Flashcards
Endodontology 1
Cards in this deck (181)
- 1What is Endodontology?The study of the form, function and health of, injuries to and diseases of the dental pulp and periradicular region, their prevention and treatment; the principal disease being apical periodontitis, caused by infection
- 2What is the aim of endodontic treatment?To preserve functional teeth without prejudice to the health of the patient
- 3What is covered in the scope of endodontics?Differential diagnosis of orofacial pain of pulpal and periradicular origin
Prevention of pulp disease and vital pulp therapies
Pulp extirpation and primary root canal treatment
Secondary root canal treatment (re-treatment)
Surgical endodontics
Bleaching of discoloured teeth
Restoring endodontically-treated teeth
Treatment of traumatised teeth - 4What is the aim of vital endodontic treatment?To preserve or restore health
- 5What does vital pulp therapy encompass?Procedures that are designed to maintain the health of all, or part of the pulp
- 6What are some things that can cause infection of the pulp?- Caries
- Leakage around restorations
- Cracks in enamel
- Periodontal pockets
- Trauma
- Dental procedures - 7How can we damage the pulp?Through physical disruption of the pulp during operative procedures - desiccation, heat, vibration
Through trauma - 8What is the reaction of the pulp to vital pulp therapy dependent on?Extent of tissue injury
Extent of infection
Defence mechanisms aimed at moderating the injury process
Repair responses to encourage wound healing
Materials applied to the pulp tissue - 9What clinical signs might be present with pulp damage?- Dark tooth discolouration
- Carious lesions
- Cracked/ split tooth
- Restorations
- Swelling
- Sinus
- Periodontal condition - 10What tests and investigations may be conducted to confirm/ exclude findings?Mobility
Tenderness to palpation (buccal/lingual sulci)
Tenderness to percussion
Pulp sensibility tests - thermal, electrical, other
Radiographs
Transillumination
Periodontal probing - 11What do common clinical techniques for pulp sensibility testing assess?The nerve supply (mainly A delta fibres)
- 12What does pulp sensibility testing only indicate?Pulp vitality
(Aka. vitality testing) - 13What do we need to make sure we do when carrying out a pulp sensibility test?Compare several teeth
- 14What are the two main methods of carrying out pulp sensibility testing?Electric Pulp Tester (EPT)
Ethyl chloride (cold) - 15What is the difference between sensitivity and specificity in pulp sensibility testing?Sensitivity: ability to detect a non-vital tooth
Specificity: ability to detect a vital tooth - 16Is sensitivity the ability to detect a non-vital or vital tooth?Non-vital tooth
- 17Is specificity the ability to detect a vital or non-vital tooth?Vital tooth
- 18Which tests are more sensitive: cold tests or electrical tests? What does this mean they are more reliable for?Cold tests are more sensitive
This means they are more reliable for telling you if a tooth is non-vital - 19What are electrical tests and cold tests similarly effective for?Specificity - detecting vital teeth
- 20What are pulp sensibility tests best used in combination with?Radiographs
- 21Vital pulp therapies should be considered for what type of inflammation?Reversible
- 22Non-vital pulp therapies should be considered for what type of inflammation?Irreversible inflammation
- 23Which classification is used for pulpal diagnoses?Endodontic Diagnosis - American Association of Endodontists (AAE) 2013
- 24What organisation produced the Endodontic Diagnosis guidance in 2013?American Association of Endodontists (AAE)
- 25Define 'normal pulp' according to the AAE classification.A clinical diagnostic category in which the pulp is symptom-free and normally responsive to pulp testing
- 26Define 'reversible pulpitis' according to the AAE classification.A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal
- 27Define 'symptomatic irreversible pulpitis' according to the AAE classification.A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing - lingering thermal pain, spontaneous pain, referred pain
- 28Define 'asymptomatic irreversible pulpitis' according to the AAE classficiation.A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing - no clinical symptoms but inflammation produced by caries, caries excavation, trauma
- 29Define 'pulp necrosis' according to the AAE classification.A clinical diagnostic category indicating death of the dental pulp - the pulp is usually non-responsive to pulp testing
