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466 Cards in this Set
- Front
- Back
What are the purposes of having patency?
|
- 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 |
|
What main functions do we want irrigants to accomplish?
|
- dissolve organic tissue
- remove inorganic - antimicrobial effect |
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What are the different techniques used with hand-files?
|
- reaming
- watch-winding - filing (anti-curvature) - circumferential filing |
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What is the advantage to having non-cutting tip instruments?
|
- reduction of ledging
- reduction of transportation - reduction of perforation |
|
what are the disadvantages of NiTi rotary instruments?
|
- Fracture Risk
- Screwing tendency in root canals - Aggressive Cuting tips - Difficult Access - Limited tactile sense - Cost |
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What is PITCH?
|
- number of flutes per millimeter
|
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Explain CYCLICAL FATIGUE:
|
- due to curvature of roots, file on one side is expanding and on other side contracting and repeatedly doing that.
|
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Explain TORSIONAL FATIGUE:
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- tip gets stuck in something, but rest of the file wants to keep moving
|
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How does one avoid fatiguing rotary files?
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- Go quick in and out 2-3 times.
|
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What does a POSITIVE RAKE ANGLE do?
|
- cut, scoop
|
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What does a NEGATIVE RAKE ANGLE do?
|
- shaves
- less efficient - more friction = more chance of fracture |
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Define RADIAL LAND:
|
- provides blade support while adding peripheral strength to resist torsional and rotational stresses
- keeps the instrument centered in the canal - prevents over-engagement |
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Pulpodental complex is derived from which embryological cells?-
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Ectomesenchymal, neural crest cells, from first branchial arch
|
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Citodifferentiation occurs in which stage of tooth development?
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Bell stage
|
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Initiation occurs in which stage of tooth development?
|
Bud stage
|
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Morphogenesis occurs in which stage of tooth development?
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Cap stage
|
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During which week does the lamina start to develop?
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5th week
|
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TRUE or FALSE: Dentin is formed before enamel.
|
TRUE
|
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TRUE or FALSE: Dentin initiates the formation of enamel.
|
TRUE
|
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When does hard tissue formation start?
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late bell stage
|
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What are the four stages of apposition?
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1. elongation of inner dental epithelium
2. differentiation of odontoblasts 3. formation of dentin 4. formation of enamel |
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Which cells produce these different types of material:
a. mantle dentin b. globular dentin c. interradicular d. reparative e. reactionary f. enamel |
a. odontoblasts
b. odontoblasts c. odontoblasts d. odontoblast-like cells e. Hohl-cells f. ameloblasts |
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What are the four morphologic zones of the pulp - from most lateral (outside) to most medial (inside)?
|
- odontoblast layer
- cell poor layer - cell rich layer - pulp proper |
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What can be found in the CELL POOR ZONE?
|
- unmyelinated nerve fibers
- capillaries |
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What can be found in the CELL RICH ZONE?
|
- fibroblasts
- macrophages - dendritic cells - undifferentiated mesenchymal cells |
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What can be found in the PULP PROPER?
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- fibroblasts
- vessels - nerves |
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When does SECONDARY DENTIN formation begin?
|
- when the tooth erupts and comes into occlusion
|
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What are the functions of the pulpal vasculature?
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- hemostasis
- respond to stimuli - regulate interstitial environment - transport nutrients / hormones - remove metabolic waste products |
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What is the order of vessels in the pulp circulation?
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ARTERIOLE -> TERMINAL ARTERIOLE -> PRE-CAPILLARY -> CAPILLARY -> VENULE
|
|
What is the purpose of lymphatics in the pulp?
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remove high molecular weight solutes
|
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Where is the location of terminals of A-delta nerve fibers in the tooth?
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Pulpo-dentinal junction
|
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Where is the location of terminals of C nerve fibers in the tooth?
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Throughout the pulp
|
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Which nerve fibers are myelinated and which are not?
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MYEL: A-delta
NOMY: C |
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What is the first type of cementum formed? Where does its collagen come from?
|
Primary acellular intrinsic fiber cementum. Initially collagen from cementoblasts, then later from fibroblasts.
|
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What is the second type of cementum formed? How and when is it formed?
|
Primary acellular extrinsic fiber: formed by PDL fibers after their incorporate into the primary acellular intrinsic fibers.
|
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Which is the "adaptive" type of cementum?
|
Secondary cellular mixed fiber cementum.
|
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The cementum sometimes seen overlapping enamel is?
|
acellular afibrillar cementum
|
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Which cementum plays no role in fiber attachment?
|
acellular afibrillar cementum
|
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What constitutes the PDL?
|
- cementoblasts / osteoblasts
- fibroblasts - stem cells - macrophages - osteoclasts - blood vessels - nerves - lymphatics - Malassez rest's of epithelium |
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Define "transcription factor":
|
a protein that binds to specific DNA sequences, therefore controlling the transcription of genetic information from DNA to mRNA.
|
|
Define "growth factor":
|
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.
|
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What is the "Zone of Weil"?
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Cell poor zone
|
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The number of roots, and morphology of rooths, is determine by which embryological structure in the Bell Stage?
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Hertwig's Epithelial Root Sheath
|
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Which is the first layer of dentin layed down?
|
MANTLE DENTIN
Type III collagen and Type I collagen |
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What is the composition of ENAMEL?
|
96% inorganic material
|
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What is the composition of DENTIN?
|
65% inorganic material
|
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What is the composition of CEMENTUM?
|
50% inorganic material
|
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What is the aim of endodontics?
|
- prevention or treatment of apical periodontitis
- mo money mo problems - to make Dr. Ochoa rich |
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What are the causes of apical periodontitis?
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- bacteria in the root canal system, dentinal tubules,
- bacterial toxins induce inflammation, damage host tissue - host defense cells get activated |
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What are the needs of intra-canal medicaments?
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- kill microorganisms
- non-selective - may damage host cells - calcium hydroxide - |
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Incorrect working lengths will result in what three errors?
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- incorrect cleaning
- incorrect shaping - incorrect obturation |
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What are some errors in working lengths?
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- over-instrumentation
- perforations - loss of working length - ledges - dentin plugs |
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What are the disadvantages of using APEX LOCATOR?
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- retreatments
- crowns - pacemakers - blood |
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What are the advantages of using APEX LOCATORS?
