what to assess in tooth before endo
TTP
swelling
increased mobility
buccal sulcus
amount of tooth structure left
restorability
clinical investigations other than radiography to assist in diagnosis
sensibility tests;
- EPT = current used to stimulate sensory nerves at pulp-dentine junction
- thermal cold test = endofrost on cotton wool
- TTP = end of mirror tapped on occlusal surface of tooth
sensitivity to hot and cold indicates what
reversible pulpitis
painful to pressure when eating indicates what
apical periodontitis
name the design principles outlined by Herbert Schilder
create a continuously tapering funnel shape
maintain apical foramen in original position
keep apical opening as small as possible
objectives of irrigant use in RCT
disinfection of root canal space
removal of smear layer
enhancement of biofilm disruption
dissolve pulp remnants
flushing out debris
what is the ideal primary endodontic irrigant
and what concentration range is it most effective
NaOCl sodium hypochlorite
3-5% [3]
name factors important for the function of NaOCl primary endodontic irrigant
concentration
volume
contact
mechanical agitation
exchange
antimicrobial efficcy
biocompatability
reasons for carrying out obturation of the prepared root canal
prevent microorganisms and fluid along RC
block apical foramina, dentinal tubules and accessory canals
prevent reinfection
fluid tight seal apically
briefly describe the steps involved in obturating the RC in an upper central incisor
- ensure debris washed away
- dry RC with paper points
- use master cone matches size/shape of prepared canal
- lightly butter in sealer
- use spreaders to place into canal, laterally compacting to walls and ensuring straight and not bent
- if needed, add accessory points
- heated instrument to burn off excess GP
- obturation verification
- final restoration
number of canals found in upper first molar
3
can be 4 [MB2]
during instrumentation of canal, where is considered the ideal end point of shaping/obturation
apical third of the root
2mm away from the apex
what is the term for maintaining communication between the pulpal space and periradicular tissues
apical foramen
what is working length in endodontics
distance from reference point on tooth surface to the point at which RC preparation should end
at least 2mm away from apex
ensure no overpreparation/instrumentation which can lead to perforation and damage to apical tissues
two common intra-operative radiographs which can be utilised during endodontic tx to aid working length determination
working length PA, endofile inserted
initial radiograph PA
master cone PA
potential causes of a corrected working length changing during the course of endodontic shaping
over instrumentation
underpeparation
curvature of canals
apical transportation
file deviation
instrument fracture
debris obstruction
what pat of the root canal filling is the most important in ensuring long term success
coronal seal
ensuring success and preventing infection
why is non setting NaOH an ideal inter-appt medicament
antimicrobial
12.5 alkali pH kills bacteria
tissue dissolution
reduces inflammatory response/calming
biocompatible
components of GP
*20% Gutta-percha
* 65% Zinc Oxide
* 10% Radiopacifiers
* 5% Plasticizers
reasons for using a sealer when using cold lateral compaction
seals space between dentinal wall and core
seals dentinal tubules
adhesion
prevents microleakage
fills voids and irregularities
lubricates during obturation
name problems with NaOCl
unable to remove smear layer along [need EDTA 17%] and mechanical aggitation
tissue irritaiton - oral mucosa/periapical tissues
dissolves collagen fibres in dentine
effect on organic material, dissolution of mineral components so becomes weaker
4 irritant complications [NaOCl]
apical extrusion leading to tissue necrosis
allergic reactions
ophthalmic injuries
fabric discolouration
A 60-year-old patient presents complaining of generalised bleeding gums. There are CPITN scores of 4 in each sextant, with 78% sites showing bleeding on probing. A panoramic radiograph shows generalised horizontal bone loss, with 50% alveolar bone loss at the worst sites. The medical history is clear and the dentition is only lightly restored.
- what diagnosis
- what stage and grade
- what factor to determine from social history
generalised periodontitis
Stage III Grade B
smoking
- A 35-year-old patient presents complaining of mobility of tooth 34, which he feels is becoming worse. On examination, tooth 34 demonstrates Grade II mobility. There is no attachment loss but there is evidence of moderate toothwear affecting a number of teeth, likely attributable to attrition. Radiographic examination reveals generalised widening of the periodontal ligament space of tooth 34 and the tooth responds positively to sensibility testing
- What is the most likely diagnosis
- how would you manage this pt
occlusal trauma
correction of occlusal relations
occlusal adjustment
restorations
orthodontics
control of plaque induced inflammaiton
orthodontics
splint
