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Adv Endo Therapy

Vet Dentistry

QuestionAnswer
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