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Flashcards

Endodontics

Michael Brown English 70 cards

Endodontics

Cards in this deck (70)

  1. 1Describe the ProTaper sequenceDescribe the ProTaper sequence
  2. 2What are the indications for endodontics?Caries
    Trauma
    NCTSL
    Pulpitis
    Resorption
    Periapical periodontitis
  3. 3What are the aims of endodontics?Remove canal contents
    Eliminate infection
    Seal canal space to prevent reinfection
  4. 4What are the design objectives of endodontics?1. Continuously tapering funnel shape
    2. Maintain position of apical foramen
    3. Keep apical opening as small as possible
  5. 5What gram negative bacteria are involved in endodontics?More in necrotic cases
    Veillonella cocci
    Prevotella
    Fusobacterium
    Porphyromonas
  6. 6What gram positive bacteria are involved in endodontics?More in failed and persistent cases
    Enterococcus faecalis
    Actinomyces
  7. 7What are the signs and symptoms of reversible pulpitis?Short, sharp pain
    Goes away once stimulus removed
    No TTP
    No peri-radicular changes
  8. 8What are the signs and symptoms or irreversible pulpitis?Spontaneous, intermittent pain
    Dull throb/ache, prolonged
    TTP
    Worse at night
    RADS -> only if advanced - PDL widening and source e.g. caries
    Not capable of healing ∴ endo indicated
  9. 9What is asymptomatic irreversible pulpitis?Rare form of pulpitis
    Still requires RCT
  10. 10What are the signs and symptoms of a necrotic pulp?No blood or nerve supply
    Asymptomatic until periodontium involved
    May have had previous symptoms
    Negative sensibility test
    TTP
    Responds to heat, relieved by cold
    RADS -> PA radiolucency and PDL widening
  11. 11How is periapical/periradicular disease classified?Acute/Chronic
    Peri-radicular periodontitis/abscess
  12. 12What are the signs and symptoms of acute peri-apical periodontitis?+++TTP
    Pain on biting
    RADS -> PDL widening but no PA lucency
    Rx - RCT/XLA
  13. 13What are the signs and symptoms of chronic peri-apical periodontitis?Asymptomatic
    No TTP
    RADS -> PDL widening and PA lucency
    Rx - RCT/XLA
  14. 14What are the signs and symptoms of an acute peri-apical abscess?Rapid onset
    +++TTP
    Pain
    Mobile
    Swelling
    Lymphadenopathy
    RADS -> PDL widening
    PA lucency
    RX - RCT/XLA
  15. 15What are the signs and symptoms of a chronic peri-apical abscess?Asymptomatic
    Draining sinus
    RADS -> PA lucency
    RX - RCT/XLA
  16. 16What are cautions/considerations for endodontic treatment?MH - CVD (bacteraemia), allergies, special care, behaviour/psychiatric problems, diabetes, blood disease, immunosuppression, pregnancy
    DH - perio.disease, unrestorable tooth, no isolation, poor crown:root ratio, dilacerated roots
    SH - poor coop, poor attendance, cost, age
  17. 17What is the general 10 year prognosis for: Irreversible pulpitis? Necrosis?Pulpitis - 90%+
    Necrosis - 80%+
  18. 18What are the risks of endodontic treatment?Pain
    Failure
    Instrument separation
    Perforation
    'mishaps' - ledges, zipping, apical transportation, blockage
  19. 19What factors are involved in endodontic referral?American Association of Endodontics Case Difficulty Form
    MH, LA, Pt mgmt, Gag/Opening, Access, Isolation, Morphology
  20. 20What are the 7 stages of mechanical preparation?1. Tooth preparation
    2. Access Cavity and RC Location
    3. Straight Line Access
    4. Initial Negotiation
    5. Coronal Flare
    6. Working Length Determination
    7. Apical Flare
  21. 21Draw access cavities for all teethDraw access cavities for all teeth
  22. 22What are the laws of symmetry?1 - orifices lie equidistant from MD line through chamber
    2 - orifices lie on a line perpendicular to the MD line through the chamber
  23. 23What is the law of colour?The pulpal floor is ALWAYS darker than the walls
  24. 24What are the laws of orifice location?1 - Always at the floor and wall junction
    2 - Always at angles in the floor/wall junction
    3 - Always at the terminus of developmental fusion lines
  25. 25What are the aims of chemomechanical disinfection?Remove canal contents
    Eliminate infection
    Seal canal to prevent reinfection
  26. 26What is manual dynamic irrigation?Agitation of irrigant with a file/GP to allow irrigant to reach working length and accessory canals
