Endodontics

Surgical Endodontics Important Notes

• Cardinal principles of flap design
  • The base of the flap should be wider than the free end to ensure adequate circulation into the flap
  • The sutured flap margins should rest on sound bone
  • Incision should be made with a firm, continuous stroke, perpendicular to cortical bone
  • Short, intermittent incisions result in tissue tags and ragged margins
• Trephination is a type of artificial fistulation in which the cortical bone is perforated to release the build-up pressure and exudate around root apex to release pain
• Semilunar incision
  • Semilunar incision Advantages
    • High healing potential
    • Minimal bone damage
  • Semilunar incision Disadvantages:
    • Inaccessibility
    • Excessive haemorrhage
    • Delayed healing
    • Scarring
• Replacement resorption
  • It is characterized by gradual root resorption including periodontal ligament, cementum and dentin of root with replacement by bone and finally the tooth becomes ankylosed
  • It is considered as success of replanted tooth
• Best storage media for avulsed tooth
  • Tooth socket
  • Patient’s saliva
  • Milk
  • Water
• Transport media for avulsed tooth
  • HBSS [Hank balanced salt solution]
  • Coconut water
  • Saliva
  • Vestibule of mouth
  • Milk
  • Saline
  • Water
    • Viaspan
    • CPP – ACP [Casein Phosphopeptide – Amorphous Calcium Phosphate]
• Contraindications of periradicular surgery
  • Proximity to anatomic structures
  • Serious systemic health problems
  • Emotionally distressed patient
  • Inaccessible surgical sites
  • Teeth with poor prognosis
• Types of post
  • Tapered or parallel
    • Tapered posts
      • They are least retentive of all posts
      • Produces high incidence of root fracture
      • Concentrates stress at the post-core junction
    • Parallel posts
      • More retentive
      • Less incidence of root fracture
      • Concentrates stress apically on the post
  • Threaded or non-threaded
    • Threaded posts
      • Produces the greatest potential for root fracture
      • Recommended for post-endodontic restorations
    • Non-threaded posts
      • Produces the least stress
      • Have the least tendency for root fracture
  • Metallic or non-metallic
• Stitch abscess may develop due to
  • Local laceration of tissue
  • Accumulation of debris at the site of suturing
  • Tying of knot in the line of incision

Surgical Endodontics Short Essay

Question 1. Indications for periapical surgery. Add a note on flap designs
Answer.

Indications Of Periapical Surgery:

Surgical drainage:

• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Read And Learn More: Endodontics Question and Answers

Flap Designs

• Semilunar flap:
  • It is a curved horizontal incision with the convex portion of the incision towards the gingival crest
  • The incision begins at the mesiobuccal fold and follows a half moon path
  • Semilunar flap Indications:
    • When incisors are involved
  • Semilunar flap Advantages:
    • Simple
    • Easy to reflect
    • Easy to maintain oral hygiene
    • Gingival attachment is not disturbed
  • Semilunar flap Disadvantages:
    • Restricted access with limited visibility
    • Limited use
• Luebke Oschenbein flap:
  • Named after Luebke and Oschenbein
  • It is a modified semilunar flap in which a scalloped horizontal incision is made in the attached gingiva with vertical incisions
  • Luebke Oschenbein flap Advantages:
    • Greater access and visibility
    • The flap is easily displaced and sutured
    • Marginal gingiva is not disturbed
  • Luebke Oschenbein flap Disadvantages:
    • Scarring is possible
• Triangular flap:
  • Indicates for surgery involving short rooted teeth
  • An incision along the gingival border forms the base of the triangle
  • A single vertical incision is carried far into the alveolar mucosa
  • Vertical incision is made between the root eminences of teeth
  • Triangular flap Advantages:
    • The possibility of incision crossing the lesion is eliminated
  • Triangular flap Disadvantages:
    • Retraction is difficult
• Trapezoidal flap:
  • Two oblique incisions are made and the entire flap is retracted toward the vestibule
  • Horizontal incisions are made to separate the flap
  • Trapezoidal flap Advantages:
    • Good accessibility
    • Convenient method
  • Trapezoidal flap Disadvantages:
    • Gingival tissue attachment is lost

Question 2. Apicectomy.
Answer.

Apicectomy

It is the ablation of the apical portion of the root end attached to soft tissues.

