Endodontics Final

Front 1

What are the purposes of having patency?

Back 1

- decreased post op sensitivity
- facilitates length determination
- minimizes apical blockage and loss of length
- reductes chance of apical strip and perforation
- help irrigants reach root canals
- enhance irrigant exchange in apical third
- allows for obturation to apical foramen
- apical patency should be done in all cases

Front 2

What main functions do we want irrigants to accomplish?

Back 2

- dissolve organic tissue
- remove inorganic
- antimicrobial effect

Front 3

What are the different techniques used with hand-files?

Back 3

- reaming
- watch-winding
- filing (anti-curvature)
- circumferential filing

Front 4

What is the advantage to having non-cutting tip instruments?

Back 4

- reduction of ledging
- reduction of transportation
- reduction of perforation

Front 5

what are the disadvantages of NiTi rotary instruments?

Back 5

- Fracture Risk
- Screwing tendency in root canals
- Aggressive Cuting tips
- Difficult Access
- Limited tactile sense
- Cost

Front 6

What is PITCH?

Back 6

- number of flutes per millimeter

Front 7

Explain CYCLICAL FATIGUE:

Back 7

- due to curvature of roots, file on one side is expanding and on other side contracting and repeatedly doing that.

Front 8

Explain TORSIONAL FATIGUE:

Back 8

- tip gets stuck in something, but rest of the file wants to keep moving

Front 9

How does one avoid fatiguing rotary files?

Back 9

- Go quick in and out 2-3 times.

Front 10

What does a POSITIVE RAKE ANGLE do?

Back 10

- cut, scoop

Front 11

What does a NEGATIVE RAKE ANGLE do?

Back 11

- shaves
- less efficient
- more friction = more chance of fracture

Front 12

Define RADIAL LAND:

Back 12

- provides blade support while adding peripheral strength to resist torsional and rotational stresses
- keeps the instrument centered in the canal
- prevents over-engagement

Front 13

Pulpodental complex is derived from which embryological cells?-

Back 13

Ectomesenchymal, neural crest cells, from first branchial arch

Front 14

Citodifferentiation occurs in which stage of tooth development?

Back 14

Bell stage

Front 15

Initiation occurs in which stage of tooth development?

Back 15

Bud stage

Front 16

Morphogenesis occurs in which stage of tooth development?

Back 16

Cap stage

Front 17

During which week does the lamina start to develop?

Back 17

5th week

Front 18

TRUE or FALSE: Dentin is formed before enamel.

Back 18

TRUE

Front 19

TRUE or FALSE: Dentin initiates the formation of enamel.

Back 19

TRUE

Front 20

When does hard tissue formation start?

Back 20

late bell stage

Front 21

What are the four stages of apposition?

Back 21

1. elongation of inner dental epithelium
2. differentiation of odontoblasts
3. formation of dentin
4. formation of enamel

Front 22

Which cells produce these different types of material:
a. mantle dentin
b. globular dentin
c. interradicular
d. reparative
e. reactionary
f. enamel

Back 22

a. odontoblasts
b. odontoblasts
c. odontoblasts
d. odontoblast-like cells
e. Hohl-cells
f. ameloblasts

Front 23

What are the four morphologic zones of the pulp - from most lateral (outside) to most medial (inside)?

Back 23

- odontoblast layer
- cell poor layer
- cell rich layer
- pulp proper

Front 24

What can be found in the CELL POOR ZONE?

Back 24

- unmyelinated nerve fibers
- capillaries

Front 25

What can be found in the CELL RICH ZONE?

Back 25

- fibroblasts
- macrophages
- dendritic cells
- undifferentiated mesenchymal cells

Front 26

What can be found in the PULP PROPER?

Back 26

- fibroblasts
- vessels
- nerves

Front 27

When does SECONDARY DENTIN formation begin?

Back 27

- when the tooth erupts and comes into occlusion

Front 28

What are the functions of the pulpal vasculature?

Back 28

- hemostasis
- respond to stimuli
- regulate interstitial environment
- transport nutrients / hormones
- remove metabolic waste products

Front 29

What is the order of vessels in the pulp circulation?

Back 29

ARTERIOLE -> TERMINAL ARTERIOLE -> PRE-CAPILLARY -> CAPILLARY -> VENULE

Front 30

What is the purpose of lymphatics in the pulp?

Back 30

remove high molecular weight solutes

Front 31

Where is the location of terminals of A-delta nerve fibers in the tooth?

Back 31

Pulpo-dentinal junction

Front 32

Where is the location of terminals of C nerve fibers in the tooth?

Back 32

Throughout the pulp

Front 33

Which nerve fibers are myelinated and which are not?

Back 33

MYEL: A-delta
NOMY: C

Front 34

What is the first type of cementum formed? Where does its collagen come from?

Back 34

Primary acellular intrinsic fiber cementum. Initially collagen from cementoblasts, then later from fibroblasts.

Front 35

What is the second type of cementum formed? How and when is it formed?

Back 35

Primary acellular extrinsic fiber: formed by PDL fibers after their incorporate into the primary acellular intrinsic fibers.

Front 36

Which is the "adaptive" type of cementum?

Back 36

Secondary cellular mixed fiber cementum.

Front 37

The cementum sometimes seen overlapping enamel is?

Back 37

acellular afibrillar cementum

Front 38

Which cementum plays no role in fiber attachment?

Back 38

acellular afibrillar cementum

Front 39

What constitutes the PDL?

Back 39

- cementoblasts / osteoblasts
- fibroblasts
- stem cells
- macrophages
- osteoclasts
- blood vessels
- nerves
- lymphatics
- Malassez rest's of epithelium

Front 40

Define "transcription factor":

Back 40

a protein that binds to specific DNA sequences, therefore controlling the transcription of genetic information from DNA to mRNA.

Front 41

Define "growth factor":

Back 41

A growth factor is a naturally occurring substance capable of stimulating cellular growth, proliferation and cellular differentiation. Usually it is a protein or a steroid hormone.

Front 42

What is the "Zone of Weil"?

Back 42

Cell poor zone

Front 43

The number of roots, and morphology of rooths, is determine by which embryological structure in the Bell Stage?

Back 43

Hertwig's Epithelial Root Sheath

Front 44

Which is the first layer of dentin layed down?

Back 44

MANTLE DENTIN
Type III collagen and Type I collagen

Front 45

What is the composition of ENAMEL?

Back 45

96% inorganic material

Front 46

What is the composition of DENTIN?

Back 46

65% inorganic material

Front 47

What is the composition of CEMENTUM?

Back 47

50% inorganic material

Front 48

What is the aim of endodontics?

Back 48

- prevention or treatment of apical periodontitis
- mo money mo problems
- to make Dr. Ochoa rich

Front 49

What are the causes of apical periodontitis?

Back 49

- bacteria in the root canal system, dentinal tubules,
- bacterial toxins induce inflammation, damage host tissue
- host defense cells get activated

Front 50

What are the needs of intra-canal medicaments?

Back 50

- kill microorganisms
- non-selective
- may damage host cells
- calcium hydroxide
-

Front 51

Incorrect working lengths will result in what three errors?

Back 51

- incorrect cleaning
- incorrect shaping
- incorrect obturation

Front 52

What are some errors in working lengths?

Back 52

- over-instrumentation
- perforations
- loss of working length
- ledges
- dentin plugs

Front 53

What are the disadvantages of using APEX LOCATOR?

Back 53

- retreatments
- crowns
- pacemakers
- blood

Front 54

What are the advantages of using APEX LOCATORS?

Back 54

- less radiation
- 96% accuracy
- less time-consuming

Front 55

What are the functions of your irrigant?

Back 55

- remove smear layer
- organic tissue disolved
- antimicrobial effect
- debris flushed

Front 56

What is the biggest disadvantage to using rotary instrumentation?

Back 56

HIGHER RISK OF FRACTURED INSTRUMENTS!

Front 57

Define "cyclical fatigue". How would you reduce it?

Back 57

Occurs when working in curved canal. On the outside of the curve the flutes are expanded, and on the inside of the curve the flutes are compressed, when rotating this constantly fluxes and produces lots of stress.
Reduced by creating straight-line access
Quick in and out 2-3 times.

Front 58

Define "torsional fatigue". How would you reduce it?

Back 58

Tip of instrument stuck in dentin – rest of instrument is still spinning
Reduced by creating a glide-path by hand instrumentation

Front 59

Define "pitch" of a file:

Back 59

Number of flutes per mm.

Front 60

Label the following:

Back 60

a. outer dental epithelium
b. inner dental epithelium
c. stellate reticulum
d. dental papilla
e. dental lamina

Front 61

Label the following:

Back 61

a. nerve bundle
b. bone
c. vasculature
d. oral ectoderm
e. tongue

Front 62

Label the following:

Back 62

a. oral ectoderm
b. dental lamina
c.
d. dental follicle
e. dental papilla
f.
g.

Front 63

Label the following:

Back 63

a. enamel organ
b. enamel knot
c. dental papilla
d. dental follicle / sac

Front 64

Label the following:

Back 64

a. dental lamina
b. outer dental epithelium
c. inner dental epithelium
d. dental papilla
e. dental follicle
f. cervical loop

Front 65

Label the following:

Back 65

a. outer dental epithelium
b. stellate reticulum
c. stratum intermedium
d. inner dental epithelium
e. dental papilla

Front 66

Label the following:

Back 66

a. inner dental epithelium
b. outer dental epithelium
c. cervical loop

Front 67

Label the following:

Back 67

a. outer enamel epithelium
b. stellate reticulum
c. stratum intermedium
d. ameloblasts
e. odontoblasts
f. dentin
g. dental pulp
h. bone

Front 68

Define "cementodentino junction":

Back 68

- cementum meets dentin
- pulp tissue ends
- periodontal tissue begins

Front 69

Define "major apical diameter":

Back 69

circumference/rounded edge, like a funner or crater, that differentiates the termination of the cemental canal from the exterior surface of the root.

Front 70

Define "minor apical diameter":

Back 70

Occurs at the CDJ and is usually not at the radiographic apex.

Front 71

What are some examinations done to assess endodontic status of teeth?

Back 71

- palpation
- mobility
- percussion
- exploration
- pulp test (cold, hot, EPT)
- probing
- tooth sleuth (fractures/cracks)
- radiograph

Front 72

PERCUSSION / PAIN / APICAL RADIOLUCENCY / TREATMENT /

Back 72

to do

Front 73

What are the four different ways files are manufactured?

