tanuja

Management Of Discolored Teeth Important Notes

• Management Of Discolored Teeth Superoxol
  • It is 30% solution of hydrogen peroxide by weight and 100% by volume in pure distilled water
  • It is mixed with sodium perborate into a paste and used in walking bleach technique
• Management Of Discolored Teeth Bleaching techniques:
  • Non vital bleaching technique
    • Thermocatalytic
      • It involves the placement of 35% hydrogen peroxide liquid into the debrided pulp chamber and acceleration of the oxidation process by heating instrument into pulp chamber.
    • Walking bleach
      • In this technique, superoxol is used
  • Vital bleaching technique
    • Power bleaching
      • 35% hydrogen peroxide is used and oxidation is acceletated by applying heat or intense light
    • Night guard bleach
      • 10-15% carbamide peroxide is applied with the help of bleaching trays
• Management Of Discolored Teeth Composition of Mc Inns solution.

Management Of Discolored Teeth Long Essays

Question 1. Management of discolored teeth
Answer.

Causes of Discolored Teeth Intrinsic Stains:

• Pre-eruptive causes:
  • Disease-Haematological disorders
  • Medication-tetracycline
• Post-eruptive causes:
  • Pulpal changes
  • Trauma
  • Aging
  • Dental caries

Causes of Discolored Teeth Extrinsic Stains:

• Daily acquired stains:
  • Plaque
  • Tobacco use
  • Poor oral hygiene
  • Gingival haemorrhage
• Chemicals:
  • Chlorhexidine
  • Metallic stains

Bleaching Is Done To Treat Discolored Teeth

Bleaching: It is a procedure which involves lightening of the color of a tooth through the application of a chemical agent to oxidize the organic pigmentation in the tooth.

Bleaching Techniques:

• For vital teeth
  • Home bleaching
  • In-office bleaching
  • Thermocatalytic
  • Non-thermocatalytic
  • Micro abrasion
• For non-vital teeth
  • Thermocatalytic
  • Walking bleach
  • Inside/Outside
  • Closed chamber
• Laser assisted bleaching

Nightguard Bleaching Indications:

• Mild generalized
• Age related
• Mild fluorosis
• Mild tetracycline staining
• Superficial staining
• Stains from smoking tobacco

Bleaching Contra-indications:

• Teeth with insufficient enamel
• Severe fluorosis
• Non-complaint patients
• Pregnancy
• Severe tetracycline staining
• Fractured tooth
• Opaque white spots

Read And Learn More: Endodontics Question and Answers

Bleaching Steps:

Bleaching Agents Used:

• 10% carbamide peroxide
• 15% carbamide peroxide
• Hydrogen peroxide

Bleaching Side Effects:

• Gingival irritation
• Altered taste sensation
• Tooth Sensitivity

Management Of Discolored Teeth Short Essays

Question 1. Vital bleaching.
Answer.

In-office bleaching:

• It uses 35% hydrogen peroxide solution

Vital bleaching Indications:

• Mild fluorosis
• Mild tetracycline stains
• In severe discoloration
• To match existing color of the crown that is lighter than natural teeth

Vital bleaching Contraindications:

• Superficial stains
• Carious tooth structure
• Hypersensitive teeth
• Children with the large pulp chamber
• Pregnant and lactating mothers
• Exposed root surfaces

Vital bleaching Technique:

At-home bleaching Indications:

• Superficial enamel discolorations
• Mild yellow discolorations
• Brown fluorosis discolorations
• Age-related discolorations

At-home bleaching Contraindication:

• Severe enamel loss
• Hypersensitive teeth
• Bruxism
• Presence of caries
• Defective coronal restorations
• Allergy to bleaching gels

At-home bleaching Technique:

Question 2. Carbamide peroxide
Answer:

Carbamide peroxide Definition

• It is also known as urea hydrogen peroxide
• Its concentration ranges from 3-45% depending on at home and in office bleach
• Commonly 10% carbamide peroxideis used

Carbamide peroxide Mechanism Of Action

• Carbamide Peroxide→Urea + Ammonia + carbon dioxide + 3.5% hydrogen peroxide

Question 3. Thermocatalytic Bleaching.
Answer.

Thermocatalytic Bleaching Light Sources Used:

• Conventional
• Tungsten halogen
• Xenon plasma
• Argon and Co₂
• Diode laser

Thermocatalytic Bleaching Indication:

• Superficial stains
• Mild to moderate stains

Thermocatalytic Bleaching Contraindications:

• Extensive restoration
• Severe discoloration
• Extensive caries

Thermocatalytic Bleaching Advantages:

• Comfortable to patient
• Less time needed
• Safe

Thermocatalytic Bleaching Disadvantages:

• Expensive
• Frequent
• Dehydration of teeth
• Rubber dam discomfort.

Thermocatalytic Bleaching Procedure:

Question 4. Microabrasion.
Answer.

Microabrasion

In it, a microscopic layer of enamel is eroded and abraded with solution leaving intact enamel.

Microabrasion Indications:

• Intrinsic stains
• Hypomineralised enamel
• Decalcification
• Enamel fluorosis
• Superficial stains

Microabrasion Contra-Indications:

• Age-related
• Hypoplastic lesions
• Deep stains
• Tetracycline staining

Microabrasion Advantages:

• Minimum discomfort
• Easy
• Results in shiny and smooth surface

Microabrasion Disadvantages:

• Ineffective for deeper stains
• Removes enamel layer

Microabrasion Steps: 

Question 5. Bleaching of non-vital tooth.
Answer.

Bleaching of non-vital tooth – Thermocatalytic technique:

Bleaching of the non-vital tooth – Walking Bleach technique:

Bleaching of the non-vital tooth- Inside/Outside Bleaching:

Closed chamber:

• Bleaching paste was applied to the tooth via a bleaching tray

Question 6. Walking Bleach.
Answer.

Walking Bleach Indications:

• Discoloration of the pulp chamber
• Moderate to severe tetracycline staining
• Dentin discoloration

Walking Bleach Contraindications:

• Defective enamel
• Enamel discoloration
• Presence of caries

Walking Bleach Steps:

Question 7. Microbrasion and macrobrasion.
Answer.

Microbrasion and macrobrasio

In it a microscopic layer of enamel is eroded and abraded with solution leaving intact enamel.

Microbrasion Indications:

• Intrinsic stains
• Hypomineralised enamel
• Decalcification
• Enamel fluorosis
• Superficial stains

Microbrasion Contra-Indications:

• Age-related
• Hypoplastic lesions
• Deep stains
• Tetracycline staining

Microbrasion Advantages:

• Minimum discomfort
• Easy
• Results in shiny and smooth surface

Microabrasion Disadvantages:

• Ineffective for deeper stains
• Removes enamel layer

Macroabrasion

• It involves using of dental drill and finishing bur to remove stains
• In this composite finishing bur is used on a high speed hand piece to remove the defect
• While working on the defect very light pressure is applied to prevent any irreversible damage to the tooth
• The process is finished with abrasive rubber point
• During the process air water spray is used to maintain the temperature and to keep the tooth hydrated

Management Of Discolored Teeth Short Questions And Answers

Question 1. Causes of Discoloration of tooth.
Answer.

Discoloration of tooth Intrinsic Stains:

• Pre-eruptice causes:
  • Disease-Haematological disorders
  • Medication-tetracycline
• Post-eruptive causes:
  • Pulpal changes
  • Trauma
  • Aging
  • Dental caries

Discoloration of tooth Extrinsic Stains:

• Daily acquired stains:
  • Plaque
  • Tobacco use
  • Poor oral hygiene
  • Gingival haemorrhage
  • Chemicals
  • Chlorhexidine
  • Metallic stains

Question 2. Mc-Innes Solution.
Answer.

Mc-Innes Solution Composition:

• 30% Hydrogen peroxide – 5 parts
• 36% hydrochloric acid – 5 parts
• Anesthetic ether – 1 part

Mc-Innes Solution Method:

Apply the solution with a cotton pellet to the stained area and allow it to remain for 5-10 minutes

Question 3. Superoxol
Answer.

Superoxol

• It is 30% solution of hydrogen peroxide by weight in 100% volume of distilled water
• It is powerful oxidizing agent
• It is highly irritating of the soft tissues

Question 4. Uses of laser in endodontics
Answer.

