Dental Decks - Endo

Which of following teeth is most likely to have 2 canals? 4, 12, 20, 28?

#12 - max 1 premolars almost always ahve two canals

Pt complains of slight tooth ache that has been "on and off" for a week. tooth is question #18. which of the following teeth would be optimum to use as a baseline.

#19 virgin, #31 occlusal sealant - adjacent and contralateral teeth without restorations (sealants are fine)

tertiary dentin

(reactive, sclerotic, or reparative dentin) an irregular and disorganized layer laid down in response to injury/irritany

about what percentage of mandibular 1 pm may have 2 canals with two apical forament?

20%

What percentage of maxillary first premolars have 2 or more canals? What is average length of these canal spaces?

91%, 20-22 mm

cementoma

AKA periapical cemental dysplasia - frequently at anterior region of mandible, starts as radiolucent lesion and then calcified - DOES NOT affect pulp vitality

7 year old arrives at office with complaint that #8 is draining pus into his mouth. Tooth had been traumatized earlier. The vitaliy tests reveal no response. What treatment should be done?

Apexification, pulpectomy; goal of apexification to induce further root development in a pulpless tooth by stimulating the formation of hard substance at the apex to allow obturation of the root canal space

2 T or F An acute apical abscess will not respond to pulp vitality tests. An acute apical abscess is only observed in associate with necrotic pulp.

Both statements are true.

(2 T or F) The chronic apical abscess is an inflammatory rxn to pulpal infection and necrosis characterized by gradual onset, little/no discomfort, and intermittent discharge of pus through associated sinus tract. The acute apical abscess is an inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues

Both true

2 T or F Condensing osteitis is diffuse radiopaque lesion representing a localized bony rxn to a low-grade inflammatory stimulus, usually seen at the apex of a tooth. Osteomyelitis is a moderate to high level inflammation of bone marrow and adjacent bone that may remain localized or spread to involve the cortex, cancellous tissue, and periosteum

Both true

Which xray film is preferred: D, E, or F

F because i is fast (sensitive) - cuts down on required radiation for a quality image

2 T or F Most bacteria in endo infection are strict aerobes The diversity of polymicrobial eno infections has been well established isolating anywhere from 3 to 12 species of microbes in the majority of endo infections

F, T.

2 T or F A mandibular canine usually requires a triangular access prep. The access should be directed slightly toward lingual surface due to slight labial axial inclination

F, T. access opening is large oval

The absence of which layer of dentin predisposes it to internal resorption by cells present in the pulp?

Predentin - immediately adjacent to odontoblast layer, unmineralized layer that if lost predisposes dentin to internal resoption by odontoclasts

How do you proceed with endo-perio lesion

Usually do endo first, and then when needed perio measures followed. Perio therapy should be initiated first if it is a primary periodontal lesion with a subsequent endo involvement

nerve endings of which cranial nerves are widely distributed within subnucleus caudalis of trigeminal (V) nerve, and profuse tangling of these nerve fibers creates potential for referred pain

VII, IX, X

Which situations offer better success for pulp capping

accidental exposure of pulp, and pulp of a young child

most acceptable way to achieve adequate root canal debridement is

achieve glassy smooth walls of the canal

In what scenario could a dentist chose not to perform RCT even when it is advised?

an asymptomatic tooth with a calcified chamber

lateral periodontal cyst

arising form cystic degeneration of clear cells of dental lamina - VITAL TOOTH

ameloblastoma

benign, locally aggressive tumor arising from odontogenic ectoderm; multilocular radiolucencies, extensive root resorption, mandible 4X more than maxilla

EDTA (ethylene diamine tetra-acetic acid) characteristics

chelating agent w/ capability to remove mineralized portion of smeat layer, can decalcify up to 50 mm thin layer of root canal wall, normally used in concetration of 17%, RC-Prep and EDTAC are other preparations of EDTA

reversible pulpitis

clinical diagnosis based upon subjective/objective findings indicating that inflammation should resolve and pulp return to normal

The _______________ in the apical portion of the pulp helps for the pulp into a semisolid mass, facilitating a ________________

collagen, pulpectomy; mainly type I and III collagen and type V in small amounts

A periodontal probing defect that may not be managed by endodontic treatment alone is a

conical shaped probing - primarily a perio problem

File dimensions

cutting surface always 16 mm (D1 at tip, D2 at 16 mm); a size 10 file with 0.02 taper is 0.1 mm at D1 and 0.1 plus .32 (0.42) mm at D2

pulp necrosis

death of dental pulp, usually nonresponsive to pulp testing

apical scar

dense collagenous tissue near appex w/ radiolucent presentation; form of repaive usually associated with RCT tooth, and having perforation of both facial and lingual osseous cortices; NONVITAL tooth

