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ABE Oral Board Review > Treatment of Endodontic Disease > Flashcards

Treatment of Endodontic Disease Flashcards

1
Q

_____ difference between infiltrations and PSA blocks for maxillary first molars

A

No
Aggarwal

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2
Q

Addition of palatal anesthesia ________ increase anesthetic success rates but does increase ______

A

Does not
Duration
Aggarwal

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3
Q

No difference between ______ and ______ for maxillary teeth

A

Lidocaine and Articaine

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4
Q

For mandibular anteriors and premolars _______ often provide sufficient anesthesia.

A

infiltrations

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5
Q

Mandibular infiltration works as a _______ and ______ nerve block

A

mental and incisive

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6
Q

Single mandibular infiltration has _____ success. Double infiltration has ______ success

A

80-87%
92-94%

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7
Q

No advantage of ______ or _____ techniques over standard IANB

A

Gow-gates or akinosi

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8
Q

_____ fold increase in parasthesias when articaine is used for IANB

A

5

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9
Q

Anesthetic _______ has little-no effect on anesthetic success

A

volume

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10
Q

_______ alone is not predictable enough to serve as primary technique for mandibular posterior anesthesia

A

infiltration

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11
Q

Commonly cited reasons for local anesthetic failure (5)

A

Lower pH of inflamed tissue
unsuccessful techniques
Altered resting potential in inflamed nerves
Upregulation of anesthetic- and tetrodotoxin resistant sodium channels
Patient anxiety

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12
Q

Success rate of standard IANB alone

A

15-57%
Reader

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13
Q

Repeat IAN successful ______

A

32%

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14
Q

Buccal infiltration after failed IANB

A

84%

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15
Q

______ significantly more effective than ______ when used as buccal infiltration

A

articaine than lidocaine

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16
Q

Caution with IO injection when coexisting ______ disease

A

cardiac
(increased heart rate)

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17
Q

Intrapulpal success rate

A

92%

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18
Q

Intrapulpal mechanism

A

pressure

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19
Q

Use of rubber dam is standard of care according to ______

A

AAE 2010

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20
Q

Rubber dam benefits (4)

A

isolation
visualization
aspiration
survival probability enhanced

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21
Q

Microscope is an integral and important part of the performance of modern endodontic techniques.

A

AAE position 2012

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22
Q

Shape and location of access preparation reflects _____

A

pulpal anatomy

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23
Q

______ provides the most consistent landmark for the pulp chamber

A

CEJ

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24
Q

High correlation between working lengths measured by ______ and _______

A

CBCT and electronic apex locators

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25
Q

Conventional vs digital films for working length determination

A

Conventional more accurate with smaller file sizes

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26
Q

Apex locators are ______% accurate

Author

A

96%
Shabahang

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27
Q

Apex locators accuracy not affected by

A

presence of solutions

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28
Q

Apex locators safe to use with

A

pacemakers
Wilson

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29
Q

______ increases irrigant efficiency at the apex

A

Maintaining patency
Vera

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30
Q

Negative aspects of maintaining patency (2)

A

transportation
increases apical cracks

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31
Q

Crown-down as defined by

A

Morgan and Montgomery

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32
Q

All instrumentation techniques ______ in terms or debris left behind

A

similar

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33
Q

Heat treated NiTi remains in

A

martensite and R phases
(More flexible, better fatigue resistance)

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34
Q

______ instruments remain better centered in the root canal system

A

rotary

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35
Q

Minimum MAF of _______ allowed penetration of irrigants to the apex

A

30.02

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36
Q

MAF should be ______ sizes larger than the initial apical size

A

3

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37
Q

2 components of the smear layer

A

surface of the canal wall
debris packed into dentinal tubules

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38
Q

Smear layer may block the _______ of NaOCl and CHX

A

disinfecting properties

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39
Q

Instrumentation leaves ______% of canal walls untouched

A

35%

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40
Q

_____ and _____ can not be instrumented

A

isthmuses and lateral anatomy

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41
Q

Properties of an ideal irrigant (5)

A

Broad antimicrobial
effective against anaerobes and facultatives
Inactivates LPS
Dissolves vital and necrotic tissue
Prevents or dissolves smear layer

