Mcqs of Endo

APPENDIX B Chapter review questions
Chapter review questions

Van T. Himel, Kent A. Sabey
5. What is the diameter at point D0 and at point D16 for a

CHAPTER 13 0.02 taper No. 20 file?
Endodontic Instruments a. 0.20 mm at D0 and 0.36 mm at D16
1. What must an instrument do to completely clean the canal b. 0.20 mm at D0 and 0.52 mm at D16
space? c. 0.02 mm at D0 and 0.18 mm at D16
a. It must be deflected at the canal orifice. d. 0.02 mm at D0 and 0.34 mm at D16
b. It must stop 2 to 3 mm short of the radiographic apex.
c. It must fit loosely into the canal. ANS: b
d. It must contact all walls and surfaces. Taper can be defined as the rate of change of cross-sectional
diameter. A file with a taper of 0.02 (2%) increases in diam-
ANS: d eter at a rate of 0.02 mm per running millimeter of length,
To mechanically débride a region of the canal space com- beginning at D0 through D16. Likewise, a file with a taper of
pletely, an instrument must contact and plane all walls. 0.04 (4%) increases in diameter at a rate of 0.04 mm per
REF: Intracanal Preparation Instruments running millimeter of length beginning at D0 through D16.
For example, a 0.02 taper No. 20 file is 0.20 mm in diameter
2. What motion is used with a reamer to clean and shape at D0, tapers 0.32 mm over 16 mm, and has a diameter of
canal walls? 0.52 mm at D16.
a. pushing REF: Instrument Design and Standardization (Taper)
b. planing
c. twisting 6. What is torsional limit?
d. vibration a. the amount of apical pressure that can be applied to a
file to the point of breakage
ANS: c b. the beginning of plastic deformation of an instrument
Files can be effective when used in both filing (pulling and c. the amount of rotational torque that can be applied to
planing) and reaming (twisting and cutting) motions; reamers a “locked” instrument to the point of breakage
are least effective when used in a filing motion. d. the amount of force necessary to prevent a file from
REF: Hand-Operated Instruments returning to its original shape upon unloading of the
force
3. Nickel-titanium alloy has increased flexibility over stain-
less steel. How does the modulus of elasticity for nickel- ANS: c
titanium alloy compare to that of stainless steel? Torsional limit is the amount of rotational torque that can be
a. It is similar to that of stainless steel. applied to a “locked” instrument to the point of breakage
b. It is one fourth to one fifth that of stainless steel. (separation).
c. It is one half that of stainless steel. REF: Physical Characteristics
d. It is two to three times that of stainless steel.
7. What is the approximate ratio of nickel to titanium in
ANS: b nickel-titanium endodontic instruments?
Nickel-titanium alloy has a modulus of elasticity that is one a. 25% nickel/75% titanium
fourth to one fifth that of stainless steel, allowing a wide range b. 75% nickel/25% titanium
of elastic deformation. c. 45% nickel/55% titanium
REF: Physical Properties d. 55% nickel/45% titanium
4. Which design variable is used to provide greater flexibility ANS: d

of instruments? New metal alloys have been incorporated in an attempt to
a. changing the cross section from triangular to square improve the quality of files. Nickel-titanium instruments are
b. changing the cross section from rhomboidal to square composed of approximately 55% nickel and 45% titanium,
c. increasing the number of flutes per millimeter although this can vary by manufacturer.
d. decreasing the number of flutes per millimeter REF: Physical Properties
ANS: d
Many design variables can affect the function, efficacy, and
efficiency of instruments. By changing the cross-sectional
design from square to triangular or rhomboid and decreasing
the number of flutes per millimeter, greater flexibility is
gained.
e38 REF: Instrument Design and Standardization
8. What canal configuration provides the greatest physical 11. Nickel-titanium undergoes what surface alteration or pro-
advantage for nickel-titanium instruments over stainless cessing to enhance its properties?
steel instruments in cleaning and shaping? a. Teflon coating
a. fine, small canals b. electropolishing
b. large canals c. magnetization
c straight canals d. demagnetization
d. irregular canal shapes
ANS: b
ANS: a Efforts to enhance the properties of nickel-titanium alloy are
Nickel-titanium instruments are more flexible and adapt more ongoing; it has been demonstrated that altering surface char-
readily to fine, curved canals10 but have no advantage over acteristics and the process of manufacturing may increase the
stainless steel files in straight and irregular canal spaces. durability and flexibility of these instruments. Electropolish-
REF: Physical Properties ing, surface coatings, and surface implantation have been tried
for this purpose.
9. How do Gates-Glidden drills differ from Peeso reamers? REF: Physical Characteristics
a. Gates-Glidden drills have a greater length of cutting
surface. 12. Regular inspection of hand files may aid in avoidance of
b. Gates-Glidden drills are more aggressive cutters. instrument separation. For what defect should a file be
c. Gates-Glidden drills have an elliptical-shaped cutting inspected?
area. a. unwinding of the flutes
d. Gates-Glidden drills are less flexible. b. rolling up or tightening of the flutes
c. distortion of the tip
ANS: c d. all of the above
Gates-Glidden rotary drills are elliptically (flame) shaped burs
with a thin shank and latch attachment and are used to open ANS: d
the orifice. They also achieve straight-line access by removing Signs that instrument separation may occur are unwinding of
the dentin shelf and rapidly flaring the coronal third of the the flutes (twisting clockwise and opening of the flutes),
canal. Gates-Glidden drills are designed to break high in the roll-up of the flutes (excessive continued clockwise twisting
shank region. This allows easier removal of the broken instru- after unwinding), tip distortion (an excessively bent tip), wear,
ment from a tooth; fracture near the cutting head may block and corrosion (Fig. 13.15). If any of these signs are observed,
a canal.33,41,42 It is important to note that these drills must be the file should be discarded.
continuously rotated. If they stop, the head may lock in the REF: Avoidance of Instrument Separation
canal, with torsional failure and fracture. Peeso rotary reamers
(originally designed for post preparation) are similar to Gates- 13. What are the characteristics of finger spreaders and plug-
Glidden drills but have longer cutting sides with or without gers, compared to handled instruments, when used for
safe tips, which are parallel rather than an elliptical shape. lateral condensation?
Peeso reamers have been suggested as a means of improving a. They are annealed to give them greater strength.
straight-line access, although they are less well-controlled b. They are best suited for straight canals.
than Gates-Glidden drills.42 c. They are more rigid, to access the canal orifice.
REF: Mechanically Operated Instruments (Rotary) d. They have greater flexibility.
10. How are broaches intended to be used in the canal? ANS: d

a. to plane canal walls with a push-pull motion The main instrument used for cold lateral compaction is the
b. to plane canal walls with a reaming motion spreader, the function of which is to laterally compact and
c. to be placed to the corrected working length around adapt gutta-percha and create space for accessory cones. Two
canal curvatures types are handle spreaders and finger spreaders (Fig. 13.17).
d. to entangle and remove canal contents by rotation The handled instruments are stiffer and are made of annealed
stainless steel. As with canal preparation instruments, spread-
ANS: d ers come in various tip sizes and tapers. Standard spreaders
Barbed broaches are stainless steel instruments with plastic increase diameter at the same rate as a file with 0.02 taper,
handles. Manufacturers create barbs on tapered wire broaches whereas highly tapered spreaders increase at a higher rate.
by scoring and prying a tag of metal away from the long axis The greater the taper, the more the canal space must be
of the wire (Fig. 13.9). The barbs entangle and allow removal enlarged or flared to facilitate spreader penetration. Both
of canal contents. This instrument should be neither bound in stainless steel and nickel-titanium spreaders are available. The
the canal nor aggressively forced around a canal curvature obvious advantage of nickel-titanium over stainless steel is
because the barbs may engage the canal wall, with instrument greater spreader penetration in highly curved canals.56 Nickel-
fracture. Barbed broaches should never be reused. The use of titanium spreaders also create less stress in curved canals
broaches has decreased in popularity. compared with stainless steel.57 Handled instruments are
REF: Hand-Operated Instruments capable of generating more force within a canal space during
obturation, so finger spreaders should be considered when
obturating curved canals (Fig. 13.18). All spreaders should be
used cautiously with regard to the amount of applied force. e39
REF: Instruments for Obturation – lateral condensation
14. How does pressure sterilization compare to dry heat ster- 16. What property of nickel-titanium allows it to be an effec-
ilization for the sterilization of sharp-edged instruments? tive rotary file in curved canals ?
a. The two types are comparably effective. a. corrosion resistance
b. Neither should be used for sterilization. b. variable taper
c. Pressure sterilization is superior. c. shape memory
d. Dry heat sterilization is superior. d. torsional strength
ANS: d ANS: c
Dry heat is superior for sterilizing sharp-edged instruments, Due to the unique crystalline structure and phase change
such as scissors, to best preserve their cutting edge. capability of nickel-titanium, most NiTi files have shape
REF: Disinfection and Sterilization memory; this is the important ability of a file to return to its
original shape after being deformed. Shape memory affords
15. What are the time, temperature, and pressure requirements nickel-titanium alloys the flexibility and toughness necessary
for sterilization of gauze-wrapped instruments using pres- for routine use as effective rotary endodontic files in curved
sure sterilization? canals.14
a. 10 minutes at 121°C and 15 psi REF: Physical Properties
b. 10 minutes at 100°C and 15 psi
c. 20 minutes at 121°C and 15 psi
d. 20 minutes at 100°C and 15 psi
ANS: c
Instruments that have been wrapped in gauze should be auto-
claved for 20 minutes at 121°C and 15 psi.58 This kills all
bacteria, spores, and viruses.
REF: Disinfection and Sterilization
e40

Richard E. Walton, Eric J. Herbranson
5. Alterations in the anatomy of the pulp space occur because

CHAPTER 14
of:
Internal Anatomy a. resorption
1. Lack of knowledge of pulp anatomy is the _________ b. age
common cause of treatment failure. c. calcifications
a. least d. all of the above
b. second most
c. third most ANS: d
d. fourth most Understanding the changes that often occur during the life
span and experience of a tooth will alert the practitioner to
ANS: b potential difficulties in locating the pulp space and/or root
This fact emphasizes the important of anatomic knowledge in canals during treatment
executing endodontic treatment. REF: Alterations in Internal Anatomy
REF: Introduction
6. Calcifications encountered in the pulp space:
2. Which of the following is the most predictable technique a. represent additional dentin formation
for determining whether a root contains two canals? b. can always be detected by radiograph
a. an apex locator c. are always attached to the chamber or canal walls
b. viewing the access with a microscope d. often prevent instruments from negotiating canals
c. searching with an explorer
d. interpreting angled radiographs ANS: a
Familiarity with the location and type of calcifications present
ANS: d in the pulp space helps the clinician locate canal orifices and
Varied angulations in radiographs are the most predictable negotiate to working length.
method to elucidate anatomic features such as multiple canals REF: Alterations in Internal Anatomy (Calcifications)
and curvatures.
REF: Methods of Determining Pulp Anatomy (Radiographic 7. Which of the following is not associated with the radicular
Evidence) pulp?
a. lateral canals
3. The shape of the canal in cross section is variable through- b. apical foramen
out the root; however, it is almost always round in the c. pulp horns
apical third. True or false? d. canal orifices
a. Both parts of the sentence are true.
b. The first part of the sentence is false; the second part ANS: c
is true. A knowledge of the location of anatomic features of the pulp
c. The first part of the sentence is true; the second part is space.
false. REF: Components of the Pulp System
d. The entire sentence is false.
8. Accessory canals are more common in the apical third;
ANS: c they also are more common in posterior teeth. True or
The cross section of the canal is rarely round and to make this false?
assumption can lead to errors in canal preparation. a. The entire sentence is true.
REF: General Considerations (Root and Canal Anatomy) b. The first part of the sentence is true, the second part is
false.
4. Multiple canals in mandibular premolars occur most often c. The first part of the sentence is false, but the second
in which population? part is true.
a. Asians d. The entire sentence is false.
b. African-Americans
c. Caucasians ANS: a
d. There is no difference by ethnicity. Knowledge of the anatomic features of the pulp space
REF: Components of the Pulp System (Accessory Canals)
ANS: b
Knowledge of common variations, either by tooth type or by
ethnicity, aid in detection of those variations and in their suc-
cessful treatment.
REF: General Considerations (Root and Canal Anatomy) e41
9. Which statement is true about the apical foramen? 11. The lingual groove defect is found most frequently in
a. The diameter remains constant throughout life. maxillary central incisors; it has a poor prognosis for treat-
b. The position of the apical foramen is often visible on ment. True or false?
radiographs. a. Both parts of the sentence are true.
c. The foramen is most commonly located 0.5 mm to b. The first part of the sentence is true, the second part is
1 mm from the anatomic root apex. false.
d. None of the above c. The first part of the sentence is false, the second part
is true.
ANS: c d. Both parts of the sentence are false.
A knowledge of the common location of the apical foramen
helps the clinician determine the proper working length. ANS: c
REF: Apical Region (Apical Foramen) The lingual groove is most commonly found in maxillary
lateral incisors, and the clinician should check for it when
10. Dens invaginatus (dens in dente) occurs most commonly performing periodontal probing.
in which teeth? REF: Variations of Root and Pulp Anatomy (Lingual Groove)
a. maxillary canines
b. maxillary lateral incisors 12. A C-shaped canal is characterized by which of the
c. maxillary and mandibular lateral incisors following?
d. mandibular first premolars a. It is most commonly found in Asian populations.
b. It usually occurs in mandibular second molars.
ANS: b c. It should be referred to an endodontist for treatment.
A knowledge of the common anomalies and where they occur d. all of the above
aids in diagnosis and treatment planning or referral.
REF: Variations of Root and Pulp Anatomy (Dens Invaginatus ANS: d
[Dens in Dente]) Identification and referral of this complex anatomic variation
maximizes the prognosis.
REF: Variations of Root and Canal Anatomy (Other
Variations)
e42

