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BDS3 - Endodontics > Obturation > Flashcards

Obturation Flashcards

1
Q

What is the objective of root canal treatment?

A

To provide an environment that allows the healing of peri-radicular tissues so that the tooth is retained as a functional unit in the dental arch.

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2
Q

What are the four theories on the biologic basis of endodontic disease?

A

Hollow tube theory (tissue fluids entered root canal created bi-products and passed through periradicular tissues)
Stagnation theory.

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3
Q

What do we need to get right when obturating a root canal?

A 
Apical/lateral seal
Sealer/core materials
Timing of obturation
Length
Assessment
Coronal seal.
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4
Q

What is the aim of filling the root canal system?

A

Prevents the passage of microorganisms and fluid along the root canal and to fill the whole canal system
Not only block the apical foramina but also the dentinal tubules and accessory canals.

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5
Q

Where do we want our root filling to extend to?

A

Inserted to the full working length.

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6
Q

What is the working length?

A

Preparation should end at the junction of the pulpal and periapical tissue
WL should be as close as possible to the CDJ
This is usually the narrowest part of the canal (apical constriction).

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7
Q

What can we use to determine the working length?

A

An apex locator (red line is when its a 0 reading and this means we have hit the PDL, 0.5mm back is our working length).

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8
Q

Why is radiographically determined working length less accurate than an electronic apex locator?

A

Varying constriction anatomy that increases with age, root resorption is a complicating factor.

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9
Q

What would happen if we were 2mm short of the apex when filling the tooth?

A

Creates harboured bacteria and decreases the outcome of a successful treatment.

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10
Q

Where do critters hide and how well do we treat these regions?

A

Dentinal tubules/apical/lateral canals

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11
Q

What does sealer do?

A

Flowable sealer penetrates tubules and seals lateral canals.

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12
Q

When should you start the filling of the root canal?

A

Should be undertaken after the completion of root canal preparation and when the infection is considered to have been eliminated and can be dried.

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13
Q

Does the presence of positive bacteria influence the outcome of treatment?

A

No.

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14
Q
  • Not appropriate to drain sinus tract at same of obturation. Try to control bacterial load and start healing before root canal.
  • Timing of obturation dependent on pulp vitality- if healthy might want to complete this so bacteria don’t have more time to ingress.
A

*

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15
Q

What are characteristics of materials that are used to fill the root canal system?

A 
"should consist of a semi solid material in combination with a root canal sealer to fill voids between the semi solid material and the root canal wall"
Biocompatible
Dimensionally stable
Able to seal
Unaffected by tissue fluids and insoluble
Non-supportive of bacterial growth
Radiopaque
Removable from the root canal if needed.
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16
Q

What is the most common core material that we use in dentistry?

A

Gutta Perca

  • produced from the juice of trees of the sapodilla family
  • natural rubber and GP are polymers of isoprene (same monomer)
  • tras polymer if polyisoprene.
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17
Q

What is the constituents of a GP cone?

A

20% GP
55% ZnO
10% radiopacifiers
5% plasticisers.

18
Q

What are GP obturation techniques examples?

A

Single point obturation, cold lateral compaction and obturation.

19
Q

What are the negatives of cold lateral compaction?

A

Voids, spreader tracts, incomplete fusion of GP cones, lack of surface adaptation and inability to Obturate laterally (can be minimised with good technique).

20
Q

What are sized matched cones?

A

They compliment file size and shape

Leave very little space for accessory cones.

21
Q

What is warm vertical compaction?

A

A continuously tapering funnel and minimal apical diameter.

22
Q

What is continuous wave obturation?

A

Heated pluggers which allows the delivery of GP. This technique allows a single tapered electric heat plugger to capture a wave of condensation at the orifice of a canal and ride it, without release, to the apical extent of downpacking in a single, continuous movement.

23
Q

What hand plugger do we use to condense apical fill during continuous wave obturation?

A

Buchanan hand plugger.

24
Q

What is carrier based obturation?

A

Carrier-based obturation is the only filling technique that can simultaneously deliver and compact warm gutta-percha to the terminus of canals that have coronal or mid-root curvatures. Once a canal has been dried, root canal sealer may be placed using the EndoActivator.