- 30What treatment would usually be considered for a tooth with pulp exposure, signs and symptoms of reversible pulpitis, and an open apex?Apexogenesis - capping or partial pulpotomy
- 31What is apexogenesis?A procedure where the vital tissue within the tooth is maintained to facilitate continued development of the immature root - a portion of the inflamed pulp is removed and filled with a bioceramic material that mains vitality in the roots
- 32What treatment would usually be considered for a tooth with pulp exposure, signs and symptoms of reversible pulpitis, and a closed apex which has been caused by trauma or mechanical means?MTA pulp capping or pulpotomy
- 33What treatment would usually be considered for a tooth with pulp exposure, signs and symptoms of reversible pulpitis, and a closed apex which has been caused by caries?MTA pulp capping or pulpotomy
or
Stepwise caries excavation
or
Root canal therapy - 34What treatment would usually be considered for a tooth with pulp exposure, signs and symptoms of irreversible pulpitis or necrosis, and a closed apex?Root canal therapy
- 35What treatment would usually be considered for a tooth with pulp exposure, signs and symptoms of irreversible pulpitis or necrosis, and an open apex?Apical barrier with MTA
or
Pulp revitalisation/ revascularisation/ regeneration - 36What procedures does vital pulp therapy incorporate?- Stepwise excavation
- Indirect pulp capping
- Direct pulp capping
- Pulpotomy (partial (superficial) or cervical (coronal))
- Apexogenesis - 37When is there a greater success rate of vital pulp therapy?Only partially inflamed pulps
Elimination of bacteria and their toxins
Complete homeostasis achievable
Bacteria tight seal in both definitive and temporary restorations - 38What is stepwise caries removal?Incremental removal of caries over a period of time to allow pulp healing and minimise exposure
- 39What is a direct pulp cap?When a dental material (usually MTA/ Biodentine/ Calcium Hydroxide) is placed on an iatrogenic/ traumatic vital pulp exposure to facilitate formation of reparative dentine
- 40What is a partial pulpotomy?Routine management of a carious exposure with hydraulic calcium silicate (MTA/ Biodentine) following removal of 1-3 mm of irreversibly inflamed pulp tissue to preserve vitality of the remainder of the pulp
- 41What type of pulp exposure is managed with a partial pulpotomy?Carious exposure
- 42What is removed during a partial pulpotomy?1-3 mm of irreversibly inflamed pulp tissue
- 43What is the aim of a partial pulpotomy?To preserve vitality of the remainder of the pulp
- 44What is the full/ coronal/ cervical pulpotomy?Management of an extensive carious lesion in younger patients with open apices by removing the entire coronal portion of the pulp and replacing it with a hydraulic calcium silicate (MTA/ Biodentine)
- 45Which patients are full/ coronal/ cervical pulpotomies usually considered for?Younger patients with open apices
- 46What is a pulpectomy?Extirpation or complete removal of the pulp prior to root canal treatment
- 47What are the indications for non-vital pulp therapy?Symptomatic irreversible pulpitis
Asymptomatic irreversible pulpitis
Pulp necrosis
Retreatment
(Apical periodontitis) - 48What is the aim of non-vital pulp therapy?To prevent or cure apical periodontitis by control of infection
- 49What are the 3 key objective of controlling infection in apical peridontitis?Prevent the spread of infection
Eliminate the infection
Prevent reinfection - 50How is a percussion test carried out? What is it used for?Handle of a hand instrument, usually a mirror, used to tap on the incisal/occlusal - for teeth that are not suitable for this, use digital pressure or get the patient to bite down on a cotton roll
Used to ascertain an inflammatory condition in the apical periodontium of a tooth - 51What else, other than endodontically involved teeth, may render teeth tender to percussion? Which direction do these teeth mostly react?Periodontal abscess or asymptomatic periodontal disease with severe loss of marginal bone
Horizontal percussion (endodontically involved teeth tend to be more reactive to vertical percussion) - 52How is a palpation test carried out? What is it used for?E/O - 2/3 fingers on one or both hands
I/O - top of index finger