Apicectomy Indications:

• Anatomical anomalies
• Persistent infections
• Need for biopsy
• Medical reasons
• Lack of time
• Over fillings

Apicectomy Contraindications:

• Systemic diseases
• Deep pockets
• Acute infection
• Short root length

Apicectomy Preparation:

• Class 1 preparation – 3 mm into root dentin
• Walls are made parallel to pulp space
• Remove all isthmus tissue
• 0-10 bevel is given
• Reset upto 3 mm of the apical portion
• Seal the apical portion
• Closure of flap
• Suturing

Apicectomy Complications:

• Bleeding
• Damage to neighboring root
• Entry into nerve
• Abscess
• Fenestration
• Increased mobility of tooth

Question 3. Root end Filling Materials/Retrograde filling materials.
Answer.

Root End Filling Materials Properties:

• Root End Filling Materials Should be well-tolerated
• Root End Filling Materials Should adhere to tooth surface
• Root End Filling Materials Should be stable
• Root End Filling Materials Should be resistant
• Root End Filling Materials Should be bactericidal
• Root End Filling Materials Should be noncorrosion
• Root End Filling Materials Should not stain
• Root End Filling Materials Should be radiopaque

Root End Filling  Materials:

• Amalgam:
  • Radiopaque
  • Well tolerated
  • Slow setting
  • Dimensionally unstable
• ZOE:
  • Weak
  • Long setting time
  • Irritation due to Eugenol
• IRM:
  • Higher success rate
• Super EBA:
  • Low solubility
  • Radiopaque
• MTA:
  • Least toxic
  • Hydrophilic
  • Radiopaque
• Composite Resin:
  • Technique sensitive
• Gold foil:
• Glass Ionomer:
• Cavit:
  • Available in single-paste forms

Question 4. Post and Core.
Answer.

Root End Filling  Post: It is a rigid restorative material placed in the root of a non-vital tooth.

Root End Filling  Core: It is a supragingival portion that replaces the missing tooth structures

Root End Filling  Functions Of Post

• Retains core
• Distributes stresses

Root End Filling  Requirements Post:

• Provide maximum protection
• Provide maximum retention
• Easy to place
• Less technique sensitive
• Biocompatible
• Easy to retrieve
• Be esthetic
• Not expensive

Root End Filling  Core:

• Biocompatible
• Easy to manipulate
• Sufficient strength
• Stable
• Cheap
• Easily available

Root End Filling  Materials:

Root End Filling  Post:

• Gold
• High platinum
• Co-Cr-Mo alloys
• Stainless steel
• Titanium
• Carbon fiber
• Zirconium
• Glass fiber
• Plastic

Root End Filling  Core:

• Dental amalgam
• Resin modified GIC
• Composite resin
• Cast core

Question 5. Effect of Dental Procedures on Pulp.
Answer.

• Effect of Dental Caries: 

• Effect of Tooth preparation: Causes aspiration of nuclei of odontoblast
• Remaining Dentin Thickness [RDT]: Dentin permeability increases with decreased RDT
• Effect of Local Anaesthesia:
  • Reduces blood flow
  • Increases irritants
• Calcium Hydroxide:
  • Causes demineralization
  • Stimulate fibroblast
  • Reparative dentin formation
• Zinc Oxide Eugenol:
  • Reduce nerve impulse
• Zinc Phosphate:
  • Toxic to pulp
• GIC:
  • Antocariogenic
• Amalgam:
  • Inflammation
  • Inhibition of reparative dentin formation
  • Cytotoxic effect
  • Copper is toxic
• PIN Insertion:
  • Dentinal fractures
  • Irritation to pulp

Question 6. Replanation/Intentional Replanation.
Answer.

Replantation/Intentional Replantation

It is the intentional removal of the tooth and its reinsertion into the socket after retrograde obturation and resection of the root tip.

Replantation Indications:

• Broken instruments in canals
• Calcified canals
• Over filling
• Curved canals
• Presence of foreign body in periapical tissue.

Replantation Contraindications:

• Medically compromised
• Periodontal involvement
• Missing buccal/lingual plate
• Nonrestorable tooth

Replantation Technique:

Question 7. Types and indications of Periradicular surgery.
Answer.

Peri-Radicular Surgery:

• Curettage
• Biopsy
• Root end resection
• Corrective surgery
• Replacement surgery
• Implant surgery

Peri-Radicular Surgery Indications:

• Surgical drainage
• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Peri-Radicular Surgery Contra-Indications:

• Mobile tooth
• Pockets
• Leukemic patients
• Cardiac surgery
• Uncontrolled hypertension
• Uncontrolled bleeding disorders
• Immuno-compromised patients
• The first trimester of pregnancy
• Apprehensive patient
• Short root length
• Proximity to vital structures
• Non-restorable tooth
• Non-strategic tooth

Question 8. Indications of endodontic surgery.
Answer.