Uses of laser in endodontics

• Diagnosis
  • Laser Doppler flowmetry – to assess blood flowmetry
  • Nd:YAG laser – for vitality test
• Pulp capping and Pulpotomy
  • To treat exposed pulp tissues using Co2 lasers
• Root canal treatment
  • To modify root canal walls
  • Sterilization of root canals
• Treatment of incomplete fracture
• Apicoectomy
• Treatment of dentinal hypersensitivity
• Sterilization of instruments
• Bleaching

Irrigation And Intracanal Medicaments Important Notes

• Sodium hypochlorite
  • It acts as
    • Lubricant during instrumentation in root canal
    • Solvent for dissolution of pulp
    • Antiseptic and disinfectant by combining both protoplasm of bacterial cell and destroying it
    • Bleaching agent by releasing nascent oxygen
  • It is used in concentration varying from 0.5-75%
  • Very Potent antimicrobial agent
  • Effectively dissolves pulpal remnants
  • Disadvantages
    • Inability to remove smear layer
    • Unpleasant taste
    • Toxicity
• Advantages of alternate use of sodium hypochlorite and hydrogen peroxide in root canal preparation
  • Effervescent reaction which pushes debris out of the canal
  • Solvent action of sodium hypochlorite on the organic debris of pulp tissue
  • Disinfecting and bleaching action of both solutions

Irrigation And Intracanal Medicaments Long Essays

Intracanal Medicaments In Endodontics

Question 1. What are various root canal irrigants? Write in detail requirements and techniques of irrigation.
Answer.

Irrigant:

Irrigant is a liquid used to lubricate the canal walls and flush out the debris and micro-organisms from the root canals

Irrigant Types:

Chemically non-active

• Water:
  • Saline
  • LA
• Chemically active [ACDE]:
  • Alkali – Sodium Hypochlorite
  • Acids – HCl
  • Antibacterial agents – Chlorhexidine
  • Chelating agents – EDTA
  • Detergents – Sodium lauryl sulfate
  • Enzymes – Streptokinase
  • Oxidizing agents – Hydrogen peroxide
    Requirements:
    • Should have antimicrobial activity
    • Should be non-toxic and biocompatible
    • Should dissolve necrotic and vital pulp tissues
    • Should be tissue or debris solvent
    • Should serve as lubricant
    • Should have low surface tension
    • Should be non-reactive to periapical tissues
    • Should not be easily neutralized in the canal and should retain its effectiveness
    • It should be of moderate cost and ease to store

Irrigant Techniques:

Irrigant Techniques Manual

• Syringe irrigation with needles:
  • It involves dispensing of an irrigant into the root canal using irrigation needles of varying gauges
  • Gauge 27-30
  • Depth of insertion 2-3mm from the working length
  • Design – blunt ended size vented needle
• Brushes:
  • Bristles help in cleaning the uninstrumented recesses of the radicular pulp spaces
• Manual dynamic agitation:
  • In this a well-fitted greater taper gutta-percha master cone is moved up and down the instrumented canal containing irrigant in short 2-3mm strokes

Irrigant Techniques Machnine assisted

• Rotary brushes
  • Consist of microbrushes attached to rotary hand pieces
• Continuous irrigation during instrumentation
  • It contains an irrigant delivery unit attached to the Quantec-E-irrigation system
• Sonic irrigation
  • involves sonic waves
• Ultrasonic irrigation
  • Operates at frequencies of 25-30kHz
• Pressure alternation devices
  • EndoVac
  • RinsEndo

Question 2. Enumerate the various root canal irrigants. What are the functions of irrigants? Write in detail on chlorhexidine and sodium hypochlorite as intracanal irrigants.
Answer.

Intracanal Medicaments In Endodontics

Irrigant:

Irrigant is a liquid used to lubricate the canal walls and flushoutthe debris and micro-organisms from the root canals

Irrigant Types:

Irrigant Chemically non-active

• Water:
  • Saline
  • LA
• Chemically active [ACDE]:
  • Alkali – Sodium Hypochlorite
  • Acids – HCl
  • Antibacterial agents – Chlorhexidine
  • Chelating agents – EDTA
  • Detergents – Sodium lauryl sulfate
  • Enzymes – Streptokinase
  • Oxidizing agents – Hydrogen peroxide

Functions Of Irrigant In Endodontics

• Remove dentinal shaving
• Germicidal
• Increase efficiency of instruments
• Dissolve necrotic tissue and remove it
• Bleaching action

Chlorhexidine:

• It is biguanide
• Available as oral rinses
• Used in concentration 0.2-2%

Chlorhexidine Advantages:

• Longer antibacterial action
• Used with sodium hypochlorite
  • When chlorhexidine comes in contact with sodium hypochlorite there is formation of parachloroaniline which is cytotoxic
  • It interferes with the seal of root filling
  • Flushing with normal saline is must
• Biocompatible

Chlorhexidine Disadvantages:

• Does not dissolve pulp tissue

Sodium Hypochlorite Solution

• It is a clear, pale, green yellow liquid
• Strong odour of chlorine
• Easily miscible with water
• Decomposes by light

Read And Learn More: Endodontics Question and Answers

Sodium Hypochlorite Mechanism:

Factors Affecting Sodium Hypochlorite Mechanism Activity:

• Increases:
  • Volume of solution
  • Heating of solution
  • Time of contact
• Decreases:
  • Strong time
  • EDTA

Hypochlorite Mechanism Activity Advantages:

• Dissolve tissue
• Antibacterial and bleaching action
• Lubricate canal
• Economical

Hypochlorite Mechanism Activity Disadvantages:

• High surface tension
• Irritate tissue
• Irritate eyes
• Causes inflammation of the gingiva
• Bleaches clothes
• Bad odour and taste
• Corrosive to instruments

Intracanal Medicaments In Endodontics

Hypochlorite Mechanism Activity combined with:

• Calcium hydroxide
• EDTA
• Chlorhexidine

Irrigation And Intracanal Medicaments Short Essays

Question 1. Irrigating Solution.
Answer.

Irrigating Solution Properties:

• Broad spectrum
• Inactive endotoxin
• Dissolve debris
• Debride the canal
• Good lubricant
• Less toxic
• Prevent/dissolve smear layer

Irrigating Solution Functions:

• Remove dentinal shaving
• Germicidal
• Increase efficiency of instruments
• Dissolve necrotic tissue and remove it
• Bleaching action

Irrigating Solution Commonly used:

• Chemically non-active:
  • Water:
  • Saline
  • LA
• Chemically active [ACDE]:
  • Alkali – Sodium Hypochlorite
  • Acids – HCl
  • Antibacterial agents – Chlorhexidine
  • Chelating agents – EDTA
  • Detergents – Sodium lauryl sulfate
  • Enzymes – Streptokinase
  • Oxidizing agents – Hydrogen peroxide

Question 2. Ideal requirements of intracanal medicaments. Describe in detail about medicaments.
Answer.

Intracanal Medicaments Functions:

• Destroy remaining bacteria
• Useful in treatment of apical periodontitis

Intracanal Medicaments Properties:

• Germicidal
• Non-irritant
• Stable
• Low surface tension
• Should not induce immune response
• Should not interfere with repair
• Should not stain tooth

Intracanal Medicaments Chemicals Used:

• Essential oils – Eugenol
• Phenolic compounds – Phenol, Aldehydes
• Calcium hydroxide
• Chlorhexidine gluconate
• Corrticosteroid antibiotic
• Antibiotic
• Halogens – Sodium hypochlorite, Iodine

Question 3. Calcium Hydroxide.
Answer.

Calcium Hydroxide

Intracanal medicament

Calcium Hydroxide Forms:

• Paste form
• Powder form

Calcium Hydroxide Indication:

• Weeping canal
• Treatment of phoenix abscess
• Resorption
• Apexification
• Pulp capping
• Decrease post-operative pain
• As sealer
• For periapical lesion

Calcium Hydroxide Disadvantages:

• Difficult to remove
• Decreases setting time

Calcium Hydroxide Functions:

• Inhibits root resorption
• Stimulates periapical healing
• Encourage mineralization

Question 4. Composition and uses of mineral trioxide aggregate.
Answer.

Mineral Trioxide Aggregate Composition:

• Tricalcium silicate
• Tricalcium aluminium oxide
• Silicate oxide
• Bismuth oxide
• Calcium
• Phosphate
• Water

Mineral Trioxide Aggregate Uses:

• As root end filling material
• Used in Pulpotomy

Irrigation And Intracanal Medicaments Short Questions And Answers

Question 1. Hydrogen Peroxide.
Answer.

Hydrogen Peroxide

It is clear, odourless liquid

Hydrogen Peroxide Mechanism:

Use: As an irrigating solution

Combine with: 5.2% NaOCl

Question 2. Eugenol.
Answer.

Eugenol

It is an intracanal medicament

Eugenol Effects:

Eugenol Low dose [Beneficial]:

• Inhibits PG synthesis
• Inhibits nerve activity
• Inhibits chemotaxis

Eugenol High dose [Harmful]:

• Induces cell death
• Inhibits cell respiration

Eugenol Uses:

• Intracanal medicament
• Root canal sealer
• Temporary sealant

Question 3. RC Prep.
Answer.