To ascertain tenderness, swelling, fluctuation, hardness, crepitation in underlying tissues - 53How do periodontal pockets and endodontic pockets differ?Number - periodontal disease usually causes multiple pockets, while endodontic disease typically causes a single, narrow pocket
Shape - periodontal pockets are usually wide-based and cone-shaped, while endodontic pockets are usually deep and narrow - 54What amount of mobility would contraindicate root canal treatment due to the tooth being a poor candidate?Movement of more than 2-3 mm
- 55What is a transillumination test?A non-invasive procedure that uses a light to examine the inside of a tooth for problems like caries and cracks
- 56What is non-vital root canal treatment aimed at?Preserving normal periradicular tissues or restoring them to health
- 57What is the aetiology of pulpal and periapical disease?Inflammatory processes and the immunogenic response
- 58What is the key driver of the inflammation of periapical disease?Pulpal infection
- 59What are the 4 main stages of apical peridontitis?1. Infection
2. Host response
3. Lesion formation
4. Bone resorption - 60Describe the 4 main stages of apical periodontitis: 1) Infection 2) Host response 3) Lesion formation 4) Bone resorption1 - Bacteria enter the root canal system, usually after trauma or infection
2 - Body's immune system responds to the infection, causing inflammation and destruction of periapical tissues
3 - Body's response to the infection results in the formation of lesions, such as cysts or granulomas
4 - The inflammation activates osteoclasts, causing the bone surrounding the tooth root to be resorbed - 61What does the inflammation of the periapical tissues activate? What does this lead to?Osteoclasts
Bone surrounding the tooth root is resorbed - 62What is the purpose of establishing accurate diagnosis of pulpal and periapical conditions?To determine what clinical treatment is needed
- 63What two groups of diagnoses are described in the AAE Endodontic Diagnosis document?Pulpal and periapical
- 64List the pulpal diagnoses included in the AAE Endodontic Diagnosis document.- Normal pulp
- Reversible pulpitis
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Pulp necrosis
-Previously initiated therapy/ treated - 65List the apical diagnoses included in the AAE Endodontic Diagnosis document.- Normal apical tissues
- Symptomatic apical periodontitis
- Asymptomatic apical periodontitis
- Chronic apical abscess
- Acute apical abscess
- Condensing osteitis - 66Define 'normal apical tissues'Not sensitive to percussion or palpation
Radiographically, the lamina dura surrounding the root is intact and PDL space is uniform - 67Define 'symptomatic apical periodontitis'Inflammation, usually of the apical periodontium , producing clinical symptoms involving a painful response to biting and/or percussion or palpation
May or may not be accompanied by radiographic changes
Severe pain to percussion and/or palpation is highly indicative of a degenerating pulp and RCT is needed - 68Define 'asymptomatic apical periodontitis'Inflammation and destruction of the apical periodontium that is of pulpal origin
Appears as an apical radiolucency
No clinical symptoms (no pain on percussion or palpation) - 69Define 'chronic apical abscess'An inflammatory reaction to pulpal infection and necrosis
Gradual onset, little to no discomfort, and intermittent discharge of pus through an associated sinus tract
Radiographically, there is typically signs of osseous destruction (radiolucency) - 70How can the source of a draining sinus tract be identified?A gutta-percha cone can be carefully placed through the stoma or opening until it stops and a radiograph is taken
- 71Define 'acute apical abscess'Inflammatory reaction to pulpal infection and necrosis
Characterised by rapid onset, spontaneous pain, extreme tenderness to pressure, pus formation and swelling of associated tissues
May be no radiographic signs of destruction
Patient often experiences malaise, fever, lymphadenopathy - 72Define 'condensing osteitis'A diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usually seen at the apex of a tooth
- 73What are the indications for systemic antibiotics in Endodontics?Acute apical abscess in medically compromised patients
Acute apical abscess with systemic involvement
Progressive infections (rapid onset of severe infection < 24 hours, cellulitis, or spreading infection, osteomyelitis)
Replantation of avulsed permanent teeth
