Flashcards
Endodontics V (100 Flashcards)
Cards in this deck (100)
- 1Procedural Complications ___ formation = artificial irregularity created on the surface of root canal wall ___ = the tendency for files to straighten out curved canals Why do ledges occur? - lack of proper straight-line access, so do not have a proper ___ path for the file to travel through - happen more often in ___ (smaller/larger) canals, ___ (longer/shorter) canals, and ___ (curved/straight) canals - inadequate irrigation and lubrication can contribute to ledges Flexible NiTi files are ___ (less/more) likely to ledge - b/c they are more flexible than stainless steel files, which are ___ (less/more) likely to transport canals When you first start instrumenting a canal, you use a small file to check the anatomy of the canal (called ___) When you create a ledge, you can use smaller instruments again to bypass a ledge once one occurs (called ___-___)ledge, transportation, glide, smaller, longer, curved, less, more, negotiation, re-negotiation
- 2Procedural Complications Instrument ___ - breakage of an instrument within the confines of a canal Why do instruments separate? - could be using excessive ___ - skipping steps by jumping to larger file sizes too soon - inadequate irrigation and lubrication (so important to irrigate canals with NaOCl and coat your instruments with EDTA) - if you are not ___ files often enough - reusing files too much can make them weaker and more likely to fracture Flexible NiTi files may be ___ (less/more) likely to form ledges, but they are ___ (less/more) likely to fracture Can use smaller instruments to ___ a separated instrument The later the instrument separates during the RCT process, the ___ (better/worse) the prognosis - b/c you have done more instrumentation and removed more bacteria Can try to remove the broken file or bypass it, but extremely difficult - as long as you have instrumented enough beforehand, you can leave the broken file in place and instrumentseparation, force, replacing, less, more, bypass, better
- 3Procedural Complications Perforation 1. ___ perforation = through the crown; occurs during access preparation 2. ___ perforation = through the pulpal floor when you are searching for the canal orifices; in teeth with a furcation 3. ___ perforation*** = due to excessive coronal flaring with an endo file - particularly relevant for ___ (mandibular/maxillary) molars b/c of danger zone on the ___ (distal/mesial_ side of the ___ (mesial/distal) root (signficant concavity at the furcation in this region) - if you flare this out too much with a file, there will be no dentin left - however on the mesial side of the mesial root, there is a lot more dentin - so always favor the ___ (mesial/distal_ side on the mesial root of mandibular molars to avoid strip perforationcoronal, furcal, strip, mandibular, distal, mesial, mesial
- 4Procedural Complications Perforation 4. ___ perforation Lateral root perforation can occur if you have a ___ formation and continue to instrument through that ledge The more ___ (apical/coronal) the root perforation, the better the prognosis Immediate ___ or sudden ___ are signs of a perforation - if you go through the side of the tooth, you will enter the PDL (lots of vessels, bleeding, patient will feel pain b/c not numb in that area) - fix with internal repair using ___root, ledge, apical, hemorrhage, pain, MTA
- 5The later in the procedure that a complication arises (whether ledge formation, instrument separation, or perforation), the ___ the prognosis because the canal is more disinfected/instrumentedbetter
- 6Trauma Protocol T - ___ booster within the first 48 hours (___ only - if you will be replanting a contaminated tooth) R - radiographs - at least ___ PA - more radiographs or panoramic x-ray needed for jaw trauma/suspected fracture A - ___ (avulsions only - if you will be replanting a contaminated tooth) V - ___ testing - EPT and cold test - do not test for true vitality b/c they do not test for ___ supply to the tooth - false negatives are rather common following trauma b/c sensory innervation can be disrupted for at least ___-___ weeks after trauma (even though vascular supply is intact) M - more A - appointments - followups are recommended at ___ weeks, ___ months, ___ months, and ___ months after the traumatic injurytetanus, avulsions, 1, antibiotics, vitality, vascular, 2-8, 3, 3, 6, 12
- 7Ellis Classification*** Class I - ___ only Class II - ___ and ___ Class III - ___, ___, and ___ Class IV - traumatized tooth that has become ___-___ Class V - ___ Class VI - ___enamel, enamel, dentin, enamel, dentin, pulp, non-vital, luxation, avulsion