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42
Q

Most common concentration of NaOCl

A

5.25%

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43
Q

NaOCl can only dissolve the ______ component of the smear layer

A

organic

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44
Q

EDTA _____ calcium ions

A

chelates

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45
Q

EDTA dissolves ______ components of the smear layer

A

both (organic and mineralized)

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46
Q

Caution when using both NaOCl and EDTA together to avoid

A

excessive erosion of root canal dentin

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47
Q

CHX binds to dentin and exhibits substantivity for up to _____ days

A

48

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48
Q

Carcinogenic precipitate when mixing NaOCl and CHX

A

Parachloroaniline

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49
Q

Passive ultrasonic irrigation improves cleanliness of both ____ and _____

A

main canal and isthmuses
Gutarts

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50
Q

No difference in outcomes between single visit and multi visit tx

Author

A

Penesis

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51
Q

pH of CH

A

between 11 and 12

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52
Q

CH reduces the cytotoxic response to LPS by destroying _____

A

Lipid A moiety

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53
Q

CH is less ______ to the apical papilla stem cells compared to ABX pastes

A

cytotoxic

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54
Q

______ or ______ should be used to remove CH from the canals

A

rotary instrumentation
PUI

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55
Q

Drawbacks of CH (5)

A

decreased fracture resistance
PDL necrosis
tissue necrosis
parasthesia
inhibits setting of eugenol based sealers

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56
Q

GP is a naturally occurring polymer of _____

A

isoprene

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57
Q

Components of GP

A

65% zinc oxide
20% GP
Other – waxes, resins, metals

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58
Q

GP is in ______ form as a cone

A

beta crystalline

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59
Q

GP is in _____ form once heated to 42-49 C

A

alpha crystalline

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60
Q

In regards to GP, Care should be used in patients with

A

severe type I allergy to latex

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61
Q

Lateral condensation ________ faster than vertical condensation

A

leaks microbes

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62
Q

____ difference in outcomes noted between lateral and vertical condensation

A

No

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63
Q

Idea behind resilon

A

Mono block – sealer bonds to both dentin and filling. Not supported by research.

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64
Q

Carrier-based systems ______ significantly more than lateral or vertical condensation

Author

A

leak
Baumgardner

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65
Q

Instrumentation and obturation should terminate at the

A

CDJ

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66
Q

Extruded obturation materials have been associated with _______

A

chronic inflammation

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67
Q

_____mm thickness of cavit required for adequate seal

A

3.5mm

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68
Q

Cavit leaks after ______ days

A

42

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69
Q

Cavit and IRM both leak more than

A

GI

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70
Q

Properties of eugenol (3)

A

alters neurotransmission, increases potassium, decreases sodium
blocks neuropeptide transmission
decreases vascular response to epi

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71
Q

Factors associated with recurrent apical periodontitis (7)

A

Coronal leakage
intraradicular infection
extraradicular infection
untreated canal anatomy
fractures
foreign body reaction
true cystic lesions

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72
Q

____ minutes of ultrasonic vibration is effective in metal post removal

A

16

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73
Q

Care must be taken when using ultrasonics to remove posts due to

A

Significant heat production capable of causing bony damage

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74
Q

Temperature increase of _____ within 15 seconds of ultrasonic without irrigation

A

10 degrees C

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75
Q

_______ is the only solvent capable of completely dissolving GP

A

chloroform

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76
Q

Silver points ____ in the presence of tissue fluid producing highly toxic byproducts

A

corrode
Seltzer

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77
Q

______ of silver points is not indicated

A

Prophylactic revision

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78
Q

Two steps to carrier-based system retreatment

A
  1. chloroform to soften surrounding GP
  2. Hand files to remove the carrier
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79
Q

Surgical endodontic therapy is indicated when

A

orthograde endodontic treatment is not feasible

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80
Q

3 modern advances in surgical endodontics

A
  1. Magnification - Von arx
  2. ultrasonic retropreparations - de Lange
  3. improved filling materials - Kim
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81
Q

With modern techniques, surgical endodontics provides _______

Author

A

Predictable means of eradicating periapical pathology

Tsesis

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82
Q

Hemostasis is essential for ____ and _____

A

visibility
minimize blood loss

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83
Q

Average of _____ mL of blood is lost during surgery

A

9.5mL
Selim

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84
Q

Bone wax is no longer used due to ______

A

robust inflammatory response

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85
Q

Epinephrine acts by interacting with blood vessel ______ receptors, producing ________