Soft tissue trauma requiring treatment (e.g. sutures, debridement) - 74What signs and symptoms would indicate an acute apical abscess with systemic involvement?Localised fluctuant swelling
Elevated body temperature >38°C
Malaise
Lymphadenopathy
Trismus - 75How would we aim to manage a fluctuant swelling in an acute apical abscess without systemic involvement?Incision and drainage
- 76What must be assessed prior to commencing root canal treatment?Restorability of the tooth
- 77What are some of the potential reasons for non-healing of apical periodontitis following treatment?Intra-radicular infection:
- Poor quality technical procedures (lack of rubber dam, inability to instrument all of root canal, poor disinfection, poor root filling)
- Missed canals
- Complex anatomy
- Coronal leakage
Extra-radicular infection
True cysts
Foreign body reaction (e.g. due to extruded GP) - 78What is the major aetiological reason for persistent apical periodontitis following RCT, irrespective of the specific cause?The root canal treatment has not adequately eliminated root and/or canal infection
- 79When should root canal treatment be reviewed?After 1 year (and for the following 3 years)
- 80According to the European Society of Endodontology, what are the 3 outcome options of root canal treatment?Favourable
Uncertain
Unfavourable - 81What would suggest a favourable outcome following RCT review?Absence of pain, swelling and other symptoms
No sinus tract
No loss of function
Radiological evidence of a normal PDL space around the root - 82What would suggest an uncertain outcome following RCT review? What needs to be done?Lesion is the same size or only diminished in size
Assess the lesion at future visits until resolved or assess for a minimum of 4 years - 83If after 4 years, we still have a radiographic lesion that is the same size or only slightly smaller, what would we classify it as? What needs to be done?Unfavourable outcome
Further treatment is needed - 84What would suggest an unfavourable outcome following RCT review? What does the tooth require?- Signs and symptoms of infection
- Radiological lesion has appeared or original lesion has increased in size
- Lesion has remained the same size or only diminished in size during 4 year assessment period
- Signs of continuing root resorption
Further treatment required - 85What exception must be noted when assessing a radiographic lesion that has remained the same size or only diminished in size during the 4 year assessment period?An extensive radiological lesion may heal but leave a locally visible, irregularly mineralised area. This defect may be scar tissue formation rather than a sign of persisting apical periodontitis. The tooth should continue to be assessed.
- 86What is the estimated success rate of primary root canal treatment?85%
- 87What is the estimated success rate of secondary root canal treatment (re-RCT)?77%
- 88What are the 3 major factors affecting the outcome of secondary RCT?Presence and size of the pre-operative periapical lesion
Apical extent of the final root filling
Quality of the coronal restoration
(Same as primary RCT, which also needs a filling with no voids) - 89What are some of the factors affecting the prognosis of non-surgical root canal treatment?Pre-operative absence of a periapical lesion
If a lesion is present, the smaller the better
Extension of the canal filling as close as possible to the apical terminus, but without extrusion
Presence of a satisfactory coronal restoration
Absence of a pre-operative sinus tract
Achievement of patency of the canal terminus
Use of EDTA and NaOCl as final rinses in secondary RCT cases
Not using CHx and NaOCl together
Absence of performation
Absence of inter-appointment flare-up - 90What is the four-year tooth survival rate following primary or secondary RCT? Note// Survival is different to RCT success95%
- 91Define 'deep caries'Caries reaching the inner third of dentine, but with a zone of hard or firm dentine between the caries and pulp, which is radiographically detectable when located on an interproximal or occlusal surface
There is a risk of pulp exposure during operative treatment - 92What is there a risk of during operative treatment of deep caries?Pulp exposure
- 93Define 'extremely deep caries'Caries penetrating the entire thickness of the dentine, radiographically detectable when located on an interproximal or occlusal surface
Pulp exposure is unavoidable during operative treatment - 94What is unavoidable during operative treatment of extremely deep caries?Pulp exposure