- 8___ fracture = refers to all fractures of teeth without pulp involvement Can involve just the enamel layer or the enamel and dentin layer Treatment:*** If only the ___ is fractured, you can smooth out the edges to prevent further soft tissue damage or lacerations with the sharp edges of a fracture line If enamel and dentin are involved, we would elect to ___ the tooth with a composite resin or something - to restore tooth to normal function and to occlude the dentinal tubules to prevent sensitivity, caries, etc.uncomplicated, enamel, restore
- 9___ fracture = fractures that involve the pulp Treatment:*** Less than 24 hours - ___ ___ ___ More than or equal to 24 hours - ___ ___ aka partial pulpotomy More than or equal to 72 hours - ___complicated, direct pulp cap, cvek pulpotomy, pulpotomy
- 10___ = bumping your tooth No displacement, no mobility, PDL is sore Treatment:*** Let the tooth ___ - so avoid biting on it for a few days and stick to a soft dietconcussion, rest
- 11___ = tooth being loosened in the socket No displacement, but increased ___ ___ rips and bleeds Treatment:*** Flexible splint for ___-___ weeks 6% chance of necrosis with ___ apices, more favorable prognosis with ___ apices (immature tooth where root is still developing)subluxation, mobility, PDL, 1-2, closed, open
- 12___ = tooth is partially extruded in a coronal direction out of the socket Treatment:*** If tooth has ___ apex, more favorable prognosis - reposition tooth in socket, ___ splint for 1-2 weeks, and monitor (3 weeks, 3 mos, 6 mos, and 12 mos) If tooth has ___ apex, less favorable prognosis - reposition tooth in socket, flexible splint, ___ if needed 65% chance of necrosis with ___ apicesextrusion, open, flexible, closed, RCT, closed
- 13___ ___ = displacement of the tooth in any direction except axially Usually, the crown is displaced ___ and the root apex is displaced ___ Treatment:*** - same as extrusion Reposition tooth in socket, ___ splint, and monitor (3 weeks, 3 mos, 6 mos, and 12 mos) - ___ as needed (aka if the tooth becomes symptomatic or if there is irreversible pulpitis or necrosis) 80% chance of necrosis with ___ apiceslateral luxation, palatally, labially, flexible, RCT, closed
- 14___ = apical displacement of the tooth Treatment:*** ___ apex - allow to re-erupt ___ apex - reposition, flexible splint, RCT 96% chance of necrosis with ___ apices - this is because as the tooth is intruded, it literally severs the vessels that supply that tooth - so necrosis is highly likelyintrusion, open, closed, closed
- 15___ = ex-articulation; complete separation of tooth from its socket in the alveolus ___-___ ___ ___ (EADT) = amount of time a tooth has been out of the mouth while dry - the longer you wait while the tooth is out of the socket, the ___ (worse/better) the prognosis gets Treatment:*** Re-implant tooth back in socket ASAP, flexible splint for 1-2 weeksavulsion, extra-alveolar dry time, worse
- 16Avulsion treatment*** (more specific) - permanent teeth since not necessary to re-implant primary teeth - but child should still see dentist in timely manner in case of any trauma ___ apex, EADT < ___ minutes - re-implant, splint ___ apex, EADT < ___ minutes - re-implant, splint, no RCT but apexification at first sign of infected pulp ___ apex, EADT > ___ minutes - re-implant, splint, RCT ___ apex, EADT > ___ minutes - may or may not re-implant/splint/RCT - plan for an ___closed, 60, open, 60, closed, 60, open, 60, implant
- 17Storage media: - ___ ___ ___ ___ (HBSS) - milk - saline - saliva - water is the ___ (least/most) desirable solutionhank's balanced salt solution, least
- 18Long-term responses to trauma 1. External resorption = initiates in the periodontium; due to damage to the ____ layer of the PDL Subcategories of external resorption: - ___ resorption = bad side effect of splints that are too rigid or left on too long; called ankylosis; replaces PDL with bone - ___ resorption = subepithelial sulcular infection from trauma or non-vital bleaching; initiating at the CEJ; ragged moth-eaten appearance on radiograph; can see a ___-colored spot on the tooth clinically - ___ ___ resorption (IRR) = bacteria and byproducts from necrotic pulp travel through the dentinal tubules to affect the periodontium; so go from inside the pulp to the PDL Margins of external resorption are ragged and ___ (poorly/well) defined With PAs at various angles, the lesion appears to movecementoblastic, replacement, cervical, pink, inflammatory root, poorly