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- less radiation
- 96% accuracy - less time-consuming |
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What are the functions of your irrigant?
|
- remove smear layer
- organic tissue disolved - antimicrobial effect - debris flushed |
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What is the biggest disadvantage to using rotary instrumentation?
|
HIGHER RISK OF FRACTURED INSTRUMENTS!
|
|
Define "cyclical fatigue". How would you reduce it?
|
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. |
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Define "torsional fatigue". How would you reduce it?
|
Tip of instrument stuck in dentin – rest of instrument is still spinning
Reduced by creating a glide-path by hand instrumentation |
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Define "pitch" of a file:
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Number of flutes per mm.
|
|
Label the following:
|
a. outer dental epithelium
b. inner dental epithelium c. stellate reticulum d. dental papilla e. dental lamina |
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Label the following:
|
a. nerve bundle
b. bone c. vasculature d. oral ectoderm e. tongue |
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Label the following:
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a. oral ectoderm
b. dental lamina c. d. dental follicle e. dental papilla f. g. |
|
Label the following:
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a. enamel organ
b. enamel knot c. dental papilla d. dental follicle / sac |
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Label the following:
|
a. dental lamina
b. outer dental epithelium c. inner dental epithelium d. dental papilla e. dental follicle f. cervical loop |
|
Label the following:
|
a. outer dental epithelium
b. stellate reticulum c. stratum intermedium d. inner dental epithelium e. dental papilla |
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Label the following:
|
a. inner dental epithelium
b. outer dental epithelium c. cervical loop |
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Label the following:
|
a. outer enamel epithelium
b. stellate reticulum c. stratum intermedium d. ameloblasts e. odontoblasts f. dentin g. dental pulp h. bone |
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Define "cementodentino junction":
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- cementum meets dentin
- pulp tissue ends - periodontal tissue begins |
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Define "major apical diameter":
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circumference/rounded edge, like a funner or crater, that differentiates the termination of the cemental canal from the exterior surface of the root.
|
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Define "minor apical diameter":
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Occurs at the CDJ and is usually not at the radiographic apex.
|
|
What are some examinations done to assess endodontic status of teeth?
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- palpation
- mobility - percussion - exploration - pulp test (cold, hot, EPT) - probing - tooth sleuth (fractures/cracks) - radiograph |
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PERCUSSION / PAIN / APICAL RADIOLUCENCY / TREATMENT /
|
to do
|
|
What are the four different ways files are manufactured?
|
- grinding
- twisted - electropolished - Ti Nitrate |
|
Define the helical angle:
|
Angle at which the flutes are positioned.
|
|
What is the G-pack sequence?
|
0.25 - 0.12, 0.10, 0.08, 0.06, 0.04, 0.02
|
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What is the function of the RADIAL LAND RELIEF area?
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Reduces the friction on the canal wall
|
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What are the disadvantages of the NiTi Rotary Systems?
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- fracture risk
- screwing tendency in root canals - aggressive cutting tips - difficult access - limited tactile sense - cost |
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What are some factors that would make access cavity preparation difficult?
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- extensive decay
- restorations - loss of crown - fixed prosthesis - calcifications - obliterated pulp |
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What are some of the purposes of achieving straight line access?
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- 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 |
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Define "working length":
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distance from a coronal reference point to the point at which the cleaning and shaping should terminate
|
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What is the primary cause of apical periodontitis?
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- bacteria in the root canal system
|
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Microbes can be found where?
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- dentinal tubules
- root canal system - cementum - periapical tissues |
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(Preza 2008) Over _____ species of bacteria have been identified in the oral cavity?
|
800
|
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Define "obligate anaerobes":
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Bacteria that cannot live in the presence of O2
|
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Define "Facultative anaerobes"
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organisms that metabolize either aerobically or anaerobically but most survive better in an environment with some O2.
|
|
Define "obligate aerobes":
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Organisms that require oxygen for aerobic cellular respiration.
|
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What is the difference between gram positive and gram negative bacteria?
|
GRAM NEGATIVE - lack an outer cell membrane consisting of peptidoglycan
GRAM POSITIVE - peptidoglycan cell membrane |
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Genetic material between bacteria can be exchanged in what three ways? Describe each.
|
- Transduction: bacteriophage exchange
- Transformation: uptake of free DNA - Conjugation: plasmid exchange |
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What are bacterial virulence factors?
|
genetic sequences that when activated allow the bacterium to invade host defence mechanisms
|
|
List 4 bacterial virulence factors:
|
- exopolysaccharide production
- lipopolysaccharide production (endotoxin) - pheromone release - surface receptor expression - bacterial toxin release (exotoxin) |
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Define "quorum sensing":
|
Stresses in the environment detected by individual cells will start a communication amongst them to start expressing these virulence factors.
|
|
What are the four types of primary dentin?
|
- mantle
- globular - intertubular - peritubular |
|
UNTREATED NECROTIC PULPS have what kind of species of bacteria predominantly?
|
- 1-12 species
- anaerobes predominantly - gram negative species (Prevotella, Fusobacterium) |
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CASES IN TREATMENT have what kind of bacteria predominantly?
|
- 1-5 species
- increase in gram positive facultative anaerobes (Streptococci, enterococci) |
|
ROOT FILLED TEETH have what kind of bacteria predominantly?
|
- 1-3 species
- gram positive facultatives predominate |
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What is the difference between ASYMPTOMATIC and SYMPTOMATIC teeth in regards to bacterial flora?
|
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 |
|
In Gomes (1996) study, which species was significantly associated with pain and sensitivity to percussion?
|
Prevotella (P. gingivalis and P. endodontalis)
|
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In Gomes (2008) which species was associated with pain of previously endodontically treated teeth?
|
Treponema denticola
|
|
Molander (1998) and Siren (1997) found significant association of endodontic failure with this species:
|
Enterococcus faecalis
|
|
What two main bacteria types have had high associations with endodontic failure?
|
Enterococcus faecalis
Actinomyces |
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Which viruses/fungi have been detected in symptomatic and large periapical lesions?
|
Active cytomegalovirus and Epstein-Barr Virus
|
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Which is the main fungi incidence reporting in both treated and untreated canals?
|
Candida albicans
|
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In the clinical study by Debelian (1995) what were their findings about bacteremia and instrumentation:
|
~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 |
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What are some sampling methods for determining microbial flora within a canal?
|
- paper points
- gutta percha - files - ultrasonic agitation - media addition |
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What are the different ways of identifying bacteria present in canal once it's been sampled?
|
- culture identification (agar plate)
- molecular identification (PCR, DNA hybridization) - immunological identification (DF IDF) |
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TRUE or FALSE: Endodontic treatment eliminates all microorganisms from the root canal?
|
FALSE
|
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TRUE or FALSE: A significant change in bacterial number, type, and environment affect their ability to sustain disease.
|
TRUE
|
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What are the three key ways to reduce overall bacterial exposure and safety to the patient during ENDODONTIC treatment?
|
- rubber dam isolation
- surface disinfection (NaOCl) - Opaldam |
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What are the alternatives to root canal treatment?
|
only alternative is extraction
|
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What are the ideal characteristics of an endodontic irrigant?
|
- 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 |
|
What factors increase efficacy of Sodium Hypochlorite?