A

alpha
vasoconstriction

86
Q

Local anesthestics containing 1:50,000 offer: (4)

A
  1. Reduced blood loss by half
  2. reduced surgical time
  3. better visibility
  4. improved post op hemostasis

Buckley

87
Q

Other hemostatic agents (6)

A
  1. racemic epi pellets
  2. ferric sulfate (curretage before close)
  3. collagen based agents
  4. cellulose based agents
  5. gelatin based agents
  6. calcium sulfate
88
Q

Intrasulcular incision is associated with ______ compared to other incision types

A

increased post op recession and scarring

89
Q

Submarginal incision requires _____ mm of attached gingiva

90
Q

Papilla-based incision mitigates the risk of ______

91
Q

______ + ______ creates the soft tissue flap

A

horizontal incision
vertical incision

92
Q

1 vertical releasing incision produces a ____ flap while two produces a _____ flap

A

triangular
rectangular/trapezoidal

93
Q

Length to width ratio of _____ is recommended for rectangular flaps

94
Q

_______ osteotomy preparations are associated with more favorable outcomes

95
Q

_____mm of apical resection will remove the majority of apical deltas

96
Q

_____mm of apical resection of MB roots of maxillary first molars may be necessary due to isthmuses

97
Q

Bevels are associated with _____

98
Q

Methylene blue uses: (4)

A
  1. outlines root anatomy
  2. delineates dentin from bone
  3. stains isthmuses
  4. stains fractures
99
Q

_____mm of retropreparation is recommended

Author

A

3mm
Matisson

100
Q

Bur retropreparations are covered in _______

A

smear layer

101
Q

Amalgam retrofillings are associated with more ________ (4)

A

leakage - Torabinejad
poor biocompatability and inflammation - Baek
poorer outcomes - Setzer

102
Q

Super EBA outcomes are ______ compared to MTA

A

as favorable
Kim

103
Q

Upon setting, MTA forms ____ and ______

A

Calcium silicate hydrate
calcium hydroxide
Camilleri

104
Q

MTA provides a ______ apical seal even in the presence of ______

A

better
blood
Torabinejad

105
Q

MTA promotes _____ and ______ coverage

A

cementum and bone

106
Q

Bioactive cements are composed of _____ and ______

A

calcium silicate
calcium phosphate

107
Q

Bioactive cements are similar to MTA in terms of ______

A

in vitro and in vivo biocompatibility
Damas, Ma

108
Q

Bioactive cements create a ________ To dentin, providing an ________

A

mechanical bond
excellent seal
Damas

109
Q

Retropreparation following root-end resection may be unnecessary for ____ and _____

A

MTA apical plugs – Andelin
Well-condensed GP – Harrison and Todd

110
Q

Sutures promote healing by ______

Author

A

primary intention
Harrison

111
Q

______ sutures are recommended

A

monofilament synthetic

112
Q

Benefits of monofilament synthetic sutures (3)

A
  1. Less traumatic
  2. Discourage inflammation
  3. promote less bacterial adhesion
113
Q

_____ suture gauges are recommended to avoid tissue necrosis and scarring

A

Smaller (6-0 and 8-0)

114
Q

Sutures should be removed _______ hours post-op

A

48-96
Velvart

115
Q

3 categories of grafts

A

osteogenic
osteoconductive
osteoinductive

116
Q

Osteogenic grafts

A

contain cells capable of producing bony matrix

117
Q

Osteoinductive grafts

A

release mediators that signal the host to induce new bone formation

118
Q

Osteoconductive grafts

A

serve as scaffolds on which new bone can grow

119
Q

Graft categories by source (4)

A

Autogenous grafts
Allografts
Xenografts
Alloplasts

120
Q

Autografts derived from

121
Q

Allografts derived from

A

non-host member of same species

122
Q

Xenografts derived from

A

different species from host

123
Q

Alloplasts are

A

Inert materials that serve as scaffolds
(not derived from biologic donors)

124
Q

Concomitant use of a bone graft and a membrane consititutes

A

guided tissue regeneration

125
Q

For apical surgery with loss of only one cortical plate, use of membranes offer ______, but may improve outcomes for ______ and _____

A

no advantage – Garrett
through-and-through lesions – Lin
Large periapical defects – Tsesis

