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165 Cards in this Set
- Front
- Back
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tooth with highest percentage of lateral canals
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max central incisor
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what is the significant anatomic feature of max central incisor?
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one of two roots that clinical view shows largest canal dimension
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what helps define the access in max central incisor?
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two pulp horns across the incisal
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what happens when max cent inc is traumatized?
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1. dentin deposition may cease w/ necrosis 2. incomplete apex formation 3. w/o secondary dentin having root walls thin
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traumatic episode in max central incisor can lead to what?
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calcific metamorphosis
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in max lat incisor, if mismanaged, the apical perforation error would be?
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apical zip --> perforation
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dental anomalies on max lat incisor
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dens invaginatus, peg laterals, gingiva-palatal grooves, talon cusps
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significant anatomic features of max lateral incisor
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distal root curvature and lingual displaced apex
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what is similar about all anterior endo access?
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each have a single canal exiting a coronal chamber, that remains centered in root
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access funnel for anterior endo access?
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stays centered yet narrows to CEJ level
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what allows for early canal negotiation
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chamber exposure
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what is a 'direct extension' of the chamber?
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canal
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what are the anterior coronal access similarities for single rooted teeth?
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1. lingual positioned enamel penetration 2. ideal outlife form is tooth specific 3. ideal bur angle differs from chamber penetration angle 3. max bur depth: first expossure for highspeed, CEJ reserved for RA #4 or #2
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for ant coronal access, burs initially oriented how?
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parallel to facial surface
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outline shape for max central incisor
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triangular
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why triangular outline for max cent inc?
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1. to ocmpletely include incisive pulp horns across incisive edge 2. triangular root shape at CEJ level
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all access forms on single rooted teeth correlate with what?
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cervica-CEJ level cross-sectional shape
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how deep is enamel penetration?
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1-1.5mm deep ONLY, parallel to facial surface
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where is long axis determined for max central incisor?
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cervical 1/3
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what is the goal of access development?
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goal is 'straight-line' access yet has an 'incisal compromise' for esthetic reasons
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what is the Incisal Compromise for access development for max central?
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straight-line access to apical 3rd would often require a coronal access form that involves incisal edge or even extend onto facial
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when decay is present, what do you do first?
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remove to establish Sound Tooth Structure
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for anterior access, NO BURS below what?
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CEJ
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where does coronal access stop in anteriors?
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at CEJ
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what is #6 used for in anterior radicular access?
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cervical refinemennt to complete access
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what is used to define and accentuate the cervical root shape and blending in anterior access?
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#6 GG
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what is critical for radicular access?
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WL
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significant anatomic features for max lat inc
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distal root curvature and lingual displaced apex
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what allows for early canal negotiation?
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chamber exposure
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what are the first goals of anterior access & chamber ID?
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1. enamel penetration for sufficient visibility 2. trial bur depth 3. tapering centered prep 4. good endo explorer
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goal of working files to moving orifices
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1. progressively develop access according to internal anatomy and 2. prevent gouging walls
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coronal access should be expanded in direction of what?
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cross-sectional root form
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what accentuates the root shape?
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cervical level of tooth
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T/F: in anterior radicular access, ligual shoulder can be easily overworked
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F: rarely
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similarities for single rooted teeth
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1. coronal access stops at CEJ 2. max depths for GG 3. straight canal technique
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rules for GG for single rooted teeth
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#6 plus 2mm from CEJ level, #5-#2 plus 2mm from initial binding
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what instrument performs cervical refinement to complete access for single rooted teeth?
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#6GG - cross-over instrument b/w coronal and radicular access
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what instrument is used to define and ACCENTUATE the cervical root shape and blending in single rooted teeth
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#6GG
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what step is critical for radicular access?
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WL
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T/F: single rooted teeth rarely need Length Control difined by 'to resistance'
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True
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how do you do WL for single rooted tooth?
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largest file binding 0.5 mm short of RL
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what are 1st and 2nd WL for?
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1st - define a 'pathway for GG and rotaries 2nd - absolute definition of max depth
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what motion 'accentuates' normal root form?
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outward sweeping
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what is predominate motion for GG drills in single rooted teeth?
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outward sweeping against dentin wall (not vertical depth)
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T/F: no canal enlargement is desirable or warranted in radicular access for single rooted teeth
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True
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what causes file tip to facial wall during straight-line access in single rooted teeth?
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restoring force
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if a file binds in straightline access for single rooted tooth, what do you do?
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1st - check/refine lingual shoulder removal 2nd - check/refine insical edge extension
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what step is MORE important in longer teeth?
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verification step
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what's different about obturation for anteriors?