|
- temperature
- time in the canal - motion |
|
What are the basic objectives in cleaning and shaping?
|
- 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 |
|
Shortly describe the STANDARDIZED TECHNIQUE:
|
- 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 |
|
Describe STEP-BACK TECHNIQUE:
|
- 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 |
|
Describe the CROWN-DOWN technique:
|
- coronal flaring FIRST
- then determination of the working length |
|
Recapitulation (patency) should be done after every ______.
|
instrument use
|
|
Describe the BALANCED FORCE TECHNIQUE
|
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. |
|
What are the properties of an ideal sealer?
|
- 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 |
|
What is this instrument called?
|
Barber broach
|
|
What type of file has this formation?
|
K3
|
|
What type of file has this shape?
|
Profile
|
|
What type of root canal morphology is this?
|
Type II
|
|
What type of root canal morphology is this?
|
Type III
|
|
What type of root canal morphology is this?
|
Type IV
|
|
What type of root canal morphology is this?
|
Type V
|
|
What instruments are these ?
|
Gates-Glidden
|
|
Draw out the access cavity for this tooth (in yo head fools):
|
|
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Draw out the access cavity for this tooth (please do not try to draw on your laptop/computer screen):
|
|
|
MEMORIZE THIS!
|
MB1 MB2 DB and P
|
|
What type of file is this?
|
K-file
|
|
What is this instrument?
|
Gates-Glidden
|
|
Label these:
|
a. dentin
b. predentin c. odontoblast layer d. cell free zone e. cell rich zone f. pulp proepr |
|
What type of file is this?
|
Hedstrom file
|
|
Label the following:
|
a. helix angle
b. cutting edge c. flute d. radial land relief e. radial land |
|
What kind of pitch and helical angle does this file have?
|
- constant pitch, constant angle
|
|
IDENTIFY THE FILE TYPE:
|
a. Reamer
b. K-file c. Hedstrom |
|
What is the order of colours/sizes for the hand files?
|
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.... |
|
Malassez Epithelial rests are remnant's of which tissue?
|
Hertwig's epithelial root sheath
|
|
Which type of cementum is primarily found in the apical third of premolars and molars, and has a "bone-like" appearance?
|
Secondary cellular intrinsic fibrillar
|
|
Which type of cementum has a laminated appearance and includes cementocytes?
|
Secondary cellular mixed fiber
|
|
What is the function of the PDL?
|
- support for the tooth
- sensory - eruptive - nutritive - homeostatic |
|
What is the primary function of the dental pulp?
|
to form dentin
|
|
What are the four functions of the pulp?
|
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. |
|
MEMORIZE THIS:
|
ok
|
|
What is the main inorganic component of DENTIN?
|
Calcium hydroxyapatite
|
|
What is the main organic component of DENTIN?
|
Type I collagen
|
|
The BULK of dentin in a tooth is what kind of dentin?
|
Intertubular dentin
|
|
What are the different file types?
|
TRIANGLE - Flex-R, Reamer
SQUARE - K-flex, K-file RHOMBOID - K-flex (large) CIRCLE - Hedstrom |
|
What is the only machined hand file?
|
Hedstrom
|
|
What is the most important step in endodontics?
|
- cleaning and shaping
|
|
WHat are the main causes of root canal failure?
|
- vertical root fracture
- loss of or inadequate coronal seal - inadequate debridement and disinfection - missed canals |
|
TRUE or FALSE: Good restoration, poor endo is better than poor restoration / good endo?
|
TRUE
|
|
What are the advantages of warm vertical condensation?
|
- possibly a better apical seal
- greater DENSITY of GP - greater chance of filling lateral or accessory canals - easier post space preparation (for CPC) |
|
What are the disadvantages of warm vertical condensation?
|
- very technique sensitive
- more time consuming - rigid pluggers do not fit around curvatures - control of vertical dimension is difficult |
|
What are the advantages of lateral condensation?
|
- efficient (time)
- ease of use - control over vertical dimension - good canal adaptation |
|
What are the disadvantages of lateral condensation?
|
- 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 |
|
TRUE or FALSE: We need to disinfect gutta percha before use?
|
TRUE
|
|
What are the properties fo Tubliseal?
|
- ZOE based - good tissue response
- easy to use - easy to mix - fairly radiopaque - non-staining - good lubricant |
|
What is the purpose of a sealer?
|
- fill voids and canal irregularities
- binding agent between core - sealer - wall - lubricant - penetrate lateral canals/ accessory |
|
TRUE or FALSE: Gutta Percha seals the root canal?
|
FALSE
|
|
What are the disadvantages of gutta percha?
|
- not bactericidal or bacteristatic
- not adhesive - not easily manipulated - not great working time (when heated) |
|
What are the advantages of GUTTA PERCHA?
|
- inert
- dimensionally stable - chemically stable - non-porous - non-toxic - radiopaque - removeable |
|
CASE EXAMPLE WITH RADIOGRAPH: What is pulpal diagnosis, what is periapical diagnosis, what is treatment, what is emergency treatment?
|
to do, ABX? pulpectomy? root canal treatment?
|
|
In UNTREATED NECROTIC what kind of bacteria predominates?
|
- anaerobes (Prevotella)
|
|
In PREVIOUSLY TREATED what kind of bacteria predominates
|
facultative anaerobes (Treponema denticola)
|
|
The dental papilla is developed during which stage?
|
- cap
|
|
DIAGNOSIS CHARTS / QUESTIONS:
|
to do
|
|
Tertiary dentin forms when?
|
- in reaction to stimuli / damage
|
|
What is the most significant advantage of CAVIT vs IRM as a temporary seal?
|
- reduces microleakage due to expansion upon setting
|
|
How thick of a layer of Cavit is needed to ensure reduction of microleakage?
|
AT LEAST 3.5 mm
|
|
What is the biggest advantage of IRM over Cavit?
|
IRM has almost Double the compressive strength of cavit
|
|
CASE:
- Symptomatic - Tender to percussion - Patient has localized vestibular swelling - Pulp tests negative - Periapex: 5 mm radiolucency What is the PULPAL and PERIAPICAL diagnosis? |
PULP: Necrotic
PD: Acute Apical Abcess |
|
CASE:
32 year old male in no distress - No significant findings - |
PULP:
|
|
What are the TREATMENT GUIDELINES for CLOSED APEX:
The tooth has been replanted before the patient's arrival at the clinic. |
- 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 |
|
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. |
- 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 |
|
What are the TREATMENT GUIDELINES for CLOSED APEX:
Dry time longer than 60 min or other reasons suggesting non-viable cells |
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 |
|
What are the TREATMENT GUIDELINES for OPEN APEX:
Tooth has been replanted before patients arrival at the clinic: |
- 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 |
|
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: |
- 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 |
|
What is the first choice of systemic antibiotic use for TRAUMA?