William T. Johnson, Anne E. Williamson
3. What is the recommended rubber dam weight for end-

CHAPTER 15
odontic procedures?
Isolation, Endodontic Access, and a. light
Length Determination b. medium
1. Rubber dam use indicates that the clinician understands c. heavy
what aspects of endodontic treatment? d. extra heavy
a. the microbial nature of disease
b. protection of the patient from aspirating or swallowing ANS: b
instruments The thickness of rubber dams also varies (i.e., light, medium,
c. a decreased success rate for endodontic treatment when heavy, and extra heavy). A medium-weight dam is recom-
strict asepsis is not followed mended for endodontic procedures because a light-weight
d. all of the above dam is easily torn during the application process. Also, the
medium-weight material fits better at the gingival margin and
ANS: d provides good retraction.
Application of the rubber dam for isolation during endodontic REF: Isolation (Rubber Dam Application)
treatment has many distinct advantages and is mandatory for
legal considerations.1 Failure to use a rubber dam indicates 4. Which of the following clamps is designed for an anterior
that the clinician does not understand the microbial nature of tooth?
the disease process, the need to protect the patient from aspi- a. No. 8
rating or swallowing instruments, the protection afforded the b. No. 212
dental staff from contaminated aerosols, and the decreased c. No. 0
success rate for treatment when strict asepsis is not followed. d. No. 24/25
In the United States, use of the rubber dam is considered the
standard of care; thus expert testimony is not required in cases ANS: b
in which patients swallow or aspirate instruments or materials, Anterior teeth: No. 9 or No. 212
because juries are considered competent to determine negli- REF: Rubber Dam Retainers (Types)
gence. Evidence exists that many general dentists unnecessar-
ily place themselves at risk by not using the rubber dam when 5. What is an advantage of a provisional crown used to
performing endodontic procedures.2 replace missing tooth structure before root canal
REF: Isolation (Rubber Dam Application) treatment?
a. It accurately reproduces tooth anatomic landmarks.
2. What is an advantage of using a plastic rubber dam retainer b. It maintains tooth orientation for access and canal
clamp? location.
a. It is radiopaque. c. It is easily removed and replaced during root canal
b. It must be removed when exposing a radiograph. treatment appointments.
c. It is less likely to damage tooth structure or existing d. It increases visibility of the root canal chamber.
restorations.
d. It obscures visibility when the chamber is calcified. ANS: c
Placement of temporary crowns is an option; however, they
ANS: c decrease visibility, result in the loss of anatomic landmarks,
The design of the rubber dam frames is also variable. For and may change the orientation for access and canal location.
endodontics, plastic frames are recommended; they are radio- Often temporary crowns are displaced during treatment by the
lucent and do not require complete removal during exposure rubber dam clamp. In general, when provisional crowns are
of interim films such as the working length and master cone placed, they should be removed during root canal treatment
radiographs/digital images. and replaced after the procedure to increase visibility, provide
REF: Isolation (Rubber Dam Application) adequate orientation, and maintain the remaining tooth
structure
REF: Replacement of Coronal Structures (Provisional
Crowns) e43
6. What is the preferred method of rubber dam placement on 9. What is an advantage of caries removal during access?
molars? a. It enhances the effectiveness of NaOCl.
a. placement as a single unit b. It reduces interappointment pain.
b. placement of a clamp and rubber dam, followed by c. It strengthens tooth structure.
attachment of the frame d. It allows assessment of restorability prior to the end-
c. placement of a clamp, followed by the dam and then odontic treatment.
the frame
d. placement of the rubber dam and frame, followed by ANS: d
placement of the clamp Caries removal is essential for several reasons. First, remov-
ing caries permits the development of an aseptic environment
ANS: a prior to entering the pulp chamber and radicular space.
Placement of the rubber dam, clamp, and frame as a unit is Second, it allows assessment of restorability prior to treat-
preferred. This is most efficient and is applicable in most ment. Third, it provides sound tooth structure so that an ade-
cases. quate provisional restoration can be placed. Unsupported
REF: Rubber Dam Placement (Placement as a Unit) tooth structure is removed to ensure a coronal seal during and
after treatment and so that the reference point for length
7. What is a major objective of the access opening? determination is not lost should fracture occur.
a. to locate the primary or largest canal REF: General Principles—caries removal
b. to achieve unimpeded straight-line access of the instru-
ments to the first canal curvature or apical one third 10. Estimated depth of access is a measurement from which
c. to expose the pulp horns of the following?
d. to remove all restorative materials a. the incisal edge of anterior teeth to the coronal portion
of the pulp chamber
ANS: b b. the occlusal reference of posterior teeth to the coronal
The major objectives of the access openings include portion of the pulp chamber
(1) removal of the chamber roof and all coronal pulp tissue, c. the incisal edge of anterior teeth to the radiographic
(2) location of all canals, (3) unimpeded straight-line access apex of the tooth
of the instruments in the canals to the apical one third or the d. the occlusal reference of posterior teeth to the radio-
first curve (if present), and (4) conservation of tooth graphic floor of the chamber
structure.
REF: Access Openings ANS: b
Before the access is begun, the preoperative radiographs
8. Which statement best describes the outline form for should be assessed to determine the degree of case difficulty.
access? At this stage, the estimated depth of access is calculated. This
a. It mimics the shape of the canal or canals. is a measurement from the midlingual surface of anterior teeth
b. It is toward the distal on the occlusal surface in molars. and the occlusal surface of posterior teeth to the coronal
c. It is a projection of the internal tooth anatomy onto the portion of the pulp chamber. Calculated in millimeters, this
external surface. information is then transferred to the access bur and provides
d. It is a constant and unchanging shape regardless of age. information on the depth necessary to expose the pulp. If the
estimated depth of access is reached and the pulp has not been
ANS: c encountered, the access depth and orientation must be reeval-
Endodontic access openings are based on the anatomy and uated. A parallel radiograph exposed with the rubber dam
morphology of each individual tooth group. In general, the removed helps in determining the depth and orientation so
pulp chamber morphology dictates the design of the access that perforations and unnecessary removal of tooth structure
preparation. The internal anatomy is projected onto the exter- can be avoided (Fig. 15.33). The estimated depth of access
nal surface. Internal pulp chamber morphology varies with the for anterior teeth is similar.41 The maxillary central and lateral
patient’s age and secondary dentin deposition. In anterior incisors average 5.5 mm for the central incisor and 5 mm for
teeth and premolars with a single root, calcification occurs in the lateral incisor. The mandibular central and lateral incisors
a coronal to apical direction with the chamber receding into average 4.5 mm for the central incisor and 5 mm for the
the root. In posterior teeth with bifurcations and trifurcations, lateral incisor. The maxillary canine averages 5.5 mm, and the
secondary dentin is deposited preferentially on the floor of the mandibular canine, with its longer clinical crown, averages
chamber, reducing the cervical to apical dimension of the 6 mm. In maxillary furcated premolars, the average distance
chamber.32,33 The mesial-distal and buccal-lingual dimensions from the buccal cusp tip to the roof of the chamber is 7 mm.42
remain relatively the same, as does the cusp to roof distance. For maxillary molars the distance is 6 mm, and for the man-
Dystrophic calcifications related to caries, restorations, attri- dibular molars it is 6.5 mm. With an average pulp chamber
tion abrasion, and erosion also can occur. In general, the pulp height of 2 mm, the access depth for most molars should not
chamber is located at the cementoenamel junction. extend beyond 8 mm (the floor of the chamber).35
REF: Access Openings REF: General Considerations
e44
11. Which of the following is not a general principle for end- molar may even exhibit a distinct separate extra distal root.
odontic access? Because of these anatomic relationships, the access outline
a. outline form form is rectangular or trapezoidal and positioned in the mesio-
b. compensation form buccal portion of the crown (Fig. 15.37).
c. caries removal REF: Access Openings and Canal Location (Mandibular
d. toilet of the cavity Molars)
ANS: b 15. Which of the following is not a major canal

The general principles for endodontic access are outline form, morphology?
convenience form, caries removal, and toilet of the cavity. a. ribbon/figure eight
REF: General Principles b. triangular
c. bowling pin
12. What is the shape of the access opening of a maxillary d. kidney bean shape
central incisor in a young patient?
a. round ANS: b
b. triangular Five major canal morphologies have been identified (Fig.
c. trapezoidal 15.7)28,40: round, ribbon or figure eight, ovoid, bowling pin,
d. square kidney bean, and C-shape. With the exception of the round
morphologic shape, each presents unique problems for ade-
ANS: b quate cleaning and shaping.
The maxillary central incisor has one root and one canal. REF: Canal Morphologies
Young individuals have prominent pulp horns, requiring
a triangular outline form to ensure that tissue and obtu- 16. To obtain an accurate measurement, the working length
ration materials are removed that might cause coronal radiographs should be made with:
discoloration. a. a loosely fitting file in place
REF: Access Openings and Canal Location (Maxillary Central b. a minimum of a No. 20 file
and Lateral Incisors) c. a positioning device and a parallel technique
d. the rubber dam removed for visibility and access
13. What is the outline shape of the access for a maxillary first
molar? ANS: b
a. round The working length is defined as the distance from a prede-
b. triangular termined coronal reference point (usually the incisal edge in
c. trapezoidal anterior teeth and a cusp tip in posterior teeth) to the point
d. square where the cleaning and shaping and obturation should termi-
nate. The reference point must be stable so that fracture does
ANS: b not occur between visits. Unsupported cusps that are weak-
The maxillary first and second molars have similar access ened by caries or restorations should be reduced. The point
outline forms. The outline form is triangular and is located in of termination is empirical; based on anatomic studies, it
the mesial half of the tooth with the base to the facial and the should be 1 mm from the radiographic apex.51,52,66,67 This
apex toward the lingual. accounts for the deviation of the foramen from the apex and
REF: Access Openings and Canal Location (Maxillary the distance from the major diameter of the foramen to the
Molars) area where a dentinal matrix can be established apically.
After access preparation, a small file is used to explore the
14. What is the outline shape of the access for a mandibular canal and establish patency to the estimated working length.
first molar with four distinct separate roots? The largest file to bind is then inserted to this estimated length
a. round because a file that is loose in the canal may be displaced
b. triangular during film exposure or forced beyond the apex if the patient
c. trapezoidal bites down inadvertently. Millimeter markings on the file shaft
d. square or rubber stops on the instrument shaft are used for length
control. A sterile millimeter ruler or measuring device can be
ANS: c used to adjust the stops on the file. To ensure accurate mea-
The coronal reference points for canal location in the man- surement and length control during canal preparation, the stop
dibular molar roots are influenced by the position of the crown must physically contact the coronal reference point. To obtain
on the root and by the lingual tipping of these teeth in the arch an accurate measurement, the minimum size of the working
(Fig. 15.36). The mesiobuccal canal orifice is located slightly length should be a No. 20 file. With files smaller than No. 20,
distal to the mesiobuccal cusp tip. The mesiolingual canal it is difficult to interpret the location of the file tip on the
orifice is located in the area of the central groove area and working length film or digital image. In multirooted teeth,
slightly distal when compared to the mesiobuccal canal. The files are placed in all canals before exposing the film.
distal canal is located near the intersection of the buccal, Angled films/images are necessary to separate superim-
lingual, and central grooves. When a distobuccal canal is posed files and structures (Fig. 15.40)58,73 to provide an effi-
present, the orifice can be found buccal to the main distal cient method of determining the working length and to reduce
canal and often is slightly more mesial. The mandibular first radiation to the patient. It is imperative that the rubber dam e45
be left in place during working length determination to ensure ANS: b

an aseptic environment and to protect the patient from swal- The coronal reference points for canal location in the man-
lowing or aspirating instruments. The film/digital sensor can dibular molar roots are influenced by the position of the crown
be held with a hemostat or a positioning device (Fig. 15.41). on the root and by the lingual tipping of these teeth in the arch
REF: Length Determination (Radiographic Evaluation) (Fig. 15.36).
REF: Access Opening and Canal Anatomy (Mandibular
17. What direction is a mandibular molar commonly tipped Molars)
in the normal mandibular arch?
a. buccal
b. lingual
e46