Primary function of pulp

dentin formation

condensing osteitis

diffuse radiopaque lesion representing localized bony reaction to low grade inflammatory stimulus, usually seen at apex of tooth

Ellis Class II fracture

enamel and dentin fracture, no pulpal involvement

Ellis Class III fracture

enamel and dnetin fracture WITH pulpal involvement -tx depends on stage of tooth (immature vs mature), and time after traumatic injury (after 24 hours chances of direct bacterial contamination increase)

Ellis class I fracture

enamel only, no pulpal involvement

1 yr after performing endo on #3 notice lesion still present on PA. What is the most likely problem?

failed to locate second MB canal

Mantle dentin

first formed dentin laid before odontoblast layer gets organized, so pattern of deposition and size of collagen fibers are different from circumpulpal dentin

secondary dentin

forms after eruption of a tooth and throughout life, resulting in gradual but asymmetric reduction in pulp size

Wat is the only type of nerve ending found in pulp

free nerve ending, specific receptor for pain - regardless of source of stimulation (cold, head, pressure) the ONLY response will be pain

granuloma

growth of granulomatous tissue continuous with the PDL resulting from death w/ diffusion of toxic products into the PA area - often symtomless, radiographically see well defined area of rarefaction (radiolucency) w/ some irregularities

how can you differentiate b/w a granuloma or cyst

histological exam

infraction

incomplete fracture of enamel without the loss of tooth structure

asymptomatic apical periodontitis

inflammation and destruction of apical periodontium of pulpal origin, appears as PA radiolucency, WITHOUT clinical symptoms

symptomatic apical periodontitis

inflammation, usually of apical periodontium, producing symptoms including painful response to biting/percussion/palpation - may/may not be associated w/ PA radiolucency

The external resorption in which an infected pulp may further complicate the resorptive process is termed at

inflammatory resorption

cyst

inflammatory response of periapex, that develops from preexisting granulomatous tissue; characterized by central, fluid filled, epithelium lined cavity surrounded by granulomatous tissue and peripheral fibrous encapsulation; well defined radiolucency w/ continuous radiopaque sclerotic border of bone, ASYMPTOMATIC

chronic apical abscess

inflammatory rxn to pulpal infection and necrosis characterized by gradual onset, little to no discomfort, intermittent discharge of pus through associated sinus tract

acute apical abscess

inflammatory rxn to pulpal infection and necrosis w/ rapid onset, spontaneous pain, tendernes to pressure, pus formation, swelling of associated tissues

symptomatic irreversible pulpitis

inflammed pulp incapable of healing; additional descriptors: lingering pain, thermal pain, spontaneous pain, referred pain

when would you consider using solvent-softened custom cones

lack of apical stop, abnormally large apical portion of canal, irregular apical portion of canal, after apexification

K-type reamers

less flutes than a file, can only ream, remove intracanal debris w/ clockwise motion, also used to place materials into apical portion of canal by using a clockwise rotation

the major advantage of zinc oxide-eugenol based sealer types is:

long history of successful usage

_______________________ require endo treatment more often than any other tooth, while ____________________ have the highest endo failure rates

mandibular first molars, maxillary first molars;

pain in the mental region mandibule can be caused from pulp of the

mandibular incisors, canines, premolars

Which mandibular anterior tooth is the most prone to endo failure due to a missed second lingual canal? How should this be avoided?

mandibular lateral incisor (44% have 2 canals); change VERTICAL angulation of the PA radiograph

pain in the ear/angle of jaw/posterior neck region can be caused from pulp of the

mandibular molars

Which of the maxillary molars is most likely to have a second canal in the mesial buccal root? Where is this typically found?

max 1st molar distal-palatal to MB1

pain in the temporal region can be caused from pulp of the

max 2 premolars

pain in the opposing quadrant or other teeth in same quadrant can be caused from pulp of the

max and mand molars

Which max anterior tooth is most likely to have the longest root length to instrument during endo? What is the ideal shape of this access prep?

max canine; oval

pain in the nasolabial region can be caused from pulp of the

max canines/premolars

pain in the zygomatic/parietal/occipital region can be caused from pulp of the

max molars

pain in the forehead region can be caused from pulp of the

maxillary incisors

Circumpulpal dentin

most of the dentin that is formed

clinical diagnostic category in which pulp is symptom free and normally responsive to pulp testing

normal pulp

traumatic bone cyst

not a true cyst (no epithelial lining), mostly found in young people, asymptomatic, radioluency that scallops roots, VITAL teeth

radicular cyst

occurs in a preexisting granuloma, seldom is painful, radiolucency at apex of NONVITAL tooth

cementoblastoma

odontogenic tumor, proliferation of cementoblasts that form a large mass of cementum or cementum-like tissue on tooth root

