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Adv Endo Therapy
Vet Dentistry
| Question | Answer |
|---|---|
| What is gouging? | penetration of the floor of the pulp chamber (i.e. with burs or files during exploration for canals) |
| What term is used to describe 'gouging' in the root canals? | ledging or hedging |
| What is the most serious complication in endo tx? | perforation |
| What is the prognosis when perforation occurs at or below the osseous crest or into the furcation? | usually very poor |
| After hemorrhage has been controlled following perforation apical to the osseous crest, what materials are used to seal the defect? | Cavit, ZOE, alloys |
| What is procedural canal blockage? | obstruction of a once patent canal preventing full instrument access to the apical stop/stricture |
| What do most blockages form from during endo tx? | packing of dentinal chips, cotton pellets, paper points, or a piece of fracture instrument |
| Loss of working length due to dentinal chip accumulation at the apical third of the canal can usually be attributed to: | too rapid increase in files size insufficient irrigation technique inadequate recapitulation lack of routine rad evaluation |
| What type of energy can be utilized to manage obstruction retrievals in the root canal? | ultrasonic |
| What is ledging? | gouging, creating a false canal by intstrumentation with excessive apical pressure |
| In what type of canal is ledging most common? | curved |
| How can ledging be prevented | Avoid excess apical instrument pressure until the file is working freely in the canal, use lube with files, use prebent files with directional stops |
| How can ledging be resolved? | place a 45 degree bend 3 mm from the tip of a size 8-15 K file. Insert this well lubricated instrument with the bent tip pointed toward the true apex and file aggressively to reduce the ledge |
| What is zipping/elliptication | transportation or transposition of the apical portion of the canal |
| What causes zipping? | failure to prebend files, excessive rotation of instruments, use of overly stiff instruments in curved canals |
| What 2 complications can result from zipping? | Elbow stricture apical perforation |
| What is the problem with an elbow stricture formation during RC therapy? | creates an apical vault that is not obutrated by a traditional cold GP point, which leaves a space for fluid accumulation that can result in RC failure |
| What should you do regarding obturation if there is apical perforation during RC instrumentation? | use a sealer containing CaOH |
| What is stripping? | endo complication that results in lateral wall perforation |
| What is the primary cause of stripping? | overzealous filing in the mid root area |
| How can one prevent stripping? | judicial use of filing presure away from the curvature of the root tip and/or toward the more bulky portion of the tooth root (anticurvature filing) |
| How should stripping be addressed when it results in lateral wall perforation? step 1 | Step 1: Fill the compromised root with CaOH and place a temporary filling. Complete traditional RC for any other non-compromised roots of that tooth |
| How should stripping be addressed when it results in lateral wall perforation? step 2 | After 4-6 weeks, remove the CaOH carefully, using only sterile saline or hydrogen peroxide to irrigate and complete standard root canal (CaOH containing sealer is best) |
| What does persistent hemorrhage during RC tx indicate? | Usually, an indication of underinstrumentation, but can also indicate over instrumentation/apical perforation |
| How does one correct apical perforation and loss of the apical stop? | Backup technique: determine working length w/apical tip of file 1-2 mm from the radiographic apex and instrument up 2-3 file sizes larger (must use carefully placed stops) |
| What type of bur should be used in vital tooth resectioning? Why? | steel burs produce less heat, less risk of pulpal insult |
| What is the functional duration of deciduous teeth in dogs and cats? | 2-5 months |
| What proportion of final expected root length is present at the time of eruption of permanent teeth? | 50% |
| In what type of teeth is apexigenesis performed? | vital teeth with endo exposure and incomplete apical development |
| In what type of teeth is apexification performed? | non-vital teeth with endo exposure and incomplete apical development |
| What 3 factors contribute to whether or not an exposed pulp maintains vitality after exposure? | 1) degree of inflammation as determined by the intensity of traumatic insult 2) amount of debris and bacterial contamination 3)duration of time between exposure and treatment |
| To what depth does inflammation extend into the pulp following traumatic exposure? | 2-3 mm from exposed surface for up to 168 hours (7 days) |
| What type of bur should be used for pulp amputation? why? | diamond bur causes the least damage to underlying healthy pulp tissue |
| Why might one consider traditional RC therapy of a tooth treated successfully with direct pulp capping? | Because there were some reports of CaOH treated canals becoming highly calcified, causing difficulties in endo instrumentation if needed at a later date |
| What measures can be taken during CaOH pulp therapy procedures to prevent excessive calcification and subsequent instrumentation difficulties of standard RC therapy if needed later on? | gentle technique taking care not to pack dentinal chips or CaOH into the underlying pulp tissue |
| If, during vital pulp therapy, bleeding continues for more than 5-6 minutes, what measures should be taken/considered? | Ensure that all inflamed hyperplastic tissue has been removed (may need to amputate more apically) |
| What is the recommended radiographic recall for patients treated with VPT? | q6-9 months for up to 2 years |