Ove A. Peters, W. Craig Noblett
4. To prevent extrusion of obturating material, cleaning and

CHAPTER 16
shaping procedures must be confined to the radicular
Cleaning and Shaping space. Canals filled to the radiographic apex would be
1. What is the preferred method to evaluate whether a canal considered the perfect result.
has been adequately cleaned? a. Both statements are true.
a. The canal is three files sizes larger than the initial b. The first statement is true; the second statement is false.
master apical file. c. The first statement is false; the second statement is true.
b. The canal walls are “glassy smooth” when explored d. Both statements are false.
with a file.
c. Dentin shavings obtained are clean and white. ANS: b
d. Irrigant runs clear with no visible debris. It should be recognized that obturation to the radiographic
apex is usually slightly overextended clinically. The principle
ANS: b of confining the material to the canal space would prevent this
There is no perfect way to assess cleaning in a clinical situa- result from being considered ideal.
tion. The most predictable method is to explore the walls with REF: Apical Canal Preparation (Termination of Cleaning and
tactile sense to determine whether they are smooth; smooth- Shaping)
ness indicates that the walls have been planed by the instru-
ments and are likely as clean as possible. 5. Which of the following is the most widely used irrigating
REF: Principles of Cleaning solution?
a. sodium hypochlorite
2. The degree of canal enlargement during shaping is dic- b. ethylenediaminetetraacetic acid (EDTA)
tated by which of the following? c. citric acid
a. method of obturation d. QMix
b. anatomy of the root
c. restorative treatment plan ANS: a
d. all of the above Although several irrigants are available, sodium hypochlorite
remains the gold standard because it accomplishes many of
ANS: d the desired effects of an irrigant.
Several factors enter into the determination that an adequate REF: Elimination of Etiology
shape has been achieved. Considering just one of the criteria
listed could result in overenlargement and/or procedural 6. The best description of the difference between nickel-
accidents. titanium and stainless steel instruments is which of the
REF: Principles of Shaping following?
a. Nickel-titanium tends to result in better shaping (less
3. The apical termination point for cleaning and shaping of transportation) in curved canals.
the root canal should be which of the following? b. Nickel-titanium usually results in better débridement.
a. the radiographic apex c. Nickel-titanium can usually be reused many more
b. the point that is the major diameter of the apical times than stainless steel.
foramen d. Nickel-titanium has sharper cutting edges.
c. within 0.5 to 2 mm of the radiographic apex
d. 0.5 mm beyond the radiographic apex ANS: a
Students should be aware of the primary advantage of nickel-
ANS: c titanium over stainless steel.
Summaries of anatomic and prognostic studies have shown REF: Principles of Cleaning and Shaping Techniques
that the most favorable outcome is achieved when the point
that is the major diameter of the apical foramen is used as the
apical termination point.
REF: Apical Canal Preparation (Termination of Cleaning and
Shaping) e47
7. What is the primary purpose of an irrigant such as sodium 11. How does the step-down technique differ from the step-
hypochlorite? back technique?
a. to kill bacteria a. It creates a funnel-shaped preparation.
b. to dissolve tissue remnants b. It facilitates tissue removal.
c. to flush out debris c. It requires fewer instruments.
d. to lubricate instruments d. It creates coronal flare early, removing interferences.
ANS: c ANS: d
Although some irrigating solutions may have other desirable Familiarity with different techniques and the differences
properties, the primary purpose of any irrigant is to flush out between them is important in selecting a technique for a spe-
the debris generated by the mechanical action of the instru- cific case.
ments used to prepare the canal. REF: Hand Instrumentation
REF: Irrigants (Sodium Hypochlorite)
12. Recapitulation is defined as:
8. Removal of the smear layer after cleaning and shaping a. the removal of accumulated debris using a small file at
does which of the following? the corrected working length
a. promotes coronal leakage b. confirmation of the working length after completion of
b. reduces dentin permeability cleaning and shaping
c. allows better adaptation of obturating materials to c. the last irrigation before drying of the canal
canal walls d. verification of the master apical file after cleaning and
d. forces bacteria into dentinal tubules shaping
ANS: c ANS: a
Improved adaptation to the canal walls reduces the opportu- Physical removal of debris is important for several reasons. If
nity for leakage along the obturating material. debris accumulates at the apical extent of the canal, it will
REF: Smear Layer Management affect adaptation of the gutta-percha cone and will harbor
irritants immediately adjacent to the apical foramen. Obtura-
9. EDTA is most effective for which of the following? tion to the working length requires removal of this debris.
a. decalcifying small canals to allow instruments to nego- REF: Recapitulation
tiate to length
b. lubricating canals to facilitate instrumentation 13. Evaluation of the canal preparation after cleaning and
c. eliminating bacteria in the canals shaping should include:
d. removing the smear layer after cleaning and shaping a. confirming that walls are “glassy smooth”
b. assessing the taper
ANS: d c. configuring the apical preparation
The use of EDTA should be limited to smear layer removal. d. all of the above
It should not be used as a primary irrigant due to its chelating
action and potential excessive erosion of dentin with extended ANS: d
exposure time. Keeping in mind what constitutes a properly prepared canal
REF: Irrigants (EDTA) leads to a realistic evaluation of the procedure and allows
correction of any deficiencies prior to obturation.
10. Which of the following is a major advantage of using a REF:
lubricant with hand instruments?
a. It ensures that canal transportation will not occur. 14. With a temporary restoration, the most important consid-
b. It aids initial canal negotiation in small, curved canals. eration is that it must be:
c. It minimizes debris production. a. at least 4 mm thick
d. It reduces operator fatigue. b. antimicrobial
c. resistant to acids
ANS: b d. placed over a cotton pellet
The use of a lubricant should be considered when difficulty
in negotiating a canal is encountered. ANS: a
REF: Lubricants Placement of a temporary restoration to prevent coronal
leakage between appointments requires adequate thickness.
REF: Temporary Restorations
e48

Harold H. Messer, Charles J. Goodacre
5. Which of the following is crucial to a definitive restoration

CHAPTER 17 after endodontic treatment?
Preparation for Restoration a. It should be placed at the time of obturation.
1. Which of the following results in the greatest loss of end- b. It should allow cuspal flexure to absorb occlusal forces.
odontically treated teeth? c. It should provide a coronal seal.
a. inadequate cleaning and shaping of the canals d. It should always be a full-coverage crown on posterior
b. inadequate obturation teeth.
c. caries and periodontal disease
d. vertical root fracture ANS: c
A critical feature of a restoration is the coronal seal, which
ANS: c prevents leakage, a major cause of failure.
Realizing that factors other than the quality of endodontic REF: Requirements for an Adequate Restoration
treatment can lead to tooth loss is an important concept in
diagnosis. 6. Which statement is most important with regard to expo-
REF: Risks to Survival of Root-Filled Teeth sure of obturating materials to oral fluids?
a. It is not a factor if a sealer is used during
2. Dentin becomes more brittle after endodontic treatment obturation.
due to loss of moisture content. b. It is a major cause of failure.
a. true c. It leads to rapid failure.
b. false d. It many cause pain with thermal changes.
ANS: b ANS: b
It is important to realize that the mechanical properties of Contamination of obturating material by oral fluids is a major
dentin change very little due to endodontic treatment. cause of failure, and every step should be taken to avoid its
REF: Structural Changes in Dentin occurrence.
REF: Coronal Seal
3. How does the survival rate for a tooth restored with cusp
protection compare to that for a tooth without cusp 7. Which statement describes the ideal timing for placement
protection? of the definitive restoration?
a. Survival rates are about the same for the two types of a. It should be placed as soon as practical.
restoration. b. It should be placed at the 6-month recall visit to ensure
b. Survival rates are better for teeth restored with pro- that symptoms do not recur.
tected cusps. c. It should be placed when radiographic evidence of
c. Survival rates are better for teeth restored without pro- healing is present.
tected cusps. d. If should be delayed if there is a questionable
d. Restorations have no effect on tooth survival rates. prognosis.
ANS: b ANS: a
Cuspal coverage is of paramount importance when restoring Delay in placement of a definitive restoration may compro-
endodontically treated posterior teeth. mise the prognosis of the tooth; therefore, placement as soon
REF: Biomechanical Factors as practical is important.
REF: Restoration Timing
4. The most significant contributing factor to reduced cuspal
stiffness (strength) that can predispose to fracture is: 8. What is the only reason to delay the definitive
a. occlusal access opening restoration?
b. loss of one or both marginal ridges a. to maximize the patient’s insurance benefits
c. an amalgam restoration placed after root canal b. if the patient is unable to pay for the restoration
treatment c. to wait for radiographic evidence of healing
d. a bonded composite restoration placed after root canal d. if there is a questionable prognosis and failure would
treatment lead to extraction
ANS: b ANS: d
Understanding the contributing factors helps prevent tooth Only a specific set of circumstances indicates a delay in
fracture if the tooth is properly restored in a timely manner. placing a definitive restoration.
REF: Loss of Tooth Structure REF: Restoration Timing e49
9. The practical principles for function and durability when 12. Which statement is most accurate about the removal of
designing a definitive restoration include all the following gutta-percha for post space?
except: a. It is performed immediately after obturation.
a. conservation of tooth structure b. It is performed only after the sealer has completely set.
b. retention c. It should leave 2 to 3 mm of gutta-percha apically.
c. placement of a post d. It is performed using a solvent solution.
d. protection of the remaining tooth structure
ANS: a
ANS: c Removal of gutta-percha at the time of obturation is optimal
A post is placed only when retention is needed for the core; due to familiarity with the canal anatomy and reference points
it is not a basic principle of restoration. The other principles used to measure length. It is not necessary to wait for the
listed apply to all restorative procedures. sealer to set completely, and there should be at least 5 mm of
REF: Restoration Design (Principles and Concepts) gutta-percha remaining. No solvents should be used for this
procedure.
10. Which of the following is an indication for placing only REF: Preparation of Tooth and Canal Space for Post and Core
a direct restoration (amalgam or composite)? (Removal of Gutta-Percha)
a. Excessive loss of tooth structure is a factor.
b. The opposing arch has been restored with full-coverage 13. When a prefabricated post system is used to restore a
crowns. posterior tooth, the most desirable post design is:
c. Esthetics is not a concern. a. tapered, passively cemented
d. The marginal ridges are intact. b. tapered, threaded, screw type
c. parallel sided, passively cemented
ANS: d d. parallel sided, threaded, screw type
An anterior or posterior tooth with intact marginal ridges and
a conservative endodontic access preparation is minimally ANS: c
compromised structurally, so a simple direct restoration may Familiarity with the post design that will maximize retention
be adequate. but minimize stress on the root dentin is critical.
REF: Planning the Definitive Restoration (Posterior Teeth, REF: Post Type, Retention, and Core Systems (Posterior
Direct Restorations) Teeth)
11. Fewer root fractures have been recorded in laboratory 14. Which statement applies to the placement of a dowel or
studies with what type of post? post through a crown or an existing restoration?
a. carbon fiber post a. It adds support for the existing restoration.
b. stainless steel post b. It helps maintain the integrity of the existing
c. titanium post restoration.
d. cobalt chromium post c. It improves the seal of the root canal.
d. It is rarely indicated.
ANS: a
The greater flexure of a carbon fiber post may be advanta- ANS: d
geous in certain restorative situations. A post adds little to an existing crown, and placement may
REF: Post Selection require additional removal of tooth structure unnecessarily.
REF: Restoring Access Through an Existing Restoration
e50