126
Q

_____ membranes are favored over _____ membranes

A

resorbable
nonresorbable

127
Q

Post-op pain is correlated with ______

A

pre-op pain – Tsesis

128
Q

Avoid post-op CHX rinses for _____ hours as it may negatively affect ______

A

48 hours
tensile wound strength

129
Q

Sinus perforations tend to _______ regardless of size

A

self-repair

130
Q

Managing sinus perforations (3)

A

Primary closure
Sinus precautions
Rx decongestant

131
Q

Aid in avoiding IAN during surgery

A

pre-op CBCT – Kovisto

132
Q

Sensory disturbance of the lower lip occurs in _____% of mn molar surgeries

133
Q

____% of patients retain permanent deficit following mn molar surgery

134
Q

Stages of healing progression (5)

A

Clotting and inflammation
epithelial healing
connective tissue healing
maturation
remodeling

135
Q

Day 1 of healing

A

Thin epithelial seal
Blood clot
PMNs predominate
Periosteal necrosis

136
Q

Day 2 of healing

A

Multi-layered epithelial seal
Type III collagen production
Macrophages predominate

137
Q

Day 4 of healing

A

Clot replaced by granulation tissue
Type 1 collagen production
Osteocyte proliferation from the endosteum

138
Q

Day 14 of healing

A

Normal sulcular epithelium
Woven bony trabeculae occupy the wound
New periosteum evident

139
Q

Day 28 of healing

A

Maturing bony trabeculae occupy the wound

140
Q

Tx recommendations for intentional replantation (5)

A

Atraumatic extraction
minimal handling of root surface
extra-oral time of less than 10 minutes
biocompatible apical fill
nonrigid post-op splint

141
Q

Success rate of intentional replantation

142
Q

Ideal donor tooth for autotransplantation has a ______ root with an ______

A

partially developed root with an open apex

143
Q

Maintaining pulp vitality in permanent teeth with open apices is called _______

A

apexogenesis

144
Q

Pulp caps should be placed _______ for the best prognosis

A

immediately – Bergenholtz

145
Q

Histologic response to pulp capping is _____ followed by ______

A

coagulative necrosis
hard tissue bridging

146
Q

______ may become useful in vital pulp therapy (cholesterol medication)

A

Simvastatin

147
Q

Removal of the coronal portion of a vital pulp to preserve the vitality of the radicular pulp

148
Q

Indications for pulpotomy (2)

A
  1. continued root development in immature permanent teeth
  2. Emergency care in mature teeth until definitive care can be completed
149
Q

______ enters systemic circulation following formocresol pulpotomies

A

Formaldehyde
Pashley

150
Q

______ and ______ are unsafe and ineffective, their use is unjustifiable.

A

Formaldehyde
paraformaldehyde
AAE

151
Q

Restorative material options for pulptomy (3)

A

CH – Cvek
MTA – Bakland
Platelet-rich fibrin – Keswani

152
Q

Treatment aimed at apical barrier creation

A

Apexification

153
Q

Apical barriers typically form in an average of _______

154
Q

CH can be changed every _____ during apexification

A

3, 6, 8 months, or never

155
Q

Long-term CH apexification has been associated with increased risk of _______

A

cervical root fracture
Cvek

156
Q

MTA apexifications outcomes are _____ or ______ compared to CH

A

equivalent or better

157
Q

MTA apexifications mitigate_____ and _____

A

decreased fracture resistance from CH
treatment time/follow-up

158
Q

Biologically based procedures designed to physiologically replace damaged tooth structures as well as cells of the pulp-dentin complex

A

Regenerative endodontics

159
Q

Etiology of pulp necrosis is ______ when considering regendo

A

unimportant
Law

160
Q

Regenerative endodontics may provide a reasonable alternative to ______

A

Apexification

161
Q

Requirements for tissue engineering (3)

A

Stem cells
growth factors
scaffold

162
Q

Mesenchymal stem cells that infiltrate the canal space for regendo originate in the ______

Author

A

Apical papilla
Lovelace

163
Q

Hargreaves recommends _____ and _____ for regendo

A

minimal instrumentation
gentle irrigation

164
Q

Regendo recommended irrigation protocol (Martin)

A

1.5% NaOCl followed by 17% EDTA

165
Q

Benefit of EDTA in regendo

A

Release of growth factors from dentin

166
Q

An intracanal medicament should be placed for _______ weeks following instrumentation and disinfection during regendo.