  27. 27What kind of syringe is used for irrigation and how is it used?Luer lock side venting needle
    2mm short of WL
    Copious irrigation and always with a reservoir in the chamber
  28. 28What do you need to discuss for informed consent?Procedure
    Prognosis
    Alternatives
    Risks -> doing and not doing Rx
    Allow pt to ask questions
    Agree to a Rx plan
  29. 29How does sodium hypochlorite work?NaClO -> dissociates into OCl and NA
    OCl + H = HOCl
    HOCl is acidic and antibacterial
    Dissolves pulp remnants and collagen
    Dissolves necrotic and vital tissue
    Disrupts smear layer but DOES NOT remove it
    Requires >10 mins to work
  30. 30What concentration of NaOCl is used?(0.5-6%)
    Commonly 3%
  31. 31What are the advantages of NaOCl?Antibacterial and acidic
    Dissolves necrotic and vital tissue
    Dissolves pulp remnants and collagen
    Disrupts smear layer
  32. 32What are the disadvantages of NaOCl?Toxicity
    Taste/smell ∴ pt comfort
    Removes organic material
    Does not remove smear layer
    May affect dentine properties
  33. 33What is the smear layer? How is it removed?Inorganic and organic debris created during preparation
    Interferes w/disinfection and sealer penetration
    Removed by EDTA (17%) /Citric Acid (10%) /Ultrasonic irrigation
  34. 34What is EDTA?Ethylenediaminetetracetic Acid
    Chelating agent
    17% used
    Removes smear layer
    Aids negotiation of calcified roots
    Applied for 1 minute
    Do not mix w/NAOCl
  35. 35What is an alternative to NAOCl?Chlorhexidine
    Cationic bisguanide ∴ antimicrobial
    Alters cell membranes and causes lysis
    Bacteriostatic and bactericidal
    DO NOT MIX w/NAOCl - cytotoxic
    Not as good as NAOCl
  36. 36Detail a final irrigation protocol1x syringe:
    NAOCl
    EDTA -> 1 minute
    NAOCl
    Dry and agitate between syringes and filling
  37. 37What is the purpose of intracanal medicaments? Give 2 examplesUsed between apts to:
    Kill of remaining bacteria and prevent further reinfection
    Reduce inflammation and exudate
    Control root resorption
    e.g. Ledermix
    Non-Set CaOH
  38. 38What is Ledermix and how does it work?Antimicrobial paste -> corticosteroid and tetracycline
    Reduces inflammation
    Good for 'hot pulps'
    Works for 5-7 days
  39. 39What is non-setting calcium hydroxide and how does it work?Antibacterial paste
    pH 12.5
    Decreases bacteria
    Works for 7 days
    Can make root brittle if left long term
  40. 40What are the aims of instrumentation?Remove infected tissue
    Allow irrigant access to apex
    Make space for medicaments and obturation
    Retain root structure and integrity
  41. 41Describe 4 envelopes of motionFiling - simple motion
    Reaming
    Watch winding -> 30˚-60˚ back and forth - good for passing files
    Balanced Force -> 60˚-120˚CW-ACW - engages and breaks dentine
  42. 42What is always carried out during instrumentation?After each removal:
    Clean files
    Irrigate
    Recapitulate
  43. 43What is the K-file sequence?WYRBGBWhat is the K-file sequence?
  44. 44What 'mishaps' can occur during instrumentation?Perforation - bleeding
    Ledges - due to poor WL
    Zipping - teardrop shape, uneven sides prepped
    Apical transportation - no resistance for GP
    Blockage - recapitulate to prevent
  45. 45Name 4 disadvantages of conventional instrumentation1. 'Mishaps'
    2. Time consuming
    3. Debris extrusion
    4. Less predictable canal shape
  46. 46What is the anatomy of a stainless steel K-file?21-31mm with 16mm cutting flute
    2% taper per mm
  47. 47What are the advantages of nickel titanium instruments?Shape memory ∴ hyperelasticity
    ∴ High Young's modulus - 8-12% taper
    Prevent 'mishaps'
    Better cutting efficiency
    Keep canal shape
    User friendly ∴ quicker and easier
  48. 48What are the disadvantages of nickel titanium instruments?Cost
    Can still separate in extremely curved canals
    Access can be difficult in post teeth
    Not suitable for complex canal anatomy
  49. 49How can instruments separate?Cyclic fatigue - tension vs compression
    Torsional fatigue -
    Flexural stress - Repeated cyclic fatigue - overuse
    Torsional stress - extensive friction - torque exceeds critical level
  50. 50Describe the ProTaper sequenceDescribe the ProTaper sequence
