1
Q
4 ways to dx vertical root fracture
A
- transillumination
- wedge and x-ray
- perio defect
- tooth slooth
2
Q
vertical fracture through ROOT has __ prognosis unless you can remove the segment and ___ and ___ are performed
A
HOPELESS prognosis unless GINGIVOPLASTY and ALVEOLOPLASTY
3
Q
tooth with vertical root fracture has ___ prognosis
A
POOR prognosis
4
Q
most vertical root fractures are caused by?
A
using too much CONDENSATION FORCE during OBTURATION
5
Q
anterior tooth fractures are usually caused by
A
accidental trauma
6
Q
cracked tooth syndrome is characterized by
A
sharp, brief pain occurring unexpectedly when pt is chewing
7
Q
3 types of flaps
A
- submarginal curved (semilunar)
- submarginal triangular and rectangular (ochsenbein-leubke)
- full mucoperiosteal (full thickness)
8
Q
submarginal curved flap (semilunar)
A
half moon shaped, curved horizontal incision in mucosa or attached gingiva with concavity towards apex
NOT for anterior tooth root-end surgery
9
Q
disadvantages of submarginal curved flap (semilunar) (4)
A
- limited access and visibility
- tearing of incision corners
- incision over bony defect -> scars
- incision limited by attachments (frenum muscles)
10
Q
submarginal triangular and rectangular flap (ochsenbein-leubke)
A
requires 4 mm attached gingiva, healthy periodontium
scalloped incision in attached gingiva with 1 or 2 vertical incisions
LESS risk of incising over bony defects
no post-surgery gingival recession
CAN be indicated for root end surgery on anterior tooth
11
Q
disadvantages of submarginal triangular and rectangular flap (O-L)
A
hemorrhage and scarring
12
Q
advantages of submarginal triangular and rectangular flap (O-L)
A
better access and visibility > semilunar flap
NOT better than full mucoperiosteal flap
13
Q
full mucoperiosteal (full thickness)
A
allows max. access and visibility
raised from gingival sulcus (elevating gingival crest + interdental gingiva)
outline precludes incisions over bony defects -> allows perio tx (curettage, SRP, bone re-shaping)
CAN be indicated for root-end surgery on anterior teeth
14
Q
disadvantage of full thickness flap
A
difficult to reposition, suture, alter
gingival recession possible
15
Q
electric pulp tester has HIGHER current if
A
tooth has CHRONIC PULPITIS
16
Q
EPT checks vitality by
A
stimulating nerve endings with a LOW CURRENT and HIGH POTENTIAL DIFFERENCE in voltage
17
Q
EPT results
- acute pulpitis = ___ current
- chronic pulpitis = ___ current
- hyperemia = ___ current
- pulp necrosis/abscess = ___ current
A
- acute = LOWER than normal (acute inflammation lowers pain threshold)
- chronic = HIGHER than normal
- hyperemia = LOWER than normal, but HIGHER than (1) acute pulpitis
- necrosis/abscess = NO response
18
Q
EPT gives false (+) in these circumstances
A
- pus-filled canal
2. nervous pt
19
Q
EPT gives false (-) in these circumstances
A
- recent trauma
- insulating restoration
- gloves
20
Q
EPT also not reliable in these circumstances
A
- secondary dentin deposits
- moisture contamination
- immature tooth (open apex)
- pt taking analgesics
21
Q
SLOB rule
A
lingual CLOSEST to cone
buccal FARTHER from cone
22
Q
if xray taken from MESIAL, the lingual surface (ML canal) will appear more ___ than the buccal surface (MB canal) which appears ___
A
ML canal more MESIAL
MB canal appears farther DISTALLY
23
Q
if xray taken from DISTAL, the lingual surface (ML canal) will appear more ___ than the buccal surface (MB canal) which appears ___
A
ML more DISTAL
MB more MESIALLY
24
Q
Dx tests for recently traumatized teeth (4)
A
- soft tissue exam
- hard tissue exam
- xray
- observe adj. and opposing teeth for injury
25
Dx tests CONTRAINDICATED for recently traumatized teeth (2)
1. EPT - pulp undergoes temp. paresthesia
| 2. percussion - painful
26
radiation safety
1. stand 6 ft away, 90-135 deg. to beam
2. FAST E-speed film
3. 70 kVp or higher (higher = lower dose)
4. collimation < 2.5 in.