|
Tetracycline
|
|
Tetracycline is not recommended in patients of which age group?
|
Under 12 years old
|
|
What alternative can be given as a systemic Abx to tetracycline?
|
- Pen V or amoxicillin
|
|
Where should splints be placed in trauma patients?
|
- buccal , to allow for endodontic access
|
|
What are some important instructions that should be given to patients following treatment of traumatised tooth?
|
- 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 |
|
What are the follow up procedures?
|
- Replanted teeth should be monitored by CLINICAL and RADIOGRAPHIC control after:
- 4 weeks - 3 months - 6 months - 1 year - annually thereafter |
|
What findings would show a FAVORABLE outcome for a CLOSED APEX trauma?
|
- asymptomatic
- normal mobility - normal percussion sound - no evidence of resorption or periradicular osteitis - lamina dura normal |
|
What findings would show a FAVORABLE outcome for an OPEN APEX trauma?
|
- asymptomatic
- normal mobility - normal percussion sound - radiographic evidence of arrested or continued root formation and eruption - pulp canal obliteration is expected |
|
What findings would show an UNFAVORABLE outcome for a CLOSED APEX trauma?
|
- symptomatic
- excessive mobility - no mobility (ankylosis) - high pitched percussion sound - radiographic evidence of resorption |
|
What findings would show an UNFAVORABLE outcome for an OPEN APEX trauma?
|
- symptomatic
- excessive mobility - no mobility (high pitched percussive sound) - radiographic evidence of resorption - |
|
What is the cell of the dental pulp most capable of transforming into other cells?
|
- undifferentiated mesenchymal cell
|
|
What would be the initial histologic appearance of a successful apicoectomy on a radiograph?
|
Woven bone
|
|
What is the initial treatment for internal resorption?
|
Pulpectomy
|
|
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. |
D
|
|
Which instrument is MOST EASILY brtoken in the root canal?
|
- Barbed broach
|
|
After application of heat, pain in a tooth lasts for approximately 10 minutes. WHat is the most likely diagnosis?
|
ACUTE IRREVERSIBLE PULPITIS
|
|
What is the antibiotic of choice for a periradicular dental abcess?
|
penicillin V
|
|
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. |
D - permit lateral cell-cell communication
|
|
Why is a post cemented with zinc phosphate cement used in an endodontically treated tooth?
|
- to retain the restoration
|
|
TRUE or FALSE: A periapical granuloma can be asymptomatic?
|
TRUE
|
|
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:
|
Lateral periodontal abcess
|
|
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?
|
- RCT
|
|
What is the most appropriate treatment for a permanent central incisor with a necrotic pulp and a wide open apex?
|
Apexification with calcium hydroxide
|
|
A dento-alveolar abcess most frequently originates from?
|
pulpal necrosis
|
|
What is the most common clinical finding in the diagnosis of an acute periapical abcess?
|
pain on percussion
|
|
The characteristic colour seen in the crowns of teeth with internal resorption is due to what?
|
presence of hyperplastic vascular pulp tissue
|
|
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:
|
Fabricate a porcelain veneer
|
|
What is dentin sensitivity associated with?
|
free nerve endings
|
|
A 30 year old HIV positive patient presents for removal of an abcessed tooth. THe most appropriate management is?
|
- treat the patient in the same way as all other patients
|
|
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:
|
Calcium hydroxide pulpotomy
- The apex is still open |
|
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:
|
- pulp capping with CaOH, a base, and restoration
- direct pulp capping is only advised for PRIMARY TEETH |
|
The epithelium covering the lesions of chronic hyperplastic pulpitis is believed to be derived from what?
|
- odontoblastic layer
|
|
The prognosis of an avulsed tooth is principally affected by what?
|
- length of time the tooth was out of the mouth
|
|
What is the success of replantation of an avulsed tooth dependent upon?
|
- length of time between avulsion and replantation
|
|
What is the purpose of metallic salts used in root canal sealers?
|
- radiopacity
|
|
Which test is the MOST USEFUL in differentiating between an acute apical abcess and an acute peridontal abcess?
|
PULP VITALITY
|
|
Gutta-percha may be softened or dissolved within the root canal by using what?
|
Xylene
|
|
AFter a thermal stimulus has been removed from a tooth, persistent pain suggests what?
|
- irreversible pulpitis
|
|
In endodontics, which perforation has the worst prognosis?
|
Furcation area of a molar
|
|
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?
|
OVERINSTRUMENTATION
|
|
Define HYPEREMIA OF THE PULP:
|
an excessive accumulation of blood in the pulp, resulting in vascular congestion
|
|
A carious maxillary central incisor with acute suppurative pulpitis requires what?
|
- opening of the canal and drainage for one week
|
|
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?
|
cracked tooth
|
|
What is the most effective agent for bleaching of discoloured and devitalized tooth?
|
hydrogen peroxide 30%
|
|
A patient has a draining sinus tract 6mm apical to the free gingival margin of a maxillary lateral incisor. What do you do?
|
Perform pulp vitality tests
|
|
How would you manage a percussion sensitive tooth that responds normally to pulp testing?
|
Occlusal assessment
|
|
Which feature would be MOST indicative of a cracked tooth?
|
- pain upon biting pressure
|
|
Which factor improves the prognosis for a successful direct pulp cap on a secondary tooth?
|
UNCONTAMINATED exposure
|
|
Severe throbbing tooth pain which increases when the patient lies down is a symptom of what?
|
Late stage of acute pulpitis
|
|
Which cells are characteristic of chronic inflammation of the dental pulp?
|
- plasma cells
- macrophages - lymphocytes -NO neutrophils present |
|
What is the most appropriate management for a tooth with a history of previous trauma that now exhibits apical resorption?
|
Complete instrumentation and medication with intracanal calcium hydroxide
|
|
What is the MOST EFFECTIVE agent in cold testing?
|
Dry ice (CO2)
|
|
Which substance causes inflammation and pain when released by pulpal fibres?
|
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 |
|
Common problems clinicians encounter in endodontics stem mainly from what areas?
|
- diagnosis
- tooth morphology - cleaning and shaping techniques |
|
What should the shape of an access cavity in a MAXILLARY CENTRAL always look like?
|
Triangular
|
|
What is the most common cause of coronal discoloration following RCT?
|
Inadequate removal of coronal pulp tissue
|
|
What are some anomalies that may be present in the morphology of a MAXILLARY LATERAL INCISOR?
|
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 |
|
How many roots does the MAXILLARY FIRST PREMOLAR usually have?
|
Commonly bi-rooted (75% of the time)
- two canals |
|
What are some variations of the radicular forms of MAX FIRST PREMOLAR?
|
- 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) |
|
Which tooth has the HIGHEST FAILURE rate of any posterior tooth for endodontic therapy?
