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Class Lit 1

Class Lit Board Prep

Class LitTopicBottom LineM & MAuthorAssociated ArticlesYear
1 Weine Classification Type I = Single canal from chamber to foramen Type II = Two canals to a single foramen Type III = Two canals to two foramina Type IV = A single canal to two foramina Weine
1 Morphology - 6-2-3 MB cusp tip to pulp chamber ceiling = 6 mm Pulp chamber height = ~2 mm Pulp chamber floor to the furcation = ~3 mm 97-98% had the pulp chamber ceiling at the level of the CEJ 100 Max and Man molars mounted and radiographed and measured Deutsch, Musikant Also did the study in premolars. 7-3-2 2004
1 Morphology - Krasner and Rankow broke the law - Law of Centrality: The floor of the pulp chamber is located in the center of the tooth at the level of the CEJ Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
1 Morphology - Krasner and Rankow broke the law - Law of Concentricity: The walls of the pulp chamber are concentric to the external tooth at the CEJ Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
1 Morphology - Krasner and Rankow broke the law - Law of Symmetry 2: Canal orifices are located on a line perpendicular to the M/D line drawn on the floor of the pulp chamber Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
1 Morphology - Krasner and Rankow broke the law - Law of Color Change: The color of the pulp chamber floor is darker than that of the walls Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
1 Morphology - Ramification 27.4% had a ramification – 17% (63%) apical, 9% (33%) mid-root, and 1% (4%) coronal, 0% furcation. Incisors had the least amount of ramifications whereas molars and premolars had the most. Over 1100 teeth were made transparent and injected with dye DeDeus 1975
1 Morphology “28% of the guts of a man’s teeth have accessory canals in the furcal region” 28% showed accessory canals in the furcation region, 29% in mand molars and 27% in max molars Vacuum dye study of over 100 human molars (max and man) Gutmann 1978
1 Morphology “Palatal roots will bone ya 85% of the time” 85% of max molar palatal roots were curved >10° toward the buccal; 53% 10-20°, 33% > 20° Radiographs of 100 max and 100 man molars. Bone, Moule 1986
1 Morphology “Berutti took the highway to the danger zone” Thinnest area of man molars is 1.5 mm apical to the bifurcation. Thickness in this area is 1.2-1.3 mm Sectioned 15 lower molars. Berutti, Fedon 1992
1 Morphology Thinnest area of man molars is 1.5mm apical to bifurcation. Thickness in this area is 0.88-1.22 mm Micro CT of 22 man molars Harris, Bowles, Fok, McClanahan 2013
1 Morphology “I whine 8.9% of the time when I find a C-shaped canal” Retrospective = 6.2% Prospective = 8.9% Study of man 2nd molars’ C-shaped canals from his buddies’ practices Weine 1998
1 Morphology Foramen deviation / CDJ to apex / Minor diameter / Cementum thickness * 18-25 / 68% / 0.5 mm / 0.3 mm / 0.5 mm * 55+ / 80% / 0.6 mm / 0.25 mm / 0.8 mm Kuttler 1955
1 Morphology Average CDJ width = 0.189 mm. Stein, Corcoran smaller than Kuttler: Mean distance from the foramen opening to the CDJ = 0.7 mm. 1990
1 Morphology 97% are curved. Increases with age. Radiographed 4,183 teeth with 7,275 canals from M/D and B/L directions. Pineda, Kuttler 1972
1 Morphology “Use my son’s caliper to measure the radix entomolaris or paramolaris” More prevalent in Chinese, Inuit, and Native Americans Radix Entermolaris = Lingual Radix Paramolaris = Buccal Calberson, De Moor, Deroose 2007
1 Morphology “Access, Den Search” Middle mesial canal = 46% of the time, but only 6.6% after conventional access preparation. Second molars (60%) vs. first molars (38%). More in younger patients After standard prep, troughed with magnification Azim, Deutsch, Solomon 2015
2 Morphology Only 75% of the first instrument to bind touched one canal wall at WL; the remaining 25% touched no canal walls They instrumented mandibular premolars. First instrument to bind at WL was set in acrylic and examined. Wu, Barkis, Roris, Wesselink 2002
2 Working Length No Significant Difference (NSD) when WL determined before versus after coronal flaring Significantly more length lost in the SS file/GG group (0.48 mm) versus the NiTi rotary group (0.22 mm) Davis, Marshall, Baumgartner 2002
2 Working Length For lengths judged as short, the actual length was 0.46 mm closer to the microscopic WL than estimated For lengths judged as long, the actual length was 1.2 mm longer than the microscopic WL than estimated Determined WL with EAL and radiographs in vivo then extracted. Williams, Joyce, Roberts 2006