- 19Internal resorption = initiates in the root canal system; due to damage to the ___ layer Inflammation due to ___ pulp from caries or trauma (like external resorption), except this time causes resorption from within the tooth ___ (better/worse) prognosis and easier to treat than external resorption Treatment:*** ___ - can use liquefied or flowable obturating material to seal the canal effectively ___ are sharp and well-defined (unlike external resorption) ___ (does/does not) move with different angled radiographs (unlike external resorption)odontoblastic, necrotic, better, RCT, margins, does not
- 20___ ___= ideal natural response to trauma; trauma induces odontoblasts to rapidly form extensive amounts of ___ dentin (aka tertiary dentin) within the pulp space More likely with open apices, intrusions, and severe crown fractures As a result of this calcific metamorphosis, you get a ___-___ color to the tooth Also refers in phenomenon called ___ ___ - pulp canal shrinks to a point where you will not be able to see it on a radiograph - because of deposition of reparative dentin Tooth basically repairs itself by laying down more dentin/tooth structure to protect itselfcalcific metamorphosis, reparative, yellow-orange, canal obliteration
- 21___ ___ (CaOH2) = stimulates secondary odontoblasts to repair with dentinal bridge formation So calcium hydroxide stimulates those undifferentiated mesenchymal cells to become ___ ___, which then make ___ dentin aka the dentinal bridge, which is a barrier that can protect the pulp Has a very high basic pH of ___ - cauterizes the tissue, irritates the secondary odontoblasts, and kills bacteriacalcium hydroxide, secondary odontoblasts, tertiary, 12.5
- 22___ ___ ___ (MTA) = stimulates cementoblasts to produce hard tissue; superior to calcium hydroxide Essentially a cement with an aggregate of 3 minerals - ___, ___, and ___ Consists of hydrophilic particles of calcium phosphate, calcium oxide, etc. Disadvantages: - Long ___-hour setting time and contains ___ ___ (opacifier) - Opacifier is good in that you can visualize the material on a radiograph, but not good because it can leak and stain the teeth (bad for anterior teeth) Advantages: - Seals really well b/c it sets in the presence of ___ (so does not dissolve in saliva aka isolation is not that big of an issue) - antimicrobial (like calcium hydroxide) - ___ and biocompatible (great sealing agent) - calcium hydroxide is very resorbablemineral trioxide aggregate, calcium, silicon, aluminum, 3, bismuth oxide, moisture, nonresorbable
- 23___ ___ ___ = includes tx options for a vital pulp where you want to maintain vitality - but there is something currently causing an issue with the pulp 1. Indirect pulp cap (IPC) 2. Direct pulp cap (DPC) 3. Cvek pulpotomy 4. Pulpotomy (PPTY) 5. Apexogenesis ___-___ ___ ___: 1. Pulpectomy (PCTY) 2. Root canal therapy (RCT) 3. Extraction 4. Apexificationvital pulp therapy, non-vital pulp therapy
- 24___ ___ ___: Calcium hydroxide or a resin modified glass ionomer is placed on a thin partition of remaining dentin that, if removed, might expose the healthy ___ Indicated when there are ___ caries approximating the pulp - if removing the caries will expose the pulp, we can elect to leave the carious dentin there and place this indirect pulp cap on top (so not directly touching the pulp but rather very close to the pulp) Can place calcium hydroxide over the region, and then place resin modified glass ionomer on top b/c ___ ___ is very resorbable and will dissolve with saliva - using ___ ___ ___ ___ to protect the CaOH2 from dissolvingindirect pulp cap, pulp, deep, calcium hydroxide, resin modified glass ionomer
- 25___ ___ ___: ___ ___ is placed directly on an otherwise healthy pulp exposure - so pulp is exposed and we want to make sure we can cover it Direct pulp cap is the treatment of choice if a tooth is fractured and the pulp exposure occurred less than ___ hours ago - so we want to try and save that pulp tissue as much as possible by capping it with calcium hydroxide Can also be used for a carious or mechanical exposure that is less than ___mm in size (so if you have a pinpoint pulp exposure when you are removing deep caries Hard tissue barrier will hopefully form within ___ weeks - so stimulating ___ ___ to make dentinal bridge to protect the pulp with a barrier ___ (less/more) favorable prognosis than indirect pulp cap - b/c of instead of maintaining that thin partition of dentin, we are relying on the secondary odontoblasts to create a tertiary dentin bridge The deeper you are into the pulp, the ___ (worse/better) your prognosis will likely bedirect pulp cap, calcium hydroxide, 24, 2, 6, secondary odontoblasts, less, worse
