CA11-MDA Chapter 54, Endodontics
Terms in this set (153)
The specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues surrounding the root of the tooth
Referring to the area of nerves, blood vessels and tissues that surrounds the root of a tooth
The specialty that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth.
Often referred to as root canal therapy
Root canal therapy
This provides an effective means of saving a tooth that might otherwise have to be extracted.
A dentist who specializes in the prevention, diagnosis, and treatment of diseases of the dental pulp and the periradicular tissues.
Physical irritation (decay) & trauma
2 main sources of pulpal nerve damage are
Most often caused by extensive decay that has moved into the pulp carrying bacteria
When bacteria reach the nerves and blood vessels, infection will result in an
A localized accumulation of pus in a cavity formed by tissue disintegration
A blow to the tooth or the jaw
Example of a trauma to the pulpal tissue
Sensitivity, discomfort & pain
This may be symptoms of pulpal nerve damage (3)
Pain when occluding
Pain during mastication
Sensitivity to hot or cold beverages
Most common Signs and Symptoms of Pulpal Damage (4)
What will result if bacteria reach the nerves and blood vessels of a tooth
subjective and objective
Diagnosis of a tooth that requires endodontic treatment is based on an examination that consists of ______ &______components
Character and duration of pain
Sensitivity to biting and pressure
Subjective examination includes an evaluation of symptoms or problems described by the patient, which include the following:
Extent of decay
Periodontal conditions surrounding the tooth
Presence of Extensive restoration
Swelling or discoloration
The objective examination is conducted by the endodontist, who evaluates the status of the tooth and surrounding tissues with regard to the following: (6)
A healthy tooth used as a standard to compare questionable teeth of similar size and structure during pulp vitality testing.
Use of a _____ ______ shows that the stimulus is capable of achieving a response.
Percussion and palpation tests
These tests are used to determine whether the inflammatory process has extended into the periapical tissues
This test is performed by tapping on the incisal or occlusal surface of the tooth in question with the end of the mouth mirror handle, which is held parallel to the long axis of the tooth to access vitality of the tooth.
Technique of examining the soft tissue with the examiners hands or fingertips
This test is performed by applying firm pressure to the mucosa above the apex of the root and noting any sensitivity or swelling.
Necrotic pulp will not respond to _____ or _____
_____ ______ is suspected when the cold relieves the pain; however, cold in teeth with _____ ____ also can initiate severe, lingering pain.
A necrotic tooth
Also called a dead, or non-vital tooth.
metallic restoration or on gingival tissue
A thermal stimulus is never used on a (2)
Heat and cold test
2 types of thermal sensitivity testing
Ice, dry ice, or carbon dioxide
During the cold test the dentist uses (3) to determine the response of a tooth to cold
The source of cold is first applied to the ____ _____ of the control tooth, then to the ____ _____ of the suspect tooth.
The _____ test is generally the least useful of the vitality tests because a painful response to heat could indicate either reversible pulpitis or irreversible pulpitis.
Pea sized piece of gutta-percha, instrument handle
For the heat test A piece of _____or ______ ____ is heated in a flame and applied to the facial surface of the tooth
To prevent material from sticking to the tooth during the heat test this should be applied to the tooth
Electric Pulp Testing
This test is used in endodontic diagnosis to determine whether a pulp is vital or nonvital
Electric pulp testing
This test can produce false positive or false negative results
Electric Pulp Testing
Test in which a small electrical stimulus is delivered to the pulp
If the patient has extensive restorations
If the patient has teeth with more than one canal (1 vital & 1 non vital)
Failing pulp can produce a variety of responses
Control teeth may not respond as anticipated
Moisture on the tooth during testing may produce an inaccurate reading
The batteries in the tester may weaken over time
Factors that may influence the reliability of the electric pulp tests (6)
This is a necessity for diagnostic testing as well as for root canal therapy
Working length image
Final instrumentation image
Root canal completion image
The following images are required for the diagnosis and completion of endodontic treatment
This periapical radiograph is taken during the diagnostic stages before treatment
Working length image
This periapical radiograph is taken once the pulp has been opened and is used to determine the length of the canal
It is easier to detect the canal length with this remaining in the tooth
Final instrumentation stage
This periapical radiograph is taken with the final size files in all canals receiving treatment
A tingling or warm sensation
During the electric pulp vitality test the patient may feel
Electric pulp testing
During this procedure a thin layer of toothpaste is placed on the tip of the pulp tester electrode
Placing a thin layer of toothpaste on the tip of the pulp tester electrode
During electric pulp testing this will provide adequate contact to conduct a current from the pulp tester to the tooth
The control tooth
During electric pulse testing which tooth is tested first
Root canal completion image
This final periapical radiograph is taken of the completed canal filled after the tooth has been temporized and the dental dam removed
This radiograph image is taken at posttreatment evaluations
Must show 4 to 5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition
Must present an accurate image of the tooth without elongation or foreshortening
Must exhibit good contrast so that all pertinent structures are readily identifiable
Requirements of Endodontic Images
4 to 5 mm
Requirements of Endodontic Images--they must show what distance beyond the apex of the tooth and the surrounding bone or pathologic condition
Is pain a subjective or objective component of a diagnosis
When the dentist taps on the tooth what diagnostic test is being performed
How many radiographs may be taken throughout the course of a root canal therapy.