2 K-files The following files remained within the confines of the original canal as follows when used to WL: Size 25/ 96% Size 35/ 84% Size 40/ 80% Size 45/ 40% Tested the deviation of various sized K-files in curved canals using balanced forces technique. Southard, Oswald, Natkin 1987
2 Ultrasonic #1 Determined methods of ultrasonic cleaning = Acoustic streaming (not cavitation) #2 Canals were significantly cleaner upon histologic exam than those without ultrasonic cleansing Ahmad, Pitt Ford, Crum 1987
2 Ultrasonic The ultrasonic group showed significantly cleaner canals and isthmuses than the control Vital human mandibular molars with hand/rotary or hand/rotary/ 1 min ultrasonic instrumentation Gutarts, Nusstein, Reader, Beck 2005
2 Ultrasonic The ultrasonic group showed significantly cleaner canals and isthmuses than the control Necrotic human mandibular molars with same protocol as Gutarts Burleson, Nusstein, Reader, Beck Gutarts 2007
2 Ultrasonic Instrumentation reduced CFU count, but Ultrasonic provided an additional reduction in CFU count with a 7x greater chance of achieving a negative culture Necrotic human mandibular molars but this time looking at bacterial growth Carver, Nusstein, Reader, Beck 2007
3 Root ZX Root ZX was 96% accurate to within +/-0.5 mm of the apical foramen (full tone). 66% were at the minor constriction or beyond even after backing up to the 0.5 mark on the Root ZX. Ex vivo study Shabahang, Goon, Gluskin 1996
3 Root ZX Root ZX located the major diameter 85% with +/- 0.5mm and 98% with +/- 0.75 mm Root ZX is not capable of detecting the 0.5 mm from the foramen. Apex is the only reproducible landmark. Ounci, Naaman 1999
3 Root ZX - Average distance to the constriction was 0.04 mm in the preflared group and 0.42 mm in the control. - EAL was more accurate if used after preflaring. Measured the accuracy of the Root ZX in vitro in canals with or without preflaring. Glued files and extracted. Ibarrola, Chapman, Howard, Knowles, Ludlow 1999
3 EAL/EPT Interference No adverse cardiac events recorded; some pacing occurred, but this was determined to be due to the normal functioning of the ICP/ICD. Studied if EAL’s and EPT’s interfered with the function of implanted cardiac pacemakers (ICP) or cardioverter/defibrillators (ICD) in vivo. 27 patients participated. Wilson, Broberg, Baumgartner, Harris, Kron 2006
3 EPT Interference EPT doesn’t interfere with pacemakers or ICDs. N=32. Elayi, Lusher, Meeks, Darrat, Morales, Miller 2015
3 Glide Path - Rotary - Creating glide path with NiTi Rotary leads to less postoperative pain (at 4 days) and faster symptom resolution than with stainless steal. Fewer flare-ups. - Rotary files push out less debris compared to SS files and checked which caused less issues. Prospective, blinded. Pasqualini, Mollo, Scotti, Cantatore, Castellucci, Migliaretti, Berutti 2012
3 Postoperative pain ProTaper Universal vs WaveOne - Postoperative pain was significantly lower in patients undergoing canal instrumentation with ProTaper Universal rotary instruments compared with the WaveOne reciprocating single-file technique. Prospective, single blind. Nekoofar, Sheykhrezae, Meraji, Jamee, Shirvani, Jamee, Dummer 2015
3 Debris extruded All methods extruded debris, but rotary techniques produced less. Step-back extruded more than the other techniques Compared the quantity of debris extruded in vitro with step-back, balanced forces, and rotary instrumentation Reddy, Hicks 1998
3 Rotary NiTi fx 0.39% incidence. Instruments were more likely to fx in: - Molars > premolars > anteriors -Teeth with more severe curvature (> 26°) -In the apical third -If the instrument had a larger taper (88% of fx instruments had 0.06 taper or larger) Prospective study of the incidence of rotary NiTi instrument fracture (ProFile, ProTaper, GT, K3) in over 3000 canals. Di Fiore, Genov, Komaroff, Li, Lin 2006
3 Rotary NiTi fx 12% with glide path vs. 26% without glide path Compared the incidence of fracture in NiTi rotary instruments (K3, ProFile, ProTaper) with/without glide path Patino, Biedma, Leibana, Canatore, Bahillo 2005
4 Hollow tube theory Hollow tube theory Rickert, Dixon Disproved it - Goldman, Pearson (1965) and Tornek (1966) 1931
4 Gutta-percha Gutta-percha (β form = solid, compactable) - Gutta-percha (matrix) ~20% - Zinc oxide (filler) ~66% -Metal sulfates (radiopacity) ~11% - Waxes & resins (plasticizers) ~3%
4 MTA MTA (pH 12.5, expands on setting) - Tricalcium silicate - Tricalcium aluminate - Dicalcium silicate - Tetracalcium aluminoferrite (Gray) - Bismuth Oxides (radiopacifier)
4 Gutta-percha • Manufacturers may add gutta-balata to the gutta-percha cones, which was shown to release proteins that cross-react with latex, possibly placing a natural rubber latex-allergic patient at risk. Costa, Johnson, Hamilton 2001