- 26___ ___ aka partial pulpotomy aka shallow pulpotomy Involves the removal of a small portion of coronal ___ (diseased/healthy) pulp The bacteria of the deep caries have infiltrated a portion of the pulp tissue - this portion of the pulp is very inflamed and there is a lot of ___ - do not want to leave this b/c it is too far gone to just pulp cap it - need to remove the infected pulp Can also use cvek pulpotomy for a traumatic pulp exposure that occurred ___ (more/less) than ___ hours and is starting to get infected - need to remove that section of the exposed pulp Can also use a cvek pulpotomy when there is a carious or mechanical exposure of ___ (larger/smaller) than ___mm in size - not feasible to do a direct pulp cap - the risk of failure of the direct pulp cap outweighs the potential benefit, which means a cvek pulpotomy is bettercvek pulpotomy, diseased, bleeding, more, 24, larger, 2
- 27___ = removal of coronal diseased pulp Buckley's ___ - this is what we use for pulpotomies to fixate the pulp in the area of fixation Consists of 19% ___, 35% ___, 15% glycerine, and 31% water Formocresol is both a ___ agent (kills bacteria) and ___ agent (fixes the pulp tissue, devitalizes it in the area of fixation, and makes it resistant to enzymatic breakdown) Controversial b/c toxic - but if used in the correct dilution for the right amount of time, the risks are minimalformocresol, formaldehyde, cresol, bactericidal, fixative,
- 28___ = involves removal of coronal and radicular dead or dying pulp tissue; part of non-vital pulp therapy Often used as ___ pain relief on teeth with irreversible pulpitis until a full RCT can be done But usually reserved for ___ teeth - non-vital and restorable primary tooth w/ pulp exposure (asymptomatic has a better chance of success) ___ ___ ___ (ZOE) in the crown, but ___ ___ in the root - no need for formocresol because the radicular pulp is also being removed Calcium hydroxide is a great material to use in this scenario because it is resorbable and can be resorbed by the underlying ___ tooth when it eruptspulpectomy, temporary, primary, zinc oxide eugenol, calcium hydroxide, permanent
- 29___ = removal of a tooth with a dead or dying pulp For primary teeth: - when the tooth is ___ (nonrestorable/restorable) - can opt to extract over a pulpectomy for a primary ___ ___ b/c they have lots of accessory canals and is therefore difficult to perform a successful pulpectomy - if the tooth is exhibiting root resorption and the patient is ___ (symptomatic/asymptomatic)extraction, nonrestorable, 1st molars, symptomatic
- 30___ ___ ___ = pulpectomy + cleaning + shaping + filling Pulp can be diseased or deadroot canal treatment
- 31___ = maintain pulp vitality in order to stimulate root development and allow the body to make a stronger root ___ ___ (CaOH2) or ___ ___ ___ (MTA) is placed on healthy or diseased pulp Includes any indirect pulp cap, direct pulp cap, cvek pulpotomy, or pulpotomy performed on an ___ ___ tooth (aka open apex) Depending on the type of pulp exposure, we can determine which vital pulp therapy we want to use Ex: if you have a pulp exposure less than 24 hours ago, then you would do a direct pulp cap (which also includes apexogenesis b/c the tooth is immature) ___ in avulsion, nonrestorable teeth, severe horizontal fracture, and necrotic teethapexogenesis, calcium hydroxide, mineral trioxide aggregate, immature permanent, contraindicated
- 32___ = tooth does not have a vital pulp; not allowing root to finish development, but rather trying to attain root end ___; disinfection of the root canal followed by induction of an acceptable apical barrier in order to block off the end of the root ___ ___ (CaOH2) or ___ ___ ___ (MTA) is placed at the base of the canal ___ (after/before) the dead or dying pulp is removed Includes ___ performed on an immature permanent tooth (open apex) - forms an apical barrier instead of allowing root to complete development - to prevent retrograde infection and spread of disease by sealing off the apexapexification, closure, calcium hydroxide, mineral trioxide aggregate, after, pulpectomy
- 33___ ___ syndrome ___ on biting and release; ___ to cold and hot; sometimes completely asymptomatic Cracks usually extend deep into dentin and propagate mesiodistal, often on the ___ ___ Dyes and trans-illumination are more helpful than ___ Tooth ___ on each cusp can aid in location of crack ___ pulp - splint with band and observe or crown ___ pulp - conservative RCT and crowncracked tooth, pain, sensitive, marginal ridge, radiographs, slooth, healthy, diseased
- 34___ ___ fracture Starts apically and progresses coronally Can occur after cementation of a ___ or excessive ___ forces on an overprepared canal - ___ (most/least) common Isolated ___ defect at the site of fracture ___-shaped or teardrop radiolucency ___-rooted tooth - extract ___-rooted tooth - extract or resect the affected rootvertical root, post, condensation, most, probing, J, single, multi