This indicates no subjective symptoms or objective signs
The tooth responds normally to sensory stimuli, and a healthy layer of dentin surrounds the pulp
This indicates that the pulpal tissues have become inflamed
Pulpitis can be described clinically as follows (2 types)
This occurs when the pulp is irritated, and the patient is experiencing pain in response to thermal stimuli. Eliminating the irritant and placing a sedative material may save the pulp
Pulpitis in which the tooth displays symptoms of lingering pain
Root canal therapy or extraction
Only treatment options for irreversible pulpitis
Inflammation of the dental pulp
Form of pulpal inflammation in which the pulp may be salvageable
Infectious condition in which the pulp is incapable of healing, which would then require root canal therapy
This inflammatory reaction to pulpal infection may be of chronic or acute onset
Periadicular abscess characterized by an inflammatory response with pain, tenderness of the tooth to pressure, pus formation, and swelling of the tissues resulting from necrosis.
Periadicular abscess characterized by the presence of a draining sinus tract. The lesion is asymptomatic, with little or no discomfort, and an intermittent discharge of pus may be noticed
This inflammatory reaction is frequently caused by bacteria en rapped in the periodontal sulcus
A patient will experience rapid onset of pain, tenderness of the tooth in response to pressure, pus formation, and swelling
Symptoms of a periodontal abscess (4)
This type of cyst develops at or near the root of a necrotic tooth
They develop as an inflammatory response to pulpal infection and necrosis of the pulp
An imflammatory reaction to pulpal infection
Pertaining to disease symptoms that persist over a long time
Pertaining to a traumatic, pathologic, or physiologic occurrence or process that has a short and relatively severe course
A decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal
The term is used to describe a tooth that does not respond to sensory stimulus
Often seen in older patients as well as in patients with traumatic injury to a tooth.
Also referred to as necrotic or nonvital
First line of treatment for endodontic treatment
An attempt to stimulate pulpal regeneration and save the pulp
Root canal therapy or surgery
If pulpal therapy is not effective the endodontist willmove to more extreme measures, which include
In an attempt to save the pulp, a covering of Calcium hydroxide is placed over an exposed or nearly exposed pulp to encourage the formation of dentin at the site of injury. This is called?
Indirect pulp capping
A temporary procedure wherein most of the carious dentin in a deep cavity is not removed. A liner and a temporary restoration are placed, and the cavity is reopened after a period of time; the remaining carious dentin is then excavated.
The goal of indirect pulp capping.
1. to promote pulpal healing by removing most of the decay, and
2. to stimulate the production of reparative dentin through placement of calcium hydroxide
Indirect pulp cap
Placement of a medicament over a partially exposed pulp
Direct pulp cap
Application of dental material with an exposed or nearly exposed dental pulp
direct pulp cap
With a _____ _____ ____ the tooth is still vital. Calcium hydroxide or an adhesive resin that is naturally compatible with pulpal tissue is placed to allow healing. When this is performed it is necessary to inform the patient that problems may develop later
This procedure involves removal of the coronal portion of an exposed vital pulp
This procedure is completed to preserve the vitality of the remaining portion of the pulp within the root of the tooth
The procedure is often indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations
Also referred to as root canal therapy, this procedure involves the complete removal of the dental pulp
Complete removal of vital pulp from a tooth
Removal of the coronal portion of a vital pulp from a tooth
What dental material would be selected for pulp capping
The coronal portion of the exposed vital pulp
How much of the pulp is removed in a pulpotomy
Endodontic spoon excavator
Spreaders and pluggers
Glick number 1
Hand Instruments for Endodontic Procedures
Hand-operated files used for endodontic procedures
Rotary-operated files and burs used for endodontic procedures
Ancillary (provides necessary support) instruments used for endodontic procedures
Double ended endodontic hand instrument that is long and straight. Used to help in locating canal openings
Endodontic spoon excavator
Double ended endodontic hand instrument that has a very long shank, which allows it to reach deep into the canal to remove coronal pulp tissue, decay, and temporary cements.
Pluggers and spreaders
These instruments are used in the obturation of the canal. They condense and adapt the gutta-percha points into the canal.