5. use lead apron and thyroid collar
6. max. dose = 50 mSv/yr
27
PULPOTOMY indicated for (4)
1. cariously exposed primary teeth with healthy pulp
2. trauma or carious exposure of immature permanent teeth
3. instead of EXT when you can't RCT
4. emergency for permanent teeth with acute pulpitis
28
can you do pulpotomy on fully developed permanent teeth?
NO. Not successful - it's only temporary tx
29
if doing pulpotomy on immature permanent tooth and bleeding isnt controlled you:
amputate at more apical level
30
uncontrolled bleeding is a sign of
inflamed pulp tissue
31
for successful pulpotomy radicular pulp must be
uninflamed (can always go more apical)
32
if apical amputation in pulpotomy can't control bleeding then:
use hemostatic agents and monitor
if vitality lost -> APEXIFICATION (pulpectomy)
33
pulpotomy is removal of ___ contents
pulp chamber only
34
APEXIFICATION goal
induce further root development in pulpless (dead) tooth by stimulating formation of hard substance at apex to allow obturation of root canal space
35
apex closes ___ yrs after eruption
2-3
36
apexification procedure
1. isolate, access, remove all pulp
2. calcium hydroxid-methylcellulose paste (ex. pulpdent), double cement seal
3. recall 3 mo. (if no apexification, new paste)
4. RCT
37
CaOH action
promotes formation of hard substance at root apex by creating ALKALINE environment
38
permanent tooth fractures, has fully formed root, LARGE exposure
what tx?
RCT
don't need apexification because root is formed
39
permanent tooth fractures, has fully formed root, SMALL exposure, SHORT TIME (30 min. - 1 hr.)
what tx?
DIRECT PULP CAP with CaOH
40
what is a PULP CAP?
most common dressing for pulp cap is?
sedative and antiseptic dressing on exposed HEALTHY pulp; allows recovery and maintain normal fxn and vitality
Dycal = calcium hydroxide
41
2 situations where pulp cap has better success
1. accidental exposure of pulp (NOT carious)
| 2. pulp of young child (NOT older ppl)
42
young pulps are more/less vascularized?
MORE, so more amenable to repair
43
pulp cap repair occurs when ____ forms at the exposure site
dentin bridge
44
pulp capping not recommended in primary teeth with CARIOUS exposures because
- high failure rate
| - pulpotomy very successful
45
if pulp cap fails and tooth becomes symptomatic, might not be able to RCT because of
___ can also cause pulp space calcification and cause a ___ color
severe calcifications in root canal -> perf
trauma; yellow
46
INDIRECT PULP CAP is
procedure is
calcium hydroxide base on thin layer of questionable dentin remaining over pulp
1. 3-4 mo. wait then reopen tooth
2. remove remaining decay
47
if indirect pulp cap and SYMPTOMATIC (heat, percussion) and exposure
eventually RCT
in meantime, EUGENOL + IRM
48
DIRECT PULP CAP is
calcium hydroxide base directly on SMALL (< 1 mm) exposure
49
favorable factors for direct pulp cap
- uninflamed pink pulp
- no excess bleeding
- no symptoms of pulpitis
- small non-carious exposure (mechanical)
- clean cavity
50
direct pulp capping very successful in __ teeth
immature
51
direct pulp cap goal
stimulate DENTIN BRIDGE; preserve underlying pulp tissue in healthy condition
52
don't do direct pulp cap on teeth with
hx of pain, percussion (+), periapical radiolucency
---> RCT
53
failure of direct pulp cap indicated by
symptoms of pulpitis or no vitality
54
adverse responses after direct pulp cap (3)
1. necrosis
2. calcification
3. internal resorption
55
criteria before canal is obturated (4)
1. good preparation to allow debridement and access to apex
2. asymptomatic tooth; dry
3. negative bacteria culture
4. no nerve (shouldn't respond to thermal test)
56
ACCESS PREP objectives (4)
1. straight line access
2. conserve tooth
3. unroof pulp chamber
4. remove pulp horns
57
what kind of access for maxillary primary incisors?
facial
58
common access istakes
1 Md molars - mesial under marginal ridge, lingual under lingual cusps
2. Md incisors - perf
3 Mx 1st PMs - perf
59
DEBRIDEMENT is
removal of foreign material and contaminated/devitalized tissue
60
most crucial aspect of RCT is
CHEMOMECHANICAL debridement
61
best/most reliable indicator of good debridement is
glassy, smooth walls
62
clean shavings on file or clean irrigant can measure good debridement, T/F?