Indications of endodontic  Surgical drainage:

• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Surgical Endodontics Short Questions And Answers

Question 1. Flaps in Endodontics.
Answer.

Flaps in Endodontics Classification:

• Full mucoperiosteal flap
• Triangular
• Rectangular
• Trapezoidal
• Horizontal
• Limited mucoperiosteal flap
• Sub-marginal curved
• Sub-marginal scalloped rectangular

Question 2. Ochsenbein – Luebke flap.
Answer.

Ochsenbein – Luebke flap

• By Neumann

Ochsenbein – Luebke flap Design:

• Vertical incision on either side of the surgical site
• Horizontal incision along attached gingiva.

Ochsenbein – Luebke flap Advantages:

• Unaltered attachment level
• Unexposed bone
• Accessibility
• Good healing

Ochsenbein – Luebke flap Indications:

• Gingivitis/periodontitis
• Bony dehiscence

Ochsenbein – Luebke flap Disadvantages:

• Disturb blood supply
• Flap shrinkage
• Limited apical orientation
• Scar formation
• Difficult wound closure

Surgical Endodontics Viva Voce

• Excessive hemorrhage during apical surgery is controlled by placing epinephrine epinephrine-containing solution in the surgical site
• In apicoectomy, a typical surgical flap used should extend one or two tooth/teeth laterally
• Parallel port is the best-preferred post
• Splinting should be removed in 7-10 days
• Hanks balanced solution is an isotonic salt solution used for preserving avulsed teeth
• Apical surgery is done with great caution on mandibular bicuspids because of their proximity to the mental foramen
• Paraesthesia is common in the mandible, especially in the premolar and molar region
• Ecchymosis results in skin discoloration from extravasation and the breakdown of blood adjacent to the surgical area
• Endodontic surgery should be avoided on lingual surfaces of molars or external oblique ridge of the mandible due to inaccessibility and difficulty in gaining access to the surgical site

Single Visit Endodontics Important Notes

• Contradications of single visit endodontics
  • Tooth with acute symptoms
  • Presence of anatomic difficulties
  • If there is possible increased stress on TMJ
• Advantages of single visit endodontics
  • Immediate familiarity with the internal anatomy, canal shape and contour facilities obturation
  • No risk of bacterial leakage
  • Reduction of clinic time
  • Less cost
• Disadvantages of single visit endodontics
  • No easy access to apical canal
  • Fatigue to the patient and clinician
  • Not possible to place intracanal disinfectant

Single Visit Endodontics Short Essays

Question 1. Single visit Endodontic.
Answer.

Single visit Endodontic

It is procedure of cleaning, shaping, disinfecting the canal followed by obturation of canal done at the same appointment.

Single Visit Endodontics Advantages:

• Convenient
• Efficient
• Comfortable
• Less painful
• Cheaper
• Less error

Read And Learn More: Endodontics Question and Answers

Single Visit Endodontics Disadvantages:

• Tireful for patient
• Mid treatment flare up
• Unable in calcified canals.

Single Visit Endodontics Contra-Indications:

• Anatomic anomalies
• Asymptomatic non-vital teeth
• Acute apical periodontitis
• Allergic patients
• TMJ disorders

Rationale Of Endodontics Important Notes

• Fish Zones
  • Zone of infection
    • Zone of infection is present in center of the lesion
    • Zone of infection is characterized by PMNs
  • Zone of contamination
    • Zone of contamination is characterized by round cell infiltration
    • Zone of contamination demonstrates cellular destruction due to toxins from the central zone of infection
    • Because of autolysis and death of bone cells the lacunae were empty
    • Lymphocytes are prevalent everywhere
  • Zone of irritation
    • Zone of irritation is characterized by macrophages and osteoclasts
    • The collagen framework was digested by phagocytic cells, the macrophages
    • Zone of irritation demonstrates much activity prepararoty to repair
  • Zone of stimulation
    • Zone of stimulation is characterized by fibroblasts and osteoblasts
    • In this zone, the effects of toxins were mild enough to be stimulant which results in laying down of collagen fibres around the zone of irritation
    • This new bone is built in irregular fashion

Rationale Of Endodontics Short Essays

Question 1. Rationale of Endodontics.
Answer.

Rationale of Endodontics

Endodontics is a branch of dealing with the disease and injuries of the pulp. Endodotic procedures are required only when the infected organisms reach the pulp or else It can be treated by conventional methods.

