CD3 Endodontics Study Set: Key Terms & Definitions

True or False:

You can heat a root canal spreader instrument?

False!

You can ONLY heat the root canal plugger instruments

What is a root canal plugger instrument used for?

Its used to compact filling material during VERTICAL condensation

CAN BE HEATED

What is the root canal spreader used for?

Used to compact filling material during LATERAL condensation

NOT to be heated, NOT to be used to find canals

What does the color of the endodontic file indicate?

It indicates the size of the tip

What is the function of stainless steel K-files?

Penetration and enlargement

What is the shape of the tip for stainless steel K files?

Square or rectangular

How long is the cutting edge on all of the stainless steel K-files?

16 mm

Why are K files (hand files) single use?

Files show signs of wear during normal uses. Single use reduces the risk of file breakage during use and increase patient safety.

Cutting efficiency is therefore achieved when a new instrument is used for each patient.

Single use files eliminate cross contamination

What is the pH of Calcium Hydroxide?

12.5

aqeuous and radiopaque

The endodontic irrigating syringe features a ______ vented needle

side

Why are 5 radiographs needed for completing an RCT?

1. Recognize anatomical information

2. Prevent incidence of endo mishape

3. Predict eventual outcomes

4. Insurance claims (need pre/post of)

5. Legal protection

The apical constriction is typically located ~_______ from the radiographic apex

0.5

True Or False:

You should am to obturate teeth AT LENGTH (~0.5 mm from the radiographic apex)

True

True or false: Practitioners electing to perform endodontic treatment are not legally held to the same standard of care as endodontists.

False:

Dentist electing to perform RCT are held to the same standard as endodontists

What are the principals of canal shaping?

Develop continuously tapering cone

"flow" across multiple places

Maintain location of foramen

Keep foramen as small as practice

What is the tip shape of ProTaper Next rotary file?

Rectangle

*2 points of contact at all times

What is the tip shape of ProTaper Universal?

Triangle

*3 points of contact as all times

What is the percent of children/teens in the USA who will have tooth injuries?

30%

What are the main etiologies of trauma injuries?

*Sports Related

Accidents

Physical Abuse

Fights

Drugs/Alcohol

Disability

Which teeth are most commonly injuried?

Anterior teeth

When evaluating dental trauma, what should you acquire during their medical history evaluation?

Lost of consciousness due to the injury

Headache, Nausea, Vomiting

Bleeding disorders

Current meds

Allergies

Tetanus immunization

Why do we care about the dental history of the trauma?

WHEN the trauma happened is critical to the treatment and the prognosis of the tooth going forward.

Ask your patient: HOW, WHEN, WHERE?

What is the one issue with pulp testing after a trauma injury?

Its not always accurate immediately following trauma

When is pulp testing considered accurate after a trauma injury?

Typically 3 months

What are the different types of tooth fractures that can occur?

Crown fracture

Crown-root fracture

Root fracture

Alveolar Fracture

What is the most common type of fracture?

Crown fracture (75% of all injuries)

What is the definition of an uncomplicated crown fracture?

Enamel fracture or enamel-dentin fracture that does NOT involve the pulp

What is the diagnosis of an uncomplicated crown fracture?

PA radiographs

Evaluate size of pulp chamber and stage of root development

Pulp test

What are the goals of an uncomplicated crown fracture?

Maintain pulp vitality

Restore normal esthetics and function

What is the treatment for an uncomplicated crown fracture?

Repair

No NS-RCT is needed

What is the definition of a complicated crown fracture?

Enamel-Dentin fracture with pulp exposure

What are the determining factors for how we treat a complicated crown fracture?

How large the exposure is

Is hemostasis possible

What is the growth stage/apical development of the root

What are the indications to do a pulp cap on a complicated crown fracture?

Short exposure period after trauma (<24hr)

Small exposure

Not associated with PDL injury

How should you pulp cap an adult tooth?

Cover the pulp with calcium hydroxide/MTA

Restore tooth

How should you pulp cap an open apex (immature) tooth?

Try to maintain pulp vitality*

Perform pulp capping or partial pulpotomy with CaOH/MTA + coronal seal

What is the definition of a crown-root fracture?

Involves enamel, cementum, and dentin

May or may not expose the pulp

What is the diagnosis of a crown-root fracture?