- 95What is soft dentine?Can be excavated with minimum resistance using hand instruments
- 96What is firm dentine?Should be resistant to excavation using hand instruments
- 97What is hard dentine?Should be sound and resistant to probe penetration and scratching
- 98What is selective carious tissue removal to soft dentine?Soft dentine is left only on the pulpal aspect of the cavity, whilst peripheral carious dentine is removed to hard dentine
- 99What is selective carious removal to firm dentine?Firm dentine is left only on the pulpal aspect of the cavity, whilst peripheral carious dentine is removed to hard dentine
- 100What is non-selective carious tissue removal?Complete removal of soft and firm carious dentine from the periphery and central aspects of the cavity until hard dentine is reached
- 101Why is peripheral carious dentine always removed to hard dentine?We cannot get a good bond to wet dentine so removing to hard dentine allows a hermetic seal in the bacteria while keeping the substrate out
- 102What are some potential pulp irritants that can lead to inflammation/ infection of the pulp?Caries
Trauma
Cracks in enamel
Leakage around restorations
Periodontal pockets
Cavity preparation - 103What is the aim of appropriate caries management within vital pulp therapy?To remove the microbial irritation and prevent new bacterial insult by placing a sealing dental biomaterial to protect exposed dentine and pulp from external stimuli
- 104List the aims of caries management and vital pulp therapy.- Management bacterial contamination
- Arrest caries progression
- Stimulate tertiary dentine formation
- Promote pulpal repair
- Restore the cavity
- Create a durable seal
- Produce a symptom free and functional tooth with a healthy pulp - 105What does selective carious-tissue removal in one stage involve?Removal to soft or firm dentine
Application of a biomaterial onto a dentine barrier in an indirect one-stage technique
Immediate placement of a permanent restoration - 106What does stepwise caries removal involve?First stage involves selective carious removal to soft dentine, to an extent that facilitates proper placement of a temporary restoration
Second stage is removal to firm dentine and placement of permanent restoration - 107What does non-selective caries removal involve?Application of a biomaterial onto a thin dentine barrier
Considered more aggressive than selective or stepwise
Leaves only hard dentine behind
No longer regarded as the treatment of choice in deep carious lesions - 108What is the rationale behind carrying out selective carious tissue removal and stepwise excavation of carious lesions?Pulps under deep caries are inflamed because of microorganisms and their by-products
When the inflammation is reversible, it may be controlled by removal of the cause the restoration of the tooth to prevent microleakage
Leaving a thin layer of caries-affected dentine may be necessary to prevent exposure and maintain pulp vitality - 109Is caries-infected dentine the inner or outer zone? Is caries-affected dentine the inner or outer zone?Infected - outer
Affected - inner - 110Describe caries-infected dentine.Necrotic
Bacteria-contaminated
Soft and wet
Denatured collagen
Loss of dentinal tubule structure
Poor bonding substrate - 111Describe caries-affected dentine.Less bacteria
Scratchy/ sticky with probe
Partial demineralisation and collagen damage
Can provide seal with restorative material - 112How does the texture of caries-infected dentine compare to that of caries-affected dentine?Infected - soft and wet
Affected - scratchy/ sticky with probe - 113How does the dentinal structure of caries-infected dentine compare to that of caries-affected dentine?Infected - denatured collagen, loss of dentinal tubule structure
Affected - partial demineralisation and collagen damage - 114What is the difference between bonding to caries-infected dentine and caries-affected dentine?Infected - poor bonding substrate
Affected - can provide a seal with restorative material - 115What does sealing infected demineralised dentine into a cavity with a restoration do?Provides a good peripheral seal
Deprives microorganisms of substrate
Leading to reduction in number of bacteria
Caries process arrests - 116Why is a temporary restoration (e.g. Poly F, GIC) left in place for 6-12 months in the stepwise excavation technique?To encourage tertiary dentine formation