F
inaccurate! need glassy, smooth walls
63
most common cause of root canal failure is
incomplete/inadequate disinfecting the root canal
64
2nd most common cause of root canal failure is
__%?
leakage from badly filled canal
40%
65
most effective way to reduce canal microorganisms is
complete canal debridement
66
objectives of root canal OBTURATION (3)
1. fluid tight seal at apical foramen
2. filling of root canal space
3. favorable biologic environ. for tissue healing
67
if accessory/lateral canal not filled during obturation, the tx is:
eval every 3 mo.
68
after endo, takes ___ mo. before you see radiolucency get smaller on xray
6-12 mo.
69
after RCT, desirable changes are (3)
1. regeneration of alveolar bone
2. deposition of apical cementum
3. PDL re-establishment
70
indications for solvent-softened custom GP cones (3)
1. no apical stop
2. abnormally big apical portion of canal
3. irregular apical portion of canal
71
solvent softened custom cones not used if __ is achieved
TUGBACK
it doesn't result in a better apical seal; should have a APICAL SEAT
72
master cone should reach how far
to apical position of prep or 1 mm short of foramen
73
why do you recapitulate?
clean apical segment of DENTIN filings not removed by irrigation
use your MAF after each increase in file size
74
regaining canal patency
- crown down (large to small)
- rotary > heated instruments
- light pressure with NiTi rotatry files
75
glass bead sterilizer sterilizeds files in __ sec at __ temp
```
15 sec
200 C (428 F)
```
76
techniques to remove GP
- rotary
- ultrasonic
- heat
- heat + instrument
- file
- chemical
77
reagent to dissolve GP
chloroform
others - xylol, halothane, benzene, carbon disulfide, essential oils, methyl chloroform, white rectified turpentine
78
irrigants (3)
1. sodium hypochlorite (NaOCl)
2. hydrogen peroxide (3%)
3. urea peroxide (gly-oxide)
79
irrigant bactericidal action better than ___
intracanal meds
80
NaOCl
- most common
- conc. in 1%, 2.6%, 5.25% (not agreed which is best, all OK)
- good tissue solvent, antimicrobial, lubricant
- toxic to vital tissue
81
can disinfect GP points in __ solution for how long?
5.25% NaOCl, 1 min.
82
2 modes of action of hydrogen peroxide (H2O2)
1. BUBBLING - foams debris from canal, an EFFERVESCENT effect
2. liberation of OXYGEN - kills anaerobic bacteria
83
Urea peroxide (gly-oxide)
- avail. in anhydrous glycerol base (gly-oxide) to prevent decomposition
- better tolerated by tissue than NaOCl
- has BETTER solvent action and MORE germicidal than H2O2
84
good irrigant for canals with normal PA tissue and WIDE apices
urea peroxide (gly-oxide)
85
best use for gly-oxide is ___ canals
narrow, curved
utilize slippery effect
86
chelating agents (3)
1. ethylene diamine tetra-acetic acid (EDTA)
2. EDTAC (EDTA + Cetavlon)
3. RC-Prep
87
chelating agents act on ___ tissues with little effect on ___ tissues
work on CALCIFIED tissues with little effect on PERIAPICAL tissue
88
action of chelating agents
act by substituting Na+ ions that combine with dentin to form soluble salts for Ca+ ions that are bound in a less soluble combination
canal edges become softer
helps prepare sclerotic canals after apex is reached with a fine instrument
89
EDTA
- removes mineralized portion of smear layer
- self-limiting, decalcifies up to 50 mm of root canal wall, stops as soon as chelator is used up
- 17% conc.