RC Prep Composition:

• EDTA
• Urea peroxide
• Carbowax

RC Prep Properties:

• Lubricant
• Cleaning agent
• Antibacterial

RC Prep Uses:

• Allows deeper penetration of medicament into the dentin

Question 4. Ledermix.
Answer.

Ledermix Composition:

• Gluco corticosteroid
• Triamcinolone
• Dimethyl chlortetracycline

Ledermix Uses:

• Initial dressing agent
• Reduces incidence of pain
• Provide rapid relief
• Useful in cases of infection and inflammation

Question 5. PBSC.
Answer.

PBS

PBSC Route Of Administration:

PBSC Form-Paste form:

• Injected into root canals
• Impregnated on paper points

Advance – Nystatin Replaces Caprylate

PBSC Disadvantage:

• Patient may have allergy to penicillin

Question 6. Schilder’s Objectives for cleaning and shaping of Canal.
Answer.

Schilder’s Objectives for cleaning and shaping of Cana

• Root canal preparation should develop continuously tapering cone
• Making preparation in multiple planes to introduce the concept of flow
• Making canal narrower apically and widest coronally
• Avoid transporation of foramen
• Keep apical opening as small as possible

Irrigation And Intracanal Medicaments Viva Voce

• EDTA is used at a concentration of 15%
• MTAD is a Mixture of Tetracycline, Acid [citric acid], and Detergent

Instrumentation Of Endodontics Important Notes

• Classification of instruments
  • Grossman’s classification
    • Exploring instruments – smooth broaches, endodontic explorer
    • Debridement – barbed broaches
    • Shaping instruments – reamers and files
    • Obturating instruments – pluggers, spreaders, lentulospirals
  • ISO grouping of instruments
    • Group 1 – hand use only
    • Group 2 – made to be attached to a handpiece
    • Group 3
      • Engine given latch type
      • Rotary canal instruments
    • Group 4 – root canal points
• Standardization of instruments
  • By Ingle le Vine
    • Numbering from 10 – 100
      • Advance by 5 up to 60
      • Advance by 10 up to 100
    • Diameter
      • D at tip – 1/10 of a mm
      • Ex. For instrument No.25 D1 = 0.25mm
      • D2 at the end of shaft
    • Length of working portion
      • 16mm from D1 to D2
    • Taper of 0.02 mm per mm
    • Angle of the tip 75 ± 15 degrees
    • Color coding
• H files
  • Made from a round blank to produce spiral flutes
  • They show higher cutting efficiency but is more prone to fracture
  • The angle between cutting edge and the long axis of the instrumentis about 60-65°
  • They are designed primarily for a linear filling motion
  • Due to positive rake angle they cut in one direction only

Endodontic Instruments

Endodontic Instruments Names

• K flex files
  • Cross section is rhombus or diamond shaped
  • They have better cutting ability and flexibility
  • The instrument is fabricated of V-4 steel
• Unifiles
  • Mc-Spadden modified the traditional H files
  • The blade present a S shape or double helix design
  • It has two continuous cutting edges
  • It can be used for cutting in both filling and reaming action
  • They are less subject to fracture
  • They are stiff in coronal and middle thirds but bends in apical 1/3rd
• Nickel – titanium files
  • Composition
    • Nickel – 54%
    • Titanium – 44%
    • Cobalt – 0.2%
    • Boran – added to improve surface hardness
  • At high temperature, it exists a body centered cubic lattice referred to as autestentic phase – a stronger phase
  • On cooling, this phase transfers to close packed hexagonal, weak phase known as martensitic phase
  • Two unique features of it are: shapre memory and super elasticity
  • The main disadvantage of it is its cutting efficiency is only 60%
• Flexogates
  • Derivative of Gates Glidden drills
  • Used to enlarge the apical region of the canal
  • Less likely to cause apical transporation
  • Less fracture resistant
  • Non cutting guiding tip
• Giromatic and Racer handpiece
  • Giromatic
    • It is commonly used reciprocating handpiece
    • It accepts only latch-type instrument
    • In this type the quarter turn motion is delivered 300 times per minute
    • It uses a barder broach or reamer through 90° reciprocating arc at a speed of 1000 cycles/min
  • Racer handpiece
    • It uses a standard file and oscillates the file in root canal
    • These instruments can be used for opening root canals but should not be used for root canal preparation
• Peaso reamer
  • They are more often used in preparing coronal portion of the root canal for past and core
  • Instrument fractures always near the shank
• Ultrasonic and sonic instruments
  • Used for cleaning and shaping of root canals
  • Ultrasonic instruments contains a magnetostrictive hand piece which hold a K file or diamond file
  • It is operated at 2000 – 25000/section
  • It uses sodium hypochlorite as irrigant
  • Sonic instruments operate at 1500 – 6500 cycles/min
  • It uses water as irrigant
• Colour coding

• Lentulospirals
  • They are used for placement of sealer, cement and calcium hydroxide
  • It must be operated clockwise in the handpiece and started or stopped outside the root canal
  • If started in the canal it may cut into the wall of the root canal and break

Endodontic Instruments Names

Read And Learn More: Endodontics Question and Answers

• Modifications of H file
  • Safety hed stroem
  • Hyflex file
  • Unifiles
  • S file
• Differences between reamer and file

Endodontic Instruments

• Gates Glidden drill
  • Uses
    • To remove lingual shoulder during access cavity preparation
    • To enlarge root canal orifices
    • For shaping cervical third of root canal in step back preparation

Instrumentation of Endodontics Long Essays

Question 1. Classify Endodontic Instruments. Describe standardization and sterilization of them.
Answer.

Grossman’s Classification:

• Exploring Instruments – Smooth broach
• Extripating Instruments – Barked broach
• Cleaning and Shaping Instrument – Files and Reamers
• Obturating Instruments – Pluggers and Spreaders

ISO And FDI Classification

• Group 1 – Hand operated Instruments
• Group 2 – Engine driven Instruments
  • Parts
  • Cutting head
  • Latch type of attachment
• Group 3 – Fabricated from single piece of metal Ex. Gates Glidden drill
• Group 4 – Usually materials Ex. GP points, paper points

Standardization: By Ingle le Vine

• Numbering from 10-100
  • Advance by 5 up to 60
  • Advance by 10 up to 100
• Diameter
  • D at tip – 1/10 of a mm
  • Ex. For instrument No.25 D1 = 0.25mm
  • D2 at the end of shaft
• Length of working portion
  • 16mm from D1 to D2
• Taper of 0.02 mm per mm
• Angle of the tip 75 ± 15 degrees
• Color coding

Endodontic Instruments

Sterilization:

Instrumentation of Endodontics Short Essays

Question 1. Endosonic Instruments.
Answer.

Introduced by Richman

Activation:

Endosonic Instruments Advantages

• Cleans the canal
• Enhances the action of NaOCl

Endosonic Instruments Types:

• Magnetostrictive
• Piezoelectric

Endosonic Instruments Mechanism:

• Navigation
• Acoustic streaming

Endodontic Instruments Names

Endosonic Instruments Uses:

• Access enhancement
• Orifice location
• Irrigation
• Sealer placement
• Guttapercha obturation
• MTA placement
• Endodontic retreatment.

Question 2. Obturating Instruments.
Answer.

• Obturating Instruments Spreaders:
  • Use: For lateral compaction
  • Material used: Stainless steel/Nickel titanium
  • Types:
    • Hand – Do not have standardized size and shape
    • Finger – Standardized and color coded to match size of GP points
• Obturating Instruments Pluggers:
  • Use: For vertical compaction, Forsectional method
  • Material use to pack: Calcium hydroxide/MTA

• Lentulospiral:

Question 3. Broaches.
Answer.

Broaches Types:

• Smooth broaches
• Barbed broaches

Broaches Broaches:

• Short handles instruments
• Made from round steel wires

Broaches Uses:

• Extripation of pulp tissues
• Removal of dressing
• Loosen necrotic debris
• Pathfinder [smooth broach]

Broaches Method Of Use:

Broaches Precaution:

• Should not be forced apically into canal

Question 4. H-files.
Answer.

H-files Manufacture:

• Round steel wire, machined to produce spiral flutes

H-file advantage:

• Higher cutting efficiency
• Push debris coronally

H-files Manner Of Use:

• Pull motion, cut dentin when the instrument is withdrawn

H-files Features:

• Positive Rake angle
• Distance between the flutes

H-files Disadvantages:

• Aggressive
• Lack flexibility
• Tend to fracture

H-files Use:

• For flaring coronal half of preparation
• To machnie straight canals

H-files Modifications:

• Unifiles
• Helifile
• S-file

Question 5. NiTi Files.
Answer.