- 117What is direct pulp capping?A method designed to preserve pulp vitality through hard tissue repair of an open exposure
Involves the application of a biomaterial directly onto the exposed pulp, prior to immediate placement of a permanent restoration - 118What is the aim of direct pulp capping?To preserve pulp vitality through hard tissue repair of an open exposure
- 119What are pulps under deep carious inflamed by?Microorganisms and their by-products
- 120How can inflammation that is reversible be controlled?By removal of microorganisms and the restoration of the tooth to prevent further contamination
- 121What properties must a pulp capping agent have?Biocompatible
Bactericidal
Ideally provide a seal (barrier) against further microbial ingress - 122What is the difference between an agent that is bacteriostatic and one that is bactericidal?Bacteriostatic: prevents the growth of bacteria (keeps them in the stationary phase of growth)
Bactericidal: kills bacteria - 123Name the types of pulp exposure.Class I
Class II - 124What is a class I pulp exposure?No pre-operative presence of a deep carious lesion
Pulp exposure judged clinically to be through sound dentine with an expectation that the underlying tooth tissue is health
E.g. exposure due to traumatic injury or iatrogenic exposure during non-selective caries removal - 125What is not present pre-operatively with class I pulp exposures?Deep carious lesion
- 126What is expected of the underlying pulp tissue in a class I exposure?That it is healthy
- 127What is a class II pulp exposure?Pre-operative presence of a deep or extremely deep carious lesion
Pulp exposure judged clinically to be through a zone of bacterial contamination with an expectation that the underlying pulp tissue is inflamed
Enhanced operative protocol recommended (aseptic procedure using magnification, disinfection, and application of a hydraulic calcium silicate cement) - 128What is present pre-operatively with class II pulp exposures?Deep or extremely deep carious lesion
- 129What protocol is recommended for class II exposures?Enhanced operative protocol:
- Aseptic procedure using magnification
- Disinfectant
- Application of hydraulic calcium silicate cement - 130Which teeth is direct pulp capping suitable for?Restorable teeth with reversible (non-infected) pulpitis
Lesion of the pulp exposure should be small and in caries-free dentine (class I exposure) - 131What should be in place for management of any pulp exposure?Rubber dam
- 132What should be used to clean the pulp wound and tooth tissue for a class I exposure?Sterile saline
- 133Outline the steps for the management of a class I pulp exposure.1. Rubber dam isolation
2. Clean pulp wound and tooth tissue with sterile saline
3. Disinfect site with cotton wool moistened in sodium hypochlorite to establish haemostasis, destroy microorganisms and remove dentine debris
4. Place hydraulic calcium silicate on exposed pulp (Biodentine)
5. Restore tooth with a high quality restoration
6. Long term follow-up to monitor pulp condition and root development - 134After cleaning the pulp wound and tooth tissue with sterile saline, what should be done in the management of a class I pulp exposure?Disinfect the site with cotton wool moistened in sodium hypochlorite to establish haemostasis, destroy microorganisms and remove dentine debris
- 135What is the purpose of using sodium hypochlorite in the management of a class I pulp exposure?Establish haemostasis
Destroy microorganisms
Remove dentine debris - 136What should be placed onto the exposed pulp following cleaning with sterile saline and disinfection with sodium hypochlorite in the management of a class I exposure?Hydraulic calcium silicate cement - Biodentine (or MTA)
- 137If placing Biodentine over a class I exposure, what would the next step be? If placing MTA over a class I exposure, what would the next step be?Biodentine - restore the tooth with a high quality permanent restoration
MTA - damp cotton wool then restore with GIC/Poly F (second visit will be needed for permanent restoration) - 138Why is long term follow-up needed following management of a class I exposure?To monitor the pulp condition and root development
- 139What alternative material, that is becoming more historic, can be used for management of a class I exposure? Why is it effective?Calcium hydroxide (e.g. Dycal)
