Endodontics MDA ch. 54
Problems that result from inaccurate measurement of length of the completed canal preparation and root canal filling:
- Perforation of the apex - Overinstrumentation or underinstrumentation of canal length, - Overfilling or underfunding of the canal, - Postoperative pain.
Wharves the purpose of debridement and shaping of the pulpal canal?
- To remove bacteria, necrotic tissue and organic debris from the root canal; - To smooth and shape the canal.
Indications for surgical endodontic intervention:
- endodontic failure - exploratory surgery - biopsy
Requirements of radiographic images:
- show 4-5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition. - present an accurate image of the tooth without elongation or foreshortening. - exhibit good contrast so that all pertinent structures are readily identifiable.
Spreaders and pluggers
-condense and adapt the gutta-percha points into the canal
How many radiographic images may be taken through the course of root canal therapy?
5 Initial, Working length, final instrumentation, root canal completion, recall
What is the success rate of the root canal therapy?
90-95%
Periradicular cyst
A cyst that develops at or near the root of a necrotic tooth
I what is applied to the the tooth during a heat test?
A heated piece of gutta-percha is placed on the facial surface of the tooth or the end of an instrument is heated and placed on the tooth.
What does the dentist use to create an opening in the coronal portion of the tooth during access preparation?
A high-speed handpiece and a round bur.
What is used to measure the distance from the reference point to the apex of the tooth?
A millimeter endodontic ruler on a periapical radiograph.
How much more time a dentist has to continue training to be specialized in endodontics?
A minimum of 3 more years
Pulpar therapy
An attempt to stimulate pulpar regeneration and save the pulp.
Periodontal abscess
An inflammatory reaction to bacteria trapped in the periodontal sulcus
Periradicular abscess
An inflammatory reaction to pulpal infection
What surgical procedure involves removal of the apex of a root?
Apicoectomy
Direct pulp cap
Application of dental material with an exposed or nearly exposed dental pulp
Hand files
Are used for cleaning and shaping the pulpar canal
Why is the working length assessed and referred to as estimated working length?
Because exact apex location vary, and these variations are not always visible in radiographs.
What instrument should be discarded after a single use because of their fragile makeup?
Broaches
How subtle estima-te working length determined?
By selecting a reference point on the tooth, usually the highest point on the incisão or occlusal surfaces.
What dental material is commonly selected for pulp capping?
Calcium hydroxide
Types of root canal sealers
Calcium hydroxide sealers, resin composite sealers and glass ionomer cement.
When pulpar therapy is not effective, what measures are taken?
Can include root canal therapy or surgery.
Physical Irritation
Can range from mild tooth sensitivity to complete nerve death of the tooth or even infection of the surrounding tissues
Root canal sealers
Cement-type material that seals out the unfilled voids during obturation process.
Sodium Hydroxide
Commonly known as household bleach.
Pulpectomy
Complete removal of vital pulp from a tooth
What portion of the pulp is removed in a pulpotomy?
Coronal portion of an exposed vital pulp
endodontist
Dentist specializing in operating within the tooth (root canal specialist)
chronic
Disease symptoms that continue for a long time
Endodontic Explorer
Double-ended instrument, long and straight. Helps in locating canal openings.
percussion
Examination technique that involves tapping on the incisal or occlusal surface of a tooth to assess vitality
What do the endodontist look for when conducting an objective examination?
Extent of decay, Periodontal conditions surrounding the tooth in question , Presence of an extensive restoration, Tooth mobility, Swelling or discoloration, Pulp exposure
Advantage of Ni-Ti files
Extreme flexibility, good strength and a longer working life
How does the cold test work?
First, the control tooth and the suspect tooth are isolated and dried. Next, the source of cold is applied first to the cervical of the control tooth, then to the cervical area of the suspected tooth.
Reversible pulpitis
Form of pulpal inflammation in which the pulp may be salvageable
What material is used for the obturation of a canal?
Gutta-percha
Endodontic Spoon Excavator
Has a very long shank that allows it to reach deep into the canal to remove coronal pulp tissue, decay, and temporary cements.
Pluggers
Have a flat tip like that of a condenser
Gates-glitter burs (drills)
Have a football shaped working end with a very long shank. Cutting edge is on the side to enlarge the walls of the pulp chamber.
Spreaders
Have a pointed tip , similar to that of an explorer.
Control tooth
Healthy tooth used as a standard to compare questionable teeth of similar size and structure during pulp vitality testing.
Function of the working end of an endodontic explorer
Helps in locating canal openings.
Irreversible pulpitis
Infectious condition in which the pulp is incapable of healing, which would then require root canal therapy.
Anesthetic techniques avalible for endodontic treatment?
Infiltration for maxillary teeth, and nerve block for mandibular teeth.
Pulpitis
Inflammation of the dental pulp
What May be used in addition to local anesthesia for pts who are extremely apprehensive?
Inhalation sedation
Medications and dental materials used in endodontics:
Irrigation solutions, root canal filling materials, and root canal sealers.
What surface of an anterior tooth will the dentist enter when performing root canal therapy?
Lingual surface
abscess
Localized area of pus originating from an infection
What are the 3 objectives that operating microscope accomplishes?
Magnification Illumination Addition of accessories
perforation
Making a hole, as in breaking through and extending beyond the apex of the root
When can a thermal stimulus be used on a metallic restoration or on gengival tissue?
Never
Will a necrotic pulp respond to heat?
No
Will a necrotic pulp respond to the cold?
No
Nonvital
Not living, as in oral tissue and tooth structure.
When is a diagnosis of the pulp presented to the pt?
Once the subjective and objective tests have been completed.