NiTi Files

Known as Nitinol [NiTi Navol Ordinance Laboratory]

NiTi Files Types And Composition:

• 55 NiTinol [55% Ni, 45% Ti]
• 60 NiTinol [60% Ni, 40% Ti]

NiTi Files Advantages:

• Shape memory
• Super elasticity
• Softer
• Corrosion resistance
• Resiliency is good

NiTi Files Disadvantage:

• Poor cutting efficiency
• Do not show signs of fatigue
• Poor resistance to fracture

Instrumentation of Endodontics Short Answers

Question 1. Lentulospirals.
Answer.

Lentulospirals

• It is a obturating instrument
• Have latch type attachment

Lentulospirals Used:

• To coat the walls of root canal for sealer

Lentulospirals Significance:

• By sealing the canal walls, space between canal wall and material is avoided

Instrument used along with it: Giromatichand piece.

Question 2. Peaso – Reamer.
Answer.

Peaso – Reamer

• It is latch type rotatory instruments
• Have cutting sides
• Made up of stainless steel

Peaso – Reamer Used For:

• For parallel post preparation
• To remove guttapercha from canal

Peaso – Reamer Precaution:

• It do not follow canal curvature
• It is not flexible
• Should be used with low speed to prevent over instrumentation and perforation

Peaso – Reamer Sizes:

Question 3. Gates glidden Drill.
Answer.

Gates glidden Drill Description:

• Head – flame shaped with safe tip
• Culting end – Resembles American football
• Shank – long, elliptical shaped

Gates glidden Drill Used Along With:

• Latch attachment, slow speed handpiece

Gates glidden Drill Uses:

• Enlarging orifice in coronal 3rd of tooth
• To prepare post space
• To remove guttapercha/instrument

Gates glidden Drill Sizes:

Question 4. Files and Reamer
Or
Cross section of files and reamers.
Answer.

Files and Reamer

• These are cleaning and shaping instrument
• Difference

Question 5. Sterlization of instruments.
Answer.

Sterlization of instruments

Instrumentation Of Endodontics Viva Voce

• Broaches break easily
• Broaches should not be inserted unless the root canal is enlarged to a size of 20 or 25 reamer or file
• File contains more number of flutes and is four sided instrument
• Giromatic and Racer are contra angled engine driven instruments
• The instrument should be used with a 1/4 – 1/2 turn and withdrawn with a pull stroke
• Gates Glidden drill and Peaso reamer are power driven instruments
• Over instrumentation causes forcing of debris into periapocal area
• Instrumentation short of apex causes ledging of canal
• Instrumentation with large instruments causes enlarging of canal
• Reamers are used with pushing-rotating motion
• Files are used with rasping or pulling motion
• H file is used to finish the instrumentation of the coronal third of the root canal
• Endodontic explorer are most commonly used diagnostic and exploring instruments for idenfication of canal orifices

Endodontic Microbiology Of Endodontics Important Notes

• Persistent positive cultures occurs due to
  • Leakage between appointments due to faulty coronal temporary restorations
  • Undetected perforation
  • Contamination of canal

Endodontic Microbiology Of Endodontics Short Essays

Question 1. Endodontic microbiology. Add a note on cultural techniques.
Answer.

Endodontic Microbiology:

• Generally, all bacteria that inhabit the oral cavity can invade the pulp space during and after pulp necrosis to participate in the infection of the canal and to enter the periapical tissues leading to periapical periodontitis.

Read And Learn More: Endodontics Question and Answers

• Facultative gram-negative bacteria
  • Neisseria
  • Capnocytophaga
  • Haemophilus
• Anaerobic gram positive bacteria
  • Actinomyces
  • Eubacterium
• Facultative gram positive bacteria
  • Enterococcus
  • Streptococcus
  • Lactobacillus

Culture Techniques:

• Cell Culture – Growth of cells occur, but does not organize into tissues
• Tissue Culture – Growth of tissue, part/whole organ occurs
• Anaerobic culture – In absence of oxygen
• Pure culture – Contains single cell species
• Primary Culture – Tissue sample taken directly from animals
• Secondary Culture – Derive from primary
• Plate Culture – Culture grown on agar media
• Streak Culture – Media inoculated by drawing infected wire
• Suspension Culture – Cells are suspended in media
• Siant Culture – Culture made on titled tube

Clinical Diagnostic Methods Important Notes

• Clinical Diagnostic Methods Grades of mobility
  • Grade 1 – noticeable/barely discernable movement of the teeth within the sockets
  • Grade 2 – lateral/horizontal mobility within a range of 1mm or less
  • Grade 3 – movement greater than 1 mm or when the tooth can be depressed into the sockets
• Clinical Diagnostic Methods Thermal tests
  • According to Grossman, a response to cold reflects a vital pulp regardless of whether it is normal or abnormal
  • A heat test does not confirm vitality
  • An abnormal response to a heat test however indicates the presence of a pulpal or periapical disorder requiring endodontic treatment
  • Thermal test should be first performed on the teeth to be used as controls
  • The tests are performed by placing the stimuli on the incisor-labial or the occlusal-buccal surface
  • According to Cohen, the temperature for performing heat tests is 65.5°C or 150F
  • The temperature of dry ice used in the cold test is -78°Clinical
  • The painful response which subsides when the stimuli are removed from the tooth indicates reversible pulpitis
  • Painful response which doesn’t subside on removal of stimuli indicates irreversible pulpitis
• Clinical Diagnostic Methods Clinical Diagnostic Methods Electric pulp testing
  • The electrolytes applied to it are Nicholas-colloidal graphite, Grossman toothpaste
  • The best localization or placement of electrolytes during this test are incisal 2/3rd of labial surfaces of maxillary premolars and molars
  • During EPT gives should not be used
  • To eliminate biased decisions, EPT is performed first on the control tooth
  • EPT cannot be used on patients having a cardiac pacemaker
  • EPT is not useful for recently erupted teeth with immature apex
  • EPT does not test the vitality of the pulp as it depends on the nerve supply to the pulp whereas pulp vitality depends on the blood supply
  • The two main varieties of pulp tester available are bi-polar and mono-polar
• Clinical Diagnostic Methods Xeroradiography
  • It uses a rigid aluminium/selenium-coated photoreceptor plate
  • The plate is electrically charged placed in a waterproof electric cassette positioned in the mouth and exposed to X-rays at a lower level of radiation
  • Advantages:
    • Produces sharper, clearer and finer details of the image
    • Reduces patient radiation dose
    • Pronounced edge enhancement effect

• Clinical Diagnostic Methods Pulse oximetry
  • It is a non-invasive oxygen saturation monitor
  • Detects pulp vitality by testing the integrity of blood supply to pulp
  • It uses red and infrared wavelengths
• Clinical Diagnostic Methods Clinical Diagnostic Methods Laser Doppler flowmetry
  • A non-invasive method to measure the blood flow
  • A better and more reliable method for determining the pulp vitality the electric pulp testing method
• Radiovisiography
  • It contains 3 components
  • Radio – consists of a hypersensitive intra=oral sensor and a conventional x-ray unit
  • Visio – consists of a video monitor and display processing unit
  • Graphy – It is high-resolution video printer that instantly provides a hard copy of the screen image

Endodontic Diagnosis

Clinical Diagnostic Methods Long Essays

Question 1. Discuss various diagnostic methods in Endodontics
Answer:

Endodontics Diagnosis:

• It is defined as the utilization of scientific knowledge to identify a diseased process and differentiate it from another disease process.

Diagnostic Process in Endodontics :

Consists of 4 steps

Step 1:

• Chief complaint:
  • Reason for which patient has come to the dentist
  • Recorded inpatient’s own words
• Medical/Dental History:
  • To know the patient’s attitude towards treatment:

Diagnostic Tests in Endodontics

Endodontics Investigation:

Step 2:

• Provisional diagnosis:
  • Based on patient’s chief complaint

Step 3:

Differential Diagnosis in Endodontics:

• Having similar signs and symptoms

Endodontic Diagnosis

Step 4:

Final Diagnosis in Endodontics

Examination:

• Extraoral:
  • Physical appearance
  • Examination of swelling
  • Palpation of salivary glands
  • Palpation of TMJ
  • Palpation of lymph nodes
• Intraoral:
  • Soft tissue examination
  • Hard tissue examination
• Radiograph:
  • Features seen in periapical lesions
    • Loss of lamina dura
    • Aetiology of necrosis
  • Interpretations
    • Black/Grey area
    • Decay, pulp, Abscess, Cyst
    • White area
    • Enamel, restoration
    • While line
    • Lamina dura

Diagnostic Methods in Endodontics Uses:

• For diagnosis
• For examining the extent of caries
• For calcification, necrosis, obstruction
• For periodontal lesions
• For examining perforation
• For determining the working length

Diagnostic Methods in Endodontics – Vitality Test:

• Thermal test:

• Electrical Pulp testing:
  Use: To suggest the vitality of tooth
  Limitation: Does not give any information about the vascular supply:
  • Instrument used:
    • Battery operated
    • Graduation form 0-10
    • Deliver direct current of high-frequency
  • Technique:

Read And Learn More: Endodontics Question and Answers

• • Precaution:
    • Recording should be compared with normal adjacent and contralateral tooth
• Test Cavity:
  • It is done only when other methods fail.