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1. incisal compromise 2. long root length 3. large root canal space 4. final GP level is much more critical
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T/F: RL - 5mm often not an issue for max anteriors
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T: b/c sometimes can't be reached
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downpack is referred to as what?
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continuous wave
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GP height should be no higher than what?
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CEJ/gum line
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max mixing time for polycarb
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30 sec
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where are IRM cones placed first?
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deepest sections i.e. proximal boxes and chamber
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how often does mand 1st PM have one root?
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95%
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how often does mand 1st PM have one canal?
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74%
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which canal is larger if 2 canals in mand 1st PM?
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Fa
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how often does mand 2nd PM have one canal
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97%
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access for mand 2nd PM must target which pulp horn?
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buccal
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files always find which canal in mand PMs?
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Fa
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mand 1st PM has what shape access?
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oval
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where is access on mand 1st PM
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3/4 buccal of central groove
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access shape for mand 2nd PM
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oval
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where will access be for mand 2nd PM
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2/3 buccal and 1/3 lingual of central groove
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what degree inclination does mand 2nd PM crown have to the root
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30 degrees
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what are the dimensions for the occlusal opening of access prep in mand 2nd PM
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4-6mm in F-L direction and 2-3mm M to D
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how would you know if you would need an 80 CZ in a mand PM
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if #3GG goes w/ minimal resistance to either 4-5mm of RL or reaches full depth of 17mm w/ no resistance
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what would you do if you had an open apical foramen?
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size canal 1mm from RL and skip 0.5mm step
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what gives added retention to large core restorations?
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post
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T/F: posts strengthen the tooth
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F
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what type of posts are usually placed in canals where CZ was 60+?
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red tri R posts
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which GG's are used for red tri R posts
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#6, #5, #4
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what type of posts are usually placed in canals where CZ was 45 or 50?
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yellow tri R
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which GG's are used for yellow tri R posts
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#5, #4, #3
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when do you use 2 step/3 step post preps?
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if WL >21mm, use 3, if WL< 21mm use 2
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when can 5mm rule be violated in post space prep?
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if post space is <6mm
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what instruments are used for post space prep refinement?
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GG
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how far apart are the steps in the post prep?
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3mm
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when are 2 step post space preps indicated?
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1. in case of canal curvature the system B meets resistance or 2. WL < 21mm
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what is diff about a 2 step post space prep?
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smallest GG won't be used and corresponding portion of post is removed from end and reshaped
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where should top of post be in relation to occlusal surface
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2mm below (not 2mm below cusp tip)
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what types of pins are placed in the post/pin prep
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.021 TMS universal pins
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where are pins placed?
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ML and DL corners of tooth
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how far away should pins be placed from surface/DEJ/post
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2mm from surface and >.5mm inside DEJ and 2mm from post
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how big is a major foramen in diameter?
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0.5-1mm
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how big is apical constriction in diameter?
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.35-.25mm
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how big is canal body about 5mm from apex?
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.45-.60 - round and parallel
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in what dimension does the canal body of a root increase above 5mm from apex?
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B-L
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how does the major apical foramen change w/ age?
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diameter increases, position deviates more
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what is the ideal terminus for the RC filling?
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CDJ
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what distinguishes pulp vs. PDL tissue?
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CDJ
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where does the apical foramen most often exit the root?
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0.5-1.0mm from anatomic apex
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what is classic enlargement in relation to RL?
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1mm short of RL
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why do we do apical clearing?
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clear final plug of apical debris that may harbor bacteria and cause prolonged infection
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what tooth is notorious for apical ramifications?
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max PM
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are lateral canals a major issue?
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only if assoc w/ a PA lesion
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since apical 3rd is often more parallel portion of canal, how is sufficient enlargement determined?
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by irregularities in cone, not flare
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a single canal in a root typically has what?
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a 'choke point'
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what accomplishes cleaning in cul-de-sacs and fins?
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NaOCL irrigation
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why are mesial roots of mand molars prone to strip perforation?
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anatomic concavity on furcation surface of dumbbell shaped root, chamber calcification (orifices over furca), and curvature (transportation mid-root)
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which teeth have type I canal configurations?
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1. max incisors 2. mand PMs 3. canines 4. DB and P of max molar 5. D of mand molars
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which teeth have type II and III canal configurations?
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max PMs, M root of all molars
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which canal configuration would be most difficult to manage?
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type IV
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what is a type IV canal configuration?
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any division of canal occurring apically
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how does aging reduce and close RC space?
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1. secondary dentin deposition 2. recession/retreating from crown
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what is the essential first step to maximize cleaning, shaping, and obturation?
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access
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what step is the best opportunity to control instruments and materials used in RC system?
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access
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what are objectives of access?
