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Endo Midterm

Mica Borgueta Englisch 82 Karten

Endo Midterm

Karten in diesem Stapel (82)

  1. 1Nerve pathway from tooth to cerebral cortex(1) Trigeminal ganglion
    (2) Trigeminal nuclear complex
    -- convergence of diff. neurons on same 2nd order neuron
    (3) Nuclei of thalamus
    (4) Cerebral cortex
  2. 2Mechanism of referred pain?Convergence theory - different neurons converge on same 2nd order neuron
  3. 3Where are C fibers and A delta fibers located in PULP?A delta:
    peripheral pulp...extending into dentinal tubule (Pulp-Dentin Junction - plexus of raschkow)
    C fiber:
    throughout pulp
  4. 4What are the characteristics of C fibers and A delta Fibers?A delta:
    - Myelinated, 1-5um diameter, 6-30 m/sec
    - sharp, pricking pain w/ low stimulation threshold (hydronamic - drill)
    C fiber
    - nonmyelinated, 0.4-1 um, 0.5-2m/sec
    - burning, aching, throbbing pain
    - high stimulation threshold (due to inflammation)
  5. 5What is the hydrodynamic theory?Liquid inside the dentinal tubule will move and stimulate A-delta fibers
    Odontoblast and nerve constitute a mechanoreceptor complex that responds to fluid movement
  6. 6What are the pulp nerve changes during inflammation?1. Activate* sleeping nociceptors
    2. Injury stimulates nerve sprouting* high expression of calcitonin and substance P
    3. Inflammation mediators* sensitize nerve fibers, increasing dental sensitivity
    4. Results Hyperalgesia* - increase in perceived magnitude of painful stimulus
  7. 7What is hyperalgesia? Happens as a result of pulp inflammationIncreased perceived magnitude of painful stimulus
    1. spontaneous pain
    2. decreased pain threshold
    3. increased response to painful stimulus
  8. 8What is the effect of inflammation mediators (bradykinin, prostaglandins) on nerve fibers?Sensitize nerve fibers increasing dental sensitivity
  9. 9Which involves hydrodynamic theory? Drilling, probing, drying, hyper-osmotic, thermal stimulation, percussion, palpation, electric pulp testingEPT, drilling, probing, drying, hyper-osmotic, thermal stimulation
    Not percussion or palpation
  10. 10What are the age changes in DENTINReduce in:
    - permeability
    - size of tubules
    - tubules more irregular
    Increase in:
    + sclerotic dentin
    + dead tracts
  11. 11What are the age changes in PULP?Reduce in:
    - size of pulp & root canal
    - cell numbers
    - nerves and blood vessels
    Increase in
    + collagen bundles
    + calcification
    + coronal pulp stone
    + radicular diffuse calcification
  12. 12SLOB RuleSame Lingual
    Opposite Buccal
    If buccal roots moved distally, it's a mesial shift
  13. 13What are the 4 zones of histopathologic appearance of apical lesion?(1) Necrotic Zone - necrotic tissue & neutrophils
    (2) Exudative Zone - macrophage, T and B cells with fibrovascular element
    (3) Granulomatous Zone - tissue repair, fibroblastic activity, new vessels
    (4) Fibrous Zone - dense collagen rich tissue
    NEGF
  14. 14Pulpal Response to caries depend on:1. Depth of caries
    2. Remaining dentin thickness
    3. Degree of mineralization of dentin
  15. 15Types of Periapical lesionsGranuloma - fibrous tissue
    Cyst - cavity lined with epithelium
    Abscess
  16. 16Primary infections caused by:Obligate anaerobes
  17. 17Secondary infections caused by:Facultative anaerobes:
    candida
    e. faecalis
  18. 18Host response to microbesPAMPs on pathogens are recognized by TLRs and PRRs on the cells of the innate immune system
    Examples of PAMPs:
    Lipopolysaccharide (LPS) (G-)
    Lipoteichoic acid (G+)
    Peptidoglycan (G+ and G-)
  19. 19What is the mos timportant test to diagnose that the apical lesion is from endo origin?- Electronic Pulp Test (vitality)
    - Cold test
  20. 20How to use EPT, Endo Ice, CO2 snow to test pulp vitality?(1) EPT - dry, isolate, control tooth and tooth contact, anterior teeth more accurate @ incisal 3rd
    (2) Endo Ice (Cold Test) - use 1112 Tetrafluroethane (irreversible/necrotic, constricted canals - false neg.)
    (3) CO2 Snow - cold test for tooth with crown
  21. 21Which teeth should be used as control teeth for EPT test?Healthy teeth
  22. 22When to use test cavity?- When all else is inconclusive, last resort
    - Drill small window to the dentin
    - Will stimulate a vital pulp and induce painful response when dentin invaded
    - Will have no effect when pulp is non-vital/necrotic
  23. 23—
  24. 24Apical Diagnosis SummaryApical Diagnosis Summary
  25. 25Which treatment (pulp capping, pulpotomy, pulpectomy) has highest success?PulpectomyWhich treatment (pulp capping, pulpotomy, pulpectomy) has highest success?