James C. Kulild, Bekir Karabucak
CHAPTER 18 5. What factors should be considered in determining the

Obturation timing of obturation?
1. What is a possible outcome with overfill of obturation a. current signs and symptoms
materials? b. pulp and periapical status
a. decreased periapical inflammation c. difficulty of the procedure
b. improved and rapid healing of periapical tissues d. all of the above
c. inadequate apical seal
d. decreased postobturation discomfort ANS: d
Several factors enter into the decision on when obturation is
ANS: c indicated. Keeping these factors in mind helps the clinician
Overfill or overextension results in increased periapical determine the optimal timing for obturation.
inflammation and delayed healing and may cause greater post- REF: Timing of Obturation
operative discomfort. The lack of a matrix against which to
compact the obturating material, as is often encountered in 6. What pulp/periapical diagnosis may result in completed
overfills, results in an inadequate seal. treatment in a single visit?
REF: Potential Causes of Failure (Overextension [Overfill]) a. symptomatic apical periodontitis
b. asymptomatic apical periodontitis
2. The optimal preparation/obturation length relative to the c. acute apical abscess
radiographic apex is: d. painful irreversible pulpitis
a. flush with the apex
b. 0.5 to 1 mm short of the apex ANS: d
c. slight extrusion of sealer but not gutta-percha Removal of inflamed pulp tissue addresses the symptoms of
d. 2 to 3 mm short of the apex endodontic pathosis in the case of painful irreversible pulpitis,
so obturation in a single visit would be acceptable.
ANS: b REF: Timing of Obturation (Patient’s Symptoms)
Prognosis studies show that the most favorable prognosis
occurs when obturating materials are contained within the 7. Which of the following is currently the only universally
canal space and within 1 mm of the apical foramen. accepted solid core obturation material?
REF: Obturation Short of the Apical Constriction (Underfill) a. gutta-percha
b. synthetic polyester resin–based polymers
3. Prognosis and outcome studies show that if there is a c. silver cones
length error, fewer problems result with which of the d. solid core (carrier-based) gutta-percha
following:
a. overfill ANS: a
b. underfill Although there are some alternatives, the most widely accepted
c. fill flush with the apex core material is gutta-percha.
REF: Core Obturating Materials
ANS: b
Containing all materials within the tooth structure and avoid- 8. Which of the following is a disadvantage of
ing extrusion into the periapical tissues carries a more favor- gutta-percha?
able prognosis. a. poor adaptation to irregularities of the canal with
REF: Obturation Short of the Apical Constriction (Underfill) compaction
b. shrinkage if altered by heat or solvents
4. Which statement best describes lateral canals? c. not easily managed and manipulated
a. They connect adjacent canals within the same root. d. difficult to partially remove from a canal
b. They may allow bacterial and necrotic debris access to
the periodontium. ANS: b
c. They are débrided with copious irrigation. The clinician should be familiar with the limitations of any
d. They are significant determinants of the prognosis in material so that the advantages can be maximized and the
endodontic outcomes. influence of the disadvantages can be minimized.
REF: Gutta-Percha (Sealability)
ANS: b
Lateral canals have little impact on the prognosis, so extraor-
dinary efforts to force obturating material into these ramifica-
tions is not necessary.
REF: Lateral Canals e51
9. Which of the following is an advantage of gutta-percha? 13. With which type of sealer might long-term solubility be a
a. adhesiveness to dentin problem?
b. slight elasticity and rebound effect a. ZnOE-based sealers
c. expansion on cooling when warmed b. plastic sealers
d. adaptation to canal irregularities with compaction c. glass ionomer sealers
d. calcium hydroxide sealers
ANS: d
The clinician should be knowledgeable about the advantages ANS: d
of gutta-percha as an obturating material. Solubility is an undesirable property in a sealer, so it would
REF: Gutta-Percha (Advantages) be appropriate to choose a less soluble material.
REF:
10. What have recent studies shown regarding synthetic poly-
ester resin–based polymers? 14. Which of the following describes lateral compaction of
a. They are adhesive to canal walls throughout their gutta-percha?
length. a. It is the technique of choice in cases involving internal
b. They are inflammatory to periapical tissues. resorption.
c. They are mutagenic. b. It involves multiple steps and an extensive
d. There is no difference in resistance to leakage com- armamentarium.
pared to gutta-percha. c. It provides good length control.
d. It is difficult to retreat.
ANS: d
Advantages over another material would be the reason for ANS: c
selecting a new or different material. If no advantage is Selection of an obturation technique should be based on the
present, then a change need not be made. advantages relative to the specific case in treatment. Length
REF: Core Obturating Materials (Resin) control is a hallmark of lateral compaction.
REF: Obturation Techniques with Gutta-Percha (Lateral
11. Which of the following is characteristic of semisolid obtu- Compaction)
ration materials (pastes or cements)?
a. They allow for easy control of obturation length. 15. What is an advantage of finger spreaders compared to
b. They exhibit no shrinkage upon setting. standard long-handled spreaders?
c. They are unpredictable and inconsistent in creating an a. better tactile sense
apical seal. b. instrument control
d. They are biocompatible and nonirritating to periapical c. less dentin stress during obturation
tissues. d. all of the above
ANS: c ANS: d
The disadvantages and limitations of semisolid materials Selection of the instrument should be based on ease of use
should be understood and recognized as factors that make and advantages over other instruments. Finger spreaders have
them unsuitable for obturation of a root canal. more advantages compared with long-handled spreaders.
REF: Pastes (Semisolids) REF: Technique of Lateral Compaction: Spreader or plugger
selection
12. What is a disadvantage of zinc oxide–eugenol (ZnOE)–
based sealers?
a. slow setting time
b. lack of adhesion to dentin
c. staining of dentin
d. all of the above
ANS: d
Disadvantages are present with each material, but the disad-
vantages of ZnOE sealers are minor compared with their
advantages.
REF: Sealers (ZnOE-Based Sealers)
e52
APPENDIX B
Chapter Review Questions

▲ Bruce C. Justman and W. Craig Noblett
Appendix B contains a series of questions for each of the draw on several statements contained within the text.
chapters. These questions have been developed not only The review questions are available in two formats, print
to test the reader’s comprehension of the material, but or electronic on the accompanying DVD. This appendix
also to ensure that the important concepts from each includes a correct answer key. The DVD includes a ratio-
chapter are highlighted. In answering these questions, nale for the correct answer, as well as the page cross refer-
the reader will become acquainted with many of the ence in which those concepts and answers can be found
critical points of information contained within each in the book.
chapter. It is the authors’ intention that by completing this
The questions are set in a multiple choice format and exercise and understanding the answers, the reader will
are drawn from the chapters; however, a specific answer be able to organize the information into a basic under-
may not be immediately evident because a question may standing of endodontics.
434
Appendix B ■
Chapter Review Questions 435
CHAPTER 1 a. Root canal diameter increases in size.

The Dental Pulp and Periradicular Tissues b. Pulp horns grow higher into the cup tips.
c. Overall size of the pulp chamber is reduced.
1. What is the primary function of the dental pulp?
d. Mesiodistal dimension of pulp space is reduced
a. induction
more than apical-occlusal dimension in molars.
b. formation
c. nutrition
10. The cementodentinal junction (CDJ) is which of the
d. defense
following?
a. the area where cementum contacts dentin inside
2. Which of the following is not a stage of tooth the canal
formation? b. located at the same level for each tooth type
a. bud c. usually located 1.0 to 2.0 mm coronal to the apical
b. cap constriction
c. bell d. the widest portion of the canal
d. basal
11. What is the defensive function of the dental pulp?
3. From what cells are odontoblasts derived? a. odontoclast activation for resorption of dentin
a. undifferentiated basal from areas of inflammation
b. undifferentiated ectomesenchymal b. odontoblast formation of enamel to increase
c. undifferentiated cartilage enamel thickness
d. dental papilla c. odontoclast differentiation into macrophages
d. odontoblast formation of dentin in response to
4. Where does deposition of unmineralized dentin injury
matrix begin and in what direction does it proceed?
a. It begins at the cusp tip and progresses laterally. 12. Which of the following is not a major component of
b. It begins at the cusp tip and progresses the odontoblast?
cervically. a. cell body
c. It begins at the cementoenamel junction and b. basally located nucleus
progresses laterally. c. cell process
d. It begins at the cementoenamel junction and d. synaptic junction
progresses coronally.
13. What cell type is primarily related to the immune
5. The cervical loop is the location of which of the system in the dental pulp?
following? a. dendritic
a. the apical constriction b. macrophages
b. formation of the pulp horn c. neutrophils
c. formation of the furcation d. all of the above
d. where inner and outer dental epithelium meet
14. What type of collagen is the most prominent found
6. What is the first thin layer of dentin that is formed? in the dental pulp?
a. predentin a. type I
b. primary dentin b. type II
c. mantle dentin c. type III
d. root sheath d. type IV
7. Epithelial cell rests of Malassez are remnants of 15. Which of the following is not a type of pulp stones?
what? a. free
a. odontoblasts b. attached
b. cementoblasts c. embedded
c. epithelial root sheath d. floating
d. teeth of the deciduous dentition
CHAPTER 2
8. Why are lateral canals clinically significant?
a. Symptoms may persist if not treated.
Protecting the Pulp, Preserving the Apex
b. They allow pulp disease to extend to periodontal 1. What is a “pulp cap”?
tissues. a. an early stage of tooth development
c. They effectively block periodontal disease from b. capping the exposed pulp with a thin layer of
extending to the pulp. lining or base material
d. They contain the greatest amount of pulp tissue. c. capping exposed necrotic tissue by placing a layer
of mineral trioxide aggregate (MTA)
9. What morphological changes occur to the dental d. a method of isolation used during root canal
pulp over time? treatment
436 Appendix B ■
2. What is the effect on blood flow to the pulp when 9. Vital pulp therapies have variable rates of success.
anesthetics with vasoconstrictors are used during What is the most significant determinant of the
restorative procedures? success of vital pulp therapy?
a. reduced by 10% its normal rate a. periapical status before the procedure
b. reduced to less than half its normal rate b. periodontal status before the procedure
c. unchanged c. pulp status before the procedure
d. increased by 25% because of stress on the pulp d. type of restorative material to be used
tissue
10. Which of the following steps are used in step-wise
3. What is dentin “blushing”? evacuation of caries?
a. the color of newly erupted teeth due to large pulp a. removing all the caries in a single visit
chambers b. placing a calcium hydroxide base at the initial
b. use of a masking color during restorative visit
procedures c. placing a glass ionomer base at each visit
c. vascular hemorrhage of pulp tissue, often during d. removing only a superficial layer of caries at the
crown preparation first visit
d. an esthetic concern requiring laminate restorations
11. How does a direct pulp cap for an accidental mechan-
4. Why are deeper carious lesions more injurious to the ical pulp exposure differ from a direct pulp cap for an
dental pulp? exposure caused by caries?
a. increased dentin permeability in deeper areas a. Pulp is likely to be severely inflamed beneath a
b. increased length of the dentinal tubule in deeper deep carious lesion.
areas b. Long-term success for a mechanical exposure is
c. decreased density of dentinal tubules in deeper low.
areas c. Long-term success for a carious exposure is high.
d. decreased diameter of dentin tubules in deeper d. A mechanical exposure should be immediately
areas root canal treated.
5. Why does a blast of compressed air directed at freshly 12. When does apical closure occur in the developing
exposed dentin create a sensation of pain? root?
a. frightens the patient a. at the time of eruption
b. air is cold b. approximately 1 year after eruption
c. rapid outward movement of fluid in patent den- c. approximately 3 years after eruption
tinal tubules d. approximately 5 years after eruption
d. rapid inward movement of fluid in patent dentinal
tubules 13. If the pulp becomes necrotic before root growth is
complete, the resultant root is
6. What is the most important characteristic of any a. short with thick dentin walls
restorative material in determining its effect on the b. short with thin dentin walls
pulp tissue? c. normal length with thick dentin walls
a. heat generated by the material d. normal length with thin dentin walls
b. speed the material sets
c. ability to form a marginal seal 14. What is apexogenesis?
d. life expectancy of the restorative material a. induction of a calcific barrier across an open apex
b. removal of the necrotic pulp
7. What effect does orthodontic tooth movement have c. determination of corrected working length
to the dental pulp? d. continued physiological root formation
a. no clinically significant changes
b. continued reliability to electric pulp testing 15. Which of the following has not been demonstrated
c. extrusion reduces pulpal blood flow for a few with MTA when used in apexification?
minutes a. good biocompatibility
d. intrusive forces have no effect on pulpal blood b. good sealability
flow c. high pH value
d. adjacent zone of necrosis
8. Should bases be used to protect the pulp beneath
metallic restorations?
CHAPTER 3
a. Yes, a thin cement base should be used.
b. Yes, a thick layer of varnish should be used.
Endodontic Microbiology
c. No, a base is only necessary if the tooth is to be 1. Which of the following is not a main portal of entry
crowned. for microorganisms to enter the dental pulp?
d. No, additional thermal insulation is rarely a. dentinal tubules
needed. b. direct pulp exposure
Appendix B ■
c. periodontal disease b. are more resistant to antimicrobial treatments