- 35Perio vs. Endo Lesions Endo = originates in the ___ Perio = originates in the ___ Perio-endo = true combined lesion - treat ___ first, then ___pulp, sulcus, endo, perio
- 36The _____ technique is used when taking endodontic radiographs.Paralleling technique (film parallel to long axis of the tooth)
- 37Why is the paralleling technique used to take endodontic radiographs?More Accurate reproduction of the tooth's dimension
Reduces superimposition
More easily Reproducible - 38Why would a Biseting angle technique be used when taking radiographs?Low palatal vault
Palatal torus present
Very Long roots - 39The biggest limitation of the bisecting angle technique is that it causes greater amount of _____.Distortion
- 40What is the SLOB rule?Same Lingual, Opposite Buccal
- 41A buccal and lingual root is superimposed in a radiograph. You can't tell which is which (root A and B) The radiograph tube is moved Mesially. Root B moves Mesially as a result of the radiographic tube moving. Is root B a buccal or lingual root?Lingual root
- 42_____ radiographs provide the most accurate measurements for estimating depth to the pulp chamber. _____ within the pulp canal system are the indisputable cause of periapical periodontitis.Bitewing
Bacteria - 43T/F Use of the Rubber Dam is Mandatory for endodontic therapy. If a tooth cannot be isolated it probably cannot be restored.1st True
2nd True - 44If a tooth is too broken down, but still can be saved and restored, ______ is indicated.Pre-isolation treatment
- 45Before endodontically treating a tooth, What must be removed?Calculus and Decay
Faulty restorations
Unsupported tooth structure
Reduce occluding cusps to avoid occlusal trauma - 46Describe the access opening for the Maxillary 1st premolar.Ovoid in shape, wider in buccal-lingual direction.
B-L extent of the outline just short of the cusp tips - 47What procedural errors are likely to occur if your access opening is the incorrect Size, shape, or in the wrong location?Orifices not visible (too small)
Difficulty with instrumentation
Lack of straight line access - 48How is an incorrect size, shape, or location of an Access opening Corrected?Enlarge the opening: make correct shape by sacrificing tooth structure
- 49How is Gouging and overextension of the access opening Prevented?Review access cavity preparations and proper shape
Measure depths of the tooth radiographically - 50What procedural errors may occur during cleaning and shaping?Loss of working length (WL)
Loss of apical stop
Irrigation accidents: bleach expressed through the apical foramen
Ingestion / Aspiration
Perforation
Stripping - 51What can cause Loss of Working Length (WL) when cleaning and shaping a canal?Inaccurate WL determination: poor radiograph for example
Packed Dentinal debris
Ledge formation
Canal transportation
Separated instruments - 52What would cause a Loss of the Apical stop during cleaning and shaping?Zipping
Inaccurate WL determination causing overinstrumentation - 53What Reference point should be used for Anterior and Posterior teeth?Anterior: Incisal edge
Posteriors: Cusp tip may be flattened. Use the cusp tip or marginal ridge that is closest to the file. - 54How do you prevent packing of dentinal debris?Frequent irrigation
Recapitulation
Ensure the rubber stop reaches the reference point every time - 55T/F The Access opening shape is the same for both Maxillary and Mandibular Premolars. The access opening for premolars is an Oval which is wider in the B-L direction.1st True
2nd True - 56Which Premolar has a Mesial concavity which should be avoided when cutting the access opening?Mx 1st Premolar
- 57Why do you use the largest size file that reaches the WL when taking a WL film?Lets you know how big the canal is
Larger file holds its position better than a smaller file: the small file may move around causing inaccuracies in the WL determination - 58Define the following as they relate to endodontic cleaning can shaping: Ledge Transportation ZippingLedge: deviation in the dentinal wall
Transportation: removal of canal wall on Outside curve in the apical ⅓ of the root
Zipping: apical foramen transportation w/ teardrop shape and movement away from the original canal curvature - 59Define the following as they relate to endodontic cleaning can shaping: Elbow Strip perforationElbow: The Narrow portion of a curved canal above a transportation or zip
Strip perforation: perforation of root dentinal wall, usually in curved roots or roots with invaginations - 60How do you Prevent Ledge formation? (these are the same factors for preventing transportation, zipping, and apical perforation)Don't skip file sizes
Pay attention to the Rubber stop: Make sure it touches the reference point
