UMKC Spreadsheet Random Part 3 Flashcards
Non-healing endo Samples from failing NS RCT, found microorganisms in 71%, fungi in 7%,
Waltimo, Haapasalo, 1997
3 Visit Endo supported 83% one step, 71% two steps (all had PAR)
Weiger, 2000
PAR vs. No PAR 96% w/o PAR, 86% w/PAR (10% difference)
Sjogren (1990)
DB and P root of Mx 1M 100% - 1 canal
Vertucci, 1984
Bacteria needed for PAR Human:32 traumatized teeth; PAR only when bacteria present in RCS, Sterile necrotic pulp = no PAR; pain increased with # of bacterial species
Sundqvist, 1976
Getting thermafills out System B at 225 degrees to insert to 10-15 mm for 6-8 sc. Then weave files and pull. Careful - melting point of plastic carrier = 300 degrees C
Wolcott, Himel, Hicks, 1999
Getting thermafills out Retreating theramafills, bypass with Hedstrom and pull
Wilcox, 1993
Pathogenesis 2 things necessary for resorption: 1) loss of protective layer (pre-cementum, pre-dentin); 2) inflammation
Trope, 1998
Predictors of post-op pain Best predictors of post op pain is pre-op pain or swelling
Walton, Fouad, 1992
Anachoresis - refuted Famous monkey study - no bacteria found in apical granuloma, inflammatory lesion prevents spread of bacteria confining them to RCS
Walton, 1992
Pathogenesis Reviews
Torabinejad, Kettering
Remove smear layer? Smear layer removal reduced the leakage of bacteria through the RCS
Walton, 2003 (Remove)
RETX own case? Re-treating one’s own failures, unlikely to debride new areas because instrumentation would only enlarge in same direction as first preparation
Wilcox, 1991
Remove smear layer? Smear layer removed best with 17% EDTA followed by 5.25% NaOCl
Yamada, 1983
Coronal Seal 3 days exposure to saliva, extensive coronal leakage to a tracer dye through apparently intact root fillings
Swanson, 1987
Lack of correlation of clinical testing and Histology Poor correlation of clinical testing result and actual histology of pulp
Seltzer, Bender, 1963
Referred Pain Acute pain can be referred to ipsilateral opposite arch (Md left to Mx left)
Sharav, 1984
Hollow Tube Theory Disputed Hollow Tube Theory - sterile empy polyethylene tubes healed in rat connective tissue
Torneck, 1966
Why do some PARs not heal? Review
Simon
Md 1M 64% - 3 canals, 29% - 4 canals
Skidmore, 1971
Flare-ups Flareup Incidence = 3%; pre-op pain is best predictor
Walton, 1992
Immune components involved Demonstrated neuropeptides in the pulp (Substance P, CGRP, NKA, NPY & VIP)
Stashenko, 1999
Compact Gutta-percha as it cools As gutta-percha cools and solidifies, shrinkage of 1-2% occurs, so compact as it cools during obturation
Wong, 1981
Strange morphology Of unusual or aberrant morphologies, 60% of time it was seen bilaterally
Sabala, 1994
Methods Described Walking bleach, Na perborate walking bleach
Spasser, 1961
Minimizing resorption Recommended placing a 2 mm base at CEJ to preclude resorption from internal bleaching, 10% of cases - cementum and enamel don’t meet
Rotstein, 1991
Access when cutting access, remember that pulp chamber is in center of crown, classic access is too far mesially
Wilcox, Walton, 1989
Tooth survival data Outcomes of 4744 teeth over 5 yrs after RETX in Delta Dental plans; 89% of teeth retained 5 yrs after RETX
Salehrabi, Rotstein, 2010
Canal configuration Type I = 1; Type II - 2 into 1; Type III - 2 separate; Type IV - 1 into 2
Weine
Preflaring canals Preflaring canals reduced rates of separation of .04 rotary files in crown-down technique
Roland, 2002
Bacteria in PAR? Large PAR = more bacterial species present; Small PAR = fewer species present; Average = 5.4 strains/canal
Sundqvist, 1992
Predictors of post-op pain Best predictors of post op pain is pre-op pain and anxiety, others include: female, allergies, no or small PAR, RETX, or age of 40-59
Torabinejad, 1988
Post space Less leakage when post space prepared at time of obturation compared to one week after obturation
Solano, 2005
Membrane needed? Through and through lesion - 88% success with GTR, 57% without it
Taschieri, Del Fabbro, 2008
Types Types of resorption: transient inflammatory (surface), progressive inflammatory, internal, external (progressive, cervical, and replacement)
Tronstad, 1988
Where to stop obturation? Best results when fill to apical constriction which ranges from 0.5-2 mm short of radiographic apex
Ricucci, 1998
Post space Argues that post space preparation weakens tooth
Trope, 1998
Culturing Used Virginia Polytechnic Institute Anaerobic Laboratory method to culture anaerobic bacteria in necrotic RCS
Wittgow, 1975
Techniques Balanced Force Technique - Crown-down to establish radicular access, CW, then CCW with apical force, CW to remove, don’t go >35 on curved canals
Roane, Sabala, 1985
Pulpotomy Demonstrated that you should remove blood clot after partial pulpotomy procedure, since it reduces healing. With no clot, got 76% healing rate.
