooth gets pushed in to socket
OPEN: ALLOW TO REERUP !!!! (BOARD ?_
closed: reposition, flex splint, RCT
96% necrosis closed apices
which one has 96% chance necrosis with closed apex?
avulsion lateral luxation intrusion luxation extrusion
intrusion
patient falls and tooth comes out. it has been only 45 minutes. what should tx be?
closed:
<60 : reimplant, splint
Open:
<60: reimplant, splint , specification first sign of pulp infection
patient falls and tooth comes out. it has been 2 hours. what should tx be?
closed
>60: reimplant, splint, RCT
open
>60: may or maynot implant, spling, rct, plan for implant
what is the best and worst store media for a tooth that comes out?
Hanks balanced salt solution -> milk _> saline -> water (hypotonic no balnce of ions)
external resorption initiates where and is due to damage of what?
periodonteium
cementoblastic layer
ankylosis is type of what ?
cervical resorption
replacement resorption
inflammatory root resporption
replacement: repalces PDL with bone
a patient that had nonvital bleeching complains about sensitivity. radiograph shows r/l on cervix of tooth. what might this patient have?
cervical resorption
bacteria and byproducts from nectoric pulp travel through dentinal tubules to affect peridontiem called what?
inflammatory root resoprtion ( external resoprtion)
internal resoprtion initates where and damages what layer
root canal system
odontoblastic layer
true or false. external resoption easier to treat than internal
false
internal is easier
tmnt for internal resorption ?
RCT
calcific metamorphosis ( discolation of anterior teeth) is caused by what?
trauma that induces odontoblasts to rapidly crease a lot of dentin in pulp space
what is radiographic finding of calcific metamorphosis
canal obliteration b/c pulp canal shrink to point you cant see it
what does caoh do?
pH?
stimulates secondary odontoblasts (repair dentinal bridge formation)
12.5 ( kills bacteria)
what does MTA do?
what is it used for?
stimulates cementoblasts
fxn: root repair, apex filler
nonresorbable ( great sealer)
indirect pulp cap uses what materials
CAOH , RMGI
drilling and expose pulp that is 1 mm. what do you do?
material you add?
direct pulp cap, caoh
portion of pulp is diseases. what do you do?
remove small portion coronal diseased pulp
theres a traumatic exposure of pulp more than 24 hours. what do you do?
cvek pulpotomy (partial)
a traumatic exposure lasts more than 72 hours. what do you do?
materials add?
pulpotomy
zoe in crown
formocresol in orifices
a primary tooth with traumatic exposure more than 72 hours that is VITAL and resotrable, what do you do?
pulpotomy
what are properties of formocresol?
what is it made of?
when do you use it?
20% formaldehyde
bactericidal and fixative ( kills bacteria/ fixes pulp)
USE PEDIATRIC PULPOTOMY OF VITAL TOOTH
doing a pulptomy on a kid, what do you use ?
formocresol
a patient has a nonvital, restorable primary tooth with pulp exposure that is ASYMPTOMATIC. what should they do>?
pulpectomy
what materials added for pulpectomy of primary tooth?
zoe in crown
caoh in root ( caoh resorbed by underlying permanent teeth)
pain relief on teeth with irreversible pulpitis
Primary teeth: nonvital and reasonable with asymptomatic pulp exposure
a patient has symptomatic molar that nonrestorable and root resporption, what should we do?
extraction
SYMPTOMATIC= extraction
what tooth is most susceptible to extraction
primary first molar= LOTS OF ACCESSORY CANALS
teenager walks in with vital pulp exposure, and is undergone pulp therapy ( CVEK, PPTy) etc. what happens now
apexogenesis ( development of apex in an IMMATURE PERMANENT TOOTH)
happens afterpulp cap placed on healthy or diseased pulp ( CaOH and MTA)
difference between apexogenesis and apexification?
apexogenesis:
- maintain pulp vitality
- caOH or MTA place following IPC, DPC, CVEK, PPTY in IMMATURE permanent tooth
specification:
- disnfection of root canal
- CaOH or MTA placed on base of canal after PCTY performed in IMMATURE PERMANENT TOOTJ
a pulpectomy is done on a teenager, what treatment should follow it?
apexification
caoh or mta placed at base of canal after pulp removed especially in IMMATURE PERMANENT TOOTH