Diagnostic Methods in Endodontics Procedure:

• Anaesthesia testing:
  • Useful when the patient is unable to localized pain.
  • Procedure:
    • Anaesthesia is the most posterior tooth in the suspected quadrant

• Bite Test:
  • Useful if the patient complaints of pain on occlusion
  • Causes of Pain:
    • Endo-period lesion
    • Crack in tooth
  • Material used:
    • Cotton swab
    • Toothpick
    • Orangewood stick
    • Tooth sloth.

Procedure:

Clinical Diagnostic Methods Short Essays

Question 1. RVG [Radio-Visiography].
Answer.

Diagnostic Methods in Endodontics – Radio:

• Sensitive intraoral sensor
• It transmits information via a fiberoptic bundle to CCD

Diagnostic Methods in Endodontics – Visio:

• Video monitor
• Display processing unit
• It magnifies the images
• It is memorised by the computer

Diagnostic Methods in Endodontics – Graphy:

• Consists of a high-resolution video printer.

Diagnostic Methods in Endodontics Advantages:

• Reduction of radiation
• Production of instantaneous images
• Control of contrast
• Elimination of film
• Magnifies images
• Storage of information
• Infection control
• Time saver

Endodontic Diagnosis

Diagnostic Methods in Endodontics Disadvantages:

• Expensive
• Soft tissue imaging is not possible
• Bulky

Question 3. Xero Radiography.
Answer.

Xero Radiography

• Does not require films/dark rooms
• Imaging was recorded on an aluminium plate coated with selenium.

Xero Radiography Procedure:

Xero Radiography Advantages:

• Edge enhancement
• Improves visualization
• Both positive and negative images are possible

Xero Radiography Disadvantages:

• Discomfort to patient
• Variation in exposure time
• Development must be done within 15 minutes

Question 4. Thermal Test/Cold Test.
Answer.

Thermal Test/Cold Test

Question 5. Electric pulp Tester.
Answer.

Electric pulp Tester Use – To suggest the vitality of the tooth

Electric pulp Tester Limitation:

• Does not give any information about the vascular supply

Electric pulp Tester Instrument Used:

• Battery operated
• Graduation from 0 – 10
• Deliver direct current of high-frequency

Electric pulp Tester Precaution:

Recording should be compared with normal adjacent and contralateral tooth

Electric pulp Tester Various Tester:

• Burton vitallometer [But not battery operated]
• Dialogue
• Pelton crame compact
• Neotest ADP

Electric pulp Tester Interpretation:

• Slight response – Inflamed pulp
• No response – Pulpal necrosis

Endodontic Diagnosis

Electric pulp Tester False Responses:

• Acute alveolar abscess
• Contact with gingival tissue
• In multirooted tooth
• Recently traumatized tooth
• Recently erupted tooth
• Patients with high pain threshold
• Calcified canal
• Partial necrosis of pulp
• Premedication
• Poor battery
• Extensive restoration

Question 6. Pulp Vitality Test.
Answer.

Pulp Vitality Test

• Thermal test:

• Electrical Pulp testing:
  Use: To suggest the vitality of tooth
  Limitation: Does not give any information about the vascular supply
  • Instrument used:
    • Battery operated
    • Graduation from 0 – 10
    • Deliver direct current of high-frequency
  • Precaution:
    • Recording should be compared with normal adjacent and contralateral tooth

Question 7. Diagnostic aids in endodontics
Answer.

Diagnostic aids in endodontics – Examination:

• Extraoral:
  • Physical appearance
  • Examination of swelling
  • Palpation of salivary glands
  • Palpation of TMJ
  • Palpation of lymphnodes
• Intraoral:
  • Soft tissue examination
  • Hard tissue examination
• Radiograph:
  • Features seen in periapical lesions
    • Loss of lamina dura
    • Aetiology of necrosis
  • Interpretations
    • Black/Grey area
    • Decay, Pulp, Abscess, Cyst
    • White area
    • Enamel, restoration
    • White line
    • Lamina dura

Diagnostic aids in endodontics Uses:

• For diagnosis
• For examining, necrosis, obstruction
• For calcification, necrosis, obstruction
• For periodontal lesion
• For examining perforation
• For determining the working length

Clinical Diagnostic Methods Short Answers

Question 1. Test Cavity.
Answer.

Test Cavity

It is done only when other methods fail.

Question 2. Anaesthesia testing.
Answer.

Anaesthesia testing

Useful when the patient is unable to localized pain.

Anaesthesia Testing Procedure:

• Anaesthesia is the most posterior tooth in the suspected quadrant.

Clinical Diagnostic Methods Viva Voce

• Tenderness on percussion of a tooth indicates extension of pulpal disease or infection into the periapical area
• Electric pulp testers most frequently employ low-frequency current
• Electric pulp testing measures the sensory nerve response to irritants of electricity
• The mobility test is the ability to move a tooth between two fingers
• Electric pulp testing is done to differentiate between vital and non-vital pulp
• A violent response to heat and instant relief to cold is indicative of reversible pulpitis
• Percussion tests evaluate the status of the periodontium surrounding teeth

Miscellaneous Important Notes

• Uses of implant
  • Periodontally involved teeth requiring stabilization
  • Transverse root fracture involving loss of apical fragment
  • Pathologic resorption of root apex
  • Pulpless tooth
  • Internal resorption

Miscellaneous Short Essays

Question 1. Apexification.
Answer.

Apexification

Treatment of non-vital immature tooth to induce root end closure by suitable medicament.

Apexification Procedure:

Question 2. Role of Radiographs in Endodontics.
Answer.

Role of Radiographs in Endodontics

• Assess root form and length
• Assess the dimension of root canals
• Assess the progression of caries
• Assess the presence of any obstructions, resorptions
• Assess lamina dura
• Periapicaltrabeculae pattern
• Root fracture
• Evaluate cases

Radiographs in Endodontics Limitations:

• 2-dimensional representation
• Necrosis cannot be determined
• Difficult to differentiate periapical lesions
• Overlapping of anatomic landmarks

Miscellaneous Short Questions And Answers

Question 1. Apexogenesis.
Answer.

Apexogenesis

Involves the treatment of traumatized vital teeth to retain the vitality of the tooth.

Apexogenesis Procedure:

Question 2. Silver Points.
Answer.

Silver Points Uses:

• Narrow, curved, and tortuous canals
• For by-passing ledges

Silver Points Available:

• Size – 60-65
• Standardized sizes

Silver Points Advantages:

• Flexible
• Can be pre-curved
• Easy to place

Silver Points Disadvantages:

• Noncompressible
• Does not reach irregularities of canals

Read And Learn More: Endodontics Question and Answers

• Difficult to remove
• Get corroded

Question 3. Glutaraldehyde.
Answer.

Glutaraldehyde

• Toxic, irritant, allergenic
• High-level disinfectant
• Use – For disinfection of heat-sensitive material
• Activation – By addition of Sodium bicarbonate
• Remains potent for 14 days
• Manner – 2% glutaraldehyde
• Immersion for 20 min – for disinfections
• Immersion for 6 – 10 hours for sterilization

Question 4. Sodium perborate.
Answer.

Sodium perborate

• Constituent of bleaching gel
• Available form – Monohydrate
  • Trihydrate
  • Tetrahydrate
• Composition – 95% perborate + 10% oxygen

Question 5. Weeping Canals.
Answer.

Weeping Canals

• After root canal treatment in some cases reddish exudates appears with periapical radiolucency

Weeping Canals Feature: Asymptomatic/Tender on percussion

• When opened in next appointment, exudates stop by again reappears in next appointment
• This is called “Weeping Canal”

Weeping Canals Treatment 1:

Reason: The pH of periapical area is acidic which turns to basic by Calcium hydroxide.

Question 6. Bicuspidization/Hemisection.
Answer.