- active in canal 5 days
90
EDTAC (EDTA + Cetavlon)
- greater antimicrobial action than EDTA
- more inflammatory potential
- inactivated by NaOCl
91
RC Prep
- foamy solution
- combines EDTA and urea peroxide
- provides chelation and irrigation
- natural effervescense increased by irrigation with NaOCl
92
zinc oxide eugenol
- based root canal sealer
| - fill discrepancies between core filling material and dentin walls (more important than core filling)
93
ZOE functions (3)
1. lubricant for gutta percha
2. forms bond btw gutta percha and dentin
3. antibacterial
94
ZOE disadvantages
- staining
- slow setting time
- non-adhesion
- solubility
95
radiopacity in sealers are from
metallic salts
96
after filling canal with gutta percha, if there is a horizontal line of material (gp or sealer) extending mesially and distally from canal to PDL space -> indicates ___
root fracture
97
MTA
- best retro filling material
| - seals APICAL portion of canal
98
___ must be placed when an apical seal may be faulty
reverse filling (MTA)
ex. calcified root canal
99
advantages of MTA (5)
disadvantages of MTA (2)
pros
1. radiopaque
2. hydrophilic
3. biocompatible
4. non-toxic
5. induces hard tissue formation
cons
1. hard to manipulate
2. long-setting time
100
apicoectomy
oblique resection of most apical portion of root
flap tissue, buccal bone around root apex removed, area curetted
101
indications for apicoectomy
- reverse filling placed, need to gain access to area of pathosis
- poorly filled apical portion removed to level of canal obturated
102
most common reason for apicoectomy and retrograde filling
retreating teeth with posts
103
indications for periradicular surgery
1. non-negotiable canal, blockage, severe root curvature
2. complications from accidents ex. instrument separation, ledge, perf
3. failed tx from irretrievable posts or root fillings
4. horizontal apical fractures where apical end of pulp becomes necrotic
5. biopsy to dx non-odontogenic causes of symptoms
104
periapical curettage
same as apicoectomy but does NOT remove root apex
objective: remove and examin diseased tissue and determining extent of lesion
105
most common bleaching agent for endo tx teeth
superoxol
106
superoxol
30% aqueous solution by weight of H2O2 in distilled water
potent oxidizing agent whose bleaching effect is from direct oxidation of stain-producing substances
107
superoxol technique
apply heat to superoxol-saturated cotton pellets in tooth chamber; repeat until tooth is lighter
heat liberates oxygen in the bleaching agent
108
most probable post-op complication of bleaching is
acute apical periodontitis
109
acute apical periodontitis (AAP)
- pain triggered by chewing or percussion
| - alone does not indicate irreversible pulpitis
110
AAP indicates
irritated apical tissues assoc. with a vital pulp with potential reversible pulpitis
111
walking bleach technique
place thick paste of sodium perborate and 203 drops of superoxol in tooth chamber with temporary restoration
112
broken instrument past apex -> what tx?
surgery
easier if wedged coronal or at curvature of canal but difficult if passed canal curvature
113
if instrument breaks in canal and periapical radiolucency present with minimal canal enlargement before the accident -> what tx?
surgery because periapical tissues had little opportunity for healing
obturate to block then apicoectomy sand retrofilling
114
if instrument breaks in canal's APICAL 1/3 and lodged tightly and no radiolucency
remaining space filled with gutta percha, eval. 3-6 mo. recall
115
prognosis of tooth with broken instrument is best if
vital pulp
| no periapical lesion
116
nickel titanium methods
1. push and pull stroke
2. reaming motion
3. engine-driven rotary (only reaming)
117
what determines canal preparation's shape
instrument's ACTION
| not type of instrument
118
filing
push-pull with emphasis on withdrawal troke
- more efficient than reamers
- greater number of flutes in contact with walls
- produces canal IRREGULAR in shape -> must be filled with gutta percha
119
reaming
clockwise rotation especially in insertion
- canal is ROUND in shape
- most efficient if using a silver cone to fill
120
circumferential filling
push-pull filing that scrapes walls to create smooth, tapered prep
-enhances prep when flaring method used
121
canal's widest diameter should be at ___; narrowest diameter at ___
widest at ORIFICE
| narrowest at dentinocemental junction (0.5-1.0 mm from radiographic apex)
122
___ mm from apex is where teeth should be filed to and filled
0.5-1.0 mm
123
barbed broaches are for
removing pulp tissue, cotton, other soft materials
NOT for canal enlargement
barbs represent a weakened point
124
hedstrom files are an effective ___ instrument
H-Type stainless steel
made using a sharp, rotating cutter to gauge triangular segments out of round blank shaft to make a sharp edge
125
hedstrom files should be used only with a ___ action
FILING
-> planes dentin walls faster than K-files or reamers
126
S-file is a modified ___ file
Hedstrom
127
K files are best for removing
hard tissue to ENLARGE canals
made by twisting a blank (SQUARE stainless steel rod)
128
K-file action in canal is in what direction?
directs pressure in what direction?
clockwise-counterclockwise
direct pressure apically (filing or reaming action)
129
what type of file is the strongest and cuts least aggressively?
K-file
K-flex file is a modified K-file
130
2 types of K isntruments
1. K files
| 2. Reamers
131
reamers have more/less flutes than k-files?