Don't force the file if it doesn't touch the reference point
Recapitulation
Take x-rays if there is concern about ledge formation - 61What step can prevent most common procedural errors in cleaning and shaping?Proper access opening with Straight line access
- 62How do you manage a Zipped canal & elbow?Managed by Obturating to the Elbow instead of the apical constriction which may have been lost due to zipping
Adjust WL and instrument to the new WL at the depth of the elbow - 63How do you manage a Strip perforation?Minimize amount of extrusion
MTA repair may be possible
Refer to specialist - 64What is the Danger Zone for Strip perforations? Which teeth are more at risk for strip perforations?Location where the canal is close to the external surface of the root often due to an invagination: Likely location for a strip perforation
Most common in Mandibular molars: distal side of the mesial root and mesial side of distal root - 65How can you prevent Strip perforations?Use Anti-curvature filing: Filing Away from thin areas (danger zones)
File is directed toward the bulky portion of the root - 66What are the common Obturation errors?Short fill: doesn't reach the apical constriction
Long fill (overfill): extrusion of obturation material
Overextension
Inadequate fill: voids/non-homogeneous - 67How do you manage a Short fill?Re-obturate the canal
- 68What commonly causes a Long fill?Lack of an Apical stop due to overinstrumentation
- 69What is the difference between Overfill and Overextension?Overfill: Excess of Obturation material beyond the confines of the canal. Canal is filled 3 dimensionally
Overextension: Excess of obturation beyond the confines of the canal. Canal is Not filled 3 dimensionally - 70How do you manage a Long fill?Remove obturation material
Create an apical seat 1.5 - 2 mm above the radiographic apex
Re-obturate - 71Diagnosis in endodonticts involves the _____ approach. The Clinical diagnosis ______ (does or does not) correlate with the histologic status of the pulp.Repair-predictive approach
Does Not - 72What 2 diagnoses are made for every tooth?Pulpal diagnosis
Apical diagnosis - 73What are the indications for using the SOAP approach?Pain (previous hx of pain)
Swelling (hx of swelling)
Trauma (hx of trauma)
Suspicious teeth
Teeth requiring new restorations
Previously endo-treated teeth
Recall
*To Establish a baseline pulpal status before treatment* - 74What does SOAP stand for?Subjective evaluation (chief complaint)
Objective evaluation (testing)
Assessment (pulpal and apical diagnoses)
Plan tx - 75What information is gathered from the Subjective evaluation?Chief complaint
Previous Hx of pain
-Frequency, severity, duration, spontaneity, location
-Source of pain - 76What information is gathered from the Objective evaluation?Confirm the chief complaint
Visual and Clinical exam: look for swellings, caries, extensive restorations, new restorations, periodontal disease, Sinus tract tracing
Periodontal exam
Radiographs taken
Pulp testing - 77How is the Palpation test done? What are you looking for?Bimanual palpation of the soft tissues over the tooth (root apices) in question as well as the adjacent teeth
Observe for Pain, tenderness, swellling, hard and soft tissue defects
Record Normal response (R), Abnormal (AR), or No response (NR) - 78How is the Percussion test done? What are you testing for?Tapping lightly on the teeth with the end of the mirror handle: Vertical and Angled percussion
Tests for Inflammation of the PDL
*Severe sensitivity to percussion is highly indicative of pulpal degeneration* - 79T/F Thermal pulp testing is a test for Vitality. Thermal testing, like most endo tests, are compared to the contralateral tooth or adjacent teeth.1st False: Does Not test Vitality
2nd True - 80When performing the Thermal pulp test, Where is the Ice stick or Endo-ice placed?Junction of the Cervical ⅓ and Middle ⅓ of the facial surface of the tooth
- 81What is the Normal response for Thermal pulp testing? What would be an Abnormal response?Test contralateral side and/or adjacent teeth
Patient feels the cold stimulus
Painful stimulus from the cold goes away when the endo-ice is removed
Abnormal response (AR): Tooth very sensitive to cold and pain Lingers (time of lingering pain is recorded) - 82T/F Unlike the thermal pulp test, the Electric pulp test can determine Vitality. The Electric pulp test produces Fewer false positives and false negatives compared to the Thermal pulp test.1st False: Does Not test vitality
2nd False: Electric pulp test produces More false +'s and false -'s - 83How is the Electric pulp test done?Electric probe placed on tooth
Current slowly increases until the patient feels a "tingling" sensation.