Bicuspidization/Hemisection

Section of the root along with the respective crown portion

Bicuspidization Indications:

• Periodontal disease
• Severe bone loss
• Untreatable roots
• Root fracture

Bicuspidization Contra Indications:

• Fused roots
• Lack of Osseous support
• Uncooperative patients

Question 7. Incision and Drainage.
Answer.

Incision and Drainage Indication:

• Purulent/Hemorrhage exudates

Incision and Drainage Protocol:

• Intraoral and localized swelling
  • Only incision and drainage
• Intraoral, diffuse swelling
• Incision and drainage
• Followed by systemic antibiotics

Incision and Drainage Hard And Diffuse:

• Allow to become soft and localized
• Incision and drainage done thereafter
• Horizontal incision is given on the dependent part by blade No.11 or 12

Question 8. Endodontic Implants.
Answer.

Endodontic Implants Indications:

• Periodontally weak teeth
• Root fracture
• Short root
• Root resorption

Endodontic Implants Contraindications:

• Curved canal
• Proximity to anatomic structures
• Insufficient tooth support.

Endodontic Implants Procedure:

Question 9. Immediate root resection.
Answer.

Immediate root resection Indication:

• Multirooted teeth.

Immediate root resection Contraindications:

• Fused roots
• Proximity to vital structures
• Uncooperative

Immediate root resection Procedure:

Question 10. Management of separated instruments.
Answer.

Management of separated instrument

• Diagnose radiographically

Management of separated instrument Retrieval System:

• Masserian kit
• Endo extractor
  • It consists a wedge that holds the instrument and removes it
• Instrument retrieval system [IRS]

Diseases Of Pulp Important Notes

• Diseases Of Pulp Formation of chloesterol crystals
  • Crystals are formed from chloesterol released by
    • Disintegrating erthrocytes of stagnant blood vessels within the lesion
    • Lymphocytes, plasma cells and macrophages
    • The circulating plasma lipids
• Diseases Of Pulp Phoenix abscess
  • It is an acute inflammatory reaction superimposed on an existing chronic lesion such as cyst or granuloma
  • The exaceberation of a chronic lesion is most commonly associated with the initiation of root canal therapy in a completely asymptomatic tooth
  • Radiograph shows well-defined periradicular lesion
• Features of hyperalgesia
  • Spontaneous pain
  • Allodynia
  • Increased response to painful stimuli
• Hyperalgesia Internal resorption
  • The cause is not known
    • Clinical Features:
      • Mostly asymptomatic
      • Pink spot if lesion occur in crown
      • Radiographically there is alteration or enlargement in the appearance of the pulp chamber or the wall of the root canal due to clastic activity
  • Hyperalgesia Treatment:
    • Extirpation by pulp stops resorption
    • Obturation of the defect requires effort and plasticized gutta percha
    • It root is perforated, the MTA should be used to repait the defect surgically
    • When repair has been completed the canal with its defect is obturated with plasticized gutta percha
• Inflammation induces
  • Vasodilation
  • Increased capillary pressure
  • Increased vascular permeability
• Chronic apical abscess
  • Asymptomatic or only slightly symptomatic if the sinus tract is obstructed
  • Sinus tract allows continuous drainage of pus forming in the periapical lesion through the oral mucosa
  • Most commonly associated with apical radiolucency
• Cracked tooth syndrome
  • Diagnostic tests for cracked tooth syndrome:
    • Visual examination aide by use of transillumination
    • Use of methylene blue dye
    • Biting test with the use of rubber wheels, cotton tip applicator, moist cotton rolls and tooth sloth
    • Cold test and EPT
    • Radiographs
    • Ultrasound
• Cracked tooth syndrome Treatment:
• • Stabilize the tooth with orthodontic band and wait for 2 weeks
    • If symptoms subsides, proceed for full coverage crown
    • If symptoms persiste, procedd for RCT and then crown
      • Extraction if tooth has poor prognosis
• Limitations of direct pulp capping in primary teeth
  • Internal resorption
  • Calcification
  • Chronic pulp infection
  • Necrosis
  • Interradicular involvement

Diseases Of Pulp And Periapical Tissues

Diseases Of Pulp Long Essays

Question 1. Describe about etiology, clinical features and treatment of acute apical abscess.
Answer.

Acute Apical Abscess:

It can be defined as a localized acute or chronic suppurative infection in the periapical region of a tooth

Acute Apical Abscess Etiology:

• Extension of pulpal infection into periapical tissue
• Fracture of tooth with pulp exposure
• Accidental perforation of the apical foramen during root canal treatment
• Extension of periodontal infection into the periapical tissues
• Anachoretic infection of the periapical tissues

Acute Apical Abscess Clinical Features:

• Acute abscess produces severe pain in the affected tooth
• There will be localized swelling and an erythematous change in the overlying mucosa
• The pain aggrevates during percussion and when pressure is applied
• It causes extrusion of the tooth from its socket

Read And Learn More: Endodontics Question and Answers

• The associated tooth in non-vital and sometimes it can be mobile also
• The affected area of the jaw may be tendered on palpation
• Application of heat intensifies pain
• Pus discharging sinus often develops
• Chronic periapical abscess often produces dull pain

Acute Apical Abscess Complications:

• Space infections
• Septicaemia
• Ludwig’s angina
• Cavernous sinus thrombosis
• Osteomyelitis

Acute Apical Abscess Radiographic Features:

• Widening of periodontal ligament space
• There is loss of lamina dura
• Area of diffuse periapical rarefaction is seen
• Margins vary from well defined to poor defined
• In advanced cases, the trabeculae are destroyed
• Radiolucency may involve adjacent tooth
• Osteitis can occur at the side of root
• Maxillary posterior teeth may lead to destruction of a portion of the antral floor
• Roots of the affected teeth may show resorption

Diseases Of Pulp And Periapical Tissues

Acute Apical Abscess Management:

• Emergency opening of the pulp chamber through passing file into the preiapical region
• Through and through drain is placed in the abscess and irrigated with 1:1 mix of 3% H2O2 and normal saline solution
• Antibiotics
  • Pencillin 500mg QID for 5 days
• Endodontic treatment
  • Root canal treatment or extraction of offending tooth as required, is carried out in 24-48 hours.
• Warm saline mouth rinse

Diseases Of Pulp Short Essays

Question 1. Apexogenesis and apexification.
Answer.

Apexogenesis and apexification

Question 2. Pulpotomy.
Answer.

Pulpotomy Definition

It is complete removal of coronal part of dental pulp followed by placement of suitable dressing or medicament which promotes healing and preserves tooth vitality

Pulpotomy Technique

Anaesthesize and isolate the tooth

• Remove the carious lesion
• Entire roof of coronal pulp is removed
• With the help of spoon excavator cut out the coronal pulp
• Irrigate the pulp chamber
• Control the bleeding with the help of moist cotton pellet
• Dry the pulp chamber
• Now place a cotton moistened with 1.5 concentration of Buckley’s formocreson solution into the canal
• Keep it for 5 minutes
• Now remove it and dry the canal
• Restore the tooth with thick paste of zinc oxide eugenol
• Place base of zinc polycarboxylate cement over it
• Finally, permanently restored with stainless steel crown

Question 3. Acute Reversible Pulpitis.
Answer.

Acute Reversible Pulpitis

It is an acute inflammatory response to a noxious stimuli

Diseases Of Pulp And Periapical Tissues

Acute Reversible Pulpitis Etiology:

• Trauma
• Thermal injury
• Chemical stimulus
• Deep restoration

Acute Reversible Pulpitis Symptoms:

• Sharp sudden pain on stimulus
• Pain relieves on removal of stimuli

Acute Reversible Pulpitis Diagnosis:

• Clinically – caries
• Traumatic occlusion
• Percussion test – Negative
• Radiograph – Normal PDL and lamina dura
• Vitality – Early response

Acute Reversible Pulpitis Treatment:

• No endodontic treatment required
• Sedative dressing placed
• Desensitize the tooth
• Use of cavity varnish

Question 4. Phoenix Abscess.
Answer.

Phoenix Abscess

It is an acute inflammatory reaction superimposed on existing chronic lesion

Phoenix Abscess Etiology:

• Influx of necrotic products

Phoenix Abscess Symptoms:

• Tender tooth
• Elevation of tooth from socket
• Tender soft tissue

Phoenix Abscess Diagnosis:

• Pulp test – Negative
• Radiograph – radiolucency at the apex

Phoenix Abscess Treatment:

• Drainage
• RCT

Question 5. Radicular Cyst.
Answer.

Radicular Cyst

Inflammatory cyst

Radicular Cyst Etiology:

• Caries
• Trauma
• Developmental defects

Radicular Cyst Symptoms:

• Asymptomatic
• Gradual swelling
• Palatal expansion
• Non-vital tooth

Radicular Cyst Radiograph:

• Round, pear/ovoid radiolucency
• Narrow radiopaque margin

Radicular Cyst Treatment:

• Endodontic treatment
• Apicoectomy
• Extraction
• Enucleation

Diseases Of Pulp Short Questions And Answers

Question 1. Reversible and irreversible pulpitis – differences
Answer.