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1. ID of canal orifices 2. completely unroof 3. stretegic removal (shoulder, lips, shelves, weak cusps) 3. conservation of tooth structure 4. straight-line access to first curvature
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what is the most critical aspect of access?
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straight-line
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what step achieves unimpeded instrument placement to apical 3rd or to level of curvature?
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radicular access
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canal outline correlates with what?
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external contours
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what is the most common reason teeth require RCT?
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dental caries
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ideal outline forms for max central incisor
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triangular
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ideal outline form for max lat incisor
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oval w/o inclusion of incisal edge
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ideal outline form for max and mand canines
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oval w/o inclusion of incisal edge
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ideal outline form for mand central and lateral incisors
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long oval WITH inclusion of incisal edge
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where is a canal ALWAYS?
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middle of root
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if you have an aged pulp space w/ recession/calcification in a single canal, what should change about access?
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should extend outline more incisally
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what is most likely spot to perf ant tooth?
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on facial below CEJ and into attachment area
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what is the most important landmark for determining location of pulp chambers, access forms, and RADICULAR REFINEMENT?
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CEJ
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what is the 'cross over' instrument b/w coronal and radicular access?
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#6GG
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what do multi-rooted molar and max PM teeth have in common?
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each have mult canals exiting a coronal chambe through peripherally located orifices
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ideal outline form for max and mand PM's
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oval
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ideal outline form for mand molars
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trapezoidal (rhomboid)
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ideal outline orm for max molars
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triangular (heart shaped)
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where is chamber in relation to periphery of tooth in post teeth?
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equidistant from periphery
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what 'repositions' canal orifices over root?
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orifice movement
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in post teeth, orifices of root canals are ALWAYS located where?
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1. at junction of walls and floor 2. at angles in floor-wall junction 3. at terminus of roots' development
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what is the key to finding orifices?
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differentiating colors of dentin
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orifice movement is required to protect what?
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normal anatomy
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what is critical for appropriate gates use?
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WL
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what is the motion for GG's in post multi-rooted teeth?
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outward anti-curvature sweeping
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in using 4, 3, 2 GG, how far do you go?
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binding, plus max of 2mm OR until resistance
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how does bacteria get o pulp space?
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carious dentin
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RCT objectives
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1. elim current infection (C&S) 2. prevent recurrence (obturation) 3. promote repair
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AAE clinical classification of normal
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RCT not indicated
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AAE clinical classification of reversible pulpitis
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RCT not indicated
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irreversible pulpitis/necrotic pulp tx?
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required
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low grade inflammation, osseous stimulation
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focal sclerosing osteolyelitis, condensing osteitis
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clear progression beyond apex, osseous breakdown
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periradicular periodontitis, acute, subacute or chroni
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infection/pus
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periradicular abscess (acute, phoenix abscess/ exacerbation or chronic)
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term that means at some location along or surrounding the root surface
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periradicular
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T/F: 'periradicular' does not exclude a perio etiology
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True
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vaguely symptomatic radiographic lesion
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subacute
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painful, often mobile tooth, with purulence
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acute (combines acute abscess and phoenix abscess)
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sinus tract w/ continuous drainage, often non-painful is described as
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chronic (same as suppurative apical periodontitis)
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electric pulp testing
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contra-indicated on teeth w/ crowns
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periradicular/periapical diagnostic test
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assess inflammation: percussion, palpation
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periradicular/pulpal diagnostic test
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ID source of pain: bite testing (tooth and cuspal) and transillumination
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periradicular/pulpal diagnostic tests help to ID what?
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teeth w/ possible incomplete cuspal cracks or crown to root fractures
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periradicular diagnostic test
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periotontal probing = eliminating a perio etiology
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T/F: taking an x-ray is diagnostic
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F
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primary tx goal of RCT
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to prevent development of or cure apical (periradicular) periodontitis
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step that tx infection/affected RC space
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C&S
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step that seals RC space to prevent recontamination
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obturation
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'minimal' osseous changes with intact LD and PDL space may be widened
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PREVENT apical periodontitis
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'definite' osseous changes w/ broken LD and PA lesions w/ size and borders
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CURE apical periodontitis
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how often is max canine have straight canal in apical 1/3?
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~40%
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direction of curve of apical 1/3 of max canine
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distal &/or labial curve
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significant anatomic feature of max canine
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broad Fa-Li root canal system in Coronal and Middle 1/3ds
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shape of max canine canal in cervical 1/3
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oval
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shape of max canine canal in middle 1/3
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round
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what direction does the apical 1/3 part of hte mand root curve?
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mesial
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significant anatomic feature of mand canine
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broad Fa-Li RC system, cusp tip is lingual to Fa-Li tooth center
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T/F: max canine is mroe likely to have 2 canals or bifurcated root system than mand
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F: mand more likely
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