Back 73

- grinding
- twisted
- electropolished
- Ti Nitrate

Front 74

Define the helical angle:

Back 74

Angle at which the flutes are positioned.

Front 75

What is the G-pack sequence?

Back 75

0.25 - 0.12, 0.10, 0.08, 0.06, 0.04, 0.02

Front 76

What is the function of the RADIAL LAND RELIEF area?

Back 76

Reduces the friction on the canal wall

Front 77

What are the disadvantages of the NiTi Rotary Systems?

Back 77

- fracture risk
- screwing tendency in root canals
- aggressive cutting tips
- difficult access
- limited tactile sense
- cost

Front 78

What are some factors that would make access cavity preparation difficult?

Back 78

- extensive decay
- restorations
- loss of crown
- fixed prosthesis
- calcifications
- obliterated pulp

Front 79

What are some of the purposes of achieving straight line access?

Back 79

- better access into the canal
- instruments more centered in the canal
- better access for obturation
- less trauma on the files due to less curvatures to go around

Front 80

Define "working length":

Back 80

distance from a coronal reference point to the point at which the cleaning and shaping should terminate

Front 81

What is the primary cause of apical periodontitis?

Back 81

- bacteria in the root canal system

Front 82

Microbes can be found where?

Back 82

- dentinal tubules
- root canal system
- cementum
- periapical tissues

Front 83

(Preza 2008) Over _____ species of bacteria have been identified in the oral cavity?

Back 83

800

Front 84

Define "obligate anaerobes":

Back 84

Bacteria that cannot live in the presence of O2

Front 85

Define "Facultative anaerobes"

Back 85

organisms that metabolize either aerobically or anaerobically but most survive better in an environment with some O2.

Front 86

Define "obligate aerobes":

Back 86

Organisms that require oxygen for aerobic cellular respiration.

Front 87

What is the difference between gram positive and gram negative bacteria?

Back 87

GRAM NEGATIVE - lack an outer cell membrane consisting of peptidoglycan
GRAM POSITIVE - peptidoglycan cell membrane

Front 88

Genetic material between bacteria can be exchanged in what three ways? Describe each.

Back 88

- Transduction: bacteriophage exchange
- Transformation: uptake of free DNA
- Conjugation: plasmid exchange

Front 89

What are bacterial virulence factors?

Back 89

genetic sequences that when activated allow the bacterium to invade host defence mechanisms

Front 90

List 4 bacterial virulence factors:

Back 90

- exopolysaccharide production
- lipopolysaccharide production (endotoxin)
- pheromone release
- surface receptor expression
- bacterial toxin release (exotoxin)

Front 91

Define "quorum sensing":

Back 91

Stresses in the environment detected by individual cells will start a communication amongst them to start expressing these virulence factors.

Front 92

What are the four types of primary dentin?

Back 92

- mantle
- globular
- intertubular
- peritubular

Front 93

UNTREATED NECROTIC PULPS have what kind of species of bacteria predominantly?

Back 93

- 1-12 species
- anaerobes predominantly
- gram negative species (Prevotella, Fusobacterium)

Front 94

CASES IN TREATMENT have what kind of bacteria predominantly?

Back 94

- 1-5 species
- increase in gram positive facultative anaerobes (Streptococci, enterococci)

Front 95

ROOT FILLED TEETH have what kind of bacteria predominantly?

Back 95

- 1-3 species
- gram positive facultatives predominate

Front 96

What is the difference between ASYMPTOMATIC and SYMPTOMATIC teeth in regards to bacterial flora?

Back 96

ASYMPTOMATIC have:
- fewer species
- lower bacterial counts
- fewer Gram positive species
- higher portion of facultative anaerobes
- lower incidence of spirochetes, bacteriodetes, fusobacterium
- higher counts of firmicutes and actinobacteria

Front 97

In Gomes (1996) study, which species was significantly associated with pain and sensitivity to percussion?

Back 97

Prevotella (P. gingivalis and P. endodontalis)

Front 98

In Gomes (2008) which species was associated with pain of previously endodontically treated teeth?

Back 98

Treponema denticola

Front 99

Molander (1998) and Siren (1997) found significant association of endodontic failure with this species:

Back 99

Enterococcus faecalis

Front 100

What two main bacteria types have had high associations with endodontic failure?

Back 100

Enterococcus faecalis
Actinomyces

Front 101

Which viruses/fungi have been detected in symptomatic and large periapical lesions?

Back 101

Active cytomegalovirus and Epstein-Barr Virus

Front 102

Which is the main fungi incidence reporting in both treated and untreated canals?

Back 102

Candida albicans

Front 103

In the clinical study by Debelian (1995) what were their findings about bacteremia and instrumentation:

Back 103

~54% had bacteremia when instrumentation 2 mm long
~31% had bacteremia when instrumentation 1 mm long (of apex)
- Bacteremia is most often caused by the over-instrumentation of necrotic and infected root canals

Front 104

What are some sampling methods for determining microbial flora within a canal?

Back 104

- paper points
- gutta percha
- files
- ultrasonic agitation
- media addition

Front 105

What are the different ways of identifying bacteria present in canal once it's been sampled?

Back 105

- culture identification (agar plate)
- molecular identification (PCR, DNA hybridization)
- immunological identification (DF IDF)

Front 106

TRUE or FALSE: Endodontic treatment eliminates all microorganisms from the root canal?

Back 106

FALSE

Front 107

TRUE or FALSE: A significant change in bacterial number, type, and environment affect their ability to sustain disease.

Back 107

TRUE

Front 108

What are the three key ways to reduce overall bacterial exposure and safety to the patient during ENDODONTIC treatment?

Back 108

- rubber dam isolation
- surface disinfection (NaOCl)
- Opaldam

Front 109

What are the alternatives to root canal treatment?

Back 109

only alternative is extraction

Front 110

What are the ideal characteristics of an endodontic irrigant?

Back 110

- effective germicide and fungicide
- non-irritating to periapical tissues
- remain stable in solution
- prolonged antimicrobial effect
- be active in the presence of blood, serum, protein, derivates of tissue
- low surface tension
- doesnt interfere with repair of periapical tissues
- not stain tooth structure
- be capable of inactivation in a culture medium
- be able to completely remove the smear layer, and be able to disinfect the underlying dentin and its tubules
- have no adverse effects on the sealing ability of filling materials
- convenient application
- relatively inexpensive

Front 111

What factors increase efficacy of Sodium Hypochlorite?

Back 111

- temperature
- time in the canal
- motion

Front 112

What are the basic objectives in cleaning and shaping?

Back 112

- remove infected soft and hard tissue
- give disinfecting irrigants access to the apical canal space
- create space for the delivery of medicaments and subsequent obturation
- retain the integrity of radicular structures

Front 113

Shortly describe the STANDARDIZED TECHNIQUE:

Back 113

- use the same working length for all instruments introduced into the canal
- once the working length is established with fine file, incrementally go to larger file to reach working length

Front 114

Describe STEP-BACK TECHNIQUE:

Back 114

- stepwise reduction of the working length for larger files
- typically 1mm or 0.5 mm increments, resulting in flared shapes with 0.05 or 0.10 taper, respectively
- this reduced preparation errors in curved canals

Front 115

Describe the CROWN-DOWN technique:

Back 115

- coronal flaring FIRST
- then determination of the working length

Front 116

Recapitulation (patency) should be done after every ______.

Back 116

instrument use

Front 117

Describe the BALANCED FORCE TECHNIQUE

Back 117

STEP 1: pressureless insertion of file, instrument is rotated CLOCKWISE 90'
STEP 2: Instrument rotated counterclockwise 180 to 270 degrees, sufficient apical pressure is used to keep the file at the same insertion depth during this step.
STEP 3: This step is similar to step 1 and advances the instrument more apically
STEP 4: After 2 or 3 cycles the file is loaded with dentin shaving and is removed from the canal with a prolonged clockwise rotation.

Front 118

What are the properties of an ideal sealer?

Back 118

- exhibits tackiness when mixed to provide good adhesion between it and canal wall when set
- radiopaque
- no shrinkage on setting
- no staining of tooth structure
- bacteriostatic, or at least does not encourage bacterial growth
- exhibits a slow set
- insoluble in tissue fluids
- tissue tolerant

Front 119

What is this instrument called?

Back 119

Barber broach

Front 120

What type of file has this formation?

Back 120

K3

Front 121

What type of file has this shape?

Back 121

Profile

Front 122

What type of root canal morphology is this?

Back 122

Type II

Front 123

What type of root canal morphology is this?

Back 123

Type III

Front 124

What type of root canal morphology is this?

Back 124

Type IV

Front 125

What type of root canal morphology is this?

Back 125

Type V

Front 126

What instruments are these ?

Back 126

Gates-Glidden

Front 127

Draw out the access cavity for this tooth (in yo head fools):

Back 127

Front 128

Draw out the access cavity for this tooth (please do not try to draw on your laptop/computer screen):

Back 128

Front 129

MEMORIZE THIS!

Back 129

MB1 MB2 DB and P

Front 130

What type of file is this?

Back 130

K-file

Front 131

What is this instrument?

Back 131

Gates-Glidden

Front 132

Label these:

Back 132

a. dentin
b. predentin
c. odontoblast layer
d. cell free zone
e. cell rich zone
f. pulp proepr

Front 133

What type of file is this?

Back 133

Hedstrom file

Front 134

Label the following:

Back 134

a. helix angle
b. cutting edge
c. flute
d. radial land relief
e. radial land

Front 135

What kind of pitch and helical angle does this file have?

Back 135

- constant pitch, constant angle

Front 136

IDENTIFY THE FILE TYPE:

Back 136

a. Reamer
b. K-file
c. Hedstrom

Front 137

What is the order of colours/sizes for the hand files?

Back 137

PRE SERIES:
06 - pink
08 - grey
10 - purple
FIRST SERIES
15 - white
20 - yellow
25 - red
30 - blue
35 - green
40 - black
SECOND SERIES
45 - white
50 - yellow
60 - red
70 - blue
80 - green

etc... etc... etc....

Front 138

Malassez Epithelial rests are remnant's of which tissue?

Back 138

Hertwig's epithelial root sheath

Front 139

Which type of cementum is primarily found in the apical third of premolars and molars, and has a "bone-like" appearance?

Back 139

Secondary cellular intrinsic fibrillar

Front 140

Which type of cementum has a laminated appearance and includes cementocytes?

Back 140

Secondary cellular mixed fiber

Front 141

What is the function of the PDL?