Reversible and irreversible pulpitis

Question 2. Differences between internal and external resorption.
Answer.

Difference between internal and external resorption

Question 3. Root resorption.
Answer.

Root resorption

Resorption of teeth can be defined as a chronic progressive damage or loss of tooth structure due to the action of odontoclasts

Root resorption Classification

• Physiological:
  • Resorption of roots of decidous teeth
• Pathological:
  • External resorption
  • Internal resorption

Question 4. Pulp stones.
Answer.

Pulp stones

Deposition of calcified mass within the dental pulp for no apparent reason is called pulp calcification

Pulp stones Types:

• Depending on microscopic structure:

• Depending upon location:

Question 5. Pocket Cyst.
Answer.

Pocket Cyst

It is the variation of radicular cyst.

Pocket Cyst athogenesis:

Question 6. Pink tooth.
Answer.

Pink tooth Etiology:

• Trauma, Chronic pulpitis:

Pink tooth Pathogenesis:

Pink tooth Symptoms:

• Asymptomic
• Appears pink due to inflamed pulp

Pink tooth Treatment:

• Pulp Extirpation

Question 7. Pulpal Diseases Classification.
Answer.

Pulpitis:

• Acute
• Chronic

Pulpal Degeneration:

• Calcific
• Other

Necrosis:

Question 8. Classification of Periradicular Diseases.
Answer.

• Acute peroradiculae diseases.
  • Acute alveolar abscess
  • Acute apical periodontitis
• Chronic periradicular disease.
  • Chronic alveolar abscess
  • Granuloma
  • Cyst
• Condensing osteitis
• External root resorption
• Diseases with non-endodontic origin

Question 9. Irreversible Pulpitis.
Answer.

Irreversible Pulpitis

It is a persistent inflammatory condition of pulp.

Irreversible Pulpitis Classification:

• Acute
• Chronic

Irreversible Pulpitis Etiology:

• Bacteria
• Injury to pulp

Irreversible Pulpitis Features:

• Sharp piercing, shooting, continuous pain that remains even after removal of stimulus
• Referred pain
• Difficult to localize
• D/D – Reversible Pulpitis

Irreversible Pulpitis Treatment:

• Pulpectomy

Question 10. Causes of Pulpal diseases.
Answer.

Causes of Pulpal diseases

• Pulpal diseases Physical:
  
  • Mechanical:
    • Trauma
    • Pathologic wear
    • Crack tooth syndrome
    • Barodontalgia
    • Thermal injury
    • Electrical injury
• Pulpal diseases Chemical:
  • Phosphoric acid
  • Acrylic monomer
• Pulpal diseases Bacterial:
  • Toxins
  • Anachoresis

Question 11. Anachoresis.
Answer.

Anachoresis

Question 12. Aerodontalgia.
Answer.

Aerodontalgia

• Dental pain occuring due to change in altitude

Aerodontalgia Features:

• Asymptomatic at ground level
• Pain occurs after few hours of reaching high altitude or into deep sea

Aerodontalgia Reason:

Question 13. Reversible Pulpitis.
Answer.

Reversible Pulpitis

It is an acute inflammatory response to a noxious stimuli

Reversible Pulpitis Etiology:

• Trauma
• Thermal injury
• Chemical stimulus
• Deep restoration

Reversible Pulpitis Symptoms:

• Sharp sudden pain on stimulus
• Pain relieves on removal of stimuli

Reversible Pulpitis Diagnosis:

• Clinically – caries
• Traumatic occlusion
• Percussion test – Negative
• Radiograph – Normal PDL and lamina dura
• Vitality – Early response

Reversible Pulpitis Treatment:

• No endodontic treatment required
• Sedative dressing placed
• Desensitize the tooth
• Use of cavity varnish

Question 14. Acute alveolar abscess
Answer.

Acute alveolar abscess

• It is localized collection of pus in the alveolar bone at the root apex of the tooth following the death of pulp with extension of the infection through the apical foramen into periradicular tissue

Acute alveolar abscess Etiology:

• Invasion of bacteria from necrotic pulpal tissue
• Trauma, chemical or mechanical
• Chemical or mechanical treatment causing periapical tissue irritation during root canal treatment

Acute alveolar abscess Clinical Features:

• Fever, increased WBC count
• Tooth is non-vital
• Rapid onset of pain
• Slight tenderness to intense throbbing pain
• Marked pain to biting
• Swelling
• Mobility

Acute alveolar abscess Treatment:

• Drainage of abscess
• Incision and drainage
• Extraction

Diseases Of Pulp Viva Voce

• In acute apical abscess pain is due to build-up of pressure periapically due to accumulation of pus
• Internal resorption is also known as Pink tooth of mummery
• The sinus tract prevents exacerbation of the lesion by providing continuou drainage of periradicular lesion
• Anachoresis refers to attraction or fixation of blood borne bacteria in areas of inflammarion
• Internal resorption is due to asysmptomatic and chronic irreversible pulpitis
• Abnormally exaggerated subjective response to painful stimuli is called hyperpathia
• Allodynia is spontaneous pain
• Dysasthesia pain arises from the pulp and periradicular tissues
• Hallmark sign of neuropathic pain is hyperalgesia
• Enamel crack can be better disclosed by using a dye or by transilluminating the tooth with fibre optic
• Chronic pulpitis is difficult to diagnose because the patient does not have any subjective symptoms
• Diagnosis of cracked tooth syndrome is made by biting on solid object and release of pressure

Asepsis In Endodontics Definitions

• Sterilization
  • It is the complete destruction of agents that are capable of causing infections, including spores.

Asepsis In Endodontics Important Notes

• Methods of sterilization
  • Physical agents
    • Sunlight
    • Drying
    • Dry heat
    • Moist heat
    • Filtration
    • Radiation
  • Chemical agents
    • Alcohol
    • Aldehyde
    • Chlorines
    • quaternary ammonium compound
    • Phenolic compounds
    • Antiseptics

Asepsis in Operative Dentistry

Asepsis In Endodontics Long Essays

Question 1. Discuss sterilization of endodontic instruments.
Answer.

Sterilization: It is the complete destruction of agents that are capable of causing infections, including spores.

Sterilization Of Endodontic Instruments Methods:

Physical Agents:

• Sunlight:
  • Natural means
  • Has bactericidal activity
• Drying:
  • Unreliable
  • Spores are unaffected
• Dry heat:
  • Consists of
    • Flaming – for culture tubes, glass
    • Red heat – needles
    • Incineration – Dressings
    • Hot air oven – At 160°C for 2 hours
  • Metallic, glass particles, powder
• Moist heat:
  • Causes denaturation of proteins
• Filtration:
• Radiation:
  • Causes:
    • Inhibition of DNA replication
    • Damaging structure of DNA
    • Denaturation of protein

Read And Learn More: Endodontics Question and Answers

• Ultrasonic vibration:

Sterilization Of Endodontic Instruments Chemical agents:

• Alcohol Ex. Ethyl alcohol
  • Bactericidal
  • Corrosive
  • Fast acting
• Aldehyde – Ex.Glutaraldehyde
  • High-level disinfectant
  • Non-corrosive
  • Long activated life
• Chlorines
• Quaternary Ammonium Compound
  Ex:
  • Benzalkonium chloride
  • Low-level disinfectant
• Phenolic compounds:
  • Low-level disinfectant
  • Used for floors, walls, and furniture
• Antiseptics
  • Iodophor Ex. Povidoneiodone
    • Broad spectrum
    • Formulated as 1% I2 solution
  • Chlorhexidine

Sterilization Of Endodontic Instruments:

Sterilization Of Endodontic Instruments Steps:

• Pre-soaking in water to soften organic debris
• Cleaning – Hand washing or ultrasonic cleaning is done
• Drying – To prevent corrosion
• Packaging – Wrapping of instruments in clothes
• Sterilization
• Drying/cooling
• Storage
• Distribution
• Sharpening of instruments

 

Asepsis in Operative Dentistry

Asepsis In Endodontics Short Questions And Answers

Question 1. Disinfection.
Answer.

Disinfection

• It is the destruction of pathogenic micro-organisms
• It permits adequate removal of pulp tissue and debris
• Leads to the enlarging of the canal by biomechanical means and the clearing of its contents by irrigation

Question 2. Glass Bead Sterilizer/Salt Bead Stabilizer.
Answer.