FEWER
132
reamers are used in canals to ___ in only a ___ action to enlarge canals
remove debris using clockwise/counterclockwise reaming action?
place materials in apical portion using clockwise/counterclockwise rotation?
SHAVE DENTIN in reaming action
CLOCKWISE for debris
COUNTERCLOCKWISE for materials
133
5 critical factors to manage traumatic avulsions
1. time
2. storage media
3. tooth socket - don't curette
4. root surface - don't scrape, dry
5 splint stabilization - up to 2 wks to allow reattachment of PDL
134
teeth replanted by __ min show little resorption
teeth replanted after ___ hrs have extensive root resorption
30
2 hrs
135
best storage media
MILK
because of neutral pH 6.5-6.8 and osmolality (for cell survival)
136
mgmt of avulsed permanent tooth replanted within 2 hrs of trauma
10-14 days after replant - clean and shape + CaOH
replace every 3 months for 1 yr
if resorption stopped, fill with gp
137
mgmt of avulsed permanent tooth > 2 hrs of trauma
ankylosis and ext root resorption probably after 2 yrs
RCT BEFORE replantation
soak tooth in 2.4% fluoride solution at 5.5pH for 20 min.
curette blood clot, irrigate with saline
rinse tooth with saline, replant
splint 4-6 wks
138
in re: avulsed tooth out > 2hrs
ankylosis gives better/worse prognosis than ext root resorption
BETTER
ext root resorption leads to failure
139
PDL cells die after __ min
60 min. of dry storage
tap water is just as bad!
140
saliva has storage up to __ hrs
| milk has storage up to __ hrs
```
saliva = 2
milk = 6
```
141
when do you RCT teeth with complete roots after avulsion?
asap!
142
teeth with incomplete roots might not need RCT if replanted within ___ min
30
143
what is the most frequent sequela to avulsed tooth replantation?
root resorption
144
external root resorption is caused by
- periradicular inflammation
- dental trauma
- ortho
- impacted teeth
- bleaching of non-vital teeth
145
external root resorption is always accompanied by __ and is the chief cause of failure of replantation of permanent teeth
bone resorption
146
3 types of external root resorption
1. surface
2. external inflammatory resorption
3. replacement resorption
147
surface resorption (1)
- caused by ACUTE INJURY to PDL and root surface
- healing forms new cementum and PDL
- root resorption limited to cementum, can heal, can't see on xray
148
external inflammatory resorption (2)
infected pulp complicates resorptive process; BOWL-SHAPED resorption areas
- involves cementum and dentin
- need necrotic pulp and bacteria
- immediate RCT stops it
149
replacement (ankylotic) resorption (3)
substituted by bone
150
causes of internal (inflammatory) root resorption
dental trauma, partial removal of pulp (pulpotomy), caries, pulp capping with calcium hydroxide, cracked tooth
151
INTERNAL (inflammatory) ROOT RESORPTION
- causes loss of vitality
| - inflammation from infected CORONAL PULP is usually the cause
152
teeth with internal resorption have hx of
trauma, crown prep, pulpotomy
153
undifferentiated reserve C.T. pulp cells are activated to form ___ that resorb tooth structure in contact with pulp
dentinoclasts
154
in internal resorption, what does the root canal look like
anatomy is altered and increases in size, appears as irregular radiolucency, the canal "disappears" into the lesion
155
tx of choice when internal resorption is detected
PULPECTOMY so resorption stops
156
internal resorption can only occur when
some pulp tissue is VITAL
note: negative does not rule out this etiology
157
pink tooth is a sign of ____
pink cause of ___
pathognomonic sign of internal resorption;
sometimes a sign of cervical root resorption
pink cause of granulation growth undermining coronal dentin
158
INTENTIONAL REPLANTATION (replant sx) and its indications (4)
-tooth that needs endo is removed, prepped, and returned
Indications
1. routine endo is impossible
2. canal blocked and periapical sx impractical
3. perf
4. previous tx failed, but non-sx tx or sx impractical
*only consider when no other alternative tx to maintain
159
how should the socket wall be treated during replantation?
don't touch!