Back 141

- support for the tooth
- sensory
- eruptive
- nutritive
- homeostatic

Front 142

What is the primary function of the dental pulp?

Back 142

to form dentin

Front 143

What are the four functions of the pulp?

Back 143

NUTRITIVE: the pulp keeps the organic components of the surrounding mineralized tissue supplied with moisture and nutrients;
SENSORY: extremes in temperature, pressure, or trauma to the dentin or pulp are perceived as pain;
PROTECTIVE: the formation of reparative or secondary dentin (by the odontoblasts).
FORMATIVE: cells of the pulp organ produce dentin which surrounds and protects the pulpal tissue.

Front 144

MEMORIZE THIS:

Back 144

ok

Front 145

What is the main inorganic component of DENTIN?

Back 145

Calcium hydroxyapatite

Front 146

What is the main organic component of DENTIN?

Back 146

Type I collagen

Front 147

The BULK of dentin in a tooth is what kind of dentin?

Back 147

Intertubular dentin

Front 148

What are the different file types?

Back 148

TRIANGLE - Flex-R, Reamer
SQUARE - K-flex, K-file
RHOMBOID - K-flex (large)
CIRCLE - Hedstrom

Front 149

What is the only machined hand file?

Back 149

Hedstrom

Front 150

What is the most important step in endodontics?

Back 150

- cleaning and shaping

Front 151

WHat are the main causes of root canal failure?

Back 151

- vertical root fracture
- loss of or inadequate coronal seal
- inadequate debridement and disinfection
- missed canals

Front 152

TRUE or FALSE: Good restoration, poor endo is better than poor restoration / good endo?

Back 152

TRUE

Front 153

What are the advantages of warm vertical condensation?

Back 153

- possibly a better apical seal
- greater DENSITY of GP
- greater chance of filling lateral or accessory canals
- easier post space preparation (for CPC)

Front 154

What are the disadvantages of warm vertical condensation?

Back 154

- very technique sensitive
- more time consuming
- rigid pluggers do not fit around curvatures
- control of vertical dimension is difficult

Front 155

What are the advantages of lateral condensation?

Back 155

- efficient (time)
- ease of use
- control over vertical dimension
- good canal adaptation

Front 156

What are the disadvantages of lateral condensation?

Back 156

- creates internal stresses
- laminated cones trap air and sealer
- condensation in apical 1/3 most difficult, but also very important
- little chance of filling lateral canals and irregularities

Front 157

TRUE or FALSE: We need to disinfect gutta percha before use?

Back 157

TRUE

Front 158

What are the properties fo Tubliseal?

Back 158

- ZOE based - good tissue response
- easy to use
- easy to mix
- fairly radiopaque
- non-staining
- good lubricant

Front 159

What is the purpose of a sealer?

Back 159

- fill voids and canal irregularities
- binding agent between core - sealer - wall
- lubricant
- penetrate lateral canals/ accessory

Front 160

TRUE or FALSE: Gutta Percha seals the root canal?

Back 160

FALSE

Front 161

What are the disadvantages of gutta percha?

Back 161

- not bactericidal or bacteristatic
- not adhesive
- not easily manipulated
- not great working time (when heated)

Front 162

What are the advantages of GUTTA PERCHA?

Back 162

- inert
- dimensionally stable
- chemically stable
- non-porous
- non-toxic
- radiopaque
- removeable

Front 163

CASE EXAMPLE WITH RADIOGRAPH: What is pulpal diagnosis, what is periapical diagnosis, what is treatment, what is emergency treatment?

Back 163

to do, ABX? pulpectomy? root canal treatment?

Front 164

In UNTREATED NECROTIC what kind of bacteria predominates?

Back 164

- anaerobes (Prevotella)

Front 165

In PREVIOUSLY TREATED what kind of bacteria predominates

Back 165

facultative anaerobes (Treponema denticola)

Front 166

The dental papilla is developed during which stage?

Back 166

- cap

Front 167

DIAGNOSIS CHARTS / QUESTIONS:

Back 167

to do

Front 168

Tertiary dentin forms when?

Back 168

- in reaction to stimuli / damage

Front 169

What is the most significant advantage of CAVIT vs IRM as a temporary seal?

Back 169

- reduces microleakage due to expansion upon setting

Front 170

How thick of a layer of Cavit is needed to ensure reduction of microleakage?

Back 170

AT LEAST 3.5 mm

Front 171

What is the biggest advantage of IRM over Cavit?

Back 171

IRM has almost Double the compressive strength of cavit

Front 172

CASE:
- Symptomatic
- Tender to percussion
- Patient has localized vestibular swelling
- Pulp tests negative
- Periapex: 5 mm radiolucency

What is the PULPAL and PERIAPICAL diagnosis?

Back 172

PULP: Necrotic
PD: Acute Apical Abcess

Front 173

CASE:
32 year old male in no distress
- No significant findings
-

Back 173

PULP:

Front 174

What are the TREATMENT GUIDELINES for CLOSED APEX:
The tooth has been replanted before the patient's arrival at the clinic.

Back 174

- leave the tooth in place
- clean area with water spray, saline or chlorhexidine
- suture gingival lacerations, if present
- verify normal position of replanted tooth both clinically and radiographically
- apply a flexible splint for up to TWO WEEKS
- administer systemic antibiotics
- check tetanus protection
- give patient instructions
- initiate RCT 7-10 days after replantation and before splint removal

FOLLOW UP

Front 175

What are the TREATMENT GUIDELINES for CLOSED APEX:
The tooth has been kept in a physiologic storage medium or HBSS and/or stored dry, extra-oral dry time has been LESS THAN 60 MIN.

Back 175

- clean root surface and apical foramen with stream of saline and soak the tooth in saline thereby removing contamination and dead cells from the root surface
- administer LA
- irrigate socket with saline
- examine alveolar socket, if fracture is present reposition
- replant tooth SLOWLY with SLIGHT digital pressure
- DO NOT USE FORCE
- suture gingival lacerations if present
- verify normal position (clinically and radiographically)
- apply flexible splint for up to TWO WEEKS, keep away from gingiva
- administer Abx
- check tetanus protection
- give patient instructions
- initiate RCT 7-10 days after replantation and before splint removal

FOLLOW UP

Front 176

What are the TREATMENT GUIDELINES for CLOSED APEX:
Dry time longer than 60 min or other reasons suggesting non-viable cells

Back 176

GOAL IS TO PRESERVE ALVEOLAR BONE CONTOUR
- remove attached non-viable soft tissue carefuly, ie with gauze
- RCT to be carried out prior to replantation or later
- administer LA
- irrigate socket with saline
- Examine socket for fracture
- replant the tooth
- suture gingival lacerations, if any
- verify normal position clinically and radiographically
- stabilize tooth for FOUR WEEKS using flexible splint
- adminster systemic Abx
- check tetanus
- give patient instructions

To slow down osseous replacement of the tooth, treatment of the root surface with fluoride prior to replantation has been suggested (2% sodium fluoride for 20 min)

FOLLOW UP

Front 177

What are the TREATMENT GUIDELINES for OPEN APEX:
Tooth has been replanted before patients arrival at the clinic:

Back 177

- leave tooth in place
- clean the area with water spray, saline or chlorhexidine
- suture gingival lacerations if present
- verify normal position
- apply flexible splint for up to TWO WEEKS
- administer systemic Abx
- check tetanus protection
- give patient instructions
- goal is to allow for possible revascularization

Front 178

What are the TREATMENT GUIDELINES for OPEN APEX:
TOoth has been kept in storage medium and extra-oral dry time is LESS THAN 60 min:

Back 178

- in contaminated clean surface with saline stream
- topical application of antibiotics has shown to enhance chances of revascularization of the pulp and can be considered if available
- administer LA
- examine alveolar socket
- remove coagulum in the socket and replant tooth with slight digital pressure
- suture gingival lacerations
- verify normal position
- apply flexible splint for up to TWO WEEKS
- administer systemic Abx
- Check tetanus protection
- give patient instructions

Front 179

What is the first choice of systemic antibiotic use for TRAUMA?

Back 179

Tetracycline

Front 180

Tetracycline is not recommended in patients of which age group?

Back 180

Under 12 years old

Front 181

What alternative can be given as a systemic Abx to tetracycline?

Back 181

- Pen V or amoxicillin

Front 182

Where should splints be placed in trauma patients?

Back 182

- buccal , to allow for endodontic access

Front 183

What are some important instructions that should be given to patients following treatment of traumatised tooth?

Back 183

- Avoid participation in contact sports
- soft diet for up to 2 weeks, thereafter normal function as soon as possible
- brush teeth with a soft toothbrush after each meal
- use chlorhexidine (0.1%) mouth rinse twice a day for 1 week

Front 184

What are the follow up procedures?

Back 184

- Replanted teeth should be monitored by CLINICAL and RADIOGRAPHIC control after:
- 4 weeks
- 3 months
- 6 months
- 1 year
- annually thereafter

Front 185

What findings would show a FAVORABLE outcome for a CLOSED APEX trauma?

Back 185

- asymptomatic
- normal mobility
- normal percussion sound
- no evidence of resorption or periradicular osteitis
- lamina dura normal

Front 186

What findings would show a FAVORABLE outcome for an OPEN APEX trauma?

Back 186

- asymptomatic
- normal mobility
- normal percussion sound
- radiographic evidence of arrested or continued root formation and eruption
- pulp canal obliteration is expected

Front 187

What findings would show an UNFAVORABLE outcome for a CLOSED APEX trauma?

Back 187

- symptomatic
- excessive mobility
- no mobility (ankylosis)
- high pitched percussion sound
- radiographic evidence of resorption

Front 188

What findings would show an UNFAVORABLE outcome for an OPEN APEX trauma?

Back 188

- symptomatic
- excessive mobility
- no mobility (high pitched percussive sound)
- radiographic evidence of resorption
-

Front 189

What is the cell of the dental pulp most capable of transforming into other cells?

Back 189

- undifferentiated mesenchymal cell

Front 190

What would be the initial histologic appearance of a successful apicoectomy on a radiograph?

Back 190

Woven bone

Front 191

What is the initial treatment for internal resorption?

Back 191

Pulpectomy

Front 192

Which of the following statements concerning root canals and their foramina is NOT true?
A. Root canals bifurcate and have dual foramina.
B. The major foramen is precisely at the apex of the tooth.
C. The root canals may join and have single foramen.
D. The dentino-cemental junction is precisely at the apex of the tooth.
E. A cross section of the canal in the apical region is relatively round.