|
MAXILLARY FIRST MOLAR
|
|
What roots does the MAX FIRST MOLAR have?
|
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 |
|
What roots does the MAND FIRST MOLAR have?
|
MESIAL ROOT:
- has two canals DISTAL ROOT: - can have one or two canals |
|
What kind of pain is very indicative of endodontic pathosis?
|
- Irreversible in nature
- intense - spontaneous - continuous |
|
Why would one observe for facial asymmetry or distention on the extra-oral examination?
|
- indicative of swelling of odontogenic origin or systemic disease
|
|
What are some things to examine the dentition about?
|
- discoloration
- fractures - abrasions - erosion - caries - large restorations |
|
What are some PERIRADICULAR tests?
|
- Percussion test
- Palpation test |
|
What is the benefit of a percussion test?
|
- does NOT give an indication of the health or integrity of the pulp tissue
- only indicates whether there is inflammation around the PDL |
|
A positive response to percussion can be caused by which factors?
|
- teeth undergoing rapid orthodontic movement
- high restoration - periodontal disease - partial or total necrosis of the pulp (that has inflamed the PDL) |
|
How is a PALPATION TEST done?
|
- 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 |
|
What does a positive PALPATION test indicate?
|
- inflammation in periapical tissues spread to the bone and mucosa
|
|
What are some PULPAL tests?
|
- thermal (hot / cold)
- electric |
|
How can one obtain RELIABLE information with a Thermal pulp test?
|
- similar tooth types should be tested and compared
|
|
What kind of information does a THERMAL TEST often provide?
|
- whether the pulp is healthy, inflamed, or necrotic
|
|
How will teeth with NECROTIC PULPS respond to a thermal test?
|
- will not respond to thermal stimulation
|
|
What kind of response will occur when THERMAL TESTING a VITAL TOOTH?
|
- sharp sensation of pain
- may occur regardless of pulp status (normal, reversible, irreversible) |
|
What does it mean when a thermal response of pulp is MORE INTESNE and PROLONGED?
|
- irreversible pulpitis
|
|
When is an ELECTRIC PULP TEST contraindicated?
|
Patients with pacemakers (cardiac)
|
|
What is the TRUE determinant of tooth vitality?
|
- condition of the tooths VASCULAR supply, not neural
|
|
What are the main reasons for FALSE POSITIVE responses with an ELECTRIC PULP TESTER (EPT)?
|
- 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 |
|
What are the main reasons for FALSE NEGATIVE RESPONSES to electric pulp tests (EPT)?
|
- 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 |
|
What are some "IF's" that would decide whether the origin of a lesion is PERIODONTAL or ENDODONTIC?
|
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 |
|
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.
|
TRUE - radiograph
|
|
When evaluating the radiograph for diagnosis of an endodontic lesion, what are some CORONAL ASPECT FEATURES that one should look for?
|
- 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 |
|
TRUE or FALSE: Pulp stones are always pathologic.
|
FALSE - pulp stones are normal characteristic and are not necesserily pathologic
|
|
When evaluating the radiograph for diagnosis of an endodontic lesion, what are some RADICULAR ASPECT FEATURES that one should look for?
|
- 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 |
|
What kind of presumption can be made when a canal disappears abruptly near the apex on a straight-line radiograph?
|
- canal is branching into extra canals
|
|
What are some SPECIAL TESTS that can be done to diagnosis endodontic lesion?
|
- test cavity
- caries removal - selective anaesthesia - transillumination |
|
How does a TEST CAVITY work?
|
- 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 |
|
When can TEST CAVITIES be used?
|
- when other tests are inconclusive
- fully crowned or splinted teeth |
|
How does SELECTIVE ANAESTHESIA work?
|
- 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 |
|
Define STRUCTURAL CRACK:
|
- break of split in the continuity of the tooth surface without a perceptible separation
|
|
A tooth with a periapical lesion that fails to resolve after proper RCT and apical surgery should be suspected of what?
|
Vertical root fracture
|
|
What terms are used for diagnosis of PULP?
|
- normal pulp
- reversible pulpitis - irreversible pulpitis - necrotic pulp |
|
What are the conditions associated with a NORMAL PULP?
|
- moderate response to pulp stimuli
- response subsides when stimulus is removed - tooth is free of spontaneous symptoms - radiograph shows intact lamina dura |
|
What are the conditions associated with REVERSIBLE PULPITIS?
|
- sharp thermal response (esp to cold)
- asymptomatic unless provoked by external stimulus - most commonly caused by defective restoration, restorative procedures, or dental caries |
|
REVERSIBLE PULPITIS is most commonly caused by what?
|
- defective restorations
- restorative procedures - dental caries |
|
What are the conditions associated with IRREVERSIBLE PULPITIS?
|
- prolonged response to temperature change
- spontaneous episodes of pain - pain from change in posture - intense throbbing pain |
|
What are conditions associated with NECROTIC PULP?
|
- 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 |
|
What are some PERIRADICULAR DIAGNOSES that can be made?
|
- acute apical periodontitis
- chronic apical periodontitis - acute apical abcess - Phoenix abcess - periapical osteosclerosis |
|
What are some conditions associated with ACUTE APICAL PERIODONTITIS?
|
- 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 |
|
What are some conditions associated with ACUTE APICAL ABCESS?
|
- 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) |
|
What are some conditions associated with CHRONIC APICAL PERIODONTISIS?
|
- usually asymptomatic but sometimes tender to percussion and palpation
- nonresponsive to pulp vitality tests - periapical radiolucency - possibly associated with a sinus tract |
|
What are some conditions associated with PHOENIX ABCESS?
|
- chronic apical periodontitis that becomes acute
- symptoms identical to acute apical abcess - periapical radiolucency - possible following treatment of necrotic tooth |
|
What are some conditions associated with PERIAPICAL OSTEOSCLEROSIS?
|
- 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 |
|
What is the KEY to successful management of endodontic emergencies?
|
- Correct diagnosis
|
|
If you are uncertain of the pulpal status after performing appropriate clinical tests, what should you do?
|
Provide palliative therapy
Give case time to resolve Wait and watch |
|
A "wait and watch" approach for endodontic emergencies is recommended when?
|
- 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 |
|
What are some causative factors of REVERSIBLE PULPITIS?
|
- high restoration
- incipient or recurrent caries - a fractured cusp - fractured restoration - exposed cervical dentinal tubuels |
|
What is a recommended emergency treatment for REVERSIBLE PULPITIS?
|
- 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. |
|
What is the recommended treatment for IRREVERSIBLE PULPITIS?
|
-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 |
|
What is the treatment of a NECROTIC TOOTH?
|
- Necrotic tissue MUST be completely removed from the canal system
|
|
What are your options when a tooth with necrotic pulp is present for an EMERGENCY visit?