Rationale of Endodontics – Causes Of Infection:

• Trauma
• Latrogenic
• Chemicals
• Aseptic techniques
• Pathologic wear
• Toxins
• Micro organisms

Read And Learn More: Endodontics Question and Answers

• • Cyst
  • Granuloma
  • Chronic abscess
• Only if the periapical pathologies occur which cannot be treated by conventional methods, endodontic procedures are the only solutions
• Thus by endodontic procedures, infection is eliminated by keeping in mind the cause and healing occurs.

Rationale Of Endodontics Short Answer

Question 1. Fish Zones.

Fish Zones

Procedural Accidents Important Notes

• Sodium hypochlorite extrusion into periradicular tissues causes
  • Immediate effects
    • Swelling
    • Pain
    • Ecchymosis
  • Long term effects
    • Paraesthesia
    • Scarring
    • Muscle weakness
    • Extrusion of hydrogen peroxide causing tissue emphysema

Procedural Accidents Short Essays

Question 1. Management of perforations.
Answer.

Management of nonfurcal cervical perforations:

• Hemorrhage control with 1:50,000 epinephrine followed by perforation repair with MTA
  Prevention:
• Study proper anatomy before proceeding with the treatment
• Remove all caries
• Repeated and thorough evaluation of radiographs is done

Management of cervical perforation in furcation area:

• Confirm the perforation through radiograph
• Electronic apex locator is used to differentiate a bleeding canal from perforation
• MTA is used for sealing perforation
  Prevention:
• Study preoperative radiographs and evaluate pulp chamber morphology
• Access bur penetration for depth and angulation should be confirmed
• Straight line access is obtained
• If crown is present remove it before access preparation
• Remove existing restorations if present

Read And Learn More: Endodontics Question and Answers

Question 2. Ledges.
Answer.

Ledges

It is an internal transporation of the canal which prevents positioning of an instrument to the apex in an otherwise patent canal.

Ledges Etiology:

• Curve canals
• Forceful instrumentation
• Failute to recapitutale
• Skipping of files

Ledges Features:

• Loss of tactile sensation
• Loosening of instrument

Ledges Treatment:

Ledges Prevention:

• Use of NiTi files
• Avoid of skipping of instruments
• Frequent irrigate
• Careful preparation

Procedural Accidents Short Questions And Answers

Question 1. Zipping.
Answer.

Zipping Definition:

• Zipping is defined as the apical transportation of a curved canal caused due to improper shaping technique

Zipping Features:

• Zip formation adopts an elliptical shape at the apical endpoint.
• Zipping is caused by using progressively larger and stiffer files to working length.
• It can result in a poorly cleaned root canal, which fails to provide a resistance form to compact gutta-percha, and leads to obturation which is vertically over-extended but internally under-filled.
• This contributes to leakage, infection, and failure.

Question 2. Masserann Kit.
Answer.

Masserann Kit

Device used to remove broken instruments from root canal

Masserann Kit Components:

• Flat gauge
• Extractor
• Stephan
• Handle

Masserann Kit Steps:

Procedural Accidents Viva Voce

• Brasseler endo extractor kit, Masserman kit, extractor system, and separated instrument retrieval system are used in retrieval of broken instruments from root canal

Endodontic Periodontal Relationship Short Essays

Question 1. Endo-Perio Lesion.

Endo-Perio Lesion:

Obturation Of Root Canal Important Notes

• Techniques of heat compaction of gutta percha
  • Vertical compaction
  • Injectable gutta percha
  • Thermo-mechanical compaction
  • Core carrier technique
• Composition of gurra percha cones

• Ideal requirements of filling material
  • Easy to introduce and easy to remove
  • Seal canal laterally as well as apically
  • Impervious to moisture
  • Should not shrink after insertion
  • Should be bactericidal
  • Should not stain the tooth
  • Should not irritate periapex
  • Should be sterile

Obturation Of Root Canal Long Essays

Question 1. Describe briefly different obturation techniques? Add a note on materials used for obturation.
Answer.