Back 192

D

Front 193

Which instrument is MOST EASILY brtoken in the root canal?

Back 193

- Barbed broach

Front 194

After application of heat, pain in a tooth lasts for approximately 10 minutes. WHat is the most likely diagnosis?

Back 194

ACUTE IRREVERSIBLE PULPITIS

Front 195

What is the antibiotic of choice for a periradicular dental abcess?

Back 195

penicillin V

Front 196

Odontoblast gap junctions
A. adhere the cells to one another.
B. attach the cells to the basement
membrane.
C. seal off the dentin from the pulp.
D. permit lateral cell-cell
communication.

Back 196

D - permit lateral cell-cell communication

Front 197

Why is a post cemented with zinc phosphate cement used in an endodontically treated tooth?

Back 197

- to retain the restoration

Front 198

TRUE or FALSE: A periapical granuloma can be asymptomatic?

Back 198

TRUE

Front 199

A patient experiences pain and some gingival swelling in the anterior segment of the mandible. The mandibular lateral incisor has a shallow restoration, is tender to percussion, and gives a positive response to the electric pulp tester. There is some mobility. The most likely diagnosis is:

Back 199

Lateral periodontal abcess

Front 200

What is the most appropriate treatment for a 0.5 cm periapical radiolucency due to a radicular cyst in association with a non-vital incisor?

Back 200

- RCT

Front 201

What is the most appropriate treatment for a permanent central incisor with a necrotic pulp and a wide open apex?

Back 201

Apexification with calcium hydroxide

Front 202

A dento-alveolar abcess most frequently originates from?

Back 202

pulpal necrosis

Front 203

What is the most common clinical finding in the diagnosis of an acute periapical abcess?

Back 203

pain on percussion

Front 204

The characteristic colour seen in the crowns of teeth with internal resorption is due to what?

Back 204

presence of hyperplastic vascular pulp tissue

Front 205

A patient complains of the discolouration of an upper central incisor. Radiographically, the pulp chamber and the root canal space are obliterated and the periodontal ligament space appears normal. The most appropriate treatment would be to:

Back 205

Fabricate a porcelain veneer

Front 206

What is dentin sensitivity associated with?

Back 206

free nerve endings

Front 207

A 30 year old HIV positive patient presents for removal of an abcessed tooth. THe most appropriate management is?

Back 207

- treat the patient in the same way as all other patients

Front 208

On Monday morning, a seven-year old child presents with a 3mm coronal fracture with pulp exposure of the max left central incisor, which occurred during a football game Sunday afternoon. The tooth is sensitive to hot and cold fluids. The treatment of choice is:

Back 208

Calcium hydroxide pulpotomy
- The apex is still open

Front 209

When preparing a cavity in a primary molar, there is a small mechanical exposure of one of the pulp horns. There is slight hemorrhage and the dentin surrounding the exposure is sound. The most appropriate treatment is:

Back 209

- pulp capping with CaOH, a base, and restoration
- direct pulp capping is only advised for PRIMARY TEETH

Front 210

The epithelium covering the lesions of chronic hyperplastic pulpitis is believed to be derived from what?

Back 210

- odontoblastic layer

Front 211

The prognosis of an avulsed tooth is principally affected by what?

Back 211

- length of time the tooth was out of the mouth

Front 212

What is the success of replantation of an avulsed tooth dependent upon?

Back 212

- length of time between avulsion and replantation

Front 213

What is the purpose of metallic salts used in root canal sealers?

Back 213

- radiopacity

Front 214

Which test is the MOST USEFUL in differentiating between an acute apical abcess and an acute peridontal abcess?

Back 214

PULP VITALITY

Front 215

Gutta-percha may be softened or dissolved within the root canal by using what?

Back 215

Xylene

Front 216

AFter a thermal stimulus has been removed from a tooth, persistent pain suggests what?

Back 216

- irreversible pulpitis

Front 217

In endodontics, which perforation has the worst prognosis?

Back 217

Furcation area of a molar

Front 218

Following the removal of a vital pulp, the root canal is medicated and sealed. The patient returns with apical periodontitis. What is the most common cause?

Back 218

OVERINSTRUMENTATION

Front 219

Define HYPEREMIA OF THE PULP:

Back 219

an excessive accumulation of blood in the pulp, resulting in vascular congestion

Front 220

A carious maxillary central incisor with acute suppurative pulpitis requires what?

Back 220

- opening of the canal and drainage for one week

Front 221

A patient complains of pain in a mandibular molar when chewing hard foods and taking cold liquids. Electric pulp tests and radiographic appearance are normal. Pain is likely caused by what?

Back 221

cracked tooth

Front 222

What is the most effective agent for bleaching of discoloured and devitalized tooth?

Back 222

hydrogen peroxide 30%

Front 223

A patient has a draining sinus tract 6mm apical to the free gingival margin of a maxillary lateral incisor. What do you do?

Back 223

Perform pulp vitality tests

Front 224

How would you manage a percussion sensitive tooth that responds normally to pulp testing?

Back 224

Occlusal assessment

Front 225

Which feature would be MOST indicative of a cracked tooth?

Back 225

- pain upon biting pressure

Front 226

Which factor improves the prognosis for a successful direct pulp cap on a secondary tooth?

Back 226

UNCONTAMINATED exposure

Front 227

Severe throbbing tooth pain which increases when the patient lies down is a symptom of what?

Back 227

Late stage of acute pulpitis

Front 228

Which cells are characteristic of chronic inflammation of the dental pulp?

Back 228

- plasma cells
- macrophages
- lymphocytes

-NO neutrophils present

Front 229

What is the most appropriate management for a tooth with a history of previous trauma that now exhibits apical resorption?

Back 229

Complete instrumentation and medication with intracanal calcium hydroxide

Front 230

What is the MOST EFFECTIVE agent in cold testing?

Back 230

Dry ice (CO2)

Front 231

Which substance causes inflammation and pain when released by pulpal fibres?

Back 231

Calcitonin gene related peptide

The dental pulp is a soft tissue of mesenchymal origin which houses a number of tissue elements including nerves, vascular tissue, connective fibers, ground substance, interstitial fluid, odontoblasts, immunocompetent cells and other cellular components. (1) Sympathetic innervation of the dental pulp terminates as free nerve endings and innervates the arterioles. (2) An interaction between exogenous irritants and defensive host cells results in the release of neuropeptides such as Substance P (SP), Calcitonin Gene Related Peptide (CGRP), Vasoactive Intestinal Polypeptide (VIP), Neurokinin A (NKA), Neuropeptide Y (NPY). Neuropeptides are proteins generated from somatosensory and autonomic nerve fibers after tissue injury. (3)

Increased production and release of these neuropeptides play an important role in initiating and propagating pulpal inflammation. (4) During inflammation, sprouting of nerve fibers is associated with increased expression of neuropeptides such as SP or CGRP closely surrounding the areas of inflammation or abscess. (5) Denervation of the inferior alveolar nerve depletes the pulp of its content of SP and CGRP, but not of NPY, and also increases the magnitude of pulpal necrosis following experimental pulpal exposures

Front 232

Common problems clinicians encounter in endodontics stem mainly from what areas?

Back 232

- diagnosis
- tooth morphology
- cleaning and shaping techniques

Front 233

What should the shape of an access cavity in a MAXILLARY CENTRAL always look like?

Back 233

Triangular

Front 234

What is the most common cause of coronal discoloration following RCT?

Back 234

Inadequate removal of coronal pulp tissue

Front 235

What are some anomalies that may be present in the morphology of a MAXILLARY LATERAL INCISOR?

Back 235

DENS-IN-DENTE:
- predispose teeth to lingual caries and pulpal involvement.
- Complicated access and treatment

DEVELOPMENTAL GROOVES:
- more frequent on lateral incisors
- if tooth is nonvital and has a vertical periodontal defect adjacent to the groove which extends to the apical region, the case is generally considered a hopeless prognosis
- if tooth is vital, perio therapy can be done to remove the groove with rotary instruments

Front 236

How many roots does the MAXILLARY FIRST PREMOLAR usually have?

Back 236

Commonly bi-rooted (75% of the time)
- two canals

Front 237

What are some variations of the radicular forms of MAX FIRST PREMOLAR?

Back 237

- two separate roots
- fused roots with separate canals
- fused roots with interconnections or webbing
- fused roots with a common apical foramen
- three-rooted teeth (approx. 6% incidence)

Front 238

Which tooth has the HIGHEST FAILURE rate of any posterior tooth for endodontic therapy?

Back 238

MAXILLARY FIRST MOLAR

Front 239

What roots does the MAX FIRST MOLAR have?

Back 239

PALATAL ROOT:
- longest root
- frequently curves towards buccal in apical third
- flat and ribbon like

DISTO-BUCCAL ROOT:
- generally conical and straight
- may curve in apical 3mm

MESIO-BUCCAL ROOT:
- most difficult root to treat
- 50% will have two canals
- ML is the elusive canal that lies in a groove on chamber floor which runs from MB orifice to palatal orifice

Front 240

What roots does the MAND FIRST MOLAR have?

Back 240

MESIAL ROOT:
- has two canals

DISTAL ROOT:
- can have one or two canals

Front 241

What kind of pain is very indicative of endodontic pathosis?

Back 241

- Irreversible in nature
- intense
- spontaneous
- continuous

Front 242

Why would one observe for facial asymmetry or distention on the extra-oral examination?

Back 242

- indicative of swelling of odontogenic origin or systemic disease

Front 243

What are some things to examine the dentition about?

Back 243

- discoloration
- fractures
- abrasions
- erosion
- caries
- large restorations

Front 244

What are some PERIRADICULAR tests?

Back 244

- Percussion test
- Palpation test

Front 245

What is the benefit of a percussion test?

Back 245

- does NOT give an indication of the health or integrity of the pulp tissue
- only indicates whether there is inflammation around the PDL

Front 246

A positive response to percussion can be caused by which factors?

Back 246

- teeth undergoing rapid orthodontic movement
- high restoration
- periodontal disease
- partial or total necrosis of the pulp (that has inflamed the PDL)

Front 247

How is a PALPATION TEST done?

Back 247

- index finger rolled while pressing the mucosa against the underlying bone
- if mucoperiosteum is inflamed this motion will reveal the existence and degree of sensitivity caused by the periapical inflammation
- if area is tender to palpation, record LOCATION, EXTENT, and whether SOFT or FIRM

Front 248

What does a positive PALPATION test indicate?