  26. 26What are the indications for pulp capping and pulpotomy?Vital Teeth
    Pulp Cap :
    - small pulp exposures on YOUNG TEETH with open apices and no symptoms
    - $ for adult teeth
    Pulpotomy
    - children w/ open apex & vital root pulp
    - adult $, emergency for irreversible pulpitis
  27. 27Why are calcium hydroxide and MTA uesd for pulp capping and pulpotomy?Calcium hydroxide - so pulp tissue can make reparative dentin; has high pH - induces hard tissue deposition and antibacterial properties
  28. 28What is apexogenes?Vital pulp therapy performed to encourage physiological development and formation of root end
    For young teeth with open apices
    (capping, pulpotomy, partial pulpotomy)
  29. 29What is purpose of root canal?Remove root canal infection
    Prevent and treat apical periodontitis
    1. Debride 2. Disinfect 3. Fill root
  30. 30What is purpose of debridement?most important component of antisepsis
    - Removal of necrotic root canal material
    - Removal of infected dentin from root canal walls
  31. 31How to disinfect root canal?Irrigation and intracanal medication
    Pure calcium hydroxide - high pH, antibacterial, tissue dissolving
    NaOCl and EDTA only, half bacteria gone
    NaOCL and EDTA + Antimicrobial Tx → effectively removes bacteria from root canal
  32. 32Why are sodium hydrochlorite, chlorhexidine, and EDTA used for irrigation?• Sodium hypochlorite - (1) antibacterial (2) dissolves pulp tissues (3) lubricate canals ….no chelating effect
    • Chlorhexidine - antimicrobial wide range and has *substantivity
    EDTA - chelator capable of removing Ca2+ from dentin; remove smear layer (minerals and collagen) on root canal walls to disinfect dentin
  33. 33Why is calcium hydroxide used for root canal medication?Has high pH and antibacterial properties and tissue dissolving abilities
    Note: E. faecalis, actinomyces israelii, and candidia albicans resistant
  34. 34What are possible mechanisms of calcium hydroxide for killing bacteria and disinfection?a. Protein denaturation
    b. Damage to DNA and cytoplasmic membranes
    c. Anti-endotoxin effect
    Note: not really effective against E. faecalis and C. albicans
  35. 35What is IKI?• Iodine Potassium Iodide
    Effective auxiliary disinfectants; flood entire pulp space; better assurance that all areas of pulp space has been reached by appropriate concentration
  36. 36Gutta Purcha Cone70% Zinc Oxide
    20% Gutta Percha
    10% Metal sulfates, pigments, wax, and resins
  37. 37ZOE SealersZinc Oxide
    Eugenol
  38. 38How to determine working length1. Subtract 1mm from Estimated Working Length = FWL
  39. 39If distance is less than 3mm SHORT orless than 0.5 mm long...Adjust to 1mm
    No more x rays needed
  40. 40If distance is MORE than 3mm short or MORE than 0.5mm long....adjust 1mm and TAKE another ray
  41. 41Root Canal Preparation 1. Straight Line Access (gates glidden burs) 2. Apical Preparation - 3 larger files than WLF 3. Step Back 4. Recapitulation 5.Apical ClearingWLF = 15
    MAF = 30    Root Canal Preparation 1. Straight Line Access (gates glidden burs) 2. Apical Preparation - 3 larger files than WLF 3. Step Back 4. Recap...
  42. 42Asepsisbeing free from disease causing stuff
  43. 43What do you use for irrigation?NaOCl - sodium hypochlorite
    EDTA
  44. 44What do you use for rinses?Chlorhexidine
    IKI
  45. 45What to use for inter-visit dressingCa(OH)2 - calcium hydroxide
  46. 46Cytotoxic Antimicrobial QuotientLowest antimicrobial conc. to kill microbes / Highest conc. to be non toxic
  47. 47Sodium hypochlorite- Antibacterial
    - dissolves necrotic and vital pulp tissue
    - removes organic components
    - neutralizes amino acids
    -0.5% concentration
  48. 48EDTA and Citric Acid- Remove smear layer, long exposure = excessive dentin removal
    - not really antibacterial**
    - Should NOT be used with NaOCl since it causes erosion of dentin
  49. 49ChlorhexidinePlaque prevention and disinfection
    - final irrigant after EDTA
    NO erosion of dentin. Irrigation after smear layer removed by EDTA or Citric Acid
    Attacks microbial cell wall
  50. 50Why don't you use Chlorhexidine with NaOCl?Creates precipitate PCA - carcinogenic
  51. 51Calcium Hydroxide (intracanal medication)- Broad spectrum antimicrobial = kills bacteria AND hydrolyzes LPS
    - Apply in canal with hand file or lentulo
    -- don't put needle IN canal, might go into IAN and apex
  52. 52How to clean mouth before endo therapy1. 30% H2O2
    2. Rinse (it'll smoke)
    3. 5% Iodine tincture
  53. 53Temporization- prevents bacterial invasion between 2 visits