A

2-4 weeks
Law

167
Q

Use of antibiotic pastes during regendo is problematic due to _____

A

negative effect on stem cell viability
Ruparel

168
Q

______ does not reduce stem cell viability

169
Q

Introduction of stem cells, growth factors, and scaffolds into the canal space is achieved by _______

A

Overinstrumentation in to the apical papilla to stimulate bleeding

170
Q

Capping material of choice for regendo is

171
Q

MTA facilitates ______ when used in regendo

A

migration and proliferation of apical papilla stem cells
Mente

172
Q

______ serves as the scaffold during regendo

Author

A

blood clot
Hargreaves

173
Q

2 aims of successful regendo

A

elimination of apical periodontitis
increase in root length and width

174
Q

Tissue formed from regendo resembles

A

cementum, PDL, and bone
Wang

175
Q

_____ has been associated with increased risk of resorption following internal bleaching.

A

Superoxol
Madison and Walton

176
Q

Non-surgical patients should have at least ______ post-op exam and use _____ to assess healing

A

1 year, PAI score
Orstavik

177
Q

_______ % of lesions take more than 1 year to heal

Author

178
Q

______% of unhealed lesions at 1 year will improve over time while _____% will worsen

A

57% improved
31% worsened
Yu

179
Q

Predictors for worsening of unhealed lesions (4)

A

size
symptoms (pain on biting at recall)
history of post-obturation flare
non ideal length

180
Q

Surgical patients should be examined _____ post-op

181
Q

For surgeries that have healed at early exam periods, periapical status remains _____ for several years

182
Q

Oral fluids may reach the apex in as little as _____ with exposure to the oral environment

A

3 days – Swanson and Madison
3 weeks – Torabinejad

183
Q

Access opening reduces tooth stiffness by _____%

184
Q

Tooth stiffness reduced by ______% when preparation involves both marginal ridges

185
Q

Significant _____ in failures in temporarily vs permanently restored teeth

A

reduction
Chugal

186
Q

_________ significantly improves outcomes of mn and mx premolars and molars

A

full coronal coverage
Sorensen and Martinoff

187
Q

Full coronal coverage does not impact outcomes for _____

A

anterior teeth

188
Q

Full coverage restorations must respect principals of _____ and ______

A

biologic width
ferrule

189
Q

Biologic width should total ______

A

3mm
Gargiulo

190
Q

Biologic width consists of ______

A

sulcus depth
epithelial attachment
connective tissue attachment

191
Q

Ferrule consists of

A

1.5-2mm of circumferential vertical wall

192
Q

Proper ferrule decreases ______ and provides _____ and _____

A

fracture rate of endo treated teeth
retention and resistance

193
Q

Proper length of posts

A

Greater of the length of the crown or 2/3 the root length

194
Q

Posts do not improve ______ or _______

A

strength
longterm outcomes

195
Q

Posts may actually _______

Author

A

decrease success rates of endo treated teeth
Doyle 2007

196
Q

_____mm of apical GP should remain following post space preparation

A

5-7mm
Mattison

197
Q

Absolute failure rate of both RCT and implants

198
Q

______% of patients with cracked teeth had symptoms eliminated with placement of a temporary crown.

A

89%
Guthrie

199
Q

_____% of crowned cracked teeth end up needing RCT

200
Q

Ethical obligations often _____ legal duties

201
Q

5 principals of ADA code of ethics

A

Patient autonomy
Beneficience
Veracity
Justice
Nonmaleficence

202
Q

Patients’ right to self governance

A

Patient autonomy

203
Q

Do no harm

A

Nonmaleficence

204
Q

Do good

A

Beneficence

205
Q

Fairness

206
Q

Truthfulness

207
Q

1 Cartridge of 2% LA is _____mg of anesthetic.

208
Q

1 cartridge of LA is _____mL

209
Q

1 cartridge of LA with 1:100k epi contains _____ mg of epi

210
Q

Max dose of epi is _____ mg which is ______ cartridges of 1:100k epi

A

0.2 mg of epi
11 cartridges

211
Q

Max dose of anesthetic is _____ mg which is _____ cartridges of 2%

A

300 mg
8.3 carps

ABE Oral Board Review (12 decks)

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