Obturation Methods:

Use of cold guttapercha:

• Lateral compaction

Use of chemically softened guttapercha:

• Chloroform
• Halothone
• Eucalyptol

Use of heat softened guttapercha:

• Vertical compaction
• System B
• Sectional compaction
• Thermoplasticized
• Solid core
• Mcspadden

Obturation Of Root Canal Lateral Compaction:

Read And Learn More: Endodontics Question and Answers

Obturation Of Root Canal Advantages:

• Reduces over filling

Obturation Of Root Canal Disadvantages:

• Do not produce homogenous mass
• May not fill canal irregularities

Obturation Of Root Canal Obturating Materials:

• Plastics – GP, resilon
• Solid/metal core – Silver points, gold
• Cements and pastes – Hydron, MTA, Calcium phosphate

Obturation Of Root Canal Properties:

• Easily introduced
• Seal canal
• Stable
• Baceriostatic
• Non-staining
• Radiopaque
• Non-irritating
• Sterile
• Easily removed
• Imprevious to moisture

Question 2. What are the various obturation techniques? Write in detail about thermoplasticized technique.
Answer.

Obturating Methods:

Obturating Methods Use of cold guttapercha:

• Lateral compaction

Obturating Methods Use of chemically softened guttapercha:

• Chloroform
• Halothone
• Eucalyptol

Obturating Methods Use of heat softened guttapercha:

• Vertical compaction
• System B
• Sectional compaction
• Thermoplasticized
• Solid core
• Mcspadden

Thermoplasticized Gutta Percha Technique

Thermoplasticized Gutta Percha Principle:

• It comprises a pressure apparatus consisting of an insulated electrically heated syringe barrel and a seledction of needles ranging from 18-25 gauge size
• The plunger is designed to prevent backward flow of the gutta percha

Thermoplasticized Gutta Percha Technique:

• Canal preparation
• Drying of canal
• Sealer is coated on the canal walls
• Gutta percha is electrically heated in a handheld gun that contains a chamber surrounded by a heating element
• Selected needle is positioned at 3-5mm short of the working lenght
• Gutta percha is gradually injected by sqeezing the trigger of the gun and the needle is gradually withdrawn as the canal gets filled apically
• Gutta percha is then compacted using pluggers of appropriate size
• Similarly the rest of the canal is filled

Question 3. Root canal sealers.
Answer.

Root canal sealers

• Root canal sealers are necessary to fill irregularities and minor discrepancies between the canal walls and filling

Root canal sealers Requirements:

• Should be tacky
• Should create hermetic seal
• Should be radiopaque
• Should be miscible
• Should be bacteriostatic
• Should set slowly
• should insoluble in oral fluids
• Should not shrink
• Should not stain

Root canal sealers Functions:

• Antimicrobial agent
• Lubricant
• Binding agent
• Fills the space between material and canal walls
• As obturationg material
• Give radiopacity

Root canal sealers Classification:

Eugenol:

• Eugenol Silver Containing:
  • Kerr sealer
    • Powder
      • Zinc oxide
      • Silver
      • Thymol iodide
    • Liquid
      • Oil of cloves
      • Canada balsam
• Eugenol Silver Free:
  • Grossman’s sealer
  • It consists of
    • Powder
      • Zinc oxide
      • Staybellite resin
      • Bismuth subcarbonate
      • Barium sulphate
      • Sodium borate
    • Liquid
      • Eugenol

Eugenol  Medicated:

• Iodoform

Eugenol Non-Eugenol:

• Hydron
• Glass ionomer
• Diaklet
  • It is chemically polyketone
  • It consists of
    • Powder
      • Zinc oxide
      • Bismuth phosphate
    • Liquid
      • Polyvinyl resin

Eugenol Advantages:

• Good adhesion to tooth
• Rapid set
• High tensile strength

Eugenol Disadvantages:

• Tacky in texture
• Difficult to manipulate

Obturation Of Root Canal Short Essays

Question 1. Ideal requirements of root canal sealers. Add a note on AH26.
Answer.

Root Canal Sealers Requirements:

• Should be tacky
• Should create hermetic seal
• Should be radiopaque
• Should be miscible
• Should be bacteriostatic
• Should set slowly
• Should be insoluble in oral fluids
• Should not shrink
• Should not stain

AH26:

• This is an epoxy resin containing sealer
• It is adhesive, well tolerated by tissues and provides good seal

AH26 Disadvantages:

• Staining of tooth structure as it contains silver
• It is insoluble in solvents

AH26 Plus:

• This eliminates all the disadvantages associated with AH26

Question 2. Obturating materials.
Answer.

Obturating materials Materials:

• Plastics – GP, resilon
• Solid/metal core – Silver points, gold
• Cements and pastes – Hydron, MTA, Calcium phosphate

Obturating materials Properties:

• Easily introduced
• Seal canal
• Stable
• Baceriostatic
• Non-staining
• Radiopaque
• Non-irritating
• Sterile
• Easy removed
• Imprevious to moisture

Question 3. Gutta Percha.
Answer.