  51. 51What are the aims of obturation?Entomb remaining bacteria
    Seal entry/exit to the root canal system
    Prevent reinfection
  52. 52Should obturation be carried out at the 1st or 2nd visit?Depends
    Vital pulp - ok to obturate
    Necrotic/Symptomatic - delay
    However, no real evidence on post op pain and success
  53. 53What is the apical limit?Found at dentino-cemental junction
    Approx 0.5-2mm from radiographic apex
    Varies w/age, anatomy, health etc
  54. 54What are the properties of an ideal sealer?Good adhesion
    Hermetic seal
    Radiopaque
    Slow set
    No shrinkage
    Bacteriostatic
    Soluble on retreatment
    Biocompatible
    Non- toxic
    Easy to use
  55. 55Give an example of a sealer What properties does it have?AH Plus - epoxy resin
    Slow set ≈ 8hrs
    Initial toxicity decreases by 24hrs
    Good seal
    Good flow
  56. 56What are the properties of an ideal obturation material?Radiopaque
    Hermetic seal
    Seals all canals
    Bacteriostatic
    Do discolouration
    Easily removed if needed
    Good working time
    Biocompatible
    Easy to use
  57. 57What is gutta percha? What are its components?Natural isoprene rubber
    Heated and cooled rapidly to make β phase used in RCT
    20% GP
    65% ZO
    10% radiopacifiers
    5% plasticisers
  58. 58How is cold lateral compaction carried out?Insert master GP
    MGP should be same as master apical file
    Check 'tug back'
    Adjust if needed
    Mark CWL
    Cone fit radiograph if needed
    Dry canal
    Sealer
    Insert MGP
    Set finger spreader 2mm short of CWL
    Compact laterally for 30s
    Insert accessory GP as needed
    Finish @ ECJ or below ging.margin (stops fluid via dentinal tubules and better aesthetics)
    Post-Op radiograph - assess length, density, voids etc
  59. 59What are the advantages and disadvantages of cold lateral compaction?ADV - Good WL control
    DISADV - poor adaptation to irregular canals
  60. 60Name 2 other types of obturation other than cold lateral compactionWarm vertical
    Carrier based
  61. 61How is a failed RCT assessed radiographically?Increase in PA area after Rx
    Development of PA area after Rx
    'mishaps'
    Under/over/poorly compacted obturation
  62. 62How is RCT judged to be a success?No symptoms
    Tooth back to function
    Radiographic evidence
    Retention
    Can monitor for up to 4 years before failure
  63. 63What are the reasons for RCT failure? Before/during/after?BEFORE - misdiagnosis
    Poor Rx plan and Pt selection
    DURING - 'mishaps'
    Missed canals
    Inadequate obturation
    Iatrogenic damage
    AFTER - recurrent caries
    *Coronal leakage* -> most important factor in success
  64. 64How are failed RCTs managed?Fix vs Refer
    Fix - re-RCT -> Protaper D files
    Apicectomy
    Monitor?
    XLA
    Refer to specialist
  65. 65What is needed for endodontic pre-treatment?Radiograph - root and 2-3mm of surrounding tissue
    Pathology, anatomy, calcification, angulation and length
    LA
    Dental dam - pt comfort, safety, bacterial invasion, inhalation risk, retract and protect ST
  66. 66How is access achieved and a cavity prepared for endodontic treatment?Remove ALL caries and defective restorations
    Can prep w/out dam if orientation poor
    Remove ALL pulp chamber roof
    Remove ALL pulpal tissue
    Gain straight line access
    Smooth walls and remove overhangs
  67. 67What are the aims of irrigation?Flush out debris
    Disinfect root canal
    Disrupt/Remove smear layer
    Lubricate instruments
    Dissolve debris
  68. 68How is working length determined?Estimated WL -> 2mm short of radiographic apex
    CWL ->
    RADS -> insert ISO 10-15 to EWL and take RAD
    If <2mm OK to new CWL
    If >2mm adjust and retake
    EAL -> hook to pts lip, attach a file and insert to canal
    0 reading = @ PDL
    take away 1mm to find CWL
    Paper points - insert and measure to blood
  69. 69In conventional endodontic treatment, what is the step back technique?Joins coronal and apical flares
    MAF set as largest file binding at CWL
    Go 1 ISO size up and REDUCE 1mm length
    Repeat until flares continuous
  70. 70—

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Flashcards on Endodontics, created by Michael Brown on 08/11/2015.
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Michael Brown
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