Endo Flashcards by Simran Sandhu

Define Endodontology

the understanding of the dental pulp form, function, health, injuries and the science of diseases

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What is Endodontics?

the skills required for the prevention and treatment of endodontic infections

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What do you have to Consider in Regards to the tooth?

history of pulp-dentine complex
pulp function
pulp space anatomy
cause of injury
peri-radicular pathology
technical aspects determining success

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What are the 4 Functions of the Pulp?

development of the tooth
sensation
nutrition - blood supply
defence

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Describe No. of Roots of each Teeth

lowers central, lateral, canine, premolars = 1 root
lower molars = 2 roots

upper central, lateral, canine = 1 root
upper 1st pre-molar = 1 or 2
upper 2nd pre-molar = 1
upper molar = 3

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What do you Need to Know About Each Tooth?

pulp chambers
canal shapes
no of roots
no and length of root canals
how to gain access

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What are 5 Pulp Responses?

Inflammation
Secondary Dentine
Recovery
Necrosis
Arterio-Venous Shunts

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What is the Process of Caries Infecting the Pulp?

demineralisation
extends in the dentine
pulp is inflamed
pulp lays down tertiary dentine
to relieve intra-pulpal pressure, arterio-venous shunt is formed
= infection stays in one place
flow of dentinal fluid from the pulp causes pain
= more inflammation, more pain
pulp chamber calcifies and shrinks
pulpal necrosis

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What are the Last Nerve Cells to Die?

C-fibres - explains the severe pain

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What Tissues and Areas do you Anaesthetise?

upper incicisor
= buccal infiltration and/or palatal

upper molars
= buccal infiltration and palatal

lower canine
= mental infiltration and or lingual

lower molar
= ID block, long buccal infiltration, lingual block

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Why May Anaesthesia not work?

Hyperaemic Pulp
- large number of dilated congested blood vessels

Infection
- nerve c fibres = hyperextendable so may not block conduction
- pH can be too acidic

Patient Factors
- increased vascularity - solution removed rapidly
- individual response
- pain threshold

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What do you Isolate With?

rubber dam
oraseal putty - seal small gaps

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Why do you Isolate? (4)

protect patient airway from risk of ingestion/inhalation from instruments
protect patient airways from irrigants
prevent oral bacteria recontamination
improves access and visualisation

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what should be ensured regarding the condition of the tooth before endodontic treatment is commenced?

the crown is deemed restorable
caries and defective restorations are removed
it will be a sound coronal restoration

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What is the Purpose of Pre-Operative Radiographs?

no of roots
no of canals
morphology
current restorations
caries presence
presence of canal sclerosis/stones/previous RCT

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What Is the Aim of Coronal Access?

remove roof of pulp chamber
no damage to pulp floor
good visualisation
retentive for temp restoration

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What is the Difference between Gates-Glidden Burs and Regular burs

safe ended - no cutting flutes or diamond at the tip
- can remove safely around the pulp chamber floor

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How do you Mechnically Prepare the 2/3 Chamber Access?

Step-Down Technique
- create funnel shape
- removes most heavily infected area
- prevent bacteria being carried apically
ONLY FOR THE CORONAL 2/3

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How do you Create a Tapered Funnel?

use the smallest file
work up to the apex constriction until it is loose
irrigate each file
keep increasing the file size until master apical is reached

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How do you Mechanically Prepare the 1/3 Apical?

K-flex files

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What Chemicals are Used?

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EDTA with files
= lubricate canals
= remove smear layer

Sodium Hypochlorite irrigant

4 Pros and 2 Cons of NAOCl

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destroy microorganisms
dissolve organic matter
lubricant
biocompatible
bleach clothes
problems if contact with healthy tissue

What Intra-Canal Medicant is Used between Visits and Why (7)?

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calcium hydroxide paste

easy to use and remove
cheap
long-lasting
antibacterial
anti-inflam
non-irritant
promote periapical healing

Why May a Temp Restoration be Placed?