4 Bacterial leakage • All canals were contaminated by 73 days, 50% by 19 days • Bacterial leakage study that tested how long it took motile bacteria (Proteus vulgaris) or nonmotile bacteria (Staph epidermidis) to penetrate an obturated root canal Torabinejad, Ung, Kettering 1990
4 Bacterial leakage • In 3 days, 79-85% of the root canal walls showed dye penetration  re-tx needed after 3 days of exposed GP • Extracted teeth were instrumented/obturated; the GP exposed to artificial saliva, then ink Swanson, Madison 1987
4 Sealer coverage • NSD between groups; none covered all the canal walls • Compared AH-26 placement by one of four techniques: 35 file, lentulo spiral, GP cone, and ENAC ultrasonic Wiemann, Wilcox 1991
4 Bacterial leakage • Microbial growth was less on IRM and Cavit than TERM • Compared leakage in vivo when sealed with Cavit, IRM or TERM over 3 weeks at 4mm thickness. Beach, Calhoun, Bramwell, Hutter, Miller 1996
4 MTA / VRF • MTA increased the resistance to VRF after 1 and 6 month of storage in STF compared with gutta-percha and sealer EL-Ma'aita, Qualtrough, Watts 2014
4 Endo vs Prosth High quality endodontics and high quality restoration will result in the best clinical outcomes Systematic review. Gillen, Looney, Gu, Loushine, Weller, Loushine, Pashley, Tay 2011
4 CaOH2 / IAN • When CaOH2 extruded and affecting the IAN, refer patient for immediate surgical management; if treated <36 hours, chances for a full recovery are significantly higher; failure to treat in the short term can lead to long-term paresthesia or dysesthesia Pogrel 2007
4 Fuji leakage • There was NSD in leakage in the first two groups; Fuji Triage is an acceptable intraorifice barrier • In vitro study of extracted teeth comparing leakage with 1 mm Fuji Triage, 2 mm Fuji Triage, no Fuji Triage Maloney, McClanahan, Goodell 2005
4 Bone / temperature - Changes in the bone vasculature and fatty infiltration were significantly less in the last group - The temperature threshold for preventing irreversible bony changes is 47°C for 1 minute • Placed a titanium chamber in rabbits and observed bone changes in vivo (50°C/1 min, 47°C/5 min, 47°C/1 min) Eriksson, Albrektsson 1983
4 Smear layer removal • Combined effect of these studies showed that smear layer removal significantly improves the apical and coronal seal regardless of obturation type, site of leakage test, sealer type, type of dye used, duration of the test, or year of publication. • Lit review that compared dye leakage studies. Most papers suggested removing the smear layer, a few supported keeping it. Shahravan, Haghdoost, Adl, Rabini, Sahbifar 2007
5 Pulp Vitality Accuracy of cold was 90% where the accuracy of the EPT was 75% Had the largest n = 656 Jesperson, Hellstein 2014
5 Pulp Vitality - Accuracy = Cold > Heat > EPT - Determined the probability that a non-sensitive reaction indicated necrotic pulp (PPV) was 100% for the 3 tests Clinicians were blinded to clinical signs, symptoms, histories, and radiographs. (therefore better LCE) Villa-Chavez 2013
5 Statistic Terms Sensitivity – The ability of a test to identify teeth that are necrotic as necrotic. “When you have disease, your tooth is sensitive” Positive Predictive Value – The probability that a positive test result will actually represent necrosis. - Accuracy – The overall rate of agreement between the diagnostic test and the gold standard. - Gold standard was considered to be accessing the tooth and seeing if bleeding was present. - Accuracy = Cold > EPT > Heat Petersson, Soderstrom - Specificity – The ability of a test to identify teeth that are vital as vital. - Negative Predictive Value – The probability that a negative test result will actually represent vitality. 1999
5 Pulp Vitality - Cold more accurate than EPT, but better combined. - Defined Sensitivity and Specificity differently than the other papers. Specifically, said that Sensitivity was the ability of tests to determine vitality and specificity was the ability to test for disease. Weisleder Good paper to quote for arguing that combinations of tests should be used to obtain a more accurate evaluation of pulpal vitality 2009
1 Morphology - Krasner and Rankow broke the law - Law of the CEJ: The CEJ is the most consistent, repeatable landmark for locating the pulp chamber Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
1 Morphology - Krasner and Rankow broke the law - Law of Symmetry 1: Canal orifices are equidistant from a M/D line drawn on the floor of the pulp chamber Observed 500 extracted and decoronated teeth Krasner, Rankow 2004
Created by: theperfs2019



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