Back 248

- inflammation in periapical tissues spread to the bone and mucosa

Front 249

What are some PULPAL tests?

Back 249

- thermal (hot / cold)
- electric

Front 250

How can one obtain RELIABLE information with a Thermal pulp test?

Back 250

- similar tooth types should be tested and compared

Front 251

What kind of information does a THERMAL TEST often provide?

Back 251

- whether the pulp is healthy, inflamed, or necrotic

Front 252

How will teeth with NECROTIC PULPS respond to a thermal test?

Back 252

- will not respond to thermal stimulation

Front 253

What kind of response will occur when THERMAL TESTING a VITAL TOOTH?

Back 253

- sharp sensation of pain
- may occur regardless of pulp status (normal, reversible, irreversible)

Front 254

What does it mean when a thermal response of pulp is MORE INTESNE and PROLONGED?

Back 254

- irreversible pulpitis

Front 255

When is an ELECTRIC PULP TEST contraindicated?

Back 255

Patients with pacemakers (cardiac)

Front 256

What is the TRUE determinant of tooth vitality?

Back 256

- condition of the tooths VASCULAR supply, not neural

Front 257

What are the main reasons for FALSE POSITIVE responses with an ELECTRIC PULP TESTER (EPT)?

Back 257

- conductor / electrode contact with large metal restoration or gingiva allows current to reach the attachment apparatus
- patient anxiety
- liquefaction necrosis
- failure to isolate and dry the teeth

Front 258

What are the main reasons for FALSE NEGATIVE RESPONSES to electric pulp tests (EPT)?

Back 258

- patient heavily premedicated with analgesics, narcotics, alcohol, tranquilizers
- inadequate contact with enamel
- recently traumatized tooth
- excessive calcification of pulp chamber
- recently erupted tooth with immature apex
- partial necrosis

Front 259

What are some "IF's" that would decide whether the origin of a lesion is PERIODONTAL or ENDODONTIC?

Back 259

ENDODONTIC:
- defect can be probed, it is usually narrow defect as compared to a wider perio defect
- radiographically, when only a portion of the root is involved, or if the furcation is involved when the mesial and distal crestal bone is intact
- pulp is necrotic or partially vital, may either be the cause or contributing factor

PERIODONTAL:
- pulp is vital
- gingiva is inflamed, bone loss is widespread and present on adjacent teeth
- upon probing, plaque or calculus is encountered, defect is diffuse and crater like

Front 260

TRUE or FALSE: Once a lesion does appear on a radiograph, the actual area involved and the amount of bony destruction are greater than the extent shown on the film.

Back 260

TRUE - radiograph

Front 261

When evaluating the radiograph for diagnosis of an endodontic lesion, what are some CORONAL ASPECT FEATURES that one should look for?

Back 261

- relationship of pulp horns to the existing restoration or caries
- presence of prior pulp cap or pulpotomy
- presence of retrogressive changes of the pulp chamber (eg recession, resorption, pulp stones)
- crestal bone levels, presence of calculus
- often canals separate at coronal root level, so additional canals can be detected here

Front 262

TRUE or FALSE: Pulp stones are always pathologic.

Back 262

FALSE - pulp stones are normal characteristic and are not necesserily pathologic

Front 263

When evaluating the radiograph for diagnosis of an endodontic lesion, what are some RADICULAR ASPECT FEATURES that one should look for?

Back 263

- separated roots
- position of canal within the root
- root pathology (calcification, resorption, fracture)
- periapical pathology including osteosclerosis and condensing osteitis
- intracanal aberrations resulting from previous treatment (eg ledging, perforations, instrumental fragments)
- location and type of radiolucency (a lateral radiolucency may indicate a large lateral canal. Teardrop or J shaped may indicate linear fracture

Front 264

What kind of presumption can be made when a canal disappears abruptly near the apex on a straight-line radiograph?

Back 264

- canal is branching into extra canals

Front 265

What are some SPECIAL TESTS that can be done to diagnosis endodontic lesion?

Back 265

- test cavity
- caries removal
- selective anaesthesia
- transillumination

Front 266

How does a TEST CAVITY work?

Back 266

- Small preparation is (without local anaesthetic) made into lingual surface of anterior tooth or occlusal surface of posterior tooth.
- If the tooth is vital, patient will experience pain as bur nears DEJ
- necrotic or inflamed pulp will not yield a comparable response

Front 267

When can TEST CAVITIES be used?

Back 267

- when other tests are inconclusive
- fully crowned or splinted teeth

Front 268

How does SELECTIVE ANAESTHESIA work?

Back 268

- useful in diagnosing painful teeth particularly when patient cannot isolate the offender to a specific arch
- to test within maxilla anaesthesia should be from ANTERIOR to POSTERIOR because of distribution of nerve fibers

Front 269

Define STRUCTURAL CRACK:

Back 269

- break of split in the continuity of the tooth surface without a perceptible separation

Front 270

A tooth with a periapical lesion that fails to resolve after proper RCT and apical surgery should be suspected of what?

Back 270

Vertical root fracture

Front 271

What terms are used for diagnosis of PULP?

Back 271

- normal pulp
- reversible pulpitis
- irreversible pulpitis
- necrotic pulp

Front 272

What are the conditions associated with a NORMAL PULP?

Back 272

- moderate response to pulp stimuli
- response subsides when stimulus is removed
- tooth is free of spontaneous symptoms
- radiograph shows intact lamina dura

Front 273

What are the conditions associated with REVERSIBLE PULPITIS?

Back 273

- sharp thermal response (esp to cold)
- asymptomatic unless provoked by external stimulus
- most commonly caused by defective restoration, restorative procedures, or dental caries

Front 274

REVERSIBLE PULPITIS is most commonly caused by what?

Back 274

- defective restorations
- restorative procedures
- dental caries

Front 275

What are the conditions associated with IRREVERSIBLE PULPITIS?

Back 275

- prolonged response to temperature change
- spontaneous episodes of pain
- pain from change in posture
- intense throbbing pain

Front 276

What are conditions associated with NECROTIC PULP?

Back 276

- possible result of an untreated pulpitis or trauma
- total necrosis usually asymptomatic until PDL affected
- no response to pulp vitality tests
- the crown will darken occasionally with anterior teeth
- possible combination of responses from multi-rooted teeth

Front 277

What are some PERIRADICULAR DIAGNOSES that can be made?

Back 277

- acute apical periodontitis
- chronic apical periodontitis
- acute apical abcess
- Phoenix abcess
- periapical osteosclerosis

Front 278

What are some conditions associated with ACUTE APICAL PERIODONTITIS?

Back 278

- local inflammation of the periapical tissues
- tenderness with percussion
- disease which may occur with vital and non-vital teeth
- PDL which may appear normal or slightly widened

Front 279

What are some conditions associated with ACUTE APICAL ABCESS?

Back 279

- an advanced form of apical periodontitis from a NECROTIC TOOTH
- it may appear normal or with a widened PDL radiographically
- moderate to severe pain
- rapid onset of swelling
- some degree of swelling with extreme tenderness to percussion and palpation
- patient may be febrile
- differential : lateral periodontal abcess (vital pulp)

Front 280

What are some conditions associated with CHRONIC APICAL PERIODONTISIS?

Back 280

- usually asymptomatic but sometimes tender to percussion and palpation
- nonresponsive to pulp vitality tests
- periapical radiolucency
- possibly associated with a sinus tract

Front 281

What are some conditions associated with PHOENIX ABCESS?

Back 281

- chronic apical periodontitis that becomes acute
- symptoms identical to acute apical abcess
- periapical radiolucency
- possible following treatment of necrotic tooth

Front 282

What are some conditions associated with PERIAPICAL OSTEOSCLEROSIS?

Back 282

- low-grade, relatively asymptomatic inflammation of periapical tissues
- present with varied symptoms sometimes
- often found in posterior teeth of yong people
- well circumscribe radiopacity around apices
- if ASYMPTOMATIC and pulp is VITAL, RCT NOT NEEDED

Front 283

What is the KEY to successful management of endodontic emergencies?

Back 283

- Correct diagnosis

Front 284

If you are uncertain of the pulpal status after performing appropriate clinical tests, what should you do?

Back 284

Provide palliative therapy
Give case time to resolve
Wait and watch

Front 285

A "wait and watch" approach for endodontic emergencies is recommended when?

Back 285

- short term sensitivity or discomfort for a few days
- history of any of the following conditions:
- recent dental treatment
- gingival recession
- loss of restoration
- possible coronal fracture

Front 286

What are some causative factors of REVERSIBLE PULPITIS?

Back 286

- high restoration
- incipient or recurrent caries
- a fractured cusp
- fractured restoration
- exposed cervical dentinal tubuels

Front 287

What is a recommended emergency treatment for REVERSIBLE PULPITIS?

Back 287

- sedative restoration (CaOH liner and IRM temporary)
- OR full coronal coverage with a cusp-protected amalgam
- OR temporary crown in the cuspal fracture case

If the symptoms persist for WEEKS then may proceed with endodontic therapy.

Front 288

What is the recommended treatment for IRREVERSIBLE PULPITIS?

Back 288

-removal of bulk of inflamed tissue
- incisors , canines, and most bicuspids are best treated with pulpectomy
- vital multicanaled bicuspid or molar may be best treated with a PULPOTOMY

Front 289

What is the treatment of a NECROTIC TOOTH?

Back 289

- Necrotic tissue MUST be completely removed from the canal system

Front 290

What are your options when a tooth with necrotic pulp is present for an EMERGENCY visit?

Back 290

METHOD A:
- obtain accurate working lengths and instrument canals to their apical constrictions

METHOD B:
- alternate pulpectomy
- canal debridement slightly short of root length

Front 291

What are the steps of a PULPECTOMY?

Back 291

- establish proper access to all canals
- irrigate thoroughly with NaOCl
- debride pulp chamber
- debride the coronal and middle portions of the root canal with Flex-R files
- determine accurate working lengths with radiographs and/or apex locators
- complete canal debridement and initial shaping
- dry canals with paper points, syringe CaOH down into canals, and temporarily seal the access opening

Front 292

What is the most recommended intra-canal medicament?

Back 292

Calcium hydroxide

Front 293

If there is a large delay in completion of the endodontic therapy what kind of restoration should be placed?

Back 293

- Glass ionomer
- Bonded composite

Front 294

What are some symptoms associated with flare-ups after endodontic therapy?