Glass Bead Sterilizer

Rapid method of sterilization

Glass Bead Sterilizer Materials Used:

• Usually salt
• Salt is replaced by glass beads smaller than 1 mm in diameter

Glass Bead Sterilizer Reason For Smaller Beads:

• Efficient in transferring heat to instruments
• Time required – 5-15 seconds
• Temperature – 437 – 465°F

Glass Bead Sterilizer Advantages:

• Easily available
• Salt is replaced by glass beads smaller than 1 mm in diameter

Glass Bead Sterilizer Disadvantage:

• Handle portion is not sterilized

Question 3. Autoclave.
Answer.

Autoclave

Moist heat sterilization method

Autoclave Principle:

Autoclave Advantages:

• Effective
• Accurate
• Rapid

Autoclave Disadvantages:

• Causes corrosion
• Melts rubber
• Unsuitable for oils

Autoclave Factors Effecting It:

• Cleaning of instruments
• Direct flow of steam
• Periodic monitoring of sterilizer

Asepsis in Operative Dentistry

Asepsis In Endodontics Viva Voce

• Hottest part of the glass bead sterilizer is along its outer rim and the temperature is lowest in the center of the surface layer of salt

Treatment Of Traumatized Teeth Long Essays

Question 1. An 18-year-old patient reports to the clinic with a fracture of maxillary central incisor involving dentin. The trauma happened one month back, discuss your treatment options.
Answer.

Enamel-Dentin Fracture

Enamel-Dentin Fracture Definition:

• A fracture confined to enamel and dentin with loss of tooth structure, but not exposing the pulp

Enamel-Dentin Fracture Clinical Features:

• Not tender to percussion
• Normal mobility
• Positive pulp sensitivity

Enamel-Dentin Fracture Radiographic Appearance:

• Visible enamel dentin loss

Enamel-Dentin Fracture Aims of Treatment:

• Elimination of discomfort
• Preservation of vital pulp
• Restoration of fractured crown

Mouth Trauma Treatment

Enamel-Dentin Fracture Treatment Options:

• Restorative procedure composite resin restoration is preferred
• Fractured segments can be approximated and bonded back by dentin bonding agents
• The use of indirect veneer is done to achieve esthetics

Enamel-Dentin Fracture Follow-Up:

• Clinical and radiographic control at 6-8 weeks and 1 year
• The tooth should be periodically tested with an electric pulp tester

Treatment Of Traumatized Teeth Short Questions And Answers

Question 1. Hank’s balanced salt solution (HBSS).
Answer.

Hank’s balanced salt solution (HBSS)

• John H.Hank formulated it
• It is a solution made to a physiological pH and salt concentration
• It is a collective group of salts rich in bicarbonate ions
• Used for washing tissues and cells
• It provides the cells with water and inorganic ions while maintaining physiological pH and osmotic pressure

Mouth Trauma Treatment

Question 2. Management of Avulsed Teeth.
Answer.

Avulsed Teeth Storage Media:

• Saliva for 2 hours:
  • Milk for upto 6 hours
  • Water/saline – ineffective
  • Hanks balanced salt solution upto 72 hours

Read And Learn More: Endodontics Question and Answers
Roof Surface:

• If clean-replant it:
  • If dirty-clean with tap water/wet sponge
    Periodontal Ligament:
• If vital – Replant it:

Socket:

• Irrigate it
• Do not curette the socket

Treatment Of Traumatized Teeth Viva Voce

• Pulpal death is the most common cause of discoloration
• Hydrogen sulfide produced by bacteria combines with pigments and darkens the tooth
• Microabrasion is a method used to remove surface stains or defects
• Mc Inn’s solution is used for the removal of endemic fluorosis stains
• Composites should be delayed for 2-3 weeks after bleaching to allow for dissipation of residual peroxides

Endodontics Of Anatomy Of Pulp Cavity And Its Access Opening Definitions

• Anatomic Apex:
  • It is the tip or end of the root determined morphologically
• Radiographic Apex:
  • It is tip or end of the root determined radiographically
• Apical Foramen:
  • It is the main apical opening of the root canal
  • Frequently located away from the anatomic or radiographic apex
• Apical Constriction:
  • It is apical portion of the root canal having the narrowest diameter

Endodontics Of Anatomy Of Pulp Cavity And Its Access Opening Important Notes

• Endodontic anatomy

Read And Learn More: Endodontics Question and Answers

• Access cavity of mandibular first molar
  • Mesiobuccal orifice is under mesiobuccal cusp
  • mandibular first molar is gained access from mesiobucco apical direction
  • Mesiolingual orifice is below the central groove
  • mandibular first molar is explained from distobuccal direction
  • The distal orifice is present in the center of tooth buccolingually
  • mandibular first molar is explained from mesial direction
• Access cavity of maxillary first molar
  • The orifice of mesiobuccal canal is gained access from distopalatal direction
  • The distobuccal canal is gained access from mesiolingual direction
  • The palatal root is gained access from buccal direction

Anatomy Of Pulp Cavity And Its Access Opening Short Essays

Question 1. Access cavity preparation in mandibular permanent first molar.
Answer.

Mandibular Permanent First Molar Anatomy:

• Average tooth length – 21.9mm
• Pulp chamber
  • Roof is often rectangular in shape
  • Mesial wall is straight
  • Distal wall is round
  • Buccal and lingual walls converge to meet mesial and distal walls
  • Roof has four pulp horns – mesiobuccal, mesiolingual, distobuccal and distolingual
  • Three distinct orifices are present in the pulpal floor – mesiobuccal, mesiolingual and distal
• Root and root canals
  • Two well-determined roots are present – Mesial and distal
  • Mesial root curves distally and distal root is straight
  • Mesial root has two canals
  • Distal root has one canal

Mandibular Permanent First Molar Access Opening:

• Enamel and dentin are pentrated in the central fossa with the bur angled towards the distal root
• Bur is penetrated until pulp chamber is reached
• A drop of the bur into the pulp chamber is left
• Remove the bulk of the roof of the pulp chamber is felt
• A trapered-cylinder bur is used to remove it
• Walls of access cavity are refined with diamond bur
• Access opening is usually trapezoidal with round corners or rectangular
• The access opening extends towards the mesiobuccal cusp to uncover the mesiobuccal canal, lingually slightly beyond the central groove and distally slightly beyond the buccal groove

Anatomy Of Pulp Cavity And Its Access Opening Short Answers

Question 1. Apical foramen.
Answer.

Apical foramen

• Apical foramen is an aperture at or near the apex of a root through which th eblood vessels and nerves of the pulp enter or leave the pulp cavity
• In young, incompletely developed teeth, the apical foramen is funnel shaped with wider portion extending outwards
• Mouth of the funnel is filled with periodontal tissue
• As root developes apical foramen becomes narrower

Apical foramen Variations:

• Apical foramen is not always most constricted portion of the root canal
• Apical constrictions are found 0.5-1 mm away from the root apex
• Apical foramen is not always located in the center of the root apex

Question 2. Nerve fibres of pulp.
Answer.

Nerve fibres of pulp

80% of the nerves of the pulp are C fibres and rest are A delta fibres

• C fibres:
  • They are unmyelinated and fine sensory afferent fibres
  • Diameter 0.3-1.2 micrometer
  • Conduction is slow – 0.4 – 2m/s
  • Distributed through out the pulp tissues
  • Experienced as a dull, poorly localized and lingering pain
  • Conduct throbbing and aching pain associated with pulp tissue damage
• A delta fibres:
  • They are myelinated axons
  • Conduction is fast 6-30m/s
  • Diameter 2-5 micrometer
  • Present at the pulpal periphery and inner dentin
  • Interpreted as short, well-localized, sharp and pricking pain
  • Associated with dental pain

Question 3. Pain pathway.
Answer.

Pain pathway

Anatomy Of Pulp Cavity And Its Access Opening Viva Voce

• The mesiobuccal canal of the maxillary first molar is the most difficult to prepare
• The access cavity of a mandibular first molar is usually triangular
• Bifurcations and trifurcations are most common in mandibular 1st premolar
• The cervical cross-section of the maxillary 1st premolar is elliptical or kideny-shaped
• Accessory canals are common in the apical third of the root
• Among anterior teeth accessory canals are common in the mandibular central incisor
• Among posteriors accessory canals are common in the mandibular first molar
• Mandibular 1st premolar contains a prominent buccal cusp and a smaller lingual cusp that gives the crown a lingual tilt of 30°
• Among single-rooted teeth bifurcated roots are commonly seen in mandibular 1st premolars followed by incisors and canines
• In the maxillary molar, the mesiobuccal root has the greatest distal curvature and is the narrowest of all three canals
• The pulp chamber of the maxillary 1st molar is the largest in the dental arch