Endo Exam 1 Notes

Would you use plastic or metal frame for RCT

Plastic recommended (Radiolucent)

Anterior Clamp is number

Premolar Clamp is number

9

2A

Which incisor can have 2 canals

Mandibular Incisors

Which canine can have 2 canals

Mandibular

Maxillary always have 1

4 steps of working length

Radiographic

Estimated (Trial) (Radiographic minus 0.5-1 mm)

Actual (Adjust file to 0.5-1 mm from apex)

Final

Why do you shorten the WL by 0.5 to 1 mm

Root is not straight and are usually curved

What is a patency file

Small file passively extend slightly beyond apical foramen without resitance

The ______ is the groove in the working surface used to collect soft tissue and debris

flute

Hand files always have a _____ taper

.02

Physical and Chemical objective of Irrigation

Physical: Promote flow of irrigant

Chemical: Disrupt bacterial biofilms, inactivate endotoxins, and dissolve tissue debris as well as smear layer

What is more important, obturation or the debridement

debridement

What is removed is more important than what is inserted

The unheated _____ phase is for lateral condensation

The heated _____ phase is for thermoplastized techniques

beta

alpha

What is lateral condensation

Master cone with sealer to WL

Use finger spreader laterally to master cone

Put more GP to fill coronal 3rd

Is disrupting bacterial biofilms chemical or physical irrigation

Chemical

Do CaOCl damage the tooth?

Yes is NaOCl is left in tooth, it can damage the dentin by reducing flexural strength and elastic modulus of dentin

Concentration of Sodium Hypochlorite

0.5 to 6%

Higher concentration have better antibacterial efficacy

Lower concentration have similar effect when used in larger volume and more frequent

Can you store sodium hypochlorite solution

It should be freshly made

Which teeth are more common to sodium hypochlorite accident

Maxillary and posterior teeth (closer to buccal surface)

Also more common in female pt

_______ is recommended to eliminate the inorganic matter

EDTA

What forms parachloroaniline

NaOCl + Chlorohexidine

Cytotoxic and possible carcinogen

_______ is unable to dissolve organic tissue

Chlorhexidine

______ is a chelating agent which removes the inorganic portion of smear layer

EDTA

What is QMix

EDTA + CHX

Effective antibacterial and smear removal

If you used NaOCl and want to use CHX what do you use before?

EDTA

Ultrasonic is high _______ and low _______

Frequency is ______ Htz

Sonics frequency is _______ Htaz

frequencies, amplitude

25-30

1-6

Encapsulation in dentin creates a _____-compliance environment that influences the defense potential of the pulp

low

(low compliance means space cannot expand to accommodate change like swelling_

What are dentin formed before root formation is complete?

Primary

Reactionary vs Reparative Dentin

Reactionary: Formed from pre-existing odontoblast

Reparative: Newly differentiated odontoblast-like cells formed due to death of original odontoblast

Coronal Pulp vs Radicular Pulp

Which is more cellular

Which is more vascular

Which is more fibrous

Coronal

Coronal

Radicular

What results in strong stimulus and odontoblast dies?

Reactionary or Reparative

Reparative

The distance from major to minor diameter is about _______

As you age the distance _______

0.5 mm

increase (more cementum canal narrows so distance increase)

++ means

+++ means

exaggerated

exaggerated and prolonged

Electric pulp test is only performed on _______ not _______

enamel and dentin, crowns

Vital pulp reads _______

Necrotic pulp reads _______

1-79

80

_______ pain is the most convincing sign of irreversible pulpitis

Spontaneous

If the tooth does not respond to 80 in EPT, the tooth is _______

necrotic

Cellulitis vs Abscess

Cellulitis is diffuse swelling, visible asymmetry, the skin or mucosa is red, hot and sensitive to the touch (Cannot be drained and needs urgent care and antibiotic)

Abscess: localized collection of inflammatory material and can be drained

If abscess is present, the tooth is ________

necrotic

Which is more painful acute or chronic apical abscess

Acute (Chronic is constantly draining through sinus tract)

What is the pulpal diagnosis if there is no spontaneous pain

Reversible Pulpitis

What is the diagnosis if there is swelling?