160
why don't you replant primary teeth?
potential danger to permanent successor
| -infxn, ankylosis
161
functions of PULP (3)
1. dentin formation
2. induction - forms dentin -> enamel formation
3. nutrition - tubules (hydration, form peritubular dentin)
162
first formed dentin laid before odontoblast layer is organized is ____
mantle dentin
163
most dentin is ___ dentin
circumpulpal
164
___ dentin forms after eruption and through life; results in gradual asymmetric rdxn in pulp size
secondary
165
irregular and disorganized dentin layer in response to injury or irritants
tertiary dentin (reparative)
166
as dental pulp ages, # of reticulin fibers increases/decreases
DECREASES
pulp is LESS CELLULAR and MORE FIBROUS
size of pulp decreases
167
as pulp ages, collagen fibers and calcifications within pulp increase/decrease?
INCREASE
168
pulp stones
calcifications assoc. with chronic pulpal disease
169
nerves in pulp
- myelinated (sensory)
- unmyelinated (motor) = regulate lumen size of blood vessels
- afferent sympathetic
170
are proprioceptors present in pulp?
NO
| they respond to stimuli regarding movement
171
what is the only nerve ending found in pulp?
free nerve endings
- it's a SPECIFIC pain receptor
- regardless of source of stimulation, the only response is PAIN
172
cells in pulp;
cells in DISEASED pulp
pulp
1. fibroblasts (mainly)
2. odontoblasts
3. histiocytes (macros and lymphocytes)
diseased pulp
1. PMNs
2. plasma cells
3. basophils
4. eosinophils
5. lymphocytes
6. mast
173
during pulpal inflammation these cells are involved in response, NOT __
involved = plasma cells, macros, lymphocytes
NOT PMNs
because there's no direct pulp exposure, it's not an ACUTE response. after exp then PMNs are chemotactically attracted
174
vital pulp response to microbial invasion is very resistant because after 2 wks exposure, only ___ mm of coronal pulp has given in
2 mm
175
apical or coronal portion of pulp has more collagen?
apical
Type 1:3 = 55:45
Type 5, small amts
176
what type of collagen predominates in dentin
Type 1
177
fibroblasts in pulp make what types of collagen? (2)
Type 1 and 2
178
central zone (pulp proper) contains ____
list 3 layers
nerves, blood vessels
1. cell-rich zone (innermost) - fibroblasts
2. cell-free zone (zone of Weil) - capillaries, nerves, nerve plexus of Rashkow
3. odontoblastic layer (outermost) - odontoblasts, next to predentin & mature dentin
179
absence of what layer predisposes dentin to internal resorption?
predentin
10-47mm of dentin matrix is unmineralized next to the odontoblastic layer
180
__ wall of md teeth is most easy to perf
lingual wall
| cause of lingual inclination
181
__% of md 1st PM has 2 canals with 2 apical foramina
25%
23% can have 2 or 3 canals
182
radiographic indication that 2 canals present
pulp canal disappears midroot
183
referred pain to mental region of mandible might be from these teeth (3)
md 1st PM
md 2nd PM
md canine
md central
184
__% md 2nd PM has 1 canal at apex
97%
- oval access
- close to mental foramen
185
pulpitis in this tooth can refer pain to the EAR
md 1st molar
186
md 1st molar has a ___ shape outline
__% cases, distal root has 2nd canal
trapezoid
40%
-pulp chamber located in mesial 2/3 of crown
187
md canine, root canal wall is thin M-D/B-L? and wide M-D/B-L?
thin mesiodistally
| wide labiolingually
188
in the md central, if there are 2 canals, which one is straighter?
labial
access is long oval
189
mx incisors, canines have __ axial inclination
DISTAL - angle bur to distal to avoid perf of mesial root
190
referred pain to FOREHEAD can be from these teeth
mx central, mx lateral
191
mx central/lateral is most likely to have a curved root
lateral
192
mx central root anatomy
access is OVAL-TRIANGULAR (more tri)
193
mx lateral root anatomy
access is OVAL
more slender than central, often has distal and/or lingual curvature or dilacerations
194
pulpitis in mx canine can refer to what area?
NASOLABIAL
195
how many canals for mx 1st PM?
2 canals
60% have 2 roots (B, palatal), usually equal in length
196
which tooth has a canal cross section shaped like a figure 8 ellipse?
mx 1st PM
-> access is THIN OVAL
careful don't perf on mesial (mesial concavity)
197
mx 2nd PM refers pain where?
usually has how many roots?
temporal (more)
nasolabial
85% 1 root, 15% have 2 roots
access is THIN OVAL
198
mx 1st or 2nd PM has higher incidence of accessory canals?
mx 2nd PM
199
mx molars pulp chamber outline is
TRIANGLE
- line connecting mesial and palatal is longest
- 59% 4th canal usually lingual to MB
200
most missed canal in mx 1st molar
palatal canal curves to ___
MB cause it's under MB cusp; access from DL position, often splits into 2 canals
curves to FACIAL
201
u-shaped radiopacity overlying palatal root apex is most likely?
zygomatic process
202
which nerves are distributed in the subnucleus caudalis of trigeminal nerve (CN V)?