|
METHOD A:
- obtain accurate working lengths and instrument canals to their apical constrictions METHOD B: - alternate pulpectomy - canal debridement slightly short of root length |
|
What are the steps of a PULPECTOMY?
|
- 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 |
|
What is the most recommended intra-canal medicament?
|
Calcium hydroxide
|
|
If there is a large delay in completion of the endodontic therapy what kind of restoration should be placed?
|
- Glass ionomer
- Bonded composite |
|
What are some symptoms associated with flare-ups after endodontic therapy?
|
- thermal sensitivity
- percussion pain - swelling |
|
FLARE UP after INITIATION of ROOT CANAL THERAPY:
Thermal sensitivity - how should you treat it? |
- repeat diagnostic tests to identify source
- possibility of missed canal - may suggest another tooth is non-vital? - may refer pain to another tooth |
|
FLARE UP after INITIATION of ROOT CANAL THERAPY:
Percussion pain - if it is from the initially treated tooth, what are some possible causes? |
- occlusal prematurity
- inadequate debridement - overinstrumentation - apical extension of infected pulpal debris - resistant to infection - missed canal - vertical fracture |
|
What are some emergency treatment options for patients with ACUTE ALVEOLAR ABCESSES?
|
- apical trephination
- incision and drainage - cortical trephination |
|
What is the treatment of PERIRADICULAR PAIN determined by?
|
severity of the signs and symptoms and necessity for establishing a drainage route
|
|
What is the best treatment for patients with MILD to MODERATE PAIN WITHOUT INTRAORAL / EXTRA ORAL SWELLING?
|
- chemo-mechanical debridement of canal system
- apical trephination if necessary |
|
Describe APICAL TREPHINATION:
|
- gently pass a #15 1 to 2mm through apical foramen to establish patency
- this will allow periapical drainage if present |
|
Patients with MODERATE TO SEVERE PAIN and LOCALIZED INTRAORAL SWELLING can be treated how?
|
Respond rapidly to incision and drainage
|
|
Patients with MODERATE to SEVERE PAIN AND DIFFUSE INTRAORAL SWELLING should be treated how?
|
- 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 |
|
What is critical in treatment of patients with DIFFUSE intraoral swelling?
|
- must be monitored closely because swelling can escalate quickly
- refer to ORAL SURGEON if it does - may require immediate hospitalization and aggressive antibiotic therapy |
|
Prior to starting INCISION AND DRAINAGE, antibiotic therapy should be intiated in what situations?
|
- medically compromised patients
- healthy patients exhibiting signs of a spreading infection (eg extraoral swelling, elevated temperature, or lymphadenopathy) |
|
What are some signs of a SPREADING infection?
|
- extraoral swelling
- elevated temperature - lymphadenopathy |
|
What are the proper steps for INCISION AND DRAINAGE?
|
- 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) - |
|
What are some causes of hemorrhage from canals?
|
- incomplete tissue removal or missed canal
- overinstrumentation into periapical tissues - an acute periapical infection - perforation |
|
TRUE or FALSE: Flaring mid and coronal root areas should be done prior to establishing patency of all canals?
|
FALSE
|
|
What is the objective of coronal access?
|
To expose and unroof the pulp chamber to gain visibility, including removal of pulp horns
|
|
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 |
c) GATES GLIDDEN
|
|
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 |
b) GREY
|
|
What shape is the access cavity for upper and lower incisors?
|
TRIANGULAR
|
|
What shape is the access cavity for UPPER and LOWER CANINES?
|
OVOID
|
|
What shape is the access cavity for UPPER and LOWER PREMOLARS?
|
OBLONG
|
|
What shape is the access cavity for UPPER and LOWER MOLARS?
a) triangular b) ovoid c) round d) oblong |
TRIANGULAR
|
|
How many upper incisors have TWO CANALS?
a) hardly any b) 5% c) 25% d) 50% e) 75% f) 95% |
a) hardly any
|
|
How many lower incisors have two canals?
a) Hardly any b) 5% c) 25% d) 50% e) 75% f) 95% |
50%
|
|
Where is an "extra" canal often found in upper molars?
|
Mesiobuccal root
|
|
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 |
b) CENTRE OF TOOTH
|
|
Upper first premolars usually have how many canals?
|
Two canals
|
|
Upper second premolars usually have how many canals?
|
One canal
|
|
TRUE or FALSE: After entering the pulp chamber, an option is to continue preparation without water spray?
|
TRUE
|
|
TRUE or FALSE: You should NOT normally extend the access for anterior teeth under the cingulum?
|
FALSE
|
|
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 |
b) nutrition
|
|
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 |
- MAX FIRST MOLAR
|
|
Root canal should be filled upto:
a) the dentinoenamel junction b) the cementoenamel junction c) most constricted apical point d) none of the above |
CEJ
|
|
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 |
b) MB
|
|
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 |
c) MESENCHYMAL CELL
|
|
If a third canal is present in the MAX FIRST PREMOLAR then where will it most commonly occur?
|
Facial root
|
|
What is the order of longest roots in the MAXILLARY FIRST MOLAR?
|
P > MB > DB
|
|
TRUE or FALSE: Roots of MAXILLARY 2nD MOLAR are LESS DIVERGENT than those of 1st molar?
|
TRUE
|
|
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 |
C. PRODUCTION OF FRICTIONAL HEAT
|
|
The optimal REMAINING DENTIN THICKNESS to protect pulp from restorative procedures is:
a) 1mm b) 2mm c) 0.5 mm d) 3 mm |
b) 2 mm is the minimal RDT which induces reparative and health pulp-organ reaction in response to restorative procedures
|
|
Pain on percussion before endodontic treatment indicates:
a) reversible pulpitis b) irreversible pulpitis c) pulpal necrosis d) inflammation of periodontal tissue |
d) inflammation of periodontal tissue
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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 |
d) Radiation of pain to ear is NOT a sign of maxillary sinusitis
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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 |
b) REVERSIBLE PULPITIS: quick sharp hypersensitive response that subsides as soon as stimulus is removed when otherwise tooth is asymptomatic
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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 |
IMMEDIATE RCT
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The cause of EXTERNAL RESORPTION is:
a) periapical inflammation b) excessive mechanical / occlusal force c) impaction of teeth d) all of the above |
ALL OF THE ABOVE
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A specific contra-indication to elective endo therapy is:
a) diabetes mellitus b) radiation therapy c) adrenal insufficiency d) recent history of myocardial infarction |
d) RECENT history of MI within 6 months and uncontrolled hypertension are principle contraindications to elective endo
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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 |
a) vital asymptomatic teeth
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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 |
a) paralleling technique
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Regardless of stimulus all afferent impulses from the pulp result in sensation of:
a) proprioception b) pain c) heat d) touch |
b) Pain is the response to all noxious stimuli applied on the pulp
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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 |
c) 5.25% sodium hypochlorite
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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 |
Can only be used to sterilize small instruments
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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 |
Temporary pulpotomy procedures in primary teeth are those in which paraformaldehyde pastes can be used to fix the pulp tissue
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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 |
The VOLUME of irrigants used is proportional to the debridement required
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This material has NO inhibitory effect on bacterial growth:
a) amalgam b) ZnO eugenol c) calcium hydroxide d) zinc polycarboxylate |
a. amalgam
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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 |
b) Reduction and immobilization
Only 20-40% of fractured roots eventually undergo pulpal necrosis |
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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 |
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.