Back 294

- thermal sensitivity
- percussion pain
- swelling

Front 295

FLARE UP after INITIATION of ROOT CANAL THERAPY:
Thermal sensitivity - how should you treat it?

Back 295

- repeat diagnostic tests to identify source
- possibility of missed canal
- may suggest another tooth is non-vital?
- may refer pain to another tooth

Front 296

FLARE UP after INITIATION of ROOT CANAL THERAPY:
Percussion pain - if it is from the initially treated tooth, what are some possible causes?

Back 296

- occlusal prematurity
- inadequate debridement
- overinstrumentation
- apical extension of infected pulpal debris
- resistant to infection
- missed canal
- vertical fracture

Front 297

What are some emergency treatment options for patients with ACUTE ALVEOLAR ABCESSES?

Back 297

- apical trephination
- incision and drainage
- cortical trephination

Front 298

What is the treatment of PERIRADICULAR PAIN determined by?

Back 298

severity of the signs and symptoms and necessity for establishing a drainage route

Front 299

What is the best treatment for patients with MILD to MODERATE PAIN WITHOUT INTRAORAL / EXTRA ORAL SWELLING?

Back 299

- chemo-mechanical debridement of canal system
- apical trephination if necessary

Front 300

Describe APICAL TREPHINATION:

Back 300

- gently pass a #15 1 to 2mm through apical foramen to establish patency
- this will allow periapical drainage if present

Front 301

Patients with MODERATE TO SEVERE PAIN and LOCALIZED INTRAORAL SWELLING can be treated how?

Back 301

Respond rapidly to incision and drainage

Front 302

Patients with MODERATE to SEVERE PAIN AND DIFFUSE INTRAORAL SWELLING should be treated how?

Back 302

- respond to incision adn drainage less rapidly
- if swelling is diffuse and not indurated (cellulitis) then delay incision procedure and:
- prescribe antibiotics, analgesics, moist heat compress, intraoral warm saline rinses to localize the swelling

Front 303

What is critical in treatment of patients with DIFFUSE intraoral swelling?

Back 303

- must be monitored closely because swelling can escalate quickly
- refer to ORAL SURGEON if it does
- may require immediate hospitalization and aggressive antibiotic therapy

Front 304

Prior to starting INCISION AND DRAINAGE, antibiotic therapy should be intiated in what situations?

Back 304

- medically compromised patients
- healthy patients exhibiting signs of a spreading infection (eg extraoral swelling, elevated temperature, or lymphadenopathy)

Front 305

What are some signs of a SPREADING infection?

Back 305

- extraoral swelling
- elevated temperature
- lymphadenopathy

Front 306

What are the proper steps for INCISION AND DRAINAGE?

Back 306

- obtain anaesthesia with nerve blocks
- make horizontal (NOT VERTICAL) incision along INFERIOR base of swelling so that gravity can assist in drainage
- obtain a sample of exudate for culturing and sensitivity testing
- probe into the wound (hemostat or curette)
-

Front 307

What are some causes of hemorrhage from canals?

Back 307

- incomplete tissue removal or missed canal
- overinstrumentation into periapical tissues
- an acute periapical infection
- perforation

Front 308

TRUE or FALSE: Flaring mid and coronal root areas should be done prior to establishing patency of all canals?

Back 308

FALSE

Front 309

What is the objective of coronal access?

Back 309

To expose and unroof the pulp chamber to gain visibility, including removal of pulp horns

Front 310

What instrument is NOT ever needed for access preparation?
a) high speed diamond burs
b) RA steel round burs
c) Gates Glidden Drills
d) Long shank burs
e) swan neck burs

Back 310

c) GATES GLIDDEN

Front 311

How can you identify DENTINE on the floor of the pulp chamber in a molar?

a) it is smooth
b) it is grey
c) it is knobbly
d) it is dark brown
e) it is hard

Back 311

b) GREY

Front 312

What shape is the access cavity for upper and lower incisors?

Back 312

TRIANGULAR

Front 313

What shape is the access cavity for UPPER and LOWER CANINES?

Back 313

OVOID

Front 314

What shape is the access cavity for UPPER and LOWER PREMOLARS?

Back 314

OBLONG

Front 315

What shape is the access cavity for UPPER and LOWER MOLARS?

a) triangular
b) ovoid
c) round
d) oblong

Back 315

TRIANGULAR

Front 316

How many upper incisors have TWO CANALS?

a) hardly any
b) 5%
c) 25%
d) 50%
e) 75%
f) 95%

Back 316

a) hardly any

Front 317

How many lower incisors have two canals?

a) Hardly any
b) 5%
c) 25%
d) 50%
e) 75%
f) 95%

Back 317

50%

Front 318

Where is an "extra" canal often found in upper molars?

Back 318

Mesiobuccal root

Front 319

The opening of the distal canals in molars is usually directly under

a) distal marginal ridge
b) centre of the tooth
c) buccal groove
d) palatal fissure
e) cusp of Carabelli

Back 319

b) CENTRE OF TOOTH

Front 320

Upper first premolars usually have how many canals?

Back 320

Two canals

Front 321

Upper second premolars usually have how many canals?

Back 321

One canal

Front 322

TRUE or FALSE: After entering the pulp chamber, an option is to continue preparation without water spray?

Back 322

TRUE

Front 323

TRUE or FALSE: You should NOT normally extend the access for anterior teeth under the cingulum?

Back 323

FALSE

Front 324

The most important function of the dental pulp is:
a) formation of the dentin
b) nutrition of the dentin
c) protection against carious invasion
d) receptor of impulses, ie. heat, cold, etc

Back 324

b) nutrition

Front 325

Four root canals are most commonly found in the:

a) mand first molar
b) max first molar
c) max second molar
d) max third molar

Back 325

- MAX FIRST MOLAR

Front 326

Root canal should be filled upto:

a) the dentinoenamel junction
b) the cementoenamel junction
c) most constricted apical point
d) none of the above

Back 326

CEJ

Front 327

The greatest curvature is present in which root canal of mandibular 1st molar?

a) distal canal
b) mesiobuccal canal
c) mesiolingual canal
d) all of the above

Back 327

b) MB

Front 328

The cell of the dental pulp that gives rise to several different types of cells is the:

a) endothelial cell
b) macrophage
c) mesenchymal cell
d) odontoblast

Back 328

c) MESENCHYMAL CELL

Front 329

If a third canal is present in the MAX FIRST PREMOLAR then where will it most commonly occur?

Back 329

Facial root

Front 330

What is the order of longest roots in the MAXILLARY FIRST MOLAR?

Back 330

P > MB > DB

Front 331

TRUE or FALSE: Roots of MAXILLARY 2nD MOLAR are LESS DIVERGENT than those of 1st molar?

Back 331

TRUE

Front 332

The maximum stress that restorative procedures impart to pulp is because of the:

a) pressure exerted by handpiece
b) transfer of bacteria via dentinal tubules
c) production of frictional heat
d) speed or rotating bur

Back 332

C. PRODUCTION OF FRICTIONAL HEAT

Front 333

The optimal REMAINING DENTIN THICKNESS to protect pulp from restorative procedures is:

a) 1mm
b) 2mm
c) 0.5 mm
d) 3 mm

Back 333

b) 2 mm is the minimal RDT which induces reparative and health pulp-organ reaction in response to restorative procedures

Front 334

Pain on percussion before endodontic treatment indicates:

a) reversible pulpitis
b) irreversible pulpitis
c) pulpal necrosis
d) inflammation of periodontal tissue

Back 334

d) inflammation of periodontal tissue

Front 335

One of which is NOT manifestation of maxillary sinus disease?

a) tenderness to palpation of maxillary molar/premolar region
b) pain on percussion of maxillary PM-M teeth
c) pain increases on bending forward
d) pain radiating to the ear

Back 335

d) Radiation of pain to ear is NOT a sign of maxillary sinusitis

Front 336

The painful response that subsides quickly when stimulus is removed is characteristic of:

a) normal pulp
b) reversible pulpitis
c) irreversible pulpitis
d) necrotic pulp

Back 336

b) REVERSIBLE PULPITIS: quick sharp hypersensitive response that subsides as soon as stimulus is removed when otherwise tooth is asymptomatic

Front 337

The recommended management of internal resorption is:

a) observe with periodic radiograph
b) assure that resorption is self-limiting
c) institute therapy only when symptoms appear
d) immediate root canal therapy

Back 337

IMMEDIATE RCT

Front 338

The cause of EXTERNAL RESORPTION is:

a) periapical inflammation
b) excessive mechanical / occlusal force
c) impaction of teeth
d) all of the above

Back 338

ALL OF THE ABOVE

Front 339

A specific contra-indication to elective endo therapy is:

a) diabetes mellitus
b) radiation therapy
c) adrenal insufficiency
d) recent history of myocardial infarction

Back 339

d) RECENT history of MI within 6 months and uncontrolled hypertension are principle contraindications to elective endo

Front 340

Single sitting root canal treatment can be done on a tooth which is:

a) asymptomatic vital tooth
b) single rooted
c) multirooted
d) non-vital

Back 340

a) vital asymptomatic teeth

Front 341

Least distortion of tooth image in the periapical X-ray is seen in:

a) paralleling technique
b) bisection techniue
c) distortion is the same in both

Back 341

a) paralleling technique

Front 342

Regardless of stimulus all afferent impulses from the pulp result in sensation of:

a) proprioception
b) pain
c) heat
d) touch

Back 342

b) Pain is the response to all noxious stimuli applied on the pulp

Front 343

Chairside sterilization of GUTTA PERCHA points is best by:

a) 90% alcohol
b) 10% hydrogen peroxide
c) 5.25% of sodium hypochlorite
d) all of the above

Back 343

c) 5.25% sodium hypochlorite

Front 344

Disadvantage of glass bead sterilizer is:

a) that is serves as emergency back up to other methods
b) it can be calibrated for correct temperature
c) its small size
d) only instruments of small mass can be sterilized

Back 344

Can only be used to sterilize small instruments

Front 345

Paraformaldehyde containing root canal cements may be used in:

a) pulpectomy procedure
b) treatment of necrotic pulp
c) treatment of teeth with large radiolucencies
d) temporary pulpotomy procedures

Back 345

Temporary pulpotomy procedures in primary teeth are those in which paraformaldehyde pastes can be used to fix the pulp tissue

Front 346

Most important aspects of irrigation of canal during root canal treatment:

a) volume of irrigants used
b) chelating agents of solution
c) irrigation needle
d) aspiration of the solution

Back 346

The VOLUME of irrigants used is proportional to the debridement required

Front 347

This material has NO inhibitory effect on bacterial growth:

a) amalgam
b) ZnO eugenol
c) calcium hydroxide
d) zinc polycarboxylate

Back 347

a. amalgam

Front 348

The initial priority in treatment of a root fracture:

a) preservation of the pulp
b) reduction and immobilization
c) root canal therapy
d) calcium hydroxide pulp therapy

Back 348

b) Reduction and immobilization
Only 20-40% of fractured roots eventually undergo pulpal necrosis

Front 349

Initial thermal and electric testing of traumatised teeth:

a) establish the base line to physiological status of the pulp
b) if positive, can be assumed to indicate healthy pulp
c) if negative means RCT should be done
d) should be repeated after 30 days to finalise the pulp condition

Back 349

d) thermal and electric testing should be repeated after 30 days because negative response immediately does not indicate pulp death as it may be under shock.