2+ PA radiographs

Pulp test

What is the treatment for crown root fractures?

Perform endodontic treatment, then restore with post and crown

What is the percentage of root fractures that occur?

7%

What is the definition of a horizontal root fracture?

Fracture involving dentin, cementum, and the pulp (ENAMEL IS NOT INVOLVED)

Coronal fragment is usually mobile and sometimes displaced

the apical segment is usually NOT displaced

What is the prognosis of a horizontal root fracture?

Apical 1/3> Middle 1/3 > Cervical 1/3

What is the diagnosis of a horizontal root fracture?

2+ PA radiographs taken at different angles (or a CBCT scan)

What is the treatment for horizontal root fracture?

Immediate reduction of the fracture segments

Complete immobilization of the coronal segment

Splint 3-4wks (or 4 months)

Endodontic treatment starts IF pulp necrosis occurs

What is the probability that a horizontal root fracture will become necrotic?

Pulp necrosis is 25% change

How long should a splint be in place is the fracture is in the apical third or middle third?

4 weeks

How long should a splint be in place if the fracture is in the cervical third?

4 months

What is the diagnosis of an alveolar fracture?

When the mobility of one tooth is tested, several other teeth move

Hematoma in adjacent attached gingiva or mucosa

What is the treatment for an alveolar fracture?

Reposition

Splint

What is the definition of a tooth concussion?

No displacement

No mobility

Usually sensitive to percussion and or tender to touch

What is the treatment for a tooth concussion?

Flexible splint is optional- can be used for comfort of the patient for 7-10 days

What is the definitino of a tooth subluxation (loosening)?

Tooth is tender to touch and mobile, but not displaced

Hemorrhage from gingival sulcus possible

What is the diagnosis of a tooth subluxation?

2+ PA radiographs with NO radiographic abnormalities

What is the treatment for a tooth subluxation?

Flexible splint is optional - 7-10 days

What is the definition of tooth extrusion (partial avulsion)?

Elongated mobile tooth

Partial displacement of tooth out of socket

Angulated radiograph: increase PDL space

What is the treatment for a tooth extrusion?

Reposition

Stabilize tooth with flexible splint for 1-2 weeks

What is the definition of a lateral luxation?

Displacement of a tooth buccally or lingually

Usually accompanied by fracture of socket

Usually locked into bone

Not tender to the touch, not mobile

What is the diagnosis of a lateral luxation?

2+ Angulated PA radiographs

What is the treatment for a lateral luxation?

Reposition the tooth into normal position

Confirm with radiograph

Stabilize tooth with flexible splint for 1-2 weeks

Follow up to see if its necrotic or needs NS/RCT

What is the definition of intrusion?

Apical displacement of tooth into the alveolar bone

Tooth is driven into the socket, compression the PDL

Tooth appears to be shortened or missing

Severe type of luxation injury

What is the treatment for intrusion in tooth with an immature root formation?

Spontaneous reposition/ re-eruption

What is the treatment for intrusion in a tooth with a mature root formation?

Reposition the tooth with ortho or surgical extrusion

Initiate endo treatment within first 2 weeks

Prognosis is POOR

What is the definition of avulsion?

The tooth is seperated from the socket completely

PDL is torn

What is the most critical factor in avulsion healing?

Minimize the extra-alveolar time

Immediate replantation = best prognosis

What are the effects of dry extra-oral time?

If the PDL dries out prior to replantation, there is an inflammatory response on the root surface, ankylosis, loss of the tooth

What are different types of storage media for avulsions?

Hanks Balanced Salt Solution

Milk

Saliva

0.9% Saline

Tap Water

Contact lens solution

Gaterade

For avulsed teeth, how should you hold them?

You should ONLY handle the crown only

DO NOT touch the root of the tooth

Do not scrub tooth

Do not wrap in tissue or cloth

What is the treatment for avulsion?

Place tooth in HBSS

Obtain radiographs

Gently aspirate the injured area without entering the socket. Irrigate lightly with saline.

DO NOT CURETTE THE SOCKET

Early replantation of an avulsed tooth is less than ____ mins

60

In an immature apex, what is the goal for an immature avulsed tooth if its been out of the mouth for less than 60 mins?

Revascularization of the pulp

No endodontic treatment is initially required

What is the treatment for an avulsed immature apex with an extra-oral dry time of <60 mins?