d. occlusal grooves c. are able to adapt to harsh environmental
conditions
2. Why is there greater dentin permeability near the d. all of the above
pulp?
a. increased thickness of dentin
b. smaller diameter dentinal tubules
CHAPTER 4
c. higher density of dentinal tubules
d. longer length of dentinal tubules Pulp and Periapical Pathosis
1. A direct pulp exposure of a carious lesion is necessary
3. Exposed dentin provides an unimpeded access for to have a pulpal response and inflammation.
bacteria to enter the pulp. a. True
a. True b. False
b. False
2. What factor is the most important in determining if
4. What is anachoresis? pulp tissue becomes necrotic slowly or rapidly after
a. artificial formation of an apical barrier carious pulp exposure and pulpal inflammation?
b. induction of a biologic calcific apical barrier a. virulence of bacteria
c. microorganism transport from blood vessels into b. host resistance
damaged tissue c. amount of circulation
d. systemic infection resulting from infected pulp d. lymph drainage
tissue
3. What is necessary for pulp and periradicular pathosis
5. Root canals can become infected through
to develop?
anachoresis?
a. exposure of pulp tissue
a. true
b. exposure of dentin
b. false
c. presence of bacteria
d. trauma
6. Which of the following is not a category of intrara-
dicular infections?
4. Which of the following statements is true regarding
a. primary
mechanical irritants?
b. secondary
a. Changes to the underlying pulp, such as odonto-
c. tertiary
blast aspiration, are irreversible.
d. persistent
b. Potential for pulp injury decreases as more dentin
7. The most common microorganisms in primary end- is removed.
odontic infections are c. Operative procedures without water coolant cause
a. gram-negative bacteria. more irritation than those performed under water
b. gram-positive bacteria. spray.
c. facultative anaerobes. d. There is decreased permeability and constric-
d. facultative aerobes. tion of blood vessels in the early stages of
pulpitis.
8. Which of the following is not a source of nutrients
for bacteria within the root canal system? 5. What nonspecific inflammatory mediators are not
a. necrotic pulp tissue present when the dental pulp is irritated?
b. inflamed vital pulp tissue a. histamine
c. proteins and glycoproteins seeping into the root b. epinephrine
canal system c. bradykinin
d. components of saliva penetrating into the pulp d. arachidonic acid metabolites
tissue
6. What cell type associated with immune response is
9. Which of the following microorganisms are com- not present in severely inflamed dental pulp?
monly present in large percentages of root canal– a. T lymphocytes
treated teeth that present with persistent apical b. B lymphocytes
periodontitis, indicative of failed treatment? c. macrophages
a. Enterococcus faecalis d. odontoclasts
b. Pseudoramibacter alactolyticus
c. Tannerella forsythia 7. What is the cause of pain during the progression of
d. Dialister invisus pulpal injury?
a. elevation of the sensory nerve threshold
10. Gram-positive bacteria have been demonstrated to b. decrease of arteriole vasodilatation
a. have a higher occurrence in post-instrumentation c. increase of venule vascular permeability
samples d. decrease of pulp tissue pressure
438 Appendix B ■
8. What is reversible pulpitis? CHAPTER 5

a. severe inflammation of pulp tissue Diagnosis and Treatment Planning
b. yields a negative response to electric pulp
1. Which of the following is not one of the five basic
testing
steps in the diagnostic process?
c. yields a positive response to thermal pulp
a. chief complaint
testing
b. medical and dental history
d. requires root canal treatment
c. oral examination
d. review of insurance coverage
9. What is irreversible pulpitis?
a. a severe inflammatory process
2. Are patients that seek endodontic treatment usually
b. precedes reversible pulpitis
younger or older than the general population?
c. resolves when the causative agent is removed
a. Age has not been shown to be a factor.
d. yields a negative response to thermal pulp
b. Patients seeking endodontic treatment are usually
testing
younger.
c. Patients seeking endodontic treatment are usually
10. Which of the following is not a hard tissue change
older.
that may result from pulpal irritation or
inflammation?
a. calcification of pulp tissue spaces 3. During a review of the patient’s healthy history, it is
b. resorption of pulp tissue spaces noted that the patient is on a regimen of intravenous
c. formation of pulp stones bisphosphonate medication. What significance does
d. thickening of periodontal ligament this hold for the patient and their treatment plan?
a. possible side effect of bleeding disorders
11. What are the signs and symptoms associated with b. possible side effect of osteonecrosis of the jaw
symptomatic apical periodontitis (acute apical c. lowered pain threshold
periodontitis)? d. inability to obtain adequate anesthesia
a. normal sensation on mastication
b. normal sensation on finger pressure 4. When pain is one of the patient’s complaints, what
c. marked or excruciating pain on tapping with a question is less relevant regarding their pain and does
mirror handle not need to be asked of the patient?
d. presence of a large periapical lesion a. When did the pain begin?
b. Is the pain always in the same place?
12. What histologic feature differentiates a periapical c. Why did you not seek treatment when the pain
granuloma from a periapical cyst? began?
a. presence of mast cells d. Once initiated, how long does the pain last?
b. presence of lymphocytes
c. presence of plasma cells 5. Why is it important to use control teeth during the
d. presence of an epithelial lined cavity clinical tests?
a. to calibrate the patient’s response
13. Which of the following is not associated with acute b. so the patient can predict which tooth is being
apical abscess? tested
a. moderate to severe discomfort c. so teeth can be tested repeatedly
b. intense and prolonged response to thermal d. to test whether isolation is adequate
stimulus
c. negative response to electric pulp testing 6. A painful response obtained by pressing or by tapping
d. tenderness to percussion and palpation on the crown indicates the presence of which of the
following?
14. What factors may impact and influence whether a. periapical inflammation.
periradicular lesions heal completely or b. pulpal inflammation.
incompletely?
a. size of the lesion 7. What is palpation testing used to determine?
b. blood supply a. pulpal inflammation
c. systemic disease b. periapical inflammation
d. all of the above c. periodontal inflammation
d. periapical histology
15. What is the most important aid in distinguishing
between endodontic and nonendodontic periradicu- 8. Which of the methods of cold testing are preferred
lar lesions? for pulp testing?
a. radiographic location a. regular ice (frozen water)
b. radiographic appearance b. refrigerant spray or CO2
c. pulp vitality testing c. flooding the arch with chilled water
d. patient’s history d. blast of air from the air/water syringe
Appendix B ■
9. How does electrical pulp testing determine the degree CHAPTER 6

of pulpal inflammation? Endodontic and Periodontal
a. A shorter response indicates a healthier pulp. Interrelationship
b. A midrange response indicates pulp
inflammation. 1. Which of the following are potential avenues for
c. A midrange response indicates partial necrosis. communication between the dental pulp and
d. It can only be used to determine the presence or periodontium?
absence of vital tissue. a. dentinal tubules
b. apical foramen
c. lateral/accessory canals
10. What are the four characteristics of a periapical lesion
d. all of the above
of endodontic origin?
a. The lamina dura of the tooth socket is intact. 2. What characterizes the diameter of dentinal tubules
b. The lucency remains at the apex in radiographs in radicular dentin?
made at different cone angles. a. The diameter is 1 μm on the root surface, 3 μm at
c. The lucency tends to resemble a round circle. the pulp.
d. It is usually associated with an irreversible b. The diameter is constant.
pulpitis. c. The diameter is 3 μm on the root surface, 1 μm at
the pulp.
11. In which situation is caries removal necessary to d. The diameter increases with age.
obtain a definitive pulpal diagnosis?
a. deep caries with no symptoms and negative pulp 3. Patent accessory canals are characterized by which of
testing the following?
b. deep caries with no symptoms and positive pulp a. They serve as a pathway for microorganisms from
testing pulp to periodontium.
c. shallow caries with mild symptoms and positive b. They can be the result of scaling and root
pulp testing planing.
d. shallow caries with mild symptoms and negative c. In the apical third, they may lead to pulp necrosis
pulp testing if exposed to oral environment.
d. All of the above.
12. How may selective anesthesia be an aid in
diagnosis? 4. A narrow, vertical probing depth associated with pulp
a. It can localize a painful tooth to a specific arch. necrosis, but only mild periodontal disease is
b. It can localize an individual painful tooth in the probably
mandibular arch. a. a vertical root fracture
c. It can confirm the tooth the patient identifies as b. a fistula
the offending tooth. c. a sinus tract
d. It can be used to start posterior and work toward d. a periodontal abscess
the anterior teeth.
5. The effect of periodontal disease on the pulp is
thought to occur by migration of _____________
13. Using the Case Difficulty Assessment system devel-
through dentinal tubules, accessory canals, or the
oped by the American Association of Endodontists,
apical foramen.
cases in which any factors score 3 should be
a. dental plaque
a. treated by a general dentist.
b. saliva
b. treated by an endodontist.
c. microorganisms
d. exudates
14. Which of the following is not a category of external
resorption? 6. Poor endodontic treatment can allow reinfection of
a. inflammatory the canal, leading to treatment failure and subsequent
b. replacement inflammatory response of the periodontal tissues.
c. regenerative a. True
d. surface b. False
15. If a patient is to be referred to an endodontist for 7. Periodontal inflammation resulting from primary
treatment, when is the most appropriate time for the endodontic disease may mimic periodontal disease by
referral? which of the following?
a. before beginning treatment a. generalized increase in probing depths in the
b. during treatment when expected difficulties affected quadrant
arise b. an apical radiolucency
c. before weekends or holidays c. a narrow deep solitary probing defect associated
d. after obturation when separated instruments are with an affected tooth
present d. all of the above
440 Appendix B ■
8. A patient presents with a chief complaint of pain 14. Treatment sequencing for primary endodontic
to cold temperatures. Examination and testing re- disease with secondary periodontal involvement
veal a maxillary left premolar exhibiting severe includes
lingering pain in response to cold. No caries or frac- a. scaling and root planing followed by endodontic
tures are noted. Periodontal probings are 6 to 9 mm treatment
around that specific tooth and 6 to 7 mm around the b. endodontic treatment followed by scaling and
other posterior teeth in the quadrant. The patient root planing
reports having a “deep cleaning” (root planing) three c. endodontic treatment followed by periodontal
times per year. What would the diagnosis in this case surgery
be? d. endodontic treatment followed by reevaluation of
a. primary endodontic disease with secondary peri- periodontal status in 2 to 3 months
odontal involvement
b. primary periodontal disease with secondary end-
odontic involvement
CHAPTER 7
c. separate and unrelated endodontic and periodon-
tal disease
Longitudinal Tooth Fractures
d. a true combined endodontic-periodontic (endo- 1. What category of longitudinal tooth fractures is most
perio) disease process severe?
a. craze lines
9. What will the long-term prognosis for the patient b. fractured cusp
described in question 8 primarily depend on? c. cracked tooth
a. successful periodontal treatment d. vertical root fracture
b. successful endodontic treatment
c. treatment sequencing 2. What clinical conditions or situations are often asso-
d. timing of treatment ciated with cusp fractures?
a. teeth with minimal caries
10. Which of the following best represents similarities b. strong support of the remaining cusps
between endodontic apical and periodontal c. missing marginal ridge
pathosis? d. occlusal composite restorations
a. Both are often the result of traumatic occlusion.
b. Both are usually symptomatic. 3. What is the common direction that fractures extend
c. Both are mediated by microorganisms. in cracked teeth?
d. Both are associated with loss of attachment. a. mesiodistal
b. faciolingual
11. The best description of the effect of moderate peri- c. apical to coronal
odontal disease (loss of attachment in the apical/ d. horizontal
middle third) on the underlying pulp is usually char-
acterized by 4. Which of the following is true as related to pulp tissue
a. no or slight regional inflammation involvement in a cracked tooth?
b. generalized acute inflammation a. The fracture always includes the pulp tissue.
c. generalized chronic inflammation b. The fracture never includes the pulp tissue.
d. necrosis c. The more centered the fracture, the greater chance
e. bacterial invasion through tubules into the pulp for pulp exposure.
d. The more facial or lingual oriented the crack, the
12. Which of the following is characteristic of the true greater the chance for pulp exposure.
combined endo-perio lesion?
a. It occurs much less frequent than the primary 5. Are pulp and periapical tests for cracked teeth consis-
endodontic lesion. tent and reliable?
b. It is usually the end result of a severe endodontic a. Both pulp and periapical testing are consistent.
lesion that causes loss of attachment. b. Pulp testing is consistent, but periapical testing is
c. It is usually the end result of a severe periodontal variable.
lesion. c. Pulp testing is variable, but periapical testing is
d. It is usually successfully managed with both end- consistent.
odontic and periodontal treatment. d. Both pulp and periapical testing are variable.
13. What is the best means of differentiating endodontic 6. How can transillumination be used to distinguish
from periodontal pathosis? between a craze line and a crack line?
a. pulp vitality testing a. It cannot be used to distinguish between the two
b. percussion entities.
c. radiographs b. Transmitted light readily passes through the air
d. probing patterns space of a fracture.
e. location of swelling c. Transilluminated light is blocked by craze lines.
Appendix B ■
d. Transilluminated light is blocked by a cracked 2. Which of the following is not a component of the
tooth. psychologic approach to pain management?
a. control
7. After access preparation of a suspected cracked tooth, b. communication
the crack line is seen to extend through the chamber c. conservation
floor. In this case, what is the prognosis and recom- d. confidence
mended treatment?
a. Prognosis is favorable and continue with root 3. What is the effect of warming the anesthetic solution
canal treatment. on the amount of pain during the injection?
b. Prognosis is questionable, inform patient and con- a. Warmed anesthetic results in less pain during
tinue with treatment. injection.
c. Prognosis is hopeless, and extraction is b. Warmed anesthetic solution results in greater pain
recommended. during injection.
d. It does not change the original prognosis, and the c. There is no difference in pain perception regard-
treatment plan is not altered. less of warming.
8. What is the preferable restoration of a cracked 4. What is a two-stage injection?