Schroder, 1971
Anachoresis - supported Anachoresis as possible way for bacteria to enter pulp, 2 requirements: bacteria, inflammation
Robinson, Boling, 1941
Are EALs safe? EALs and EPTs safe in 27 patients (cardiac pacemakers)
Wilson, Baumgartner, 2006
Sargenti Paste formaldehyde containing N2 formulation produces extensive tissue necrosis, won’t be resorbed so surgery may be needed to remove
Spangberg, 1974
C-shaped canals 1988 2.7%, 1998 7.6% C shaped in Mand 2nd M. Asians more
Weine
Ca(OH)4 Ca(OH)2 inactivates LPS in vitro
Trope, Barthel, 1997
Strangulation theory Disproved strangulation theory, cat study that showed localized increase in pressure with no strangulation
Tonder, 1983
PCR Popularized use of polymerase chain reaction in endodontics
Siqueira, 2005
Endotoxin Symptomatic teeth and those with PAR have increased LPS than asymptomatic teeth
Schein, Schilder, 1975
Fracture categories 5 categories of tooth fractures: craze lines, cruspal fx, cracked tooth, split tooth, VRF
Rivera, 2003 (AAE Coll for Exc)
Obturation fill 94% = Short 2 mm
Sjogren (1990)
Extrusion Apical worm, if RCS flood with irrigant, extrusion will always occur
Vande Visse, Brilliant, 1975
Flap considerations recommended PBI (papilla base incision) for surgery to preclude gingival recession
Velvart, 2002, 2004
RETX 81% healed; 93% functional (with perforation - 42% healed)
Toronto (Friedman)
Size vs. taper GT 20 and 40 files were tested with 0.06/0.08/0.10 tapers; size 40 was found to better clean the canals, no diff among tapers within the size groups
Usman, Baumgartner, 2004
Goal of Shaping Tapered prep permits better debridement of apical preparation, reduces over-instrumentation of foramen and improves ability to obturate
Walton, 1976
Caution with US retroprep First report of US and Cracks, Cracks may be due to impact of US tip against dentin and heat formation
Saunders, Gutmann, 1994
Coronal Seal Coronal microleakage is important cause of RCT failure
Saunders, Saunders, 1994
Remove smear layer? Smear layer produced during RCt may inhibit bacterial colonization of root canals
Walton, 1994 (Don’t remove)
Calcification If cannot bypass calcification, then C&S & obturate to level of calcification and place on recall for potential surgery
Schindler, 1988
Calcified canals Even when no canal appears on radiograph, there will usually be a clinical canal at least the size of a #10 file.
Walton 1990
Pacemaker cautions? EALs and EPTs safe in 27 patients
Wilson, Baumgartner, 2006
Surfactants, heat, and concentration Optimizing conc, temp, flow, and surface tension can improve the tissue-dissolving effectiveness of hypochlorite 50-fold
Stojicic, Haapasalo, 2010
Membrane needed? GTR may be beneficial for treatment of large PA lesions (> 10 mm),through and through lesion, or endo/perio lesion
Tsesis, 2011
Strange morphology Den evaginatus (prevalence 1-2%): composed of enamel, dentin, and pulpal extension; usually premolars, mostly in Mongoloid people
Senia, Regezi 1974
Size vs. taper White dentinal shavings don’t indicate fully debrided canal
Walton, 1976
MTA Review of MTA and all aspects of it
Torabinejad, Parirokh, 2013
Regendo SCAP cells viable following necrosis
Sonoyama & Huang, 2008
Irrigation methods Showed limitations of NaOCl to reach apical 3 mm of RCS
Senia, 1971
Apexification 91-94% healing with MTA (can do it in one visit)
Witherspoon
3rd S RCT showed that success rate of 2nd surgery performed on same tooth is 92.9% (Modern technique)
Song, 2011
PAR formation primary bone-resorbing cytokine in human PAR = IL-1 beta; bacterial induced IL-1 beta and prostaglandins are destructive
Want, Stashenko, 1993
Outcomes assessment Using scope, US and Super EBA: 94 cases w/ success of 96%; 85% granuloma, 15% cyst
Rubenstein, Kim, 1999
2 Visit Endo supported 74% two steps, 64% one step
Trope, 1990
Direct Pulp Cap <50% (caries exposure - consider IP)
Tronstad
Cells of pulp Cells of pulp: odontoblasts, fibroblasts, undifferentiated mesenchymal cells, macrophages, lymphocytes, dendritic cells
Ten Cate
Inject slowly Inject slowly (1-2 mL/min) to get better spread of LA and therefore better hemostasis
Roberts, Sowray, 1987
Pulp microcirculation Resin replica of microcirculation
Takahashi, Kim, 1982
Gutta-percha GP exists in beta-semicrystalline state, undergoes change to alpha phase upon heating (47 degrees C), compactable not compressable
Schilder, 1974
NiTi Description of heat treated NiTi and its improved properties
Shen, 2013
Landmark Articles Cleaning (irrigate) and Shape (mechanical) to facilitate placement of root canal filling
Schilder, 1967
PAR formation Rat model: Th1 pro-inflammatory in expansion phase of PARL, Th2 more dominant after lesion equilibrium has been established
Stashenko, 1999
Focal Infection Theory No clear evidence that bacteria from RC can cause disease in remote sites of body
Siqueira, 2002
Going long GP activates C3 complement; may explain why over-extension with GP may induce bone resorption in some patients
Serene, Vesely
In the case-control study, overall healing rates were 91.8% for cases with a fractured instrument and 94.5% for matched controls (p > 0.05, Fisher?s exact test). Healing in both groups was lower in teeth with a preoperative periapical radiolucency (86.7% versus 92.9%, p > 0.05).
Spili, 2005