CN VII, IX, X
creates potential of referred pain to many sites
203
transplantation is
transfer of tooth from one socket to another in same person or another person
when root isn't fully developed - better prognosis
204
force controlled vertical tooth movement occlusally in a socket is called
orthodontic extrusion
INDICATIONS
- prior to implant
- untx subgingival pathoses
205
to stablize intentionally replanted tooth
ask pt to close in CO for rest of the day
206
disadvantage of endodontic implants is
lack of apical seal
207
procedure to apically position gingival margin and/or reduce cervical bone is called
crown lengthening
-to tx subg caries, perfs, resorptions
208
root submersion
resection of tooth roots 3 mm below alveolar crest then cover with mucoperiosteal flap
-will prevent alveolar resorption and maintain better proprioception
INDICATIONS
-rampant caries, adverse periodontal conditions, repeated failure of prosthetic cases, med complex, avoid esthetic defect
209
the earliest and most common symptom of pulpal edema/inflamed pulp (acute pulpitis)
thermal sensitivity
usually involves increased and persistent pain to cold
210
best way to test thermal response
rubber dam; bathe each tooth in hot/cold water
211
thermal test false (-) in teeth that are
immature
recently traumatized
or premedicated with analgesic
212
__ is the only reliable clinical evidence that 2' dentin has formed
decr. tooth sensitivity (cause tubules calcified)
213
conditions that DON'T require endo (3)
1. cementoma (periapical cemental dysplasia) - usually anterior md, wont' affect pulp vitality
2. traumatic bone cyst - not true cyst cause no epithelial lining, teeth usually vital
3. globulomaxillary cyst - jxn of globules and mx processes, btw lateral and canine, tooth vital
214
conditions that DO require endo (4)
all NONVITAL
1. apical scar - periapical granuloma, cyst, abscess
2. radicular cyst
3. chronic dental abscess
4. chronic periapical granuloma - asymptomatic, most COMMON sequelae of pulpitis
215
___ is a condition that results from a pulpal infxn that extends through the apical foramen into periapical tissues
periapical abscess
MOST COMMON of all abscesses
- pus in alveolar bone at root apex after pulp dies
- first symptom is tenderness -> throbbing with swelling
- won't respond to EPT or cold but maybe heat
- ER: drain and rx abx -> RCT
216
acute osteomyelitis is most commonly caused by
dental infection
- occurs in jaw
- serious sequelae of periapical infxn
- often spreads into MEDULLARY SPACES
- severe pain, temp/fever, lymphadenopathy
- teeth are loose and sore
217
radiographic features of acute osteomyelitis
- takes 1-2 wks to see it
| - diffuse lytic changes -> MOTH EATEN radiolucency
218
__ is an acute abscess that develops through the periodontal pocket; involves alveolar bone loss, pocket formation, periodontal pathologic conditions
periodontal abscess
palpation (+)
percussion (+)
EPT responsive (UNLIKE periapical abscess)
BACTERIA = gram (-) rods ex. capnocytophaga, vibrio, fusobacterium
219
__ is a rare abscess that occurs when bacteria invade thru a break in the gingival surface
GINGIVAL
-caused by mastication, oral hygiene procedures, dental tx
220
__ is a long-standing low-grade infxn of periapical bone with the root canal being the source of infxn
chronic apical abscess (suppurative apical periodontitis)
- asymptomatic
- tx by RCT
-differential: NOT a cyst or granuloma because those are well-defined radiolucencies
221
__ is an apical lesion that develops as an acute exacerbation of a chronic apical abscess
PHOENIX abscess (suppurative apical periodontitis - recrudescent abscess)
- granulomatous zone gets infected
- dx on acute symptoms and xray
percussion (+)
x-ray: big PA radiolucency
222
massive invasion of pulpal contaminants will result in a __
acute abscess (Phoenix)
223
__ to __ % of bone must be altered before you see it on an xray
30-50%
occurs at the jxn between the cortical and cancellous bone
224
__ is a localized collection of pus inside alveolar bone at the apex after pulpal death, with infxn extending into periapical tissue
acute apical/alveolar abscess (AA)
- 1st symptom is tenderness -> throbbing, swelling
- tooth might get loose, pt gets fever
EPT (-)
Cold (-)
Heat (+) maybe
Tx: drain, later RCT
225
__ is a growth of granulomatous tissue continuous with the PDL due to pulpal death with diffusion of toxic products into the periapical area
granuloma
- usually asymptomatic
- xray: well defined radiolucency with some irregularity
226
__ is an inflammatory response of the periapex that develops from pre-existing granulomatous tissue
central, fluid-filled, epithelium-lined cavity, surrounded by granulomatous tissue and peripheral fibrous encapsulation
CYST
- asymptomatic
- xray: well defined radiolucency
227
granuloma and cyst are only differentiated by
HISTOLOGY
228
in endo-perio lesions, what tx is first?