    1. Cavit
    2. Intermediate Restorative Material
    3. Fuji IX (glass ionomer)
  54. 54When do you use Cavit?NOT in vital teeth, it will suck up fluid from dentinal tubules and cause pain
    Good sealer, but not as strong and needs moisture to set
  55. 55Intermediate Restorative MaterialZnO + polymetylmethacrylate
    Eugenol + Acetic Acid
    If pulp is exposed and not enough time, use it
  56. 56What type of temporization do you do in inter-visit endo tx?Ca(OH)2
    Cavit
    Fuij IX
    NO COTTON    What type of temporization do you do in inter-visit endo tx?
  57. 57Before obturation and endo treatment and still has stuff in canals, what do you use to temporize?Dycal + Fuji IX
    or
    IRM... NO CAVIT
  58. 58Sources of Odontogenic Toothache?1. Pulp-Dentin Complex
    2. Periradicular Tissues
    3. Neuroanatomy
    4. Peripheral Sensitization
    5. Central Sensitization
    6. Inflammatory Mediators
  59. 59Pulp-Dentin Complex PainHypersensitive teeth
    Pulpal Pain - pulpitis
    Difficult to localize bc of pulpal nociceptors having high degree of convergence in CNS
  60. 60Pain from periradicular tissueseasier to localize bc many mechanoreceptors in PDL (A beta)
    pain decreasing...may be sign infection is getting worse
  61. 61Peripheral Sensitization PainInflammatory mediators sensitize PRIMARY afferent nociceptors
    - increased responsiveness and reduced thresholds - little gives pain
  62. 62Central Sensitization painIncreased responsive of nociceptive neurons in CNS to thermal or afferent input below threshold
    SECONDARY order neurons become sensitizes
    stimuli applied outside the injury in surrounding area; refferred pain
    Anti-inflammatory WON'T resolve
  63. 63A beta fibersIn Periradicular Tissues
    Palpation and Percussion = positive
  64. 64Pulp Testing: EPT and Cold Tests - activates what fibers?Excites A fibers - shallow stimulation
    C fibers generally not activated
  65. 65What fibers are involved in painful pulpitisC fibers - dull, throbbing pain
    Spontaneous pain indicates pulp seriously damaged
  66. 66What type of bacteria in necrotic pulp?Mostly aneerobes
    P. denticola, P. gingivalis, P. endodontalis, P. intermeida, P. melaninogenica
  67. 67Which bacteria in root canal treated teeth?Primary infection - Obligate Anaerobes,
    Secondary Infection - Facultative anaerobes
  68. 68Why bacteria important (Kakehashi Study)Rat model - germ free vs conventional rats damage teeth for pulp response
    Bacteria - cause of pulpal and periradicular disease --> necrotic pulp
  69. 69Dental Pulp cellsOdontoblasts
    fibroblasts
    macrophage
    dendritic
    lymphocyte
    mast cells
    pulp stem cells
  70. 70What can also result from no endo problem lik ehigh filling, ill fit crown, and periodontial problemSymptomatic apical periodontitis
  71. 71For irreversible pulpitis, what could relieve the pain?Pulpotomy
  72. 72If symptomatic apical periodontitis, what do you need to do?Need pulpectomy
  73. 73If pulp necrosis, what therapy?Need to clean canal to relieve symptoms
  74. 74How to anesthetize: Mandibular anteriors? Maxillary anteriors? Maxlilary molars? If it doesn't work?Mandibular anteriors - mandibular block
    Maxillary anteriors - BUCCAL infiltration
    Maxillary molars - lingual, buccal, sometimes PSA
    Doesn't work - may do PDL or intrapulpal
  75. 75Which type of tooth is hard to anesthetize?Mandibular teeth
    Four common mandibular nerve anomalies that lead to local anesthesia failure:
    Sensory neurons of mylohyoid nerve
    Bifid mandibular nerve
    Retromolar foramen
    Contralateral innervation
  76. 76Mechanism of intrapulp anesthesia- binds to voltage gated Na ion channels
  77. 77What is the most missed canal?Mesio-lingual canal of 1st mandibular molar
    - use endo explorer to find canals
  78. 78The working length radiograph is taken with?1. Mesial or distal shift except for maxillary anterior teeth
    2. with files placed to estimated WL in ALL canals present, simultaneously
  79. 79The working length file is:used to determine corrected working length
  80. 80What is the master apical file?3x larger than FWL
    WLF = 15 so... MAP is 20-->25-->30!
  81. 81What is AH26?Polymer Sealer
    Epoxyresin - 34 hrs
    AH plus - 8 hrs
  82. 82When can't the tooth be obturated?Can't obturate if symptomatic and can't dry canal
    If can't dry sealer, can't dissolve and get space in the canal

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Karteikarten am Endo Midterm, erstellt von Mica Borgueta am 16/08/2018.
Erstellt von
Mica Borgueta
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