Numerical value recorded 0-80
Numerical value compared to contralateral / adjacent teeth. - 84What are the Contraindications for Electric pulp testing?Cannot be used on Restorations
- 85What Additional tests are available to help evaluate the pulp? (in addition to thermal and electric pulp tests)-Selective anesthesia: patient can't tell if pain is coming from upper or lower (anesthetize one area to confirm if pain remains or not)
-Transillumination: can help identify fractures
-Test cavity - 86List all of the potential Pulpal diagnosesNormal
Reversible pulpitis
Symptomatic irreversible pulpitis
Asymptomatic irreversible pulpitis
Pulpal necrosis
Previously-treated
Previously initiated therapy - 87How is Reversible pulpitis differentiated from Symptomatic irreversible pulpitis?-Spontaneous pain is highly indicative of Irreversible pulpitis
-Lingering pain (> ≈10 sec) from a thermal pulp test is indicative of Irreversible pulpitis - 88How is Asymptomatic irreversible pulpitis differentiated from Pulpal necrosis?-Necrosis has No Response from a thermal pulp test while asymptomatic irreversible pulpitis has a Normal Response to the thermal pulp test
-Asymptomatic Irreversible pulpitis may have a normal response but caries extends to the pulp radiographically
-Periapical radiolucency is indicative of Pulpal Necrosis - 89What are the Key characteristics of Reversible pulpitis?Hypersensitive to thermal test
Not severe
Infrequent episodes of pain
Minimal lingering
Inflammation will resolve on its own and pulp will return to normal. - 90What are the Key characteristics of Symptomatic irreversible pulpitis?Painful to thermal test
Lingering pain
Increased frequency
*Spontaneous pain*
Pulp is incapable of healing - 91What are the Key characteristics of Pulpal Necrosis?Death of the pulp
Pulp is non-responsive to pulpal testing - 92List the Periradicular (apical) diagnosesNormal apical tissues
Symptomatic apical periodontitis
Asymptomatic apical periodontitis
Acute apical abscess
Chronic apical abscess
Condensing osteitis - 93What are the Key characteristics of Normal apical tissue diagnosis?Not sensitive to Palpation or Percussion tests
Normal response to thermal test
Intact Lamina dura and PDL space - 94What are the Key characteristics of Symptomatic apical periodontitis?-Painful response to Biting, Palpation, and/or Percussion tests
-May or may not be associated with radiographic changes - 95What are the Key characteristics of Asymptomatic apical periodontitis?-No pain to palpation or percussion tests
-Radiographic changes: Loss of Lamina dura, Widened PDL, periapical radiolucency - 96What are the Key characteristics of Acute apical abscess?-Extreme pain
-Patient presents w/ fever, malaise, lymphadenopathy. patient cannot bite down
-Swelling
-Tooth mobile
-May or may not be associated with radiographic changes - 97What are the Key characteristics of Chronic apical abscess?-Inflammatory reaction of the pulp due to necrosis
-No to Slight discomfort (mostly asymptomatic)
-Tooth has a Sinus tract to the soft tissue or to the Sulcus - 98What is included in the Plan portion of SOAP?Treatment plan
Endodontic tx plan
Resorative tx plan (perio tx plan if needed)
-Other plans may include: no tx, caries removal, restore and reevaluate, extract, refer, etc - 99A Typical endodontic emergency involves ______ symptoms.A Typical endodontic emergency involves ______ symptoms.
- 100What are the steps to Emergency endodontic treatment?-Identify the etiology of the problem (diagnosis)
-Eliminate the Source if possible
-Determine Restorability of the tooth
-Discuss Prognosis: inform the patient of available alternative treatments (informed consent)
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- Praxis Flashcards: Endodontics Flashcards on Endodontics V (100 Flashcards), created by ACAPUN INSTITUTE on 02/08/2021.
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