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Free eugenol in root canal sealer cements is significant because it increases:
a) dimensional stability b) setting time c) cytotoxicity d) strength |
Free eugenol is NOT biocompatible and increases cytotoxic reaction
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Working length of a REAMER:
a) 16 mm b) 20 mm c) 10 mm d) 15 mm |
16mm is the working length, whereas actual length may vary from 21, 25, or 29
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Solvent used along with Hedstroem file to remove gutta-percha:
a) alcohol 10% b) sodium hypochlorite c) chloroform d) formocresol |
Guttapercha dissolves in CHLOROFORM
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The main component of most root canal sealers is:
a) resin b) precipitated silver c) zinc oxide eugenol d) corticosteroid |
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
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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 |
Silver cones are best suited for NARROW CURVED CANALS because of its rigid nature
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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 |
GP's lack of rigidity in small sizes is its main disadvantage because of difficult to maneavre it through small canals
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According to recent studies, the intracanal medicament with longer lasting antimicrobial effect is:
a) iodine b) phenol c) CMCP d) CA(OH)2 |
CaOH is proved to be the intra-canal medicament of choice.
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Pulpal inflammation reaches periodontal area through:
a) lateral canals in root b) apical area of root c) furcation area d) all of the above |
Pulpal inflammation reaches periodontium through all of those methods.
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Before a root amputation, the canal orifice is sealed with:
a) gutta percha b) zinc phosphate c) amalgam d) sealant |
Amalgam is used to seal the orifices of canal before a amputation to create perfect seal
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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 |
Canal calcifications can be negotiated with the help of a chelating agent like EDTA which softens the dentin.
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The filling of choice in root canals in primary teeth is:
a) cavit b) chloropercha c) ZnO eugenol w/ catalyst d) CaOH paste |
Primary teeth are filled with "Resorbable Paste" which contains ZnO eugenol with catalyst which is resorbed along with roots when primary teeth are exfoliated
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Apexification in teeth with blunder-buss canals is best done with:
a) ZnO eugenol b) CaOH with CMCP c) gutta percha d) endoseal |
CaOH with CMCP is used for apexification of teeth with wide canals and open apices
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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 |
Formocresol pulpotomy is indicated in primary teeth free of inflammation or infection
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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 |
EPT is NOT reliable in checking vitality of primary teeth
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What does EDTA stand for>
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Ethyl-Diamine Tetra Amine
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Pathologic changes in periapical tissue in primary teeth are more apparent:
a) in apical area b) in furcation area c) same in both |
b) more apparent in the furcation area
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Primary teeth with internal resorption:
a) should be treated with pulpectomy b) pulpotomy should be done c) extraction |
c) extraction
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The definitive method for diagnosing tetracycline staining is by:
a) history b) vitality test c) UV light d) visual examination |
c) UV light is used to distinguish tetracycline stain from fluorosis or other staining of teeth
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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 |
Bleaching of vital teeth can initiate cervical erosion response
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What percentage of sodium hypochlorite is used at the school?
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2.5%
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Irreversibly inflamed pulps have:
a) analgesia b) hypoalgesia c) hyperalgesia |
c) Hyperalgesia, an altered state with decreased pain threshold and increased / inappropriate response to stimulus
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What is the best test for determining if pulpal anaesthesia has been achieved?
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Cold test
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What are the five cardinal signs of inflammation?
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rubor - red
tumor - swelling dolor - pain calor - heat functio laesa - loss of function |
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What is the composition of:
TYLENOL #1 |
Codeine = 8mg
Acetaminophen = 300mg |
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What is the composition of:
TYLENOL #2 |
Codeine = 15mg
Acetaminophen = 300mg |
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What is the composition of:
TYLENOL #3 |
Codeine = 30mg
Acetaminophen = 300mg |
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What is the composition of:
TYLENOL #4 |
Codeine = 60mg
Acetaminophen = 300mg |
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What is the composition of:
EMPRACET |
Codeine = 30mg
Acetaminophen = 325mg |
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What is the composition of:
222 |
Codeine = 8mg
ASA = 375mg |
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What is the composition of:
282 |
Codeine = 15mg
ASA = 350mg |
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What is the composition of:
292 |
Codeine = 30mg
Acetaminophen = 375mg |
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What is the composition of:
PERCODAN |
Oxycodone = 5mg
ASA = 325mg |
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What is the composition of:
PERCOCET |
Oxycodone = 5mg
Acetaminophen = 325mg |
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What is your FIRST CHOICE antibiotic for management of dental infection?
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Penicillin VK
(if ineffective) Clindamycin / Cephalexin (if ineffective) add Metronidazole |
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Show me some COMMON ANTIBIOTIC prescriptions:
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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 |
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What is the general doseage of PENICILLIN V?
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300-600mg QID
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What is the general doseage of AMOXICILLIN?
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250-500mg TID
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What is the general doseage of CLOXACILLIN?
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250-500mg QID
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What is the general doseage of CEPHALEXIN?
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250-500mg QID
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What is the general doseage of ERYTHROMYCIN?
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250-500mg QID
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What is the general dosing of CLINDAMYCIN?
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150-300mg QID
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What is the general dosing of METRONIDAZOLE?
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250-500mg TID
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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 |
d) mixture
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Bleaching in vital teeth CANNOT be done:
a) extremely large pulp horns b) very dark teeth c) sensitive teeth d) all of the above |
All of the above
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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 |
c) reduces diffusion of toxic substances through tubules
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Biologically active sealers which promote periapical healing contain:
a) ZnO-Eugenol b) Corticosteroid c) CaOH2 d) Silver pts |
ZnO Eugenol
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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 |
Results because of host-resistance to pulpal irritation
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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 |
APICAL THIRD - should have good "tug-back" resistance and fit the canal snugly in apical third
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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 |
b) Keeping patency = recapitulation
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Intracanal medication is:
a) necessary for complete canal cleaning b) prevents post-treatment pain c) generally contra-indicated d) placed with paper point |
a) necessary for complete canal cleaning
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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 |
all of the above
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THe most common error while opening pulp chamber of mandibular incisors is:
a) lingual perforation b) labial perforation c) incisal fracture d) lateral perforation |
B) labial perforation
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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 |
Mesiobuccal has greatest curvature in lower 1st molar
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"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 |
Trigger zone.