Front 350

Free eugenol in root canal sealer cements is significant because it increases:

a) dimensional stability
b) setting time
c) cytotoxicity
d) strength

Back 350

Free eugenol is NOT biocompatible and increases cytotoxic reaction

Front 351

Working length of a REAMER:

a) 16 mm
b) 20 mm
c) 10 mm
d) 15 mm

Back 351

16mm is the working length, whereas actual length may vary from 21, 25, or 29

Front 352

Solvent used along with Hedstroem file to remove gutta-percha:

a) alcohol 10%
b) sodium hypochlorite
c) chloroform
d) formocresol

Back 352

Guttapercha dissolves in CHLOROFORM

Front 353

The main component of most root canal sealers is:

a) resin
b) precipitated silver
c) zinc oxide eugenol
d) corticosteroid

Back 353

c) zinc oxide eugenol is the base component of most sealers, though eugenol free sealers are available for those allergic to it, eg AH-26

Front 354

Silver cones as canal filling material may be used:

a) narrow curved canals in which enlargement beyond a no 20 or 25 is unadvisable
b) large canals of anterior teeth
c) surgical cases in which root resection is anticipated
d) incomplete large or irregular canals of young patients

Back 354

Silver cones are best suited for NARROW CURVED CANALS because of its rigid nature

Front 355

The disadvantage of gutta-percha as a filling material:

a) biocompatibiltiy
b) difficult of preparing post-space
c) solubility in chloroform and xylol
d) lack of rigidity in smaller size

Back 355

GP's lack of rigidity in small sizes is its main disadvantage because of difficult to maneavre it through small canals

Front 356

According to recent studies, the intracanal medicament with longer lasting antimicrobial effect is:

a) iodine
b) phenol
c) CMCP
d) CA(OH)2

Back 356

CaOH is proved to be the intra-canal medicament of choice.

Front 357

Pulpal inflammation reaches periodontal area through:

a) lateral canals in root
b) apical area of root
c) furcation area
d) all of the above

Back 357

Pulpal inflammation reaches periodontium through all of those methods.

Front 358

Before a root amputation, the canal orifice is sealed with:

a) gutta percha
b) zinc phosphate
c) amalgam
d) sealant

Back 358

Amalgam is used to seal the orifices of canal before a amputation to create perfect seal

Front 359

Canal calcifications:

a) indicate poor prognosis
b) are observed with developmental disorders
c) can be managed with burs
d) require the use of chelating agents for treatment

Back 359

Canal calcifications can be negotiated with the help of a chelating agent like EDTA which softens the dentin.

Front 360

The filling of choice in root canals in primary teeth is:

a) cavit
b) chloropercha
c) ZnO eugenol w/ catalyst
d) CaOH paste

Back 360

Primary teeth are filled with "Resorbable Paste" which contains ZnO eugenol with catalyst which is resorbed along with roots when primary teeth are exfoliated

Front 361

Apexification in teeth with blunder-buss canals is best done with:

a) ZnO eugenol
b) CaOH with CMCP
c) gutta percha
d) endoseal

Back 361

CaOH with CMCP is used for apexification of teeth with wide canals and open apices

Front 362

Formocresol pulpotomy is indicated in:

a) primary teeth free of inflammation or infection
b) permanent teeth with traumatic exposure
c) primary teeth with radiolucency
d) incompletely formed permanent teeth

Back 362

Formocresol pulpotomy is indicated in primary teeth free of inflammation or infection

Front 363

Electric pulp tester:

a) is of great value in determining vitality of primary teeth
b) is not reliable in primary teeth
c) gives accurate results in permanent and primary teeth

Back 363

EPT is NOT reliable in checking vitality of primary teeth

Front 364

What does EDTA stand for>

Back 364

Ethyl-Diamine Tetra Amine

Front 365

Pathologic changes in periapical tissue in primary teeth are more apparent:

a) in apical area
b) in furcation area
c) same in both

Back 365

b) more apparent in the furcation area

Front 366

Primary teeth with internal resorption:

a) should be treated with pulpectomy
b) pulpotomy should be done
c) extraction

Back 366

c) extraction

Front 367

The definitive method for diagnosing tetracycline staining is by:

a) history
b) vitality test
c) UV light
d) visual examination

Back 367

c) UV light is used to distinguish tetracycline stain from fluorosis or other staining of teeth

Front 368

Bleaching of vital teeth:

a) causes irreversible pulpitis
b) utilizes the "walking bleach" technique
c) can initiate cervical erosion response
d) affect both enamel and dentin

Back 368

Bleaching of vital teeth can initiate cervical erosion response

Front 369

What percentage of sodium hypochlorite is used at the school?

Back 369

2.5%

Front 370

Irreversibly inflamed pulps have:

a) analgesia
b) hypoalgesia
c) hyperalgesia

Back 370

c) Hyperalgesia, an altered state with decreased pain threshold and increased / inappropriate response to stimulus

Front 371

What is the best test for determining if pulpal anaesthesia has been achieved?

Back 371

Cold test

Front 372

What are the five cardinal signs of inflammation?

Back 372

rubor - red
tumor - swelling
dolor - pain
calor - heat
functio laesa - loss of function

Front 373

What is the composition of:
TYLENOL #1

Back 373

Codeine = 8mg
Acetaminophen = 300mg

Front 374

What is the composition of:
TYLENOL #2

Back 374

Codeine = 15mg
Acetaminophen = 300mg

Front 375

What is the composition of:
TYLENOL #3

Back 375

Codeine = 30mg
Acetaminophen = 300mg

Front 376

What is the composition of:
TYLENOL #4

Back 376

Codeine = 60mg
Acetaminophen = 300mg

Front 377

What is the composition of:
EMPRACET

Back 377

Codeine = 30mg
Acetaminophen = 325mg

Front 378

What is the composition of:
222

Back 378

Codeine = 8mg
ASA = 375mg

Front 379

What is the composition of:
282

Back 379

Codeine = 15mg
ASA = 350mg

Front 380

What is the composition of:
292

Back 380

Codeine = 30mg
Acetaminophen = 375mg

Front 381

What is the composition of:
PERCODAN

Back 381

Oxycodone = 5mg
ASA = 325mg

Front 382

What is the composition of:
PERCOCET

Back 382

Oxycodone = 5mg
Acetaminophen = 325mg

Front 383

What is your FIRST CHOICE antibiotic for management of dental infection?

Back 383

Penicillin VK
(if ineffective)
Clindamycin / Cephalexin
(if ineffective)
add Metronidazole

Front 384

Show me some COMMON ANTIBIOTIC prescriptions:

Back 384

RX: penicillin VK 300mg
mitte: fifty-eight (58) tablets
sig: iv stat, then ii q6h until done
----------------------------------
RX: erythromycin 250mg
mitte: thirty(30) capsules
sig: ii stat, then i q6h until done
-----------------------------------
RX: metronidazole 250mg
mitte: twenty-eight (8) tablets
sig: i q6h until done
--------------------------------
RX: clindamycin 150mg
mitte: fourty (40) capsules
sig: ii q6h for three days, then i q6h until done

Front 385

What is the general doseage of PENICILLIN V?

Back 385

300-600mg QID

Front 386

What is the general doseage of AMOXICILLIN?

Back 386

250-500mg TID

Front 387

What is the general doseage of CLOXACILLIN?

Back 387

250-500mg QID

Front 388

What is the general doseage of CEPHALEXIN?

Back 388

250-500mg QID

Front 389

What is the general doseage of ERYTHROMYCIN?

Back 389

250-500mg QID

Front 390

What is the general dosing of CLINDAMYCIN?

Back 390

150-300mg QID

Front 391

What is the general dosing of METRONIDAZOLE?

Back 391

250-500mg TID

Front 392

The "walking bleach" technique:

a) uses heat treatment
b) requires patient to report in 24 hours
c) can be done in poorly obturated canal
d) uses mixture of sodium perborate and 35% hydrogen peroxide

Back 392

d) mixture

Front 393

Bleaching in vital teeth CANNOT be done:

a) extremely large pulp horns
b) very dark teeth
c) sensitive teeth
d) all of the above

Back 393

All of the above

Front 394

The smear layer on dentinal walls act to prevent pulpal injury by:

a) its antimicrobial activity
b) eliminating need for cavity liner
c) reduces diffusion of toxic substances through tubules

Back 394

c) reduces diffusion of toxic substances through tubules

Front 395

Biologically active sealers which promote periapical healing contain:

a) ZnO-Eugenol
b) Corticosteroid
c) CaOH2
d) Silver pts

Back 395

ZnO Eugenol

Front 396

Periapical osteosclerosis is characterised by:

a) host resistance to pulpal irritation
b) decreased bone density
c) acute inflammation
d) expansion of cortical plates of bone

Back 396

Results because of host-resistance to pulpal irritation

Front 397

The primary gutta-percha cone must fill the canal wall tightly in the:

a) apical third
b) middle third
c) cervical third
d) entire canal

Back 397

APICAL THIRD - should have good "tug-back" resistance and fit the canal snugly in apical third

Front 398

Recapitulation is:

a) using successively larger files to flare the canal
b) removing the debris with smaller instruments than the instrument that goes to the apex
c) circumferential filing with H-file
d) using various types of files and reamers to enlarge the canal

Back 398

b) Keeping patency = recapitulation

Front 399

Intracanal medication is:

a) necessary for complete canal cleaning
b) prevents post-treatment pain
c) generally contra-indicated
d) placed with paper point

Back 399

a) necessary for complete canal cleaning

Front 400

Three dimensionally filling of root canal does the following:

a) prevents reinfection
b) prevents percolation of periapical exudate into root canal space
c) creates favourable biological environment for tissue healing
d) all of the above

Back 400

all of the above

Front 401

THe most common error while opening pulp chamber of mandibular incisors is:

a) lingual perforation
b) labial perforation
c) incisal fracture
d) lateral perforation

Back 401

B) labial perforation

Front 402

The root canal of mandibular 1st molar with greatest curvature is:

a) M-buccal canal
b) M-lingual canal
c) D-buccal canal
d) D-lingual canal

Back 402

Mesiobuccal has greatest curvature in lower 1st molar

Front 403

"Trigeminal neuralgia" can be distinguished from pain of dental origin by:

a) intensity of pain
b) duration of pain
c) presence of trigger zone
d) pain to heat stimulation

Back 403

Trigger zone.