25
Q

What options can you explore for a large open apex tooth that isnt suitable for obturation?

A

MTA, biodentine etc.

26
Q

Is MTA easy to remove?

A

No. But it is osteoinductive- if you place it next to tissue we see bone and cementum growing around surface.

27
Q

What is resilon?

A

Resin based system
Dentine bonding technology
Thermoplastic synthetic polymer based on polymers of polyester contained bioactive glass and radiopaque filers
“Mono block”- resin running through root canal space into crown- single restoration.

28
Q

What are the 3 functions of a sealer?

A
  • Seals space between dentinal wall and core
  • Fills voids and irregularities in canal, lateral canals and between GP used in lateral condensation
  • Lubricates during obturation.
29
Q

What are the ideal properties of a sealer?

A 
Exhibits tackiness to provide good adhesion
Establishes a hermetic seal
Radiopacity
Easily mixed
No shrinkage on setting
Non-staining
Bacteriostatic or does not encourage growth
Slow set
Insoluble in tissue fluids
Tissue tolerant
Soluble on retreatment.
30
Q

What is a zinc oxide eugenol based sealer and how does it work?

A
  • Zinc oxide antimicrobial and may afford cytoprotection
  • Resin acids affect lipids in cell membrane thus strongly antimicrobial/cytotoxic
  • Although toxic, may overall be beneficial with long lasting antimicrobial effect combined with cytoprotective effects
  • Free eugenol which remains can act as an irritant
  • Lose volume with time due to dissolution- resins can modify this.
31
Q

What are the advantages and disadvantages of a GI sealer?

A
  • advocated due to dentine bonding properties
  • minimal antimicrobial activity
  • greater solubility
  • removal upon retreatment is difficult
  • little clinical data to support use.
32
Q

What sealer do we use in the dental hospital?

A

AH plus sealer.

33
Q

What are the properties of an ENDORez sealer (resin)?

A 
Is a UDMA resin based sealer
Hydrophilic
Good penetration into tubules
Biocompatible
Good radiopacity.
34
Q

What are the properties of a calcium silicate sealer?

A 
High pH (12.8) during the initial 24 hour set
Hydrophilic
Enhanced biocompatibility
Doesnt shrink on setting
Non-resorbable
Excellent sealing ability
Quick set- 3/4 hours, requires moisture
Easy to use.
35
Q

*remember sealers containing organic materials such as aldehydes are not recommended.

A

*

36
Q

How do you check the quality of a filling material?

A

Should be checked with a radiograph
The radiograph should show the root apex with prefably between 2-3mm of the periapical region clearly identifiable. The prepared root canal should be filled completly unless space is need for a post. The prepared and filled canal should contain the original canal. No space between canal filling and canal wall should be seen, There should be no canal space visible beyond the end point of the root canal filling.

37
Q

What do you need to look at during your assessment of your obturation?

A 
-Primarily based on post-op radiograph
length
taper density
GP and sealer removal to facial CEJ in anteriors and canal orifice in posteriors
Subjective!
38
Q

Why should the tooth be restored after a root canal filling?

A

To prevent bacterial recontamination of the root canal system or fracture of the tooth.

39
Q

Where should you stop your GP at the orifiace?

A

Finish obturation at orifice or just below orifice level
GP rapidly becomes infected if exposed directly to oral bacteria
Zn/Eugenol materials are cytotoxic and form effective antibacterial barrier
rmGI or flowable composite.

40
Q

What is regenerative endodontics?

A

BIOLOGICALLY BASED PROCEDURES DESIGNED TO REPLACE DAMAGED STRUCTURES, INCLUDING DENTINE AND ROOT STRUCTURES AS WELL AS CELLS OF THE PULP DENTINE COMPLEX.

41
Q

What are the two futures of endodontics?

A

Vital pulp therapies

Pulp regenerative therapies.

42
Q

*remember no filling material or technique can compensate for inadequate chemomechanical disinfection.

A

*

BDS3 - Endodontics (10 decks)

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