tooth? a. Injection of one cartridge of anesthetic, waiting 5
a. post and core and crown minutes followed by injection of a second car-
b. amalgam core tridge of the same anesthetic solution.
c. cast inlay b. Injection of one cartridge of anesthetic, followed
d. full coverage crown by injection of a second cartridge of a different
anesthetic solution.
9. How does a split tooth differ from a cracked c. Injection of a quarter cartridge of anesthetic under
tooth? the mucosal surface, waiting until regional anes-
a. A split tooth precedes a cracked tooth. thesia, then injection of the remainder of the car-
b. A split tooth has an incomplete fracture. tridge to full depth.
c. A split tooth has separable tooth segments. d. Injection of a quarter cartridge of anesthetic under
d. A cracked tooth has the fracture extending the mucosal surface, waiting until regional anes-
faciolingually. thesia, then injection of a cartridge of different
anesthetic solution to full depth.
10. What direction does a vertical root fracture (VRF)
primarily occur? 5. When does the onset of pulpal anesthesia occur after
a. mesiodistal the inferior alveolar injection?
b. faciolingual a. immediately
c. coronal and extending apically b. 0 to 5 minutes
d. no primary direction c. 10 to 15 minutes
d. 30 minutes
11. What is a demonstrated major cause of VRFs?
a. traumatic occlusion 6. Does the direction of the needle bevel affect the effec-
b. occlusal biting habits tiveness of the inferior alveolar nerve block?
c. loss of one or both marginal ridges a. Needle bevel toward the mandibular ramus
d. condensation forces during obturation improves success.
b. Needle bevel away from the mandibular ramus
12. Which is not a possible treatment of a VRF in a mul- improves success.
tirooted tooth? c. Half the cartridge should be injected with the
a. tooth extraction bevel toward the ramus, the needle rotated, and
b. nonsurgical retreatment of the affected root the second half of the cartridge injected with the
c. root amputation of the affected root bevel away from the ramus.
d. hemisection and extraction of the affected root d. Direction of the needle bevel does not affect
success.
CHAPTER 8
Local Anesthesia 7. Is anesthesia of the maxilla commonly more or less
successful than anesthesia in the mandible?
1. What is the allodynia phenomenon? a. more successful
a. Inflamed tissue has an increased threshold of b. less successful
pain. c. comparable success rates
b. Inflamed tissue has a decreased threshold of
pain. 8. Does increasing the volume of anesthetic solution
c. Inflamed tissue is much less sensitive to a mild affect the duration of pulpal anesthesia?
stimulus. a. For mandibular anesthesia, increasing the volume
d. Inflamed tissue responds mildly to a stimulus that improves the success rate with the inferior alveolar
would otherwise be very painful. nerve block.
442 Appendix B ■
b. For maxillary infiltrations, increasing the volume d. Another supplemental injection should not be
increases the depth of pulpal anesthesia. attempted first.
c. For maxillary infiltrations, increasing the volume
increases the duration of pulpal anesthesia. 15. What are the most difficult teeth to anesthetize with
d. For maxillary infiltrations, increasing the volume irreversible pulpitis?
has no effect on the success rate of pulpal a. maxillary molars
anesthesia. b. mandibular molars
c. maxillary anterior teeth
9. What additional anesthesia procedure should be d. maxillary premolars
administered if the classic signs of anesthesia
are present after a standard injection, but the 16. Why should an anesthetic agent not be injected
patient still has sharp pain when the bur enters the directly into a swelling before an incision for
dentin? drainage?
a. repeat the initial injection a. The anesthetic will cause a decreased flow of
b. wait an additional 15 minutes and attempt access exudate following incision.
again b. A direct injection will spread the infection.
c. repeat the injection using a different type of anes- c. There is an increased chance of aspirating
thetic solution blood.
d. use a supplemental injection technique for a d. The swelling has increased blood supply so the
second injection anesthetic is transported quickly into systemic cir-
culation, diminishing the effect.
10. What is a consideration of the intraosseous (IO)
injection?
a. It has not been proved effective. CHAPTER 9
b. It has been recommended as the primary injection Endodontic Emergencies and Therapeutics
technique.
c. It allows the anesthetic solution to be deposited 1. What is the difference between a true endodontic
directly into the pulp tissue of the tooth. emergency and urgency?
d. It allows the anesthetic solution to be deposited a. A true emergency is a condition requiring an
directly into the cancellous bone adjacent to the unscheduled office visit.
tooth. b. A true emergency may be rescheduled for conve-
nience of the patient.
11. What is the best site for an IO injection of a c. An urgency indicates a more severe problem.
premolar? d. An urgency may need to be seen after normal
a. mesial perforation and injection office hours.
b. apical perforation and injection
c. distal perforation and injection 2. How many teeth are usually involved in a true
d. site of injection not important emergency?
a. one tooth
12. What is an important requirement for effectiveness b. two teeth
when using a periodontal ligament (PDL) injection? c. often several teeth throughout the mouth
a. back-pressure during injection d. often teeth in only one quadrant
b. direction of the needle bevel toward the root
surface 3. Which of the following is not an important factor in
c. direction of the needle bevel away from the root assessing the quality and quantity of pain?
surface a. spontaneity
d. all four line angles receive the injection b. intensity
c. time of day of occurrence
13. Can a PDL injection be used for individual tooth d. duration
selective anesthesia as an aid in diagnosis?
a. PDL injection is useful for single tooth 4. Which of the following is not an immediate goal of
anesthesia. the emergency treatment plan?
b. PDL injection is not useful for single tooth a. pharmacotherapeutic management of swelling
anesthesia. b. reducing the irritant
c. reduction of pressure
14. Which of the following is an important consideration d. removal of the inflamed pulp or periradicular
of the intrapulpal injection (IP)? tissue
a. The injection should be given with
back-pressure. 5. What is the most critical factor in a pretreatment
b. It will take several minutes for the injection to take emergency?
effect. a. adequate health history
c. A long-acting anesthetic should be used. b. pain management
Appendix B ■
c. patient management a. more common than flare-ups following cleaning

d. adequate provisional restoration and shaping
b. infrequent and usually resolve spontaneously
6. What is the preferred treatment for an emergency c. approximately 10% to 15% occurrence
appointment with a diagnosis of irreversible pulpitis d. often require nonsurgical root canal retreatment
with symptomatic apical periodontitis?
a. caries excavation with provisional restoration
b. trephination through the mucosa and bone
c. partial or total pulpectomy
d. pharmaceutical management of swelling
CHAPTER 10
7. What is the emergency treatment of choice for pulp