endo
perio first only if it's primary periodontal lesion
229
common clinical finding of perio prob is
pain to lateral percussion on a tooth with wide sulcular pocket
230
probing lesions (3)
1. conical-shaped
2. blow-out (acute)
3. narrow sinus tract
231
conical shaped probing lesion
can't be managed by endo alone, typical of perio problem, bone loss at crestal bone and progresses apically
232
blow-out (acute) probing lesion
non-vital (necrotic) pulp that can completely heal after RCT, normal sulcus depth until area of swelling (drops near apex)
233
narrow sinus tract lesion
normal probing depth, except narrow area, probe can pass down root to some distance
tooth is non-vital
234
reversible pulpitis (pulpal hyperemia = pulpal inflammation)
- most commonly caused by bacteria
- pain requires external irritant to evoke painful response
- sharp and brief pain, stops when irritant is removed
- percussion (-)
- pulp responds more to cold than hot
235
__ is an excess accumulation of blood in the pulp due to vascular congestion
pulpal hyperemia
- engorgement of pulpal vessels with blood
- when you remove the cause -> pulp normal
236
how do hyperemic teeth respond to EPT
lower current than normal
237
best way to reduce pulp injury during tooth prep is to
minimize dehydration of dentin
238
irreversible pulpitis (acute pulpitis) is
a condition characterized by SPONTANEOUS PAIN with periods of cessation, intermittent
- LINGERS after irritant is removed
- usually not readily localized
- incr. by heat and relieved by cold
- lying down or bending over intensifies the pain (incr. pressure)
- percussion (+)
239
necrotic pulp (pulp death)
- may have no painful symptoms, no EPT response
| - sometimes response to heat but not cold
240
bacteroides involved in pulpal-periradicular infxn (2)
porphyromonas
| prevotella
241
bacteria species in infected root canals (5)
1. eubacterium
2. peptostreptococcus
3. fusobacterium
4. porphyromonas
5. prevotella
242
what species isnt as important in the progression of caries as it is the initiation?
streptococcus
243
virulence factors in periradicular pathosis (4)
1. LPS (gram - bacteria)
2. enzymes - neutralize abs and complement components
3. extracellular vesicles - bacterial adhesion, proteolytic activities, hemagglutination, hemolysis
4. fatty acids - affect chemotaxis, phagocytosis
244
if vital pulp is exposed for 2 weeks, bacteria won't penetrate more than __ mm
2 mm
245
endo contraindications
1. non-restorable/non-strategic tooth
2. bad peiro support
3. vertical root fracture
4. internal/external resorption
5. can't instrument canal/surgery
246
is hemophilia a contraindication to endo?
no but check with physician
247
post guidelines
- leave 4 mm gutta percha
- threaded screw posts incr. fracture -> PARALLEL and TAPERED are preferred
- cusps adj. to lost marginal ridges should have ONLAY
248
why are endo posterior teeth more prone to fracture?
destruction of coronal structure
249
min. restoration for endo tx teeth is
onlay -> cuspal coverage
250
pulp chamber retained amalgam, __ mm into each canal
3 mm
251
Anterior tooth fractures are usually do to
Accidental trauma
252
RCT for horizontal root fracture is not indicated if
Fracture site remains in close proximity and pulp is vital
253
Symptoms of cracked tooth syndrome
Sharp, brief pain occurring unexpectedly when pt chews
254
3 types of surgical flaps
1. Submarginal curved (semilunar)
2. Submarginal triangular and rectangular (Ochsenbein-Leubke)
3. Full mucoperiosteal