Process of filling a root canal
Instrument that has a flat tip like that of a condenser
Instrument that has a pointed tip, similar to that of an explorer
Glick Number 1
Instrument that has a paddle-shaped end that is designed for placement of temporary restorations, and the rod-shaped plugger at the opposite end is ideal for removal of excess gutta-percha
Glick Number 1
Instrument used for placement or removal of gutta percha
Hand operated files are color coded according to their
These are used for cleaning and shaping the pulpal canal
The hand operated files are available in stainless steel and
Ni-Ti-nickel titanium files
These files provide the advantages of extreme flexibility, good strength, and a longer working life.
This file has a twisted design and is used in the initial debridement (cleaning) of the canal and during later stages of shaping and contouring the canal.
(Hand operated file) The conventional ____ ___ ___ has a stiff feel that is very effective for straight canals
Flexible K-type file
For narrow canals and curved canals, some dentists prefer what type of file?
Provides greater cutting efficiency because of its design. It can be used for final enlargement of the canal after a Gates-Glidden bur or a Pesso reamer has been used.
This file has its spiral edges arranged so that cutting occurs only on the pulling stroke, making the dentinal walls smooth and easier to fill
Hand operated file that is a thin flexible, tapered metal hand instrument that has tiny fishhook-like projections along the shaft that are used to remove vital, inflamed hemorrhagic pulp tissue from the canal
This hand operated file can be used to remove cotton pellets and paper points
Similar to hand files but are latch-type files placed in a high-torque, low rpm handpiece designed for Ni-ti rotary instruments
Gates glidden burs
Also known as gates glidden drills
Gates Glidden burs or gates glidden drills
A bur that has a football shaped working end with a very long shank. They have a latchtype attachment & are operated in a clockwise direction
Also known as Pesso Reamers
Pesso files or Pesso reamers
Works in the same manner as a gates-glidden bur
A small, color coded, round piece of rubber, silicone, or plastic that is slid onto hand operated files to prevent perforation of the apex of the tooth during instrumentation
Making a hole, as in breaking through and extending beyond the apex of the root.
Sterile absorbent pieces of paper rolled into long, narrow points and held with locking pliers and is inserted into the canal to absorb the irrigating solution and to dry the canal. Available in a variety of sizes ranging from fine to course
What dental instrument has tiny projections and can be used to remove pulp tissue?
Can endodontic files be placed in a handpiece for use?
What type of file is best suited to shape and contour the pulpal canal
Commonly known as household bleach
irrigation solutions, root canal filling materials, and root canal sealers
Medicaments and Dental Materials in Endodontics include
In endodontics irrigating the canal facilitates the removal of materials from the canal and provides tissue dissolution, _______,_______ and hemorrhage control.
A clear, colorless liquid with disinfectant and bleaching properties for endodontics
This solution is a antimicrobial agent that has a solvent (able to dissolve) action on necrotic pulp tissue and organic debris.
A colorless, crystalline toxic phenol compound that is used as an antimicrobial agent for disinfection of the pulp canal
Gutta percha points
Made from a rubber material taken from the palaquium gutta tree. An organic substance that is solid at room temperature and becomes soft and pliable when heated. Used to obturate (fill) the canal after treatment. It is radiopaque and used with a sealer.
Root canal sealer
Cement type material that seals out the unfilled voids during the obturation (filling of the root canal) process
Calcium hydroxide, zinc oxide eugenol and glass ionomers
Cements that can be used as a root canal therapy
Infiltration for Maxillary & Nerve block for mandibular
Anesthetic techniques for endodontic treatment are
The standard of care established by the american dental association for endodontic treatment requires the use of a
Estimated working length
Working length of the completed canal prep and root canal filling is also known as
Electronic Apex Locator
Supplemental technique that can be used to facilitate identification in the apex of the root canal. It can reduce the number of radiographs required for working length determination. With this the apical foramen is identified more accurately than when radiographs are used alone
To remove or clean out the pulpal canal
Purposes of debridement
To remove bacteria, necrotic tissue, and organic debris from the root canal, to smooth and shape the canal so that the filling material can be completely adapted to the walls of the canal.
Surgical removal of the apical portion of the root with the use of a tapered fissure bur in the a high speed handpiece
This may be required to remove the pathologic (diseased) soft tissue around the root apex.
This means the removal of the diseased tissue by scraping with a curettel
Also referred to as root end filling and is performed when the apical seal is not adequate.
A surgical procedure that is used to remove one or more roots of a multirooted tooth without removing the crown
gutta-percha, amalgam, or composite
A small preparation is made at the apex and sealed with filling materials such as
Persistent infection, severely curved roots, perforation of the canal, fractured roots, extensive root resorption, pulp stones, or accessory canals that cannot be treated
To determine why healing did not occur
Indications for surgical intervention
The root and the crown are cut lengthwise and removed. Most often performed on mandibular molars
Success rate for a root canal therapy
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