Symptoms of pulpar nerve damage
Pain when occluding, Pain during mastication, Sensitivity to hot or cold beverages, Noticeable facial swelling, Fever, Tenderness of the surrounding gums, Cracked or discolored teeth.
What are gutta-percha points made from?
Palaquium gutta tree
Used as an antimicrobial agent for disinfection of the pulp canal:
Parachlorophenol
When the dentist taps on a tooth , what diagnostic test is being performed?
Percussion
Tests used to determine whether the inflammatory process has extended into the periapical tissue.
Percussion and palpation
acute
Pertaining to a traumatic, pathologic, or physiologic occurance or pricess that has a short and relatively sever course.
What should be applied to the tooth surface before heat testing to prevent the material from sticking to the tooth surface?
Petroleum jelly
What are the three mais source of pulpar nerve damage ?
Physical irritation and trauma
Indirect pulp cap
Placement of a medicament over a partially exposed pulp
Gutta percha
Plastic type of filling material used in endodontics
Obturation
Process of filling a root canal
Headstrong file
Provides greater cutting efficiency. Can be used for final enlargement of the canal after burs are used.
What diagnosis is giving when pulpar tissues are inflamed?
Pulpitis
Good quality of this is necessary for diagnostic testing, as well for root canal therapy?
Radiographic imaging
Periradicular
Referring to the area of nerves, blood vessels, and tissues that surrounds the root of a tooth
Root amputation
Removal of one or more roots without removal of the crown of the tooth
Pulpotomy
Removal of the coronal portion of a vital pulp from a tooth
root canal therapy
Removal of the dental pulp and filling of the canal with material
Latch-type files placed in a high-torque, low rpm handpiece designed for Ni-Ti rotary instruments:
Rotary-operated files and burs
Retrograde restoration
Small restoration placed at the apex of a root.
rubber stops
Small, color-coded, round piece of rubber, silicone or plastic that slide onto hand-operated files to prevent perforation of the apex of the tooth. File measured on a xray and the stop is placed precisley at the predetermined working length of the canal.
Types of irrigation solutions:
Sodium hypochlorite, hydrogen peroxide and parachlorophenol.
Instruments used in the obturation of the canal
Spreaders and pluggers
Paper points
Sterile absorbent pieces of paper rolled into long, narrow points. Inserted into canal to absorb the irrigating solution and dry the canal
Would pain be a subjective or an objective component of a diagnosis?
Subjective
What types of examination are needed for an endodôntico diagnosis?
Subjective examination and objective examination
Apical curettage
Surgical removal of infectious material surrounding the apex of a root
Apicoectomy
Surgical removal of the apical portion of the tooth through a surgical opening made in the overlying bone and gingival tissues.
Hemisection
Surgical separation of a multirooted tooth through the furcation area
Electronic Apex Locator
Technique used to facilitate identification in the apex of the root canal.
Cold test
The dentist uses ice, dry ice, or carbon dioxide to evaluate the response of a tooth to cold.
Which is the least useful of the vitality tests and why?
The heat test. Because a painful response to heat could indicate rather reversible pulpitis or irreversible pulpitis.
Which instrument can be heated for placement or removal of gutta-percha?
The plugger end.
What type of endodontic files can be used in a handpiece ?
The rotary-operated files
What indicates normal pulp?
The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp.
Root canal completion image
This final periapical radiograph is taken of the completed canal filled after the tooth has been temporized and the dental dam removed.
Initial radiograph
This periapical radiograph is taken during the diagnostic stages before treatment
Final instrumentation image
This periapical radiograph is taken with the final size files in all canals receiving treatment.
Recall image
This radiographic image is taken at posttreatment evaluations
What instruments and accessories are designed for?
To be flexible and fit into the pupal canal.
Working length image
To determine the length of the canal
What are irrigation solutions?
To facilitate the removal of materials from the canal and provide tissue dissolution.
Why is a rubber stop used on a file?
To prevent perforation on the apex of the tooth during instrumentation.
Debridement
To remove or clean out the pulp canal
When is surgical endodontic technique used?
To save a tooth from extraction
Tooth # 21 is the questionable tooth for positive tooth endodôntico treatment. What tooth would be used as a control tooth?
Tooth # 28
necrosis
Tooth that does not respond to a sensory stimulus.
Palpation
Touching or feeling for abnormalities within soft tissue
K-type file
Twisted design and is used in the initial debridement (cleaning) of the canal and during later stages of shaping and contouring the canal.
Pesso files (pesso reamers)
Used primarily when the tooth requires a post preparation for placement of the final restoration
When is an irreversible pulpitis suspected during a cold test?
When the cold relieves the pain.
What can result if bacteria reach the nerves and blood vessels of a tooth?
abscess
Objective examination
conducted by the endodontist, who evaluates the status of the tooth and surrounding tissues
Pulp fibrosis
decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal
What type of moisture control is recommended for root canal therapy?
dental dam
electric pulp testing
determine if pulp is vital or nonvital. delivers small electric stimulus to pulp.
Subjective examination
includes an evaluation of symptoms described by the pt: -Chief complaint (biggest problem) -Character & duration of pain -Painful Stimuli -Sensitivity to biting and pressure
Give another term used for necrotic or necrosis
nonvital
What surface of the posterior tooth would the dentist enter with a rotary bur when opening a canal for root canal therapy?
occlusal surface
Glick Number 1
paddle-shaped end for placement of temporary restorations, and rod-shaped plugger at other end is for removal of excess gutta-percha.
Reamer file
similar to k type but with father spaces cutting edges - removes dentin structure to widen canal
pulp capping
the placing of a covering over an exposed tooth pulp
Broaches
used to remove vital, inflamed hemorrhagic pulp tissue from canal
trauma
wound or injury such as a blow to a tooth or the jaw , can cause damage to surrounding tissue.
