Endodontics

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

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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

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• 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

Endodontic Emergencies Short Essays

Question 1. Endodontic Emergency.
Answer.

Endodontic Emergency Definition:

• It is defined as pain and/or swelling caused by inflammation or infection of the pulp and/or periradicular tissues necessitating an emergency visit to the dentist for immediate treatment.

Endodontic Emergency Classification:

Endodontic Emergency Before treatment:

• Endodontic emergencies presenting with pain and/or swelling
  • Cracked tooth syndrome
  • Symptomatic reversible pulpitis
  • Symptomatic irreversible pulpitis
  • Phoenix abscess
  • Acute alveolar abscess
  • Celluitis
• Traumatic injuries
  • Crown/root fracture
  • Luxation injuries
  • Tooth avulsion

Endodontic Emergency Treatment

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Endodontic Emergency During treatment:

• Hot tooth
• Endodontic flare-ups

Endodontic Emergency After treatment:

• Postobturation pain
• Vertical root fracture

Question 2. Vertical Root Fracture.
Answer.

Vertical Root Fracture

• These are longitudinal fractures that originate in the roots of teeth

Endodontic Emergency Treatment

Vertical Root Fracture Etiology:

• Over instrumentation
• Over filling
• Persistent pain
• Hyper occlusion
• Poor coronal seal

Vertical Root Fracture Clinical Features:

• Site – Faciolingual plane
• Sign – Crunching sound
• Symptom – Pain at the site

Vertical Root Fracture Diagnosis:

• Radiograph shows widening of PDL

Vertical Root Fracture Treatment:

• Retreatment done
  • Repair
  • Root resection
  • Extraction

Cleaning And Shaping Of Root Canal Important Notes

• Cleaning And Shaping Of Root Canal Step back method
  • It is also called flare telescopic or serial root canal preparation
  • Once the canal has been enlarged in the apical third to at least non-25, each consecutive larger root canal instrument used for shaping the canal is placed short of the apex
  • This results in apical enlargement and marked taper from apical to corona;
    Advantages:
  • Less chances of periapical trauma
  • Facilitates removal of more debris
  • The development of an apical matrix or apical stop prevents overfilling of the root canal
  • Greater condensation pressure can be exerted which often fills lateral canals with the sealer
    Disadvantages:
  • Apical extrusion of the debris through the apex
• Cleaning And Shaping Of Root Canal Modified Stepback
  • The preparation is completed in the apical area and then the step back begins 2-3mm up the canal
  • This gives a short almost parallel retention form to receive primary gutta-percha cone
• Cleaning And Shaping Of Root Canal Step-down Technique
  • It is called the crown down pressure less technique
  • Gates Glidden drills or large-sized files are used in the control 2/3rd of the canal and progressively smaller files are used from the coronal preparation until the desired length is obtained
    Advantages:
  • Eliminates the extrusion of the debris through the apex during instrumentation
  • Achieves complete cleansing of the canal
  • It helps in achieving a biocompatible seal at the apex
  • Prevents post treatment discomfort
  • Provides a coronal escape way that reduces the piston in-cylinder effect responsible for debris extrusion from the apex

Obturation Of Root Canal

• Cleaning And Shaping Of Root Canal Hybrid Technique
  • Proposed by Goeing and Buchanan
  • Uses both step down and step back technique
  • The coronal portion is enlarged by step down technique
  • The apical portion is enlarged by the back technique
• Cleaning And Shaping Of Root Canal Balanced force concept
  • Uses flex-R-file with the non-cutting tip
  • Reaming action using clockwise insertion and counter clockwise cutting and removal with apical force
  • The entire preparation steps down beginning with flaring of coronal and mid thirds of the canal with Gates Glidden drills 1-6
  • It involves placement, cutting, and removal using only rotary motion
  • Apical pressure application is adjusted to match the file strength
  • Clockwise rotation which sets the instrument should never exceed 180°
  • Counterclockwise rotation with apical pressure is 120° or greater
  • By these actions, the instrument advances toward the apex
  • With this technique problems of instrument breakage and root perforations are encountered
• Cleaning And Shaping Of Root Canal Cleaning And Shaping Of Root Canal Principles of root canal preparation
  • Outline form
  • Convenience form
  • Toilet of cavity
  • Retention form
  • Resistance form
  • Extension for prevention
• Cleaning And Shaping Of Root Canal Schilder objectives
  • Cleaning And Shaping Of Root Canal Mechanical objectives
    • Continuous tapering canal shape with the narrowest cross-sectional diameter apically and widest diameter coronally
    • Walls should taper evenly towards the apex
    • To give the prepared root canal the quality of flow
    • Should keep the apical foramen as small as practical
  • Cleaning And Shaping Of Root Canal Biologic Objectives
    • To debride and disinfect the root canal system
    • Necrotic debris should not be forced periodically
    • Sufficient space for intracanal medicaments and irrigants should be created

Obturation Of Root Canal

Cleaning And Shaping Of Root Canal Long Essays

Question 1. Classify techniques for root canal preparation. Discuss the crown-down technique.
Answer.