Management of Traumatic Dental Injuries
necrosis without swelling? 1. Why is age a “good news/bad news” situation with
a. trephination for drainage dental trauma?
b. pulpotomy a. Pulps have an incomplete and decreased blood
c. canal débridement to corrected working length supply.
d. single visit root canal treatment b. Pulps are better able to recover and have a better
repair potential.
8. A patient may present with localized swelling; inci- c. Poor development will continue in teeth with
sion for drainage may be indicated. What does drain- damaged necrotic pulps.
age accomplish? d. Dentin has more strength in younger teeth.
a. patient reassurance and management
b. decrease in blood flow to the area 2. Which of the following factors does not need to be
c. allows administration of anesthetic solution to the considered when evaluating a crown fracture with
apex pulp exposure?
d. removal of a very potent irritant—purulence a. extent of fracture
b. stage of root development
9. At an emergency appointment, should teeth be left c. position in the arch
open to drain? d. length of time since the injury
a. Yes, only if there is swelling.
b. Yes, only if there is no swelling. 3. Which of the following is not a step as part of the
c. No, teeth should have an interappointment tem- technique for a shallow (partial) pulpotomy?
porary restoration placed. a. rubber dam isolation
b. pulp tissue removed to about 2 mm below the
10. What is the most important consideration of admin- exposure
istering antibiotics with a localized apical abscess? c. use of a large round carbide bur in the slow-speed
a. The dosage should be for 10 days. handpiece to remove tissue
b. It should be a broad-spectrum antibiotic. d. restoration of the cavity with a hard-setting
c. The dosage levels should be higher than usual. cement
d. Antibiotics are ineffective and should not be
prescribed. 4. How long should horizontal root fractures be splinted
if the coronal section was displaced and
11. What is the incidence of interappointment repositioned?
flare-ups? a. not indicated
a. primarily after obturation at a range of 4.4 to b. 7 to 10 days
6.0% c. 4 to 6 weeks
b. overall at a range of 1.8 to 3.2% d. 3 months
c. overall at a range of 10.7 to 21.3%
d. primarily after vital pulp removal at a range of 7.5 5. Which of the following are types of luxation
to 10.7% injuries?
a. concussion
12. Which of the following has been identified as signifi- b. intrusion
cant factor related flare-ups? c. extrusion
a. teeth with vital pulps d. all of the above
b. teeth without periradicular radiolucency
c. patient presenting with preoperative pain or 6. What is recommended with pulp testing for teeth
swelling with traumatic injuries?
d. completing endodontic treatment in a single a. use of electric pulp testing or carbon dioxide ice
visit to test the injured and adjacent teeth
b. opposing teeth also be tested
13. What is a consideration of postobturation c. retesting is done in 4 to 6 weeks
emergencies? d. all of the above
444 Appendix B ■
7. What information does the color change of the clini- b. The permanent successor is partially erupted.
cal crown provide? c. The intruded tooth appears foreshortened on the
a. There has been a pulp exposure. radiograph.
b. The initial change is gray in color, which always d. The intruded tooth appears elongated on the
indicates pulp necrosis. radiograph.
c. Discoloration may be reversed without
treatment.
CHAPTER 11
d. Calcific metamorphosis discoloration tends to be
yellow to brown and always indicates pulp
Endodontic Radiography
necrosis. 1. Diagnostic radiology is helpful in all of the following
except:
8. What factor should be considered that determines the a. identifying pathosis
treatment of an intrusive luxation injury? b. determining root anatomy
a. depth of intrusion c. determining pulp anatomy
b. stage of root development d. determining pulp responsiveness
c. availability of adjacent teeth for stabilization
d. amount of soft tissue injury 2. What are working length radiographs?
a. Radiographs made by removing the rubber dam.
9. Of the following, what is the best transport medium b. Radiographs placed using an XCP positioning
to use for transporting an avulsed tooth? device.
a. saliva c. Radiographs that help establish an estimated
b. distilled water working length.
c. wrapped in a tissue d. Radiographs determine the distance from the
d. milk radiographic apex to a reference point.
10. Which type of medication is indicated for patients
3. Radiographs are useful to evaluate the following qual-
with avulsed teeth?
ities of an obturation except which of the following?
a. narcotic analgesic
a. length
b. steroid
b. density
c. tetanus booster if more than 5 years since last
c. sealer thickness
administered
d. canal configuration
d. all of the above
11. What additional treatment should be used on the 4. Radiographs are useful in evaluating success and
root surface if an avulsed tooth is replanted after failure at recalls because they do which of the
more than 1 hour after avulsion? following?
a. thorough scrubbing with antimicrobial soap for a. record subjective symptoms
disinfection b. show pulp vitality
b. scaling of the root surface c. may show failures that often occur without adverse
c. soaking the tooth in 2.4% doxycycline for 5 to 20 signs or symptoms
minutes d. accurately diagnose apical pathosis
d. soaking the tooth in a 2.4% solution of sodium
fluoride for 5 to 20 minutes 5. The most accurate radiographs are made by doing
which of the following?
12. Which of the following types of external resorption a. having the patient hold the film in place with
has not been identified with replanted avulsed their index finger
teeth? b. using a paralleling device
a. surface c. increasing/decreasing the vertical angulation to
b. inflammatory move superimposed objects out of the field of
c. refractory vision
d. replacement d. having the rubber dam in place for isolation
13. When is root canal treatment indicated in a mature 6. Use of a paralleling technique may not be feasible
avulsed, replanted tooth? when which of the following occurs?
a. at the time of replantation a. There is a high palatal vault.
b. within 7 to 10 days after replantation b. There are maxillary tori.
c. after 3 months if there is no response to pulp c. A fixed prosthesis is present.
testing d. There are exceptionally short roots.
d. when periapical pathosis is noted
7. F Speed film requires how much less exposure com-
14. A deciduous tooth that has suffered an intrusive luxa- pared to E Speed film?
tion should be extracted if what occurs? a. 10% to 15%
a. The child cries but is compliant. b. 20% to 25%
Appendix B ■
c. 30% to 35% 15. Digital radiography has not been proven to do which
d. 50% of the following?
a. provide superior image quality
8. What does the cone-image shift do? b. reduce radiation to the patient
a. It gives a clear 2-dimensional image. c. increase speed of obtaining an image
b. It superimposes facial and lingual structures. d. accurately and reliably be transmitted between
c. It assists in identifying superimposed canals. computers
d. It moves apical endodontic lesions away from the
root apex.
CHAPTER 12
9. What occurs as the cone position moves away from
parallel?
Endodontic Instruments
a. Objects on the film shift toward the direction of 1. What must an instrument do to completely clean the
the cone. canal space?
b. The facial or buccal object shifts less than the a. be deflected at the canal orifice
lingual object. b. be 2 to 3 mm short of the radiographic apex
c. The lingual object moves relatively in the same c. fit loosely into the canal
direction as the cone. d. contact all walls and surfaces
d. The buccal object moves relatively in the same
direction as the cone. 2. What motion is employed with a hand instrument to
clean and shape canal walls?
10. What is a disadvantage to the cone-image shift? a. pushing
a. Lingual objects become more distorted than buccal b. broaching
objects. c. reaming
b. There is excessive contrast between radiolucent d. vibration
and radiopaque objects.
c. It may superimpose normal anatomic structures 3. Nickel-titanium alloy has increased flexibility over
over the root apices. stainless steel. How does the modulus of elasticity for
d. It does not reveal additional canals within a nickel-titanium alloy compare to that of stainless
root. steel?
a. similar to stainless steel
11. Which of the following is a distinguishing charac- b. one-fourth to one-fifth that of stainless steel
teristic of a radiolucent lesion of endodontic c. half that of stainless steel
pathosis? d. 2 to 3 times that of stainless steel
a. Apical/radicular lamina dura is present and
intact. 4. What is a disadvantage as a result of the increased
b. A round ball shape is characteristic. flexibility of nickel-titanium instruments?
c. The radiolucency stays at the apex regardless of a. difficulty in negotiating curvatures
cone angulation. b. inability to rotate in the canals
d. There is no apparent cause of pulpal necrosis. c. cannot precurve the files to bypass ledges
d. tendency to bind in small canals
12. A radiolucency of endodontic origin is usually present
with what type of pulpal diagnosis? 5. According to ADA Specification No. 28, what is the
a. normal pulp rate of increase in file diameter per running millime-
b. reversible pulpitis ter of length for a K-type file from point D0 to point
c. irreversible pulpitis D16?
d. necrotic pulp a. 0.02 mm per running millimeter of length
b. 0.04 mm per running millimeter of length
13. What is the usual radiographic appearance of con- c. 0.06 mm per running millimeter of length
densing osteitis? d. parallel sided so no increase in diameter
a. diffuse radiopaque appearance
b. uniform smooth borders 6. What is torsional limit?
c. irregular moth-eaten appearance around the a. amount of apical pressure that can be applied to a
apex file to the point of breakage
d. presence of a radiolucent inflammatory lesion b. the beginning of plastic deformation of the
instrument
14. A mesial projection cone adjustment during working c. amount of rotational torque that can be applied
length radiographs is indicated for what? to a “locked” instrument to the point of
a. maxillary anterior teeth breakage
b. maxillary molars with a mesiolingual canal d. amount of force necessary so that a file does not
c. mandibular incisors return to its original shape upon unloading of the
d. mandibular molars with a second distal canal force
446 Appendix B ■
7. Which is a stronger metal alloy: carbon steel or stain- CHAPTER 13

less steel? Internal Anatomy
a. Carbon steel is stronger.
b. Stainless steel is stronger. 1. Lack of knowledge of pulp anatomy is the __________
most common cause of treatment failure.
8. How do Gates-Glidden drills differ from Peeso a. least
reamers? b. second
a. Gates-Glidden drills are a greater length of cutting c. third
surface. d. fourth
b. Gates-Glidden drills are more aggressive cutters.
c. Gates-Glidden drills have an elliptical-shaped 2. Of the following, which is the best technique to
cutting area. determine if a root contains two canals?
d. Gates-Glidden drills are less flexible. a. apex locator
b. viewing access with a microscope
c. searching with an explorer
9. How are broaches intended to be used in the
d. interpreting angled radiographs
canal?
a. planing of canal walls by a push-pull motion
3. The shape of the canal in cross-section is variable but
b. planing of canal walls by a reaming motion
is almost always round in the apical third.
c. placed to the corrected working length around
a. Both parts of the sentence are true.
canal curvatures
b. The first part of the sentence is false, the second
d. entangling and removing canal contents by
part is true.
rotation
c. The first part of the sentence is true, the second
part is false.
10. Which of the following describes the filing motion? d. The entire sentence is false.
a. a single-step motion
b. used only on the furcation side of a molar root 4. Multiple canals in mandibular premolars occur most
canal often in which population?
c. with a 360-degree rotation motion a. Asians
d. circumferential movement around the canal b. African-Americans
walls c. Caucasians
d. No difference by ethnicity
11. Regular inspection of hand files may aid in avoidance
of instrument separation. What file defects should be 5. Alterations in the anatomy of the pulp space occur
looked for on inspection? because of which of the following?
a. unwinding of the flutes a. resorption
b. rolling up or tightening of the flutes b. age
c. distortion of the tip c. calcifications
d. all of the above d. all of the above
12. What are the characteristics of finger spreaders and 6. Calcifications encountered in the pulp space do which
pluggers compared to handled instruments when of the following?
used for lateral condensation? a. represent additional dentin formation
a. They are annealed to give them greater strength. b. can always be detected by radiograph
b. They are best suited for straight canals. c. are always attached to the chamber or canal
c. They are more rigid to access the canal orifice. walls
d. They have greater flexibility. d. often prevent instruments from negotiating
canals
13. Is pressure sterilization superior to dry heat steri-
lization for sterilization of sharp-edged instruments? 7. Which of the following is not associated with the
a. Both are equal and comparable and effective. radicular pulp?
b. Neither should be used for sterilization. a. lateral canals
c. Yes, pressure sterilization is superior. b. apical foramen
d. No, dry heat sterilization is superior. c. pulp horns
d. canal orifices
14. What are the time, temperature, and pressure neces-
sary for sterilization of gauze-wrapped instruments 8. Accessory canals are more common in the apical
using pressure sterilization? third, and more common in posterior teeth.
a. 10 minutes at 121ºC and 15 psi a. The entire sentence is true.
b. 10 minutes at 100ºC and 15 psi b. The first statement is true, the second is false.
c. 20 minutes at 121ºC and 15 psi c. The first statement is false, the second is true.
d. 20 minutes at 100ºC and 15 psi d. The entire sentence is false.
Appendix B ■
9. Which of the following are true regarding the apical c. The rubber dam protects the patient from swallow-
foramen? ing or aspirating instruments and materials.
a. The diameter remains constant throughout d. The rubber dam injures soft tissue from the pres-
life. sure of the clamp.
b. The position of the apical foramen is often visible
on radiograph. 2. What is the recommended rubber dam weight for
c. The foramen is most commonly located 0.5 mm endodontic procedures?
to 1.0 mm away from the anatomic root apex. a. light
d. None of the above. b. medium
c. heavy
d. extra heavy
10. Dens invaginatus (dens in dente) occurs most com-
monly in which teeth?
a. maxillary canines 3. Why are plastic rubber dam frames recommended
b. maxillary lateral incisors over metal frames?
c. maxillary and mandibular lateral incisors a. They are radiolucent.
d. mandibular first premolars b. They are easier to remove during exposure of
interim radiographs.
c. They are more comfortable for the patient.
11. The lingual groove defect is (1) found most frequently d. They are easier to place.
in maxillary central incisors and (2) has a poor prog-
nosis for treatment.
4. Which of the following clamps is designed for an
a. Statements 1 and 2 are true.
anterior tooth?
b. Statement 1 is true, statement 2 is false.
a. No. 8
c. Statement 1 is false, statement 2 is true.
b. No. 212
d. Statements 1 and 2 are false.
c. No. 0
d. No. 24/25
12. A C-shaped canal is characterized by which of the
following? 5. What is an advantage of a provisional crown used to
a. has complex internal anatomy replace missing tooth structure before root canal
b. is most commonly found in Asian populations treatment?
c. usually occurs in mandibular second molars a. It accurately reproduces tooth anatomic
d. should be referred to an endodontist for landmarks.
treatment b. It maintains tooth orientation for access and canal
e. all of the above location.
c. It is easily removed and replaced during root canal
13. Of the following, which tooth or root is the most treatment appointments.
likely to have two canals? d. It increases visibility of the root canal chamber.
a. Maxillary second premolar
b. Mandibular first molar mesial root 6. What is the preferred method for rubber dam place-
c. Mandibular lateral incisor ment on molars?
d. Maxillary first molar mesiobuccal root a. placement as a unit
b. placement of a clamp and rubber dam, followed
by attachment of the frame
14. The lingual root of the maxillary first molar often has
c. placement of a clamp, followed by the dam and
a curvature in the apical third to which of the
then the frame
following?
d. placement of the rubber dam and frame, followed
a. buccal
by placement of the clamp
b. lingual
c. mesial
d. distal 7. What is a major objective of the access opening?
e. none of the above, the root is usually straight a. Locate the primary or largest canal.
b. Achieve unimpeded straight-line access of the
instruments to the first canal curvature or apical
one third.
CHAPTER 14
c. Expose the pulp horns.
Isolation, Endodontic Access, and Length d. Remove all restorative materials.
Determination
1. What is true of the rubber dam? 8. Outline form for access is described best by which of
a. The rubber dam is elective for endodontic the following?
treatment. a. It mimics the shape of the canal or canals.
b. The rubber dam allows irrigating solution to b. It is toward the distal in the occlusal surface in
contact and disinfect surrounding soft tissues. molars.
448 Appendix B ■
c. It is a projection of the internal tooth anatomy CHAPTER 15

