Pulp Care Flashcards
Healthy pulp
Vital, free of inflammation
Reversible Pulpitis
- Vital
- Sensitive to cold/sweet
- short lasting pain as long as stimulus applied.
- Respond to sensibility tests
- NO CHANGE IN PULPAL BLOOD FLOW
- No Rg change
Not TTP
Symptomatic Irreversible pulpitis
-Vital, responds to tests
-Sensitive to hot
-pain lasts longer than stimulus application
-Spontaneous, referred
-sleep disturbance
-Increase in pulpal blood flow
OTC analgesics ineffective
Not TTP
Necrotic pulp
Death of pulp
NO response to sensibility tests
TTP
Rg - osseous breakdown
Asymptomatic irreversible pulpitis
Vital inflammed pulp, no healing
NO clinical signs
respond to thermal tests
BLEEDS PROFUSELY IF EXPOSED
Previously treated
RC filling and non responsive to thermal/EPT
Previously initiated
Partial pulp treatment carried out - pulpotomy
Normal apical diagnosis
- NOT TTP
- no sensitive to palpation
- LD intact and no radiolucency
Symptomatic apical periodontitis
TTP
Painful when biting
Rg - normal PDl space width
PA radiolucency
Asymp apical periodontitis
Pulpal origin of inflam
Apical radiolucency
NO TTP/palpation
Chronic apical abscess
inflam and response to pulpal necrosis GRADUAL ONSET little/no discomfort diacharging pus through sinus Rg - sign of osseous breakdown
Acute apical abscess
Inflam to pulpal inflam and necrosis Pain, TTP, pain on biting SPONTANEOUS RAPID ONSET Rg - No sign of osseous breakdown
chemomechanical disinfection principles
- create a continously tapering funnel
- keep apical foramen in the same position
- maintain apical opening as small as poss
Ideal properties of disinfectant
Cheap lubricate canal not affect dentine properties not interact with dental materials biocompatible dissolve organic and inorganic mateial non allergenic washing action friction reduction bacteriocidal Biofilm disruption good penetration of canal
Sodium hypochlorite features
GOLD STANDARD DISINFECTANT
-NaOCl - Na and OCl, ionises in water forming an equilibrium with hydrochlorous acid
-Antibacterial action
-dissolves pulp remnants (necrotic & vital)
-Helps disrupt smear layer
-
Factors for NaOCl
Conc - 0.5-0.6%
Volume - 10-15ml in canal
Contact time
Mechanical aggitation
NaOCl - issues (Dis)
- Affects dentine properties
- Can’t remove smear layer by itself
- Apical extrusion
- Affect organic material
- Discolour fabrics
- OPTHALMIC INJURIES
- Allergic reaction
Removal of smear layer?
- EDTA (17%)
- Citric Acid (10%)
- Ultrasonic irrigation
- NaOCl
Symps of apical extrusion
- pain
- bruising along superficial venous vasculature
- swelling
- haemorrhage
- airway obstruction
- neurological coplications
- tingling lip
Apical extrusion risk factors
- loss of control of working length
- greater force during irrigation
- needle locked in canal
- larger apical diameter
- higher NaOCl conc
- root resorption
FLOW RATE - 1ml/15s
Management of apical extrusion of NaOCl
LA physiological saline - irrigate canals reassure patient dress tooth - nsCaOH - advise on analgesia, swelling management, prevention of secondary inf
REFER IF SEVERE
What is an intracanal medicament
usually an antimicrobial paste that is placed in a RC between appointments in order to prevent re-inf and reduce inflammation.
eg. corticosteroid/tetacycline
ns CAOH features
pH12.5
antibacterial activity
removes tissue debris
hydrolysis of LPS - reduced inflam potential
What is coronal flaring
the secind stage of root canap instrumentation.
Achieved using a combo of SS handfiles, gates glidden burs and/or NiTi instruments
-Sequentially smaller instruments are used as progress is made from coronal-apical third of canals
Modified double flare technique - what is it
2 stages of apical prep are..?