Has a high pH (alkaline) and antimicrobial - 140How does calcium hydroxide work when using it in direct pulp capping?It has an alkaline pH and is antimicrobial
It has a caustic effect on the superficial pulp tissue (up to 0.7 mm)
A layer of liquefaction necrosis forms under the wound dressing and coagulated necrotic tissue forms beneath
The necrotic tissue becomes diffusely calcified and hard tissue formation occurs beneath, which develops into dentine (bridge) - 141Why is calcium hydroxide a less effect material than the hydraulic calcium silicate cements for direct pulp capping?The dentine bridges that are formed often have tunnel defects - therefore incomplete
The calcium hydroxide itself is soluble and does not seal well or prevent microleakage - 142According to the 'ESE Position Statement: Management of deep caries and the exposed pulp' (2019), when is the only time direct pulp capping should be caried out for carious exposures (class II)?After non-selective carious tissue removal
- 143What are some of the concerns about direct pulp capping?Inability to correctly diagnose pulp condition in every case
Operative procedures during treatment may create irreversible pulpitis
Presence of dentine particles may induce increased inflammation, particularly when forced into the pulp tissue - 144What concern with direct pulp capping is shown in this image?Dentine chips that have become lodged in the pulp tissue - they likely harbour bacteria so may induce increased inflammation
- 145Why might the size of exposure be a problem when managing a carious exposure using direct pulp capping?Large exposures are likely to be infected with bacteria and the pulp damaged by the operative procedure
- 146What might carious exposures on the axial wall cause?Necrosis coronally
- 147Why might carious exposures on the axial wall cause necrosis coronally?Potential interruption in the blood supply to the coronal portion leading to necrosis of the pulp above and inflammation of the pulp below
- 148Do inflamed or non-inflamed pulps have a poorer outcome following direct pulp capping?Inflamed pulps
- 149Inflamed pulps have a poorer outcome with direct pulp capping than non-inflamed pulps, making it a controversial technique to use following carious exposure. What alternative procedure may be preferred?Partial pulpotomy
- 150What is the estimated success rate of direct pulp capping?80-90%
- 151Which demographic are considered to be better candidates for direct pulp capping? Why is this?Young patients
- Enhanced blood supply
- Open root apices
- Pulps free of age-related change - 152How and when should direct pulp capping be reviewed?6 months - history, examination, sensibility tests
1 year - IOPA (for 4 years) - 153What guidance is given regarding management of class II exposures by the ESE (position statement: management of deep caries and the exposed pulp)?If further caries excavation is necessary (i.e. it is not the caries-free environment needed for a direct pulp cap) after exposure, a partial pulpotomy may be preferable due to the risk of transporting infected dentine chips into the pulp
Direct pulp caps using hydraulic calcium silicate cements should only be carried out in caries-free exposures (class I) - 154Why do the ESE recommend carrying out a partial pulpotomy if further caries excavation is necessary after exposure?Due to the risk of transporting infected dentine chips into the pulp
- 155In what situation should direct pulp caps using hydraulic calcium silicate cements only be carried out?Caries-free exposures (class I)
- 156What is a partial pulpotomy?A procedure in which part of an exposed vital pulp is removed, usually as a means of preserving the vitality and function of the remaining part
- 157How is a partial pulpotomy carried out?Surgical removal of the exposed (infected) pulp and dentine surrounding an exposure to a depth of approximately 2 mm, followed by placement of a wound dressing on the non-infected tissue
- 158What type of tooth is suitable for a partial pulpotomy?A restorable tooth with reversible or partial pulpitis diagnosed from history, examination, pulp testing and radiographs but with healthy, non-infected pulp tissue below the diseased, infected tissue
- 159When carrying out a partial pulpotomy, how will we know when healthy pulp is reached?It will stop bleeding when we do our haemorrhage control measures using the cotton wool moistened with sodium hypochlorite
- 160Outline the treatment strategy of a partial pulpotomy.1. Rubber dam (should already be in place)