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LOWER TEETH ACCESS CAVITIES
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memorize
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UPPER TEETH ACCESS CAVITIES
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memorize
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What are the SEVERAL CLINICAL PRESENTATIONS that are considered endodontic emergencies?
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- 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 |
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What are the primary objectives of CLEANING AND SHAPING of the root canal?
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- 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 |
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Define APEXOGENESIS:
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Maintenance of pulp vitality in an immature tooth to allow for physiologic tooth and root development
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Define APEXIFICATION:
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Inducing an apical hard tissue barrier in a tooth with an immature apex where the pulp is necrotic (or removed)
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What material is used in PHYSIOLOGIC APEXIFICATION?
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CaOH2
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What material is used in ARTIFICAL APEXIFICATION?
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Dentin chips MTA
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What forms the dentin of the tooth?
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PULP
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The pulp has what functions?
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"Formative, nutritive, sensory, defensive"
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What is the first phase of treatment in APEXIFICATION?
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Disinfection of root canal system and dentinal tubules
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What are some aspects of APEXIFICATION that make treatment difficult?
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"Thin, weak walls, open apex, difficult to get working length determination, young patient"
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Who popularized the apexification technique in North America?
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"Frank, A.L."
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What are the advantages of performing APEXIFICATION?
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"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"
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What are the disadvantages of performing APEXIFICATION?
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"No thickening of root canal walls, no apical formation"
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What is the pH of CaOH2?
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ph = 11 (very basic)
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What are the disadvantages of using CaOH2 apexification?
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"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?"
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What are the characteristics of MTA?
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"mineral tri-oxide aggregate, high pH, biocompatible, excellent seal, sets in 4-6 hours"
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What are the advantages of MTA apexification?
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"Fewer appointments, more predictable barrier, easier on patient"
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What are the disadvantages of MTA apexification?
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"No thickening of root canal walls, no apical formation"
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Does MTA has osteo-inductive activity? Describe?
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"Yes, induces formation of a cemental bridge at the open apex of teeth undergoing apexification treatment. "
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TRUE or FALSE: MTA is significantly better than CaOH2 for clinical success of apexification.
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FALSE: they are about equal
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What is the difference between APEXOGENESIS and APEXIFICATION?
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"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"
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Describe steps in INDIRECT PULP CAP:
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partial caries removal -> dycal -> permanent restoration
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Describe the steps in DIRECT PULP CAP:
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complete caries removal -> dycal over pulp exposure -> PERMANENT restoration
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Describe the steps in a PARTIAL PULPOTOMY:
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complet caries removal -> removal of inflamed pulp ~2mm -> MTA -> permanent restoration
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What is the order in which ROOT APICES close first?
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M-D before B-L
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What kind of a diagnosis would confirm inflammation?
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Histology
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When should a pulpectomy be performed?
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If remaining radicular pulp is clinically inflamed = hemorrhage not controlled
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What are your options for treatment of a non-vital immature tooth?
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"Apexification, pulp space revascularization, extraction"
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CaOH2 has similar radiodensity to what structure?
|
Dentin chips MTA
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What should the CaOH2 powder be mixed with?
|
"LA, saline, or CHX"
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When should the CaOH2 dressing be replaced?
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When voids are present in it (monitored radiographically)
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Define PULP REVASCULARIZATION
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the restoration of blood circulation of an organ or area
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Define REGENERATION
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replacement of missing;/lost tissue with newly formed functional, structure tissue just like the original tissue
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Define REVITALIZATION:
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- new VITAL TISSUE in canal space
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What are some findings in AVULSION/REPLANTATION studies?
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- Topical ABX improve pulp space revascularization
- open apex is reuired for ingrowth of new tissue - necrotic un-infected pulp acts as scaffold |
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What is the aim of ENDODONTICS?
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- prevention or treatment of apical periodontitis
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Is bacteria found in the periapical lesion?
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Not usually
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What causes apical periodontitis?
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- direct host tissue damage from bacterial toxins
- toxins induce host defense cells -> inflammation - host defense cells cause lesion |
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What are some MO's found in previously treated teeth with persisting PAR's?
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- gram positive predominate
- facultative anaerobes - enterococcus faecalis in 1/3 |
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TRUE or FALSE:
E. faecalis can resist antibacterial effect of CaOH? |
TRUE
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What are some treatment options for previously treated endo teeth with PAR?
|
- no treatment
- orthograde endodontic re-tx - surgical endo tx (apicoectomy / retrofill) - extraction |
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What are some reasons that an endo can fail? not heal?
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- 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 |
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What is the hallmark of foreign body reaction?
|
multi-nucleated giant cells
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In the Ray and Troppe study which had HIGHEST SUCCESS?
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highest = GE + GR
lowest = PR + PR GR + PE > GE + PR |
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Exposed root canal filling material leaks in as little as how many days?
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3 days
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What are the different types of endo emergencies?
|
- symptomatic irreversible pulpitis
- symptomatic apical periodontitis - acute apical abcess - flare up - hypochlorite accident |
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What is the difference between EMERGENCY and URGENCY?
|
- True emergency is a condition that requires an unscheduled office visit, severity of problem means it can't be rescheduled
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What are some examples of "URGENCY" type cases?
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- 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 |
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What are the most important factors in emergency situations?
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- establish and maintain control of situation
- gain confidence with patient - provide attention and sympathy - treat patient as an important individual |
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What is your management of symptomatic irreversible pulpitis?
|
- anaesthesia
- access - pulpectomy (30file) or otomy - intracanal medicament - temp resto - relieve occlusion |
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What is the most important thing to rule out in Symptomatic apical periodontitis?
|
- rule out crack using tooth slooth
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What is the management of Acute APical Abcess?
|
- anaesthesia
- establish drainage and/or incision - ABX (Pen VK) - Anaglesics (NSAIDs) |
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What is a key symptom in SYMPTOMATIC IRREV PULPITIS?
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- hot pain
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What is the key symptom in SYMPTO APICAL PERIODONTITIS?
|
- percussion pain
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What is the key symptom in ACUTE APICAL ABCESS?
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- swelling-
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What is the composition of IRM?
|
Zinc oxide and eugenol
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What is the composition of Cavit?
|
- zinc oxide and Ca sulfate
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What is the time span for Cavit?
|
0-4 weeks
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What are some reasons a 2-visit appointment may be needed?
|
- 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 |
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What are some advantages of 1 visit endo?
|
- lower flare up rate
- dont have to refamiliarize yourself with tooth - environmentally friendly - less expensive - accepted by patients |
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What are some pathways of communication between dental pulp and the periodontium?
|
- apical foramen
- dentinal tubules - lateral and accessory canals |