Front 404

LOWER TEETH ACCESS CAVITIES

Back 404

memorize

Front 405

UPPER TEETH ACCESS CAVITIES

Back 405

memorize

Front 406

What are the SEVERAL CLINICAL PRESENTATIONS that are considered endodontic emergencies?

Back 406

- irreversible pulpitis and normal periapex
- irreversible pulpitis and acute apical periodontitis
- necrotic pulp with acute apical periodontitis with no swelling
- necrotic pulp, fluctuant swelling, with drainage
- necrotic pulp, fluctuant swelling, no drainage
- necrotic pulp, diffuse facial swelling, with drainage through canals
- necrotic pulp, diffuse facial swelling with no drainage

Front 407

What are the primary objectives of CLEANING AND SHAPING of the root canal?

Back 407

- remove infected soft and hard tissue
- give disinfecting irrigants access to the apical canal space
- create space for delivery of medicaments and subsequent obturation
- retain the integrity of radicular structures

Front 408

Define APEXOGENESIS:

Back 408

Maintenance of pulp vitality in an immature tooth to allow for physiologic tooth and root development

Front 409

Define APEXIFICATION:

Back 409

Inducing an apical hard tissue barrier in a tooth with an immature apex where the pulp is necrotic (or removed)

Front 410

What material is used in PHYSIOLOGIC APEXIFICATION?

Back 410

CaOH2

Front 411

What material is used in ARTIFICAL APEXIFICATION?

Back 411

Dentin chips MTA

Front 412

What forms the dentin of the tooth?

Back 412

PULP

Front 413

The pulp has what functions?

Back 413

"Formative, nutritive, sensory, defensive"

Front 414

What is the first phase of treatment in APEXIFICATION?

Back 414

Disinfection of root canal system and dentinal tubules

Front 415

What are some aspects of APEXIFICATION that make treatment difficult?

Back 415

"Thin, weak walls, open apex, difficult to get working length determination, young patient"

Front 416

Who popularized the apexification technique in North America?

Back 416

"Frank, A.L."

Front 417

What are the advantages of performing APEXIFICATION?

Back 417

"Will allow filling of the root canal space, can entomb any remaining bacteria in dentinal tubules, can seal the apical foramen from leakage, can save a tooth that otherwise would have been lost"

Front 418

What are the disadvantages of performing APEXIFICATION?

Back 418

"No thickening of root canal walls, no apical formation"

Front 419

What is the pH of CaOH2?

Back 419

ph = 11 (very basic)

Front 420

What are the disadvantages of using CaOH2 apexification?

Back 420

"Can take a long time to form an apical barrier (> 12 months), several appointments required, permeable/unpredictable barrier (periradicular inflammation may persist), fracture of dentin possible?"

Front 421

What are the characteristics of MTA?

Back 421

"mineral tri-oxide aggregate, high pH, biocompatible, excellent seal, sets in 4-6 hours"

Front 422

What are the advantages of MTA apexification?

Back 422

"Fewer appointments, more predictable barrier, easier on patient"

Front 423

What are the disadvantages of MTA apexification?

Back 423

"No thickening of root canal walls, no apical formation"

Front 424

Does MTA has osteo-inductive activity? Describe?

Back 424

"Yes, induces formation of a cemental bridge at the open apex of teeth undergoing apexification treatment. "

Front 425

TRUE or FALSE: MTA is significantly better than CaOH2 for clinical success of apexification.

Back 425

FALSE: they are about equal

Front 426

What is the difference between APEXOGENESIS and APEXIFICATION?

Back 426

"If pulp is vital in immature tooth then we want to preserve the vitality of at least the radicular pulp. Apexification is done when the tooth is non-vital, so the procedure is done to allow for proper RCT"

Front 427

Describe steps in INDIRECT PULP CAP:

Back 427

partial caries removal -> dycal -> permanent restoration

Front 428

Describe the steps in DIRECT PULP CAP:

Back 428

complete caries removal -> dycal over pulp exposure -> PERMANENT restoration

Front 429

Describe the steps in a PARTIAL PULPOTOMY:

Back 429

complet caries removal -> removal of inflamed pulp ~2mm -> MTA -> permanent restoration

Front 430

What is the order in which ROOT APICES close first?

Back 430

M-D before B-L

Front 431

What kind of a diagnosis would confirm inflammation?

Back 431

Histology

Front 432

When should a pulpectomy be performed?

Back 432

If remaining radicular pulp is clinically inflamed = hemorrhage not controlled

Front 433

What are your options for treatment of a non-vital immature tooth?

Back 433

"Apexification, pulp space revascularization, extraction"

Front 434

CaOH2 has similar radiodensity to what structure?

Back 434

Dentin chips MTA

Front 435

What should the CaOH2 powder be mixed with?

Back 435

"LA, saline, or CHX"

Front 436

When should the CaOH2 dressing be replaced?

Back 436

When voids are present in it (monitored radiographically)

Front 437

Define PULP REVASCULARIZATION

Back 437

the restoration of blood circulation of an organ or area

Front 438

Define REGENERATION

Back 438

replacement of missing;/lost tissue with newly formed functional, structure tissue just like the original tissue

Front 439

Define REVITALIZATION:

Back 439

- new VITAL TISSUE in canal space

Front 440

What are some findings in AVULSION/REPLANTATION studies?

Back 440

- Topical ABX improve pulp space revascularization
- open apex is reuired for ingrowth of new tissue
- necrotic un-infected pulp acts as scaffold

Front 441

What is the aim of ENDODONTICS?

Back 441

- prevention or treatment of apical periodontitis

Front 442

Is bacteria found in the periapical lesion?

Back 442

Not usually

Front 443

What causes apical periodontitis?

Back 443

- direct host tissue damage from bacterial toxins
- toxins induce host defense cells -> inflammation
- host defense cells cause lesion

Front 444

What are some MO's found in previously treated teeth with persisting PAR's?

Back 444

- gram positive predominate
- facultative anaerobes
- enterococcus faecalis in 1/3

Front 445

TRUE or FALSE:
E. faecalis can resist antibacterial effect of CaOH?

Back 445

TRUE

Front 446

What are some treatment options for previously treated endo teeth with PAR?

Back 446

- no treatment
- orthograde endodontic re-tx
- surgical endo tx (apicoectomy / retrofill)
- extraction

Front 447

What are some reasons that an endo can fail? not heal?

Back 447

- inadequate microbial control during initial endo tx
- leakage during final resto placement (no rubber dam?)
- inadequate coronal seal post-endo
- rasistant bacteria
- extra-radicular infection
- cyst?
- inadequate aseptic control
- poor access cavity design
- missed canals
- inadequate instrumentation
- leaking temps
-ledged canals

Front 448

What is the hallmark of foreign body reaction?

Back 448

multi-nucleated giant cells

Front 449

In the Ray and Troppe study which had HIGHEST SUCCESS?

Back 449

highest = GE + GR
lowest = PR + PR
GR + PE > GE + PR

Front 450

Exposed root canal filling material leaks in as little as how many days?

Back 450

3 days

Front 451

What are the different types of endo emergencies?

Back 451

- symptomatic irreversible pulpitis
- symptomatic apical periodontitis
- acute apical abcess
- flare up
- hypochlorite accident

Front 452

What is the difference between EMERGENCY and URGENCY?

Back 452

- True emergency is a condition that requires an unscheduled office visit, severity of problem means it can't be rescheduled

Front 453

What are some examples of "URGENCY" type cases?

Back 453

- reversible pulpitis: cold pain that does not linger
- asympto irreversible pulpitis, chronic apical abcess, or asympto apical periodontitis
- hyper-sensitive teeth caused by exposed dentin
- sensitivity due to whitening

Front 454

What are the most important factors in emergency situations?

Back 454

- establish and maintain control of situation
- gain confidence with patient
- provide attention and sympathy
- treat patient as an important individual

Front 455

What is your management of symptomatic irreversible pulpitis?

Back 455

- anaesthesia
- access
- pulpectomy (30file) or otomy
- intracanal medicament
- temp resto
- relieve occlusion

Front 456

What is the most important thing to rule out in Symptomatic apical periodontitis?

Back 456

- rule out crack using tooth slooth

Front 457

What is the management of Acute APical Abcess?

Back 457

- anaesthesia
- establish drainage and/or incision
- ABX (Pen VK)
- Anaglesics (NSAIDs)

Front 458

What is a key symptom in SYMPTOMATIC IRREV PULPITIS?

Back 458

- hot pain

Front 459

What is the key symptom in SYMPTO APICAL PERIODONTITIS?

Back 459

- percussion pain

Front 460

What is the key symptom in ACUTE APICAL ABCESS?

Back 460

- swelling-

Front 461

What is the composition of IRM?

Back 461

Zinc oxide and eugenol

Front 462

What is the composition of Cavit?

Back 462

- zinc oxide and Ca sulfate

Front 463

What is the time span for Cavit?

Back 463

0-4 weeks

Front 464

What are some reasons a 2-visit appointment may be needed?

Back 464

- Root canal anatomy
- Inability to obtain dryness at obturation
- procedural complications
- Time restriction (patient, doctor)
- Patient co-operation (age, med condition)
- TMJ problems
- Pre-op diagnosis (large swelling, purulent, cystic)
- Ability to obtain infection control
- Inability to keep mouth open
- Not able to stay in physical position for long
- Not able to leave work for long periods of time

Front 465

What are some advantages of 1 visit endo?

Back 465

- lower flare up rate
- dont have to refamiliarize yourself with tooth
- environmentally friendly
- less expensive
- accepted by patients

Front 466

What are some pathways of communication between dental pulp and the periodontium?

Back 466

- apical foramen
- dentinal tubules
- lateral and accessory canals