Techniques For Root Canal Preparation:

• Step-back technique:
  • Conventional step-back
  • Passive step-back
• Crown down or step down technique and its modifications
  • Crown down pressure less
  • Double flare
  • Balanced force
• Hybrid technique

Cleaning And Shaping Of Root Canal Crown Down Technique:

• It involves the preparation of the coronal two-thirds of the canal first followed by a middle and apical third of the canal

Techniques For Root Canal Preparation Procedure:

Techniques For Root Canal Preparation Advantages

• Shaping is easier
• Elimination of the bulk of the tissue, debris, and micro-organisms from the the coronal and middle third before apical shaping.
• Minimizes debris extrusion

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• Better access and control over apical enlarging instruments
• Better penetration of irrigants

Question 2. Enumerate various techniques of canal preparation. Write in detail about the step-back technique.
Answer.

Obturation Of Root Canal

Techniques For Root Canal Preparation:

• Step-back technique:
  • Conventional step-back
  • Passive step-back
• Crown down or step down technique and its modifications
  • Crown down pressure less
  • Double flare
  • Balanced force
• Hybrid technique

Techniques For Root Canal Preparation Step Back Technique:

• It involves the preparation of the coronal two-thirds of the canal first followed by a middle and apical third of the canal

Techniques For Root Canal Preparation Step Back Technique Stage 1:

Techniques For Root Canal Preparation Step Back Technique Stage 2:

Example: For working length 22mm and the first file used is No-20

Techniques For Root Canal Preparation Step Back Technique Advantage:

• More flare at the coronal part
• Popular technique
• Ability to prepare a proper apical stop before preparation of the middle third and coronal third of the root canal

Techniques For Root Canal Preparation Step Back Technique Disadvantages:

• Difficult to irrigate
• Chances of pushing debris periodically
• Time-consuming
• Iatrogenic errors

Cleaning And Shaping Of Root Canal Short Essays

Question 1. Crown Down Technique.
Answer.

Crown Down Technique

It involves the preparation of the coronal two-thirds of the canal first followed by a middle and apical third of the canal.

Crown Down Technique Advantages

• Shaping is easier
• Elimination of the bulk of the tissue, debris, and micro-organisms from the coronal and middle third before apical shaping
• Minimizes debris extrusion
• Better access and control over apical enlarging instruments
• Better penetration of irrigants
  • Enhances tactile sensation
  • Coronal flaring
  • Removes debris coronally
  • Straight line access
  • Decreased frequency of blockage

Obturation Of Root Canal

Question 2. Balanced force technique.
Answer.

Balanced Force Technique Steps:

Balanced Force Technique  Uses:

• Engage a small amount of dentin
• Shear off dentin
• Loosen the debris

Balanced Force Technique  Advantages:

• Lesser canal transportation
• Can manipulate files at any point
• File cutting at the apical end

Cleaning And Shaping Of Root Canal Viva Voce

• Recapitulation is returning to a small instrument from time to time before advancing to a larger size
• Recapitulation prevents the packing of dentin filling and ensures patency of the root canal through the apical foramen
• Biomechanical preparation should provide smooth, funnel-shaped tapered walls for obturation
• Step back technique is beginning the preparation at the apex and working back up to the canal coronally with larger and larger instruments
• Step down technique begins coronally and the preparation is advanced apically using smaller and smaller instruments

Working Length Determination Important Notes

• Methods for determing working length
  • Radiographic
    • Grossman formula
    • Ingle’s method
    • Weine’s method
    • Kutler’s method
    • Radiographic grid
    • Xeroradiography
    • Digital radiography
    • Subtraction radiography
  • Non-radiographic
    • Digital tactile sense
    • Paper point method
    • Electronic Apex locators
• Grossman’s method
  • An instrument is placed in the root canal and a radiograph is taken
  • By measuring the length of radiographic images of both the tooth and measuring instrument as well as actual length of the instrument, the clinician can determine the actual length of the tooth by formula

\(\frac{\text { Actual length of tooth }}{\text { Actual length of instrument }}=\frac{\begin{array}{c}
\text { Apparent length of } \\
\text { tooth in radiograph }
\end{array}}{\begin{array}{c}
\text { Apparent length of } \\
\text { instrument in radiograph }
\end{array}}\)

• Apex locators

Working Length Determination Long Essays

Question 1. Mention various methods to determine working length and describe any one in detail.
Answer.

Working Length Determination

Various methods to determine working length and describe any one in detail

Working length: The distance from a coronal reference point to a point at which canal preparation and obturation should terminate.