Preparation of coronal aspect of RC - SS handfiles to a taper
- Apical enlargement
- Apical taper creation (Deep shaping)
RC filling - Thermoplastic compaction techniques
- Cold lateral compaction
- Warm lateral compaction
- Warm vertical compaction
- carrier based systems
Adv of cold lateral compaction
- Golfd standard
- long term success
- allow good filling length control
- Inexpenxive and easy to use
Dis of Cold lateral compaction
- time consuming
- no homogenous mass of GP produced
- in large canals multiple accessory cones needed
- vertical r# risk
examples of RC sealers
ZOE - Pulp canal sealer
CaOH - Sealapex
Resin - AH plus
What is lateral compaction
Root canal filling technique
- lateral pressure applied with a spreader to a GP point. This allows space for accessory cones. Repeat process until canal filled.
Factors that influence RCT outcome
- preoperative status of PA tissues
- quality of RC
- CORONAL SEAL
- MH
- Files used
- irrigant used
- RC filling used
- technique used to fill RC
What is the purpose of canal instrumentation
- Remove infected H/S tissue
- give irrigant space to work in canal
- create space for medicaments
- retain integrity of radicular structure
Name 2 techniques used during instrumentation and describe them
- watchwinding - 30-60 degree back/forward and light apical pressure
- Balanced force - 90 degree clockwise, 180 anticlockwise 3x then clean and recapitulate.
ISO files colours
15/45, 20/50, 25/55, 30/60, 35/70, 40/80
15/45 - white 20/50 - yellow 25/55 - red 30/60 - blue 35/70 - green 40/80 - black
How do a blockage and a ledge happen
-Blockage - dentine debris packed into apical prtion of canal
-Ledge - internal transportation of canal (while working short of length)
Place curve in instrument
What is apical zipping/transportation
How to avoid
- result of the instruments desire to straighten inside a canal.
- Overenlargement of outer aspect of curvature and under prep of inner
Precurvature of instrument / follow sequence / never rotate in curved canal
Factore afffecting the prognosis of a perforated tooth
time size persistance of bleeding into canal periodontal irritation repair material
NiTi vs SS instruments
NiTi adv / dis
NiTi adv
> flexibility, > size & tapers, >cutting efficiency, more user friendly
Dis - instrument #, >cost, difficult access, can’t be used in curved canals.H
How can instrument separation occur
- Torsional stress - extensive instrument surface encounters excessive friction on canal walls
- flexural strength - repeated cycle metal fatigue. Freely rotating in curvature - tension and compression repeated cycles.
Obturation materiall ideal props
- easily manipulated
- dimensionally stable
- seals canal
- non irritant
- radiopaque
- no tooth discolouration
- easily removed
- unaffected by tissue fluids
- inhibit bacterial growth
GP constituents
Beta form used in dentistry
20%GP, 65% ZnO, 10% radiopacifiers, 5% plasticiser
Ideal sealer properties
- Radiopaque
- good adhesion
- easily mixed
- establishes seal
- slow set
- tissue tolerant
- soluble on retreatment
- no shrikage on setting
- non staining
- bacteriostatic
Examples of root sealers
ZO ZO and E ZOE Resin - AH26, Epoxy Calcium silicate - high pH(12.8) no shrink on setting, quick set, non resorbing
Factors that could influence endo failure
presence of inf (sinus/PA) coronal seal poorly condenesd root filling iatrogenic - perforation root # patency achieved instrument separation blockage/ledge
Laws of endodontics
- Centrality - Floor of PC located at CEJ level
- Concentricity - at CEJ level, the PC anatomy follows that of the external surface
- Law of CEJ - distance from PC to wall same circumferentially
- Symmetry 1 - orifices of canals located EQUIDISTANT to line placed m-d through floor NOT MAX MOLARS
- Symmetry 2 - orifices of canals loe on line perpindicular to m-d drawn line NOT MM
- Colour change - PC floor DARKER than walls
- Orifice location 1 - where floor/wall meet
- Orifice location 2 - at angles of floor/wall junction
9 Orifice location 3. - located at end of root development fusion
Options for retreatment
NS retreatment Surgical XLA orthograde RT Keep under obvs
Indications for periradicular surgery
failure of prev endo
anaomical deviation
procedural error
exploration surgery
Contraind to periradicular surgery
Close to vital structure
inadequate perio support
not restorable tooth
MH contraind
Periradicular surgery root filling materials
MTA - long set, good sealing ability, radiopaque, moisture tolerance, cementum regeneration, biocomp, dimensionalbly stable, no stain, corrosion
,
Amalgam
Disadvantages/warnings for use of MTA
Material can reduce moisture in canal - this can make the tooth dehydrated and more prone to # (brittle)