Gutta Percha

Endodontic filling material

Gutta Percha Forms:

• Alpha
• Beta
• Amorphous

Gutta Percha Available Forms:

• GP points
• Auxillary points
• Greater taper
• Syringe
• Medicated

Gutta Percha Advantages:

• Compactibility
• Inertness
• Dimensional stable
• Tissue tolerance
• Radiopacity
• Plasticity
• Dissolve in some solvents

Gutta Percha Disadvantages:

• Lack of rigidity
• Lack of adhesiveness
• Easily displaced

Question 4. Grossman’s Sealer.
Answer.

Grossman’s Sealer Composition:

Grossman’s Sealer Powder:

• Zinc oxide
• Staybelite resin
• Barium sulfate
• Bismuth subcarbonate
• Sodium borate

Grossman’s Sealer Liquid:

• Eugenol

Grossman’s Sealer Properties:

• Plasticity
• Slow setting time
• Good sealing

Grossman’s Sealer Disadvantage:

• Require vigorous mixing
• Setting time – 2 hours at 37°C

Grossman’s Sealer Influenced By:

• Quality of ZnO and pH
• Mixing
• Humidity
• Temperature and dryness of slab and spatula

Obturation Of Root Canal Short Questions And Answers

Question 1. Composition of Grossman’s sealer.
Answer.

Grossman’s sealer Powder:

• Zinc oxide
• Staybelite resin
• Barium sulfate
• Bismuth subcarbonate
• Sodium borate

Grossman’s sealer Liquid:

• Eugenol

Question 2. Diaket
Answer.

Diaket

• By Schmidt in 1951

Diaket Composition:

Diaket Powder:

• Zinc Oxide
• Bismuth phosphate

Diaket Liquid:

• 2,2 dihydroxy – 5,5 dichlorodiphenyl methane
• Triethanolamine
• B-diketone
• Caproci acid
• Copolymers

Diaket Advantages:

• Good adhesion
• Fast setting
• Stable
• Superior tensile

Diaket Disadvantages:

• Toxic
• Tacky
• Setting is effected by phenol

Question 3. Mcspadden compaction.
Answer.

Mcspadden compaction Technique:

McSpadden compaction Advantages:

• Less time
• Easy to insert
• 3D obturation

McSpadden compaction Disadvantages:

• Unable in narrow and curved canals
• Frequent breakage
• Overfilling
• Shrinkage of guttapercha

 

Question 4. AH Sealer
Answer.

AH26:

• This is an epoxy resin containing sealer
• It is adhesive, well tolerated by tissues, and provides a good seal

AH26 Disadvantages:

• Staining of tooth structure as it contains silver
• It is insoluble in solvents

AH26 Plus:

• This eliminates all the disadvantages associated with AH26

Obturation Of Root Canal Viva Voce

• Gutta-percha cones may be kept sterile in screw-crapped vials containing alcohol.
• Lateral compaction is easy and quick to perform.
• Tug back refers to the apical seal fit of the master cone.
• Inadequate obturation is the most common cause of RCT failure.
• Silver cones are contraindicated in filling a root canal if the tooth is to be restored with a post and care.
• Ideally, the length of the post and core should be 2/3rd of the root canal.
• Injectable gutta-percha is especially useful while managing canal irregularities.
• Thermafill contains a center carrier which is grooved along 600 of their circumference. and has a coating of gutta-percha.
• The silver cone is stiffer than gutta-percha.
• Endorez is a visible light-curable urethane dimethacrylate resin-based sealer.

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• Irrigation And Intracanal Medicaments Short And Long Essay Question And Answers
• Cleaning And Shaping Of Root Canal Short And Long Essay Question And Answers
• Obturation Of Root Canal Short And Long Essay Question And Answers
• Single Visit Endodontics Short And Long Essay Question And Answers
• Endodontic Emergencies Short And Long Essay Question And Answers
• Procedural Accidents Endodontic Short And Long Essay Question And Answers
• Surgical Endodontics Short And Long Essay Question And Answers
• Management Of Discolored Teeth Short And Long Essay Question And Answers
• Endodontics Treatment Of Traumatized Teeth Short And Long Essay Question And Answers
• Asepsis In Endodontics Short And Long Essay Question And Answers
• Diseases Of Pulp Short And Long Essay Question And Answers
• Endodontics Miscellaneous Short And Long Essay Question And Answers

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.

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• 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