Week 1 Flashcards
what do endodontists do?
manage inflammation of
the specialized connective tissues within and surrounding the teeth; more specifically, they deal with inflammation (and infection) that generally commences in the pulp tissue and progresses to the periradicular tissues via portals of communication that convey the neurovascular supply
Normal/Healthy Pulp
Requires no treatment
Routine diagnostic tools:
Sensibility tests
- Cold
- Hot
- EPT
Percussion test
Palpation test
Periodontal probing
X-rayDiseased Pulp
diagnosis?
histologically?
Diagnosis
- Reversible pulpitis
- Irreversible pulpitis
- Necrotic pulp (non-vital)
Requires treatment/intervention
Vital pulp therapy
Non-vital pulp therapy (pulpectomy)
Histologically
- Inflamed: acute vs chronic (pulpitis)
- Infected or even localized abscess
- Necrotic as a result of infection or trauma
ept stands for?
Electric pulp testing
Non-surgical endodontic treatments
a. Vital pulp therapy
- - Purpose: to keep vital pulp
b. Non-surgical RCT for non-vital pulp (NSRCT)
- - Purpose: to remove infected pulp & root dentin to restore periapical health
c. Regenerative endodontics
- - Purpose: to revascularize and/or regenerate pulp tissue for immature teeth
Surgical treatments
Purpose: to remove infected root end tissues (root tip, granuloma/cyst)
- Peri-radicular curettage
- Root-end resection (Apicoectomy)
- Root resection (root amputation) or hemi-section
- Intentional replantation
- Incision & Drainage (I & D)
NSRCT stands for?
NON-SURGICAL ROOT CANAL THERAPY
CDJ means?
Cementodentinal Junction
Direct pulp capping
A dental material placed directly on a mechanical or traumatic vital pulp exposure
Indirect pulp capping (step-wise caries excavation)
Incremental removal of caries over a period of time to allow pulpal healing and to minimize exposure
Pulpotomy (pulp amputation)
- – Surgical removal of the coronal portion of a vital pulp as a means to preserving vitality of the remaining radicular portion
- – Usually performed as an emergency procedure for temporary relief of symptoms or as a therapeutic measure
Partial pulpotomy (Shallow pulpotomy, Cvek pulpotomy)
Surgical removal of a small diseased portion of vital pulp as means of preserving the remaining coronal and
radicular pulp tissue
Full Pulpotomy
- Removing infected coronal pulp and leaving only the vital intact radicular pulp
- Indication:
- Carious pulp exposure in deciduous and young
permanent teeth - Pulp must be vital and asymptomatic
- All the carious dentin and coronal pulp are to
be removed
Partial Pulpotomy (Cvek pulpotomy)
- Removing 2 mm of coronal pulp from the exposure site with a high-speed sterile
diamond bur with ample flushing with sterile saline - Bleeding control with saline solution
- Capping with Ca(OH)2 and sealed with ZnOE cement and later replaced with amalgam
- Follow the same protocol for direct pulp capping
apexogenesis
Apexogenesis refers to a VITAL pulp therapy procedure performed to encourage physiological development and formation of the root end.
Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation.
Apexification
Apexification = method of inducing a calcified barrier at the apex of a NONvital tooth with incomplete root formation.
Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.
Functions of dentin
1. Form a network for the diffusion of nutrients
throughout dentin
2. Dentinal fluid and sensitivity
3. Protect coronal pulp
a) Prevent bacterial penetration
- Streptococci 0.5 μm in diameter
- Usually no bacteria in the tubules at the extreme front of the carious lesion
b) Dentinal fluid
c) Tertiary dentin formation
d) Sclerotic dentin formation
e) Low thermal conductivity
4. Protect coronal & radicular pulp
5. Hardness, elastic modulus and shape for chewing and fracture resistancedentin tubules have what shape?
inverted cone shape
Surface dentin vs Deep dentin near pulp has ___ % surface area containing tubules
- Surface dentin: 1% surface area contains tubules, mostly intertubular dentin
- Deep dentin near pulp: 22% surface area contains tubules
Number of tubules in crown per square millimeter
- 45,000 near the pulp
- 29,000 in the mid-dentinal area
- 20,000 in the periphery
Cvek pulpotomy is aka?
Partial Pulpotomy
___ shape curvature of dentin tubules due to crowding of _______ as they move toward pulp
S shape
- due to crowding of odontoBlasts as they move toward pulp
1) coronal dentin is most and least permeable where?
2) is axial or coronal dentin more permeable?
1) Most permeable in pulp horn area; Least permeable
in central occlusal region
2) axial more permeable than occlusal dentin
Cervical and mid-root dentin have higher permeability
and higher tubular density than?
apical dentin
- apical has more convoluted tubules, areas with no tubule openings, and more crowded
decreased tubular permeability:
1) immediatly
2) long-term
3) chemically
4) physically
1) For vital teeth, dentin permeability can dramatically decrease during the first day following injury (85%)
2) laying down teritary dentin, crystalline deposits
3) desensitizing reagents
4) sealing off the tubular openings
pupal changes with age?
begins when?
BEGINS AT 20 yrs
- decrease pulpal cells: odontoblasts and fibroblasts
- increase relative fibrous content
- decrease supportive elements like vessels and nerve endings
- – atherosclerotic and calcification
- diffuse calcifications
- pulp stones
Calcifications in typically occurs in ______ pulp and ______ pulp
coronal pulp and radicular pulp
diffuse calcifications
linear calcification usually close to blood vessels, nerves or collagen
*predominantly in the radicular region of the pulp
Dentin changes with age
BEGINS at 30 years
- tubular area decreses - results in decreased fracture resistance by 20-40%
- increase in minerals
- decrease response or false negative responses to cold test
- increase in hardness of outer dentin (near DEJ)
1a) Transparent zone of pathologic scerotic dentin?
1b) Tubules are completely or partially occluded by intratubular precipitation of?
1a) at the base of slow progressive active lesions and arrested lesions
1b) whitlockite (magnesium-substituted tricalcium phosphate) crystals or peritubular dentin-like deposition
pulp stones?
true vs false?
free vs attached vs embedded pulp stones?
Discrete circular calcific masses within
pulpal tissue
** True pulp stone = small island of dentin with tubules and
odontoblasts
** False pulp stone = concentric layering of calcified tissue
** Free = island of calcified tissue
** Attached = fused to dentin wall
** Embedded = stones that have become surrounded by dentin
MOLECULES AFFECTING DENTINOGENESIS
1) IL-1β
- Promoting the proliferation of dental pulp stem cells
- Short-term treatment with IL-1β increased gene expression of osteocalcin
- long term decreses gene
2) TNF-α
- Promoting mineralization in short- term cultures and inhibit mineralization in long term dental apical papilla cell culture
3) IL-1 α + TNF-α
- Synergistically increased BD-2 mRNA expression
4) NGF
5) TGF-β
MOLECULES REGULATING TERTIARY DENTIN
FORMATION
1) TGF-β
- Expressed by odontoblasts
- Secreted to dentin matrix and released upon demineralization
- Important in pulp repair
2) NGF
- Expressed by odontoblasts (mainly odontoblast process), pulp fibroblasts and nerve fibers
- Upregulated under caries and cavity preparation in odontoblast cell bodies or newly differentiated odontoblast like cells
primary, secondary, tertiary and Sclerotic
primary= before root forms
secondary= after root completlyformed
tertiary= Reparative and Reactionary dentin
Sclerotic= Pathologic: abrasion, attrition, caries