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when the treatment is not completed in one visit

seal the tooth
restore function
prevent over-eruption
restore aesthetics

What are some Common Temporary Materials?

kalzinol (zincoxide eugenol), glass ionomer, polycarboxylate cement

What are the 2 Aims of RCT?

provide hermetic seal of the canal system prevent microorganisms from entering and re-infecting t

What is Used to Obturate the Canals? Describe its Properties.

GP points - gutta percha made of zinc oxide and radioopaquers properties - visco-elastic - softened by heat/solvents

How does the Apical Region Differ from Coronal Region?

- low oxygen levels - nutrients are from periradicular tissues rather than oral cavity - bacteria is less accessible to treatment

What is Periapical Disease?

disease progresses to periapical as there is no physical or biological barriers to microbial ingress

What are the 4 Zones of Inflammation in Periapical Disease?

Inf = infected C = Contaminated Irr = irritated Stim = stimulated

What is in a Periapical Lesion?

granuloma consisting of: 45% epithelialise granulomatous tissue - fibroblasts fibrous capsule over: - small blood vessels - lymphocytes - plasma cells - macrophages

Describe Reversible Pulpitis

short duration sharp pain sensitive to cold and sweet pain is in response to stimulus

Irreversible Pulpitis

long duration throbbing, aching pain sensitive to hot, can be relieved by cold exacerbated by pressure spontaneous

Which 3 Neurons are Responsible for Pain?

AB = small diameter, myelinated = touch and pressure = low threshold = fast Ad = small diameter, myelinated = temperature = low threshold = fast C = large diameter, unmyelinated = high threshold = slow dull pain

What are the Problems on Diagnosing?

can only correctly diagnose when the tissue is removed - by then too late relies on patients symptoms to be accurate

Define SOCRATES

Site Onset Character Radiation Alleviation Time Exacerbating factors Severity

How can you Check Neural Response?

Electric Pulp Test Cold test

What is the Best Choice of Radiograph?

periapical

4 Pulpal Diagnoses in Order of Severity.

Dentine Hypersensitivity Reversible Pulpitis Irreversible Pulpitis Pulpal Necrosis

5 Endodontic Diagnoses in Order of Severity/

Acute Apical Periodontitis Chronic Apical Periodontitis Acute Exacerbation of Chronic Periodontitis Chronic Periapical Periodontitis with Suppuration Peripapical Abscess

How can you detect the Apical Constriction?

EAL - electronic apex locator diagnostic radiograph

What is the Apical Constriction?

the point at which PDL and root dentine meet

How do you Establish the Working Length?

use EAL - get zero reading and subtract 0.5mm - the zero reading is the point in which the canal ends - if you work to zero = wide apical constriction

What are other Chemical Irrigants aside from NaOCl and why are they not used?

EDTA - not antimicrobial, doesn't dissolve organic tissue Chlorhexadine - does not dissolve organic tissue - highly toxic when mixed with NaOCl = para-chloroaniline - carcinogenic precipitate

How much Irrigation is Used?

30ml

What is a heated plugger used for?

removing excess GP compacting GP in the coronal 1/3 root canal DO NOT LEAVE GP IN THE PULP CHAMBER

Describe Chemomechanical Preparation.

mechanical and chemical preparation of the canal - using Gates-Glidden burs - step-down technique - files to clean - use EDTA chelating agent - irrigate

What Intra-Canal Medicament is used to Be Placed in the Canals between Visits?

calcium hydroxide paste

Endodontic Sealers are used on the GP Points, give 3 Materials that are used.

zinc oxide eugenol, calcium hydroxide, glass ionomer

Endodontic Sealers are used on the GP Points, give 3 Materials that are used.

zinc oxide eugenol, calcium hydroxide, glass ionomer

After the Tooth has been Prepared, what are the 11 Steps.

1. choose GP with the same size point as master apical file 2. dry canals with paper points 3. place sealer on GP and insert 4. place finger spreader to compact against the wall 5. fill in the space with accessory GPs 6. repeat until you cant find any more in 7. take radiograph to ensure the root is filled to the correct length 8. use heated plugger 9. seal it in 10. final restoration 11. final radiograph

Endo Flashcards

(51 cards)