Acute apical abscess

Transient Inflammation

Progessive Inflammation

Cell death

Reversible

Irreversible

Necrosis

Are periapical lesion dependent on the pulp

No

_______ anaerobic bacteria become predominant during primary intra-radicular infections

obligate

Two types of bacteria in root canal

Planktonic (in fluid easy to remove)

Biofilm (hard to remove)

Secondary infection are microorganism introduced during _______

Persistent or Recurrent infection are microorganism that can resist intracanal antibacterial procedures and endure periods of deprivation

RCT

Caries, plaque, calculus are _______ infection

secondary

What is the most common secondary endo bacteria

Facultative anaerobic gram positive cocci (Enterococcus faecalis)

In chronic apical abscess extra-radicular infection is ______ on the intra-radicular infection

In apical actinomycosis, extra-radicular infection is ______ on the intra-radicular infection

dependent

independent (RCT may not heal and require surgery)

Primary Endo infections are _______

Secondary/Persistent infections are _______

polymicrobial

facultative anaerobic gram positive cocci (Enterococcus faecalis)

________ ________ are healing tissues with fibroblasts, collagen, proliferation capillaries, and leukocytes

Granulation Tissue

_________ is chronic inflammatory tissue primarily infiltrated with leukocytes, plasma cells, and macrophages

Granuloma

_______ cyst are inflammatory lesion with a distinct pathological cavity completely enclosed in epithelial lining

_______ cyst are lined with epithelium, but communicates with root canal

True or Bay

Pocket

_______ is a acute inflammatory consisting primarily of PMNs

Abscess

Can you differentiate between granuloma or cyst clinically

No only histology

Which is more likely to heal: Pocket cyst or True cyst

Pocket Cyst (Connected to apical foramen)

Pocket also can regress by apoptosis

Condensing osteitis vs Idiopathic Osteosclerosis

Condensing Osteitis (treated by RCT) caused by inflammation

Idiopatic Osteosclerosis does not need treatment

Tell by radiograph (widening of PDL and large decay)

Radiolucency is _______ density

Radiopacity is ______ density

decreased

increased

If the lamina dura is intact the tooth is ________

non-inflammatory

The ________ duct cyst is the most common non-odontogenic cyst

nasopalatine (not foramen if it grows)

What are dentigerous cyst

Cyst always with impacted tooth

Mandibular and Maxillary 3rd molars and Max canines

What are odontogenic keratocyst

Jaw cyst in mandible especially posterior

Lateral periodontal cyst

Mandibular lateral/canine/premolar area

In older pt

Central Giant Cell Granuloma

In anterior area

Treated by surgical removal

A simple bone cyst are a ______

pseudocyst (not lined in epithelium)

What progress from radiolucent to mixed to radiopaque

Cemento-Osseous Dysplasia

What are florid COD

Multiple quadrant Cemento-Osseous Dysplasia

Usually in black females

Idiopathic Osteosclerosis vs Condensing Osteitis

Condensing Osteitis require RCT

Biopsy if symptomatic

X-ray to see if expands

What is multiple myeloma

Malignancy of plasma cell

Very large lesion

4 Types of Canal Configuration (Weine)

1-1 1 canal 1 apex

2-1 2 canal 1 apex

2-2 2 canal 2 apex

1-2 1 canal 2 apex

8 Types of Vertucci Canal

1-1

2-1

1-2-1

2-2

1-2

2-1-2

1-2-1-2

3-3

Maxillary premolar have _____ concavity at the _____ which may cause lateral perforation

mesial, CEJ

How many roots and canal do mandibular 1st molar have?

2 roots

3 or 4 canals

If 3 (MB, ML, D)