2. Carefully remove diseased tissue to minimise further trauma to pulp
3. Amputate pulp with diamond bur with water cooling
4. Clean pulp wound and tooth tissue with sterile saline
5. Disinfect side with NaOCl to establish haemostasis, remove dentine debris, and kill microorganisms
6. Place hydraulic calcium silicate cement on exposed pulp tissue and restore - 161What is a cervical/ full coronal pulpotomy?Complete removal of the coronal pulp and application of a biomaterial directly onto the pulp tissue at the level of the root canal orifice(s), prior to placement of a permanent restoration
- 162Which teeth are full coronal pulpotomies usually carried out on?Primary teeth
Immature permanent teeth - 163At what level is the biomaterial placed in a full coronal pulpotomy?At the level of the root canal orifice(s)
- 164What is the aim of a full coronal pulpotomy?To allow continued physiological development and formation of the root end, in particular the continued development of the tooth apex (apexogenesis)
- 165What is the rationale behind full coronal pulpotomies in immature permanent teeth?Removal of diseased (infected) coronal pulp tissue and the placement of a wound dressing on the non-infected pulp stump, followed by the restoration of the tooth to prevent microleakages stabilises the condition and prevents further microbial contamination - this allows root development to continue
- 166What is the only situation in which a full coronal pulpotomy is considered for a mature permanent tooth?As an emergency (e.g. trauma)
(Or as an intermediate on the way to RCT) - 167What are the main concerns with full coronal pulpotomies?Microleakage of microorganisms may be more important than the choice of wound dressing agent (coronal seal)
Superimposed mechanical trauma during the operative procedure can have a negative impact on the outcome
Presence of dentine particles may induce increased inflammation - 168Why does development of a blood clot during a pulpotomy have a negative impact on the outcome?It can induce dystrophic calcification and internal resorption
It also forms a culture medium for bacteria - 169What is dystrophic calcification?Deposition of calcium (as calcium phosphate crystals) in body tissues in areas that have been injured or damaged
- 170What can development of a blood clot during a pulpotomy cause?Dystrophic calcification
Internal resorption - 171When should reviews for vital pulp therapies (capping and pulpotomy) be performed?At 6 and 12 months
Then follow up yearly for up to 4 years with radiographs - 172When should the first radiograph following vital pulp therapy be taken? When should subsequent radiographs be taken?1 year
Then yearly for up to 4 years - 173What is success of vital pulp therapy defined as?Absence of symptoms and maintenance of pulp vitality after at least one year
- 174What are some of the features of favourable clinical outcome after vital pulp therapy?No symptoms of pulpitis or apical periodontitis
Positive response to pulp testing (beware older patients, pulpotomies, heavily restored)
No tenderness on palpation or percussion
Immature teeth (young patients) should show continued root development
Healthy peri-apical tissues on radiograph
May see dentine bridge formation - 175Name the main materials used for pulp capping, pulpotomy and apexification.Calcium hydroxide (becoming historical)
Hydraulic calcium silicate cements - MTA and Biodentine - 176Why is Biodentine considered to be a better material to use than MTA?Similar biological properties to MTA but:
- Faster setting time
- More operator-friendly
- Tooth coloured
- MTA requires 2 stages (Biodentine can just be cut back and the tooth restored using the sandwich technique) - 177What are the properties of mineral trioxide aggregate (MTA)?Biocompatible
Prevents microleakage
Promotes regeneration of tissues - 178What are some of the clinical applications of MTA?
- 179What is the pH of MTA?12.5
- 180What is the working time of MTA? What is the setting time of MTA? How does the radiopacity of MTA compare to that of amalgam?Working time - 5 mins
Setting time - 4 hours
Radiopacity < amalgam - 181Continued from L1. intro to year 3 endo programme
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- Undergraduate Restorative Dentistry (Endodontics) Flashcards on Endodontology 1, created by Riya X on 16/12/2024.
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