Rinse root surface w/ saline

remove coagulation from socket

Replant tooth

Splint for 1-2 weeks - flexible wire of a diameter up to 0.016" or 0.4mm

What is the treatment for an avulsed mature tooth with an extra-oral dry time of <60 mins?

rinse root surface w/ saline

remove coagulation frmo socket

Replant tooth

Splint for 1-2 weeks

Endodontic treatment is ALWAYS started within 7-10 days

follow-up

* this is the same tx for immature tooth >60 mins

What is the treatment for a mature avulsed tooth with an extra-oral dry time of >60 mins?

Remove debris and PDL

Soak tooth in NaF for 5 mins

Replant tooth

Splint for 4-6 weeks flexible wire w/ diameter of 0.016" or 0.4mm

Endo treatment started with 7-10 days

What type of splinting material can be used?

Flexible wire w/ diameter up to 0.016" or 0.4mm

OR

Nylon fishing line 0.13-0.25 mm

What is the function of creating a flexible splint for teeth?

Allows physiologic tooth movement during healing

In an avulsed/traumatized tooth, how long should calcium hydroxide be in place for?

1-2 months

What retentive restorative material should be avoided in avulsed teeth?

Try to avoid post placement

What are the factors affecting prognosis of an avulsion?

1. Extra-oral Dry time

2. Transport conditions

3. Time before endodontic treatment (7-10 days)

4. Splinting technique and time

(non-rigid, minimal time)

5. Stage of root development

6. Root surface treatment

What are three complications that can follow after traumatic injuries?

Pulp Necrosis

Pulp Canal Obliteration

Root resorption (inflammatory)

What is pulp obliteration?

a condition characterized by the pronounced deposition of hard tissue along the internal walls of the root canal that fills most of the pulp system leaving it narrowed and restricted.

What is a common finding in teeth with pulpal obliteration?

Yellow discoloration

This does NOT imply the presence of pulp or periapical disease

When is RCT indicated for pulp obliteration?

When there are clinical symptoms and/or definite radiographic findings suggestive of periapical disease

What is root resorption?

Loss of pre-cementum, cementoblasts and epithelial rests of Mallassez. Denuded root surface, hard tissue resorbing cells remove damaged periodontal ligament and cementum

What are the three types of external root resorption?

Surface resorption

Imflammatory root resorption

replacement root resorption *ankylosis

What is surface resorption (localized injury)?

Localized injury to cementum (concussion, subluxation)

Local inflammatory response

May/may not be visible on radiograph

No treatment is required

What is inflammatory root resorption?

Damage of the periodontium

Bacteria within tubules

2 visit NS/RCT

Which luxation injury has the worst prognosis?

Intrusion

What is replacement resorption?

Severe damange to the peridontium

Fusion of the tooth root with the adjacent alveolar bone

What is the diagnosis of replacement resorption (ankylosis)?

Tooth is immobile

High Percussive tone

No visible PDL space

What is the treatment of replacement resorption (ankylosis)?

Cannot be arrested or repaired

*Can survive for number of years

What is dentin hypersensitivity?

Short, exaggerated, sharp, painful response that is elicited when exposed dentin is subjected to thermal, mechanical, or chemical stimuli

What kind of pulpal diagnosis is associated with dentin hypersensitivity?

Reversible pulpitis

What is the hypothesis behind dentin hypersensitivty?

Brannstrom's hydrodynamic theory

What is Brannstrom's hydrodynamic theory?

Fluid movement in the dentinal tubules, following a stimulus, can initiate a reaction which causes pain

For dentin hypersensitivity.....What can fluid movement be caused by?

Dehydration, osmotic changes, mechanical probing, or thermal probing

For the dentin hypersensitivity experiment, what teeth were tested?

Premolars that were tx planned for orthodontic extractions

For dentin hypersensitvity, when the tooth is dehydrated this causes pain. What will help stop this pain?

Reapply fluid to the tooth

What type of stimulus causes an outward movement of fluid on the dentin?

Cold

What type of stimulus causes an inward movement of fluid on the dentin?

Heat

How is dentin hypersensitivity often treated?

Treated by covering the dentin

Desensitizing agent +/- restoration

What are biomaterials that are used in dentistry?

Bioceramics

Bioglasses