Methods:

• Radiographic:
  • Grossman formula
  • Ingle’s method
  • Weine’s method
  • Kutler’s method
  • Radiographic grid

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• • Xeroradiography
  • Digital radiography
  • Subtraction radiography
  • Non-radiographic
  • Digital tactile sense
  • Paper point method
  • Electronic Apex locators
• Radiographic method:
  Method:

• • The rule for subtraction:
    • No resorption – 1mm
    • Bone resorption – 1.5mm
    • Bone and root resorption – 2mm
  • Advantages:
    • The following can be viewed
      • Anatomy of tooth
      • Curvature of canal
      • Relationship with adjacent structures
  • Disadvantages:
    • Observation variation
    • Superimposition
    • Two-dimensional view
    • Time-consuming
    • Radiation exposure
• Grossman method:

\(\frac{\text { Actual length of tooth }}{\text { Actual length of instrument }}=\frac{\begin{array}{c}
\text { Apparent length of } \\
\text { tooth in radiograph }
\end{array}}{\begin{array}{c}
\text { Apparent length of } \\
\text { instrument in radiograph }
\end{array}}\)

• Kuttler’s method:

• • Narrow canal – 10-15 no. file
  • Average – 20-25 no. file
  • Wide – 30-35 no file

Radiographic Grid: Millimeter grid superimposed on radiograph

• Endometric probe:

Working Length Determination Short Essays

Question 1. Nonradiographic methods for working length determination.
Answer.

Non Radiographic Methods

• Non Radiographic Methods Non Radiographic Methods Paper point method:
  Steps:
  • Introduce paper-points inside the apex
  • Leave it for 1 min
  • Remove paper point
  • Observe it
  • When paper point penetrates the periodontium, the paperpoint will be wet
  • Measure the length of dry part
    Disadvantages:
  • Incorrect determination
  • Can be easily curved
• Non Radiographic Methods Tactile method:
  • Introduce the file till it stops
  • Mark the level with stopper
  • Take smaller file
  • Introduce it into canal
  • Repeat steps and compare it with larger file
  • Steps are repeated till 2 files measure same length
• Non Radiographic Methods Apical periodontal sensitivity:
  • Introduce smallest file into canal
  • It may go deeper and file slip very easily
  • At this moment the patient feel pain
  • This means file reaches periodontal tissues
    Apical periodontal sensitivity Advantages:
  • Doesn’t require special devices
  • Cheaper
  • Very quick method
  • Easy to perform
    Apical periodontal sensitivity Disadvantages:
  • Incorrect
  • Destroys periodontal tissues
• Apex locators:
  Apex locators Uses:
  • As adjacent to radiograph
  • Used to locate apical constriction or CDJ or apical foramen
    Apex locators Components:
  • Lip clip
  • File clip
  • Electronic devices
  • Cord connecting them
    Apex locators Advantages:
  • Use for pulp vitality
  • Objective
  • Accurate
    Apex locators Disadvantages:
  • Over estimated
  • Problematic in immature apex
  • Inaccurate in cases of
    • Presence of pulp tissue in canal
    • Blockage
    • Narrow file
    • Low battery

Question 2. Electronic Apex Locaters.
Answer.

Electronic Apex Locaters Uses:

• As adjacent to radiograph
• Used to locate apical constriction or CDJ or apical foramen

Electronic Apex Locaters Components:

• Lip clip
• File clip
• Electronic devices
• Cord connecting them

Working Length Determination

Electronic Apex Locaters Advantages:

• Use for pulp vitality
• Objective
• Accurate

Electronic Apex Locaters Disadvantages:

• Over estimated
• Problematic in immature apex
• Inaccurate in cases of
  • Presence of pulp tissue in canal
  • Blockage
  • Narrow file
  • Low battery

Contradictions: Patient with cardiac pacemakers.

Classification:

Question 3. EDTA
Answer.

EDTA

It is chelating agent

EDTA Properties:

• Effect depends on its concentration
• Non-toxic
• Optimal cleansing and shaping of canals

EDTA Functions [HELS]:

• Hold debris in suspension
• Emulsification
• Lubrication
• Smear layer removal

EDTA Mechanism:

EDTA Uses:

• Time saver
• Easier Manipulation of Instruments
• Dissolve dentin
• Enlarges canals

EDTA Forms:

• EDTAT
• EDTA-C
• Rc Prep
• R.EDTA

Question 4. Sodium Hypochlorite.
Answer.

Sodium Hypochlorite

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

Sodium Hypochlorite Mechanism:

Factors Affecting Sodium Hypochlorite Activity:

• Sodium Hypochlorite Activity Increases:
  • Volume of solution
  • Heating of solution
  • Time of contact
• Sodium Hypochlorite Activity Decreases:
  • Storage time
  • EDTA
    Advantages:
  • Dissolve tissue
  • Antibacterial and bleaching action
  • Lubricate canal
  • Economical
    Disadvantages:
  • High surface tension
  • Irritate tissue
  • Irritate eyes
  • Causes inflammation of the gingiva
  • Bleaches clothes
  • Bad odour and taste
  • Corrosive to instruments

Sodium Hypochlorite Activity Combine with:

Working Length Determination

• Calcium hydroxide
• EDTA
• Chlorhexidine

Working Length Determination Short Answers

Question 1. Apex locators – generations.
Answer.

Apex locators – generations