Review of Endodontic Principles Flashcards
What is endodontoogy?
Endodontology is concerned with the study of the form, function and health of, injuries to and diseases of the dental pulp and periradicular region, their prevention and treatment; the principal disease being apical periodontitis, caused by infection
What causes endodontic disease?
Bacteria
Who presented he research to prove tat bacteria causes Endodontic diseases
Kakehashi
What are the three key features needed for disease to occur?
- Micro organisms
- Host
- Time
Why is studying endodontic microbiology important?
Can hep identity which bacteria is playing a key role in progression of the disease
This canhelpwiith treatment planning as we can get rid of the harmful bacteria
Do we only remove/kill the harmful bacteria when carrying out root Canal treatment?
No we try and remove all the bacteria in the root canal
Is the distribution of bacteria in the root canal even?
No
Theres more aerobic bacteria found near the apex of the canal
More bacteria in general is found in the coronal third as that is where the most nutrients are found
Name the 2 different types of bacteria systems found in eat root canal
- Planktonic
2. Bioflm
What are planktonic bacteria|?
They are free floating
Which of the 2 bacterial systems is easier to remove?
Planktonic bacteria
What is a plaque biofilm?
An aggregation of micro organisms growing a solid substrate
Describe plaque biofilms found in the root canal
They are a complex community made-up of a lot of different bacteria
Their xtra cellular matrix is made up of thick dense polymeric substances which is hard to remove
How are biofilms resistance to eradication
1, Physical barrier- poor anti microbial penetration and sequester cells from host immune cells
- It is difficult to remove mechanically
- In a biofilm there is a transfer of genes which can increase virulence factors and resistance
What is Endodontology clinically?
It is the diagnosis and management of:
- Pulpal disease
- Periapical disease
What is the biggest problem we encounter when trying to diagnose endodontic disease
We are reliant on patients description of the symptoms (we can’t seethe disease until we start treatment)
Theres a poor correlation between symptoms and histological status of ethnic pulp
Which nemonic do we use to help us diagnose endodontic disease
SOCRATES
Go through SOCRATES
Site Onset Characteristic Radiation Alleviating factors Time Exacerbating factors Severity
After taking a pain history what else can we use to help us reach a diagnosis?
- We can use sensitivity tests and radiographs
2. Also look at soft tissues looking for palpations, swelling and sinus
What is the problem with using radiographs to diagnose Endodontic disease?
Until the critical plate has been lost the lesion may not be visible with conventional radiography
What new technique has Coe out to overcome the problem of a tick cortical bone obstructing our view of a lesion
Contemporary CBCT imaging technology can overcome the problem as it takes 75microns slices of the entire area
What are the problems associated with CBCT
It is a higher dose than normal radiographs so must consider dose and benefits
When looking at the tooth before reaching a diagnosis what do we look at?
Palpation
Percussion (GENTLE)
Mobility
What problems can arise wen we do special sensitivity tests?
Need to be wary of multi rooted test as they can give false positives
What do we have to put-on before starting rot canal treatment
RUBBER DAM
Why is putting rubber dam important
- Makes it easier for you to treat them clinically
- Important from a medico legal standpoint
- Makes treatment more efficient
What di we use t chemo-mechanically prep the can
Instruments are suited to shape the canal
Irrigants are use to clean
What is the aim of chemo mechanically prepare the canal
Aiming to produce a shape that optimises irrigation and simplifies obturation
List Schilder’s design objectives
- Continuously tapering funnel from the apex to the access cavity
- Cross sectional diameter should be narrower at every point apically
- The root canal preparation should Flo with the shape of the original canal
- The apical foramen should remain in its original position and be kept as small as possible
Why is it important that the apical foramen raisin in the sam potion and is as small as possible before an after RCT
Because when you are irrigate and obturate you don’t want exudate to leak out of the canal
List schuldet’s BIOLOGICAL objectives
- Don’t force necrotic debris beyond the foramen
- Use all the instruments to share the roots themselves
- Remove all of the tissue from the root canal space
- Try and create a sufficient space for intra canal medicaments
At the end of preparing your canal what do you want to achieve?
A canal that cane irrigated and obdurated properly
MAKE SURE TO LEAVE SOME TOOTH to avoid breakage
What is the problem associated with under preparing the canal?
Irrigation fluid and needle will not be able to get through and clean the whole canal system
Name the two different types contemporary instrumentation techniques
Hand
Automated
When you are preparing the canals what is the first thing you try to do?
Coronal flare always first
Name the preparation technique we can use when using hand instruments
- Step back
2. Modified double flare `
Which of the two instrumentation technique is more favoured?
Automated as its safer, efficient and quicker
On clinics how are we going to use hand instruments|
- For scouting
2. Patency filing
What is Patency filing?
Passing a small file 1mm through the apex to help remove derives and aid irritant flow
Name the 2 ways we can manipulate hand instruments
- Balanced force
2. Stem winding
Nam the 2types of automated instruments
- Rotary
2. Reciprocation
What are rotary instruments
Instruments that Constantly rotate in one direction
What are reciprocation instruments
Instruments that Rotate in one direction then the opposite then the original etc
Which metal makes up hand instruments?
Stainless steel
What automated instruments made up of?
Nickel titanium
What is the main difference between nickel titanium and stainless steel
Nickel titanium is significantly more flexible than stainless steel
Name the 2 ways flew can fracture
- Torsional fracture
2. Cyclic fracture
What is a torsional fracture?
When you apply too much pressure to the file and it breaks
What is a cyclic fracture
Multiple cycles of compression can cause the file to fracture at the point of fracture
How can we avoid problems when suing automated instruments
1, Consider both angle androids of curvature
- Use thinner files
- Always keep the canal moving in the canal
- Dont force engagement of files
Are thick files more likely to fracture or thin? why ?
Thicker files more likely to fracture due to cyclic fatigue in curved canals