| What are 6 different materials that can be used to promote apexification? Which is most commonly used? | Calcium hydroxide (most common) Zinc oxide pastes Antibiotic pastes Walkoff's paste Diaket Tricalcium phosphate |
| What type of calcification occurs at the apical foramen in apexification? | osteoid (bone like) or cementoid (cementum like) |
| What type of tissue interface is required for successful apexification? | the apex must be entirely encompassed by cortical bone |
| How might the presence of a periapical radiolucency affect apexification | may delay or interfere with it since the process requires being surrounded by healthy cortical bone |
| What additional measure should be take during an apexification procedure if there is a periapical lucency present? | radicular currettage and drainage to stimulate bony healing |
| What irrigant should be used during instrumentation for apexification treatment? | sterile saline |
| What is suggested as the fill material of choice for apexification? | 8 parts CaOH powder + 1 part barium sulfate powder mixed with sterile fluid or anesthetic into a paste consistency |
| How long does apexification take? | 6-24 months |
| What is the recommended recall interval after apexification procedure performed? | q 3 months until radiographic apical closure is noted, then canal is re-entered for physical confirmation of apical closure and traditional RC obturation is performed |
| What is the most common indications for surgical endodontic therapy? | standard endo therapy is not possible (due to internal root accessibility) or has not been successful (due to external root end complicaitons) |
| What types of abnormalities may prevent apical access for traditional RC therapy? | 1) canal stricture resulting from excessive/irregular dentinal deposition 2)endoliths 3) dentinogenesis imperfecta 4) dental dysplasia 5) dens in dente 6) fusion 7) dilaceration |
| What might persistent (longer than 9-12 months) periapical lucency following traditional RC therapy indicate? | procedural failure and persistent infection OR periapical cyst formation |
| How does a periapical cyst form? From what tissue? | Chronic irritation of the epithelial cells of the rests of Malassez caught in a periapical granuloma results in rapid proliferation and cyst formation |
| What are some contraindications for surgical root canal therapy? | deviations from normal in 1) systemic patient health 2) crown structure 3) root/peri-radicular structures 4) periodontal health 5) anatomic location |
| What are 4 major categories of apical surgical intervention? | 1) peri-radicular drainage 2) periapical curettage 3) apical resection/apicoectomy 4) retrograde obturation |
| How does radiographic peri-apical lucency develop? | acidic exudate accumulates and erodes the cortical plate, then hormonal response to the inflammation further demineralizes the bone |
| What is the purpose of periapical drainage? | To relieve pain, swelling, and discomfort associated with periapical exudate accumulation and to allow periapical healing for increased success of standard endo tx |
| Describe the flap creation and trephination process to establish periapical drainage | Mucosal flap is half-moon extending from adjacent teeth on either side of affected tooth and involving apical portion of attached gingiva of affected tooth. Trephine hole made w/round bur 1-2 mm coronal to apex of affected tooth. |
| Why might periapical curettage be performed in conjunction with periapical drainage? | To remove apical pathology such as granuloma or cysts (histopath should be performed) |
| What types of processes can cause periapical lesions? | developmental metabolic traumatic odontogenic infective neoplastic |
| How is periradicular drainage maintained? | After flushing (+/- curettage) Pack the pocket with an umbilical tape section sutured in place for 3-6+ days |
| When should apicoectomy be performed? | 1) to remove a necrotic/diseased apex to allow healing after standard coronal access obturation 2) to allow retrograde filling is standard access obturation cannot be completed or has repeatedly failed |
| What is the most important point for successful apicoectomy? | complete extraction of the apical tip |
| What is the limit for how much root can/should be removed w/apicoectomy so as not to overcompromise crown:root ratio? | refrain from removing >1/2 the root structure |
| How much root length is removed when apicoectomy is performed for retrograde filling? | 4-6 mm, cut at a 45 degree angle in apical direction |
| What are 2 techniques that can be employed to perform retrograde filling? | Class I cavity preparation Slot of Matzuri |
| To what depth is the apex prepared for retrograde filling with either/both techniques? | 3-5 mm |
| What are potential complications of the use of zinc amalgum in the presence of moisture? | expansion (4%)-->creep, restorative & root fx, loss of apical seal, procedural failure |
| What measures are taken to optimize success when amalgum is used for retrograde fill? | good undercut and use of cavity varnish in a dry environment |
| What products, in addition to amalgum, offer advantageous retrograde fill properties? | zinc oxide-eugenol products: Super EBA and IRM MTA (no cavity varnish needed) |
| Does transplantation of dental pulp stem cells (DPSC) and/or PRP into root canals enhance new tissue formation when compared to induction of a simple blood clot into the canal? J Endod 2102 38(12) | no |
| What is the difference between a true cyst and a pocket cyst? PoP pg 566 | A true cyst has a lumen completely enclosed by epithelium; A pocket cyst opens to the apical root canal with an epithelial collar at the root apex |
| What is the biologic status of a pocket cyst? PoP p 567 | constitutes an extension of the infected root canal space into the periapex (walls off the periapical infxn away from periapical bone) |
Created by:
lamarron
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