The main concept of the cone shift technique is that as the verical or horizontal angulations of the x-ray tube head changes, the object buccal or closest to the tube head moves to the __________ side of the xray when compared to the lingual object

opposite

wholes doing vital pulpotomy on young immature permanent tooth, hemorrhage after pulp amputation could not be controlled w/ cotton pellets, even after several mins. What is next step?

perform amputation at a more apical level - can find uninflamed pulp more apically; if this fails, then hemostatic agents used as a compromise

what is pain to alteral percussion associated with?

perio problem

Which cells are involved at the onset of chronic pulpal inflammation?

plasma cells, macrophages, and lymphocytes - chronic has no direct exposure of caries w/ pulp, once turns to acute, PMN cells are chemotactically attracted to area

Most characteristic radiographic evidece of a vertical root fracture

radiolucent halo surrounding the root of the fracture (PDLs)

mineral trioxideaggregate (MTA) has what advantages?

radiopaque, hydrophillic, biocompatable, not toxic, induction of hard tissue formation (high pH) - cons are difficult to manipulate and has long setting time

while cleaning and shaping the canal, an instrument separates in the canal. As you attempt to retrieve it, the btoken instrument passes partially through the apex, thus partly protruding into the PA lesion. How do you manage?

raise a flap, remove the instrument surgically followed by filling w/ gutta--percha

a pheonix abscess is also known as a:

recrudescent abscess - develops when granulomatous zone becomes contaminated or infected by elements from the root canal, pain to percussion, PA radiolucency - always preceded by asymptomatic apical periodontitis AKA acute exacerbation of asymptomatic apical periodontitis

root submersion

resection of tooth roots 3 mm below alveolar crest - coronal portion of tooth removed and roots are covered w/ mucoperiosteal flap - prevents further alveolar resorption

What fibers are found in pulp

reticulin fibers, collagen fibers, both unmyelinated and myelinated nerve fibers; NOT proprioception nerve fibers

techniques to remove gutta-percha include

rotary removal, ultrasonic removal, heat removal, heat and instrument removal, file and chemical removal

the earliest and most common symptom associated with an inflammed pulp is

sensitivity to hot/cold stimuli (thermal sensitivity)

K-type files

strongest of all files, and cut the least aggressively, can ream or file

Tooth #9 requires root end surgery. Which flap design is generally NOT indicated (for anteriors)?

submarginal curved flap (semilunar) - limited access among other issues

previously initiated therapy

tooth previously treated by partial endo (pulpotomy/pulpectomy)

transplantation

transfer of a tooth from one alveolar socket to another - either in same person or a different person

suggested irrigants during root canal therapy

urea peroxide (Gly-Oxide), hydrogen peroxide, sodium hypochloride

Which type of fracture does not show up well on xray. Why?

vertical root fracture, parallel to the xray film; can have J shaped radiolucency from apex to midline of root

Hedstrom files (H-type)

very sharp edge, effective cutting instrument - if used carefully with FILLING action only, will plane the dentin walls much faster than K-type files/reamers; modification of this file is the S file

asymptomatic irreversible pulpitis

vital inflammed pulp is incapable of healing; additional descriptors: no clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

Indications for interntional replantation

when routine endo therapy impractical, when canal obstructed, when perforating or external resorption present, when previous treatment has failed

Which of following teeth is most likely to have a curved root? Max CI, Max LI, Max K9, Mand CI

MAX LI

Which mandibular molar is most likely to have 4 root canals? Where is the 4th canal typically located?

Mandibular first distal root

Which mandibular premolar typically displays greater variation in root canal morphology and number of canals?

Mandibular first pm - 27% have 2 canals

2 T or F Hydrogen peroxide is a key ingredient to internal and external bleaching. The walking bleach technique requires the sodium perborate to be changed every day.

T, F. Hydrogen peroxide used in 30-50% concentrations,; Walking bleach uses sodium perborate an water, placed in chamber and changed every 4-7 days

2 T or F Retreating a tooth with a post is the most common reason for an apicoectomy and retrograde filling. Whenever a reverse filling procedure is to be used, apicoectomy is mandatory to provide a table into which the prep and filling will be placed.

T, T

2 T or F The action of using a file often dictates the shape of the canal. A reaming action produces a canal that is relatively round in shape

T, T

2 T or F Internal resorption of a tooth is generally believed to be caused by inflammation due to an infected coronal pulp. This condition if frequently precipitated by traumatic injury to the tooth.

T, T.