onto the external surface. Cleaning and Shaping
d. It is a constant and unchanging shape regardless
1. What is the preferred method to evaluate if a canal
of age.
has been adequately cleaned?
a. The canal is three file sizes larger than the initial
9. What is an advantage of caries removal during
master apical file.
access?
b. The canal walls are “glassy smooth” when explored
a. It enhances the effectiveness of NaOCl.
with a file.
b. It reduces interappointment pain.
c. Dentin shavings obtained are clean and white.
c. It strengthens tooth structure.
d. Irrigant runs clear with no visible debris.
d. It allows assessment of the restorability prior to
the endodontic treatment.
2. The degree of canal enlargement during shaping is
dictated by which of the following?
10. Estimated depth of access is a measurement from
a. method of obturation
b. anatomy of the root
a. incisal edge of anterior teeth to the coronal portion
c. plan for post placement
of the pulp chamber
d. all of the above
b. occlusal reference of posterior teeth to the coronal
portion of the pulp chamber 3. The apical termination point for cleaning and shaping
c. incisal edge of anterior teeth to the radiographic the root canal should be which of the following?
apex of the tooth a. the radiographic apex
d. occlusal reference of posterior teeth to the radio- b. at the major diameter of the apical foramen
graphic floor of the chamber c. within 0 to 2 mm of the radiographic apex
d. 0.5 mm beyond the radiographic apex
11. What is the shape of the access opening of a maxil-
lary central incisor in a young patient? 4. To prevent extrusion of obturating material, clean-
a. round ing and shaping procedures must be confined to
b. triangular the radicular space. Canals filled to the radio-
c. trapezoidal graphic apex would be considered to be the perfect
d. square result.
a. Both statements are true.
12. What is the outline shape of the access for a maxillary b. The first statement is true; the second statement is
first molar? false.
a. round c. The first statement is false; the second statement
b. triangular is true.
c. trapezoidal d. Both statements are false.
d. square
5. For the irrigating solution to effectively reach the
13. What is the outline shape of the access for a man- apical third of the canal, the apical canal should be
dibular first molar with four canals? enlarged to at least a No. _____ file.
a. round a. 25 or 30
b. triangular b. 20 or 25
c. trapezoidal c. 35 or 40
d. square d. 45 or 50
14. To obtain an accurate measurement, how should the 6. Which of the following is the most widely used irrig-
working length radiographs be made? ant solution?
a. They should be made with a loosely fitting file in a. sodium hypochlorite
place. b. ethylenediaminetetraacetic acid (EDTA)
b. They should be made with a minimum of a No. c. MTAD
20 file. d. saline
c. They should be made with a positioning device
and a parallel technique. 7. The best description of a difference between nickel-
d. They should be made with the rubber dam removed titanium and stainless steel instruments is which of
for visibility and access. the following?
a. Nickel-titanium tends to result in better shaping
15. An apex locator is helpful in patients with which of (less transportation) in curved canals.
the following? b. Nickel-titanium usually results in better
a. with high palatal vaults debridement.
b. with implanted cardiac pacemakers c. Nickel-titanium can usually be reused many more
c. with missed canals times than stainless steel.
d. with a strong gag reflex d. Nickel-titanium has sharper cutting edges.
Appendix B ■
8. What is the primary purpose of an irrigant such as a. inadequate cleaning and shaping of the canals
sodium hypochlorite (NaOCl)? b. inadequate obturation of the root canal system
a. kill bacteria c. restorative factors
b. dissolve tissue remnants d. vertical root fracture
c. flush out debris
d. lubricate instruments 2. How does the survival rate for a tooth restored with
cusp protection compare to a tooth without cusp
9. A major advantage to using a lubricant during clean- protection?
ing and shaping is: a. about the same
a. It ensures that canal transportation will not b. a tooth with protected cusps has an enhanced
occur. survival rate
b. It reduces torsional force on the instrument, c. a tooth without protected cusps has an enhanced
decreasing the possibility of fracture. survival rate
c. It minimizes debris production. d. restorations have no effect on tooth survival
d. It reduces operator fatigue. rates
10. Removal of the smear layer after cleaning and shaping 3. Dentin becomes more brittle following the endodon-
does which of the following? tic treatment due to loss of moisture content.
a. promotes coronal leakage a. True
b. decreases dentin permeability b. False
c. allows better adaptation of obturating materials to
canal walls
4. The greatest contributing factor to reduced cuspal
d. forces bacteria into dentinal tubules
stiffness (strength) that predisposes to fracture is
11. EDTA is most effective for which of the following
a. occlusal access opening
uses?
b. loss of one or both marginal ridges
a. decalcifying small canals to allow instruments to
c. an amalgam restoration placed after root canal
negotiate to length
treatment
b. lubricating canals to facilitate instrumentation
d. a bonded composite restoration placed after root
c. bacterial elimination in canals
canal treatment
d. removing smear layer after cleaning and shaping
5. Which of the following describes a definitive restora-
12. How does the “crown-down” technique differ from
tion after root canal treatment?
the “step-back” technique?
a. It should be placed at the time of obturation.
a. It creates a funnel-shaped preparation.
b. It should allow cuspal flexure to absorb occlusal
b. It facilitates tissue removal.
forces.
c. It requires fewer instruments.
c. It should provide a coronal seal.
d. It creates coronal flare early, reducing torsional
d. It should always be a full-coverage crown on pos-
stress on the instruments.
terior teeth.
13. Recapitulation is defined as:
a. The removal of accumulated debris using a small 6. Exposure of obturating materials to oral fluids can be
file at the corrected working length. described by which of the following?
b. Confirmation of working length after completing a. It is not a factor if a sealer is properly used during
cleaning and shaping. obturation.
c. The last irrigation before drying the canal. b. It is a major cause of failure.
d. Verifying the master apical file after cleaning and c. It leads to rapid failure.
shaping. d. It may cause pain to thermal changes.
14. Of the following, which is the most important con- 7. Which of the following describes a definitive
sideration of a temporary restoration? restoration?
a. antimicrobial a. It should be placed as soon as practical.
b. placed over a cotton pellet b. It should be placed at the 6-month recall visit to
c. resistant to acids assure symptoms do not recur.
d. at least 4 mm thick c. It should be placed when radiographic evidence of
healing becomes evident.
d. It should be delayed if there is a questionable
prognosis.
CHAPTER 16
Preparation for Restoration 8. What is the only reason to delay the definitive
1. What is the leading cause for loss of endodontically restoration?
treated teeth? a. to maximize the patient’s insurance benefits
450 Appendix B ■
b. if the patient is unable to pay for the restora- CHAPTER 17

tion Obturation
c. to allow radiographic healing to become evident
1. What is a possible outcome when there is an overfill
d. if there is a questionable prognosis and failure
of the obturation materials?
would lead to extraction
a. decreased periapical inflammation
b. improved and rapid healing of periapical lesions
9. The practical principles for function and durability c. inadequate apical seal
when designing a definitive restoration include the d. decreased postobturation discomfort
following except which of the following?
a. conservation of tooth structure
2. What is the optimal preparation/obturation
b. retention
length relative to the radiographic apex with pulp
c. placement of a post
necrosis?
d. protection of the remaining tooth structure
a. flush
b. 0.5 to 1.0 mm short
10. What is an indication for use of a direct (amalgam or c. slight extrusion of sealer but not gutta-percha
composite) restoration? d. 1.0 to 3.0 mm short
a. Excessive tooth structure has not been lost.
b. The opposing arch has been restored with full
3. Prognosis and histologic studies show that if there is
coverage crowns.
a length error, there are less problems resulting with
c. Esthetics is not a concern.
d. Only one of the marginal ridges has been lost.
a. overfills
b. underfills
11. Fewer root fractures have been recorded in laboratory
studies when what type of post has been used? 4. Which of the following describes lateral canals?
a. cobalt chromium alloy post a. They connect adjacent canals within the same
b. stainless steel post root.
c. titanium post b. They may allow bacterial and necrotic debris to
d. carbon fiber post leak into the periodontium.
c. They are débrided with copious irrigation.
12. Which of the following describes removal of gutta- d. They are significant in the outcome of most root
percha for post space preparation? canal treatments.
a. immediately after obturation
b. after the sealer has completely set 5. What factors should be considered when deciding the
c. to a depth that allows 2 to 3 mm of remaining timing for obturation?
gutta-percha a. signs and symptoms present
d. completed using solvents b. pulp and periapical status
c. difficulty of the procedure
13. When using a prefabricated post system to restore d. all of the above
a posterior tooth, the most desirable post design
is 6. What pulp and periapical diagnosis may have com-
a. tapered, passively cemented. pleted treatment in a single visit?
b. tapered, threaded screw type. a. symptomatic (acute) apical periodontitis
c. parallel sided, passively cemented. b. asymptomatic apical periodontitis (chronic apical
d. parallel sided, threaded screw type. periodontitis)
c. acute apical abscess
14. Which of the following describes retentive pins? d. painful irreversible pulpitis
a. Retentive pins help strengthen the restoration.
b. Retentive pins minimize stresses to dentin. 7. What material is currently the only universally
c. Retentive pins are the most effective antirotation accepted solid core obturation material?
method for post and cores. a. gutta-percha
d. Retentive pins should not be used because the risks b. synthetic polyester resin-based polymers
outweigh any potential gain. c. silver points
d. solid core (carrier) gutta-percha
15. Placement of a dowel or post through a crown or an
existing restoration is described by which of the 8. Which of the following is a disadvantage of gutta-
following? percha?
a. It adds support for the existing restoration. a. poor adaptation to canal irregularities with
b. It helps maintain integrity of the existing compaction
restoration. b. shrinkage if altered by heat or solvents
c. It improves the seal of the root canal. c. not easily managed and manipulated
d. It is rarely indicated. d. difficult to partially remove from a canal
Appendix B ■
9. Which of the following is an advantage of gutta- b. the possible procedures that may be necessary for
percha? correction
a. adhesiveness to dentin c. how this might affect the outcome
b. slight elasticity and rebound effect d. the root canal treatment will be completed free of
c. expansion on cooling of warmed gutta-percha charge
d. adaptation to canal irregularities with
compaction 2. Which of the following is not a common cause of a
perforation during access preparation?
10. What have recent studies shown synthetic polyester a. mandibular molar with a lingual axial inclination
resin-based polymers to be? of the tooth
a. adhesive to canal walls throughout their length b. searching for canals through an under-prepared
b. inflammatory to tissues access opening
c. mutagenic c. directing the bur parallel to the long axis of the
d. no difference in leakage when compared to gutta- tooth
percha d. presence of a misaligned cast restoration
11. Which of the following have semisolid obtu- 3. What measures are used to prevent perforation during
ration materials (pastes or cements) been shown to access preparation?
do? a. relating tooth angulations independent of the
a. They provide easy control of obturation length. adjacent tooth
b. They exhibit no shrinkage upon setting. b. using only straight-on radiographs
c. They provide an unpredictable and inconsistent c. always having a rubber dam in place before begin-
apical seal. ning access preparation
d. They are biocompatible and nonirritating to peri- d. having a thorough knowledge of both surface and
apical tissues. internal tooth anatomy
4. Which of the following is not an early sign or indica-

12. Which of the following describes the complete setting
tion of a perforation?
of zinc oxide–eugenol (ZnOE)-based sealers?
a. pain during access preparation
a. The setting occurs at approximately 1 hour if left
b. sudden appearance of hemorrhage
exposed to air.
c. burning pain and bad taste during irrigation with
b. The setting depends on contact with dentin.
NaOCl
c. The setting usually requires weeks or months.
d. radiographically malpositioned file
d. The setting usually is approximately 24 hours.
5. If a lateral root perforation does occur, what is the
13. What type of sealer may have a problem with long-
most favorable location for perforation repair?
term solubility?
a. at or above the height of crestal bone
a. ZnOE-based sealers
b. below the crestal bone in the coronal third of the
b. plastic sealers
root
c. glass ionomer sealers
c. on the furcal side of the coronal root surface
d. calcium hydroxide sealers
d. a zipping perforation at the apex of the root
14. Which of the following describes lateral compaction 6. What is the ideal time and material for a nonsurgical
of gutta-percha? repair of a furcation perforation?
a. It is indicated for cases with internal resorption. a. immediate repair with amalgam
b. It involves multiple steps and special b. immediate repair with mineral trioxide aggregate
armamentarium. (MTA)
c. It manages length control well. c. delayed repair with amalgam
d. It is difficult to retreat. d. delayed repair with MTA
15. What is a disadvantage of finger spreaders as com- 7. What is a common cause of ledge formation?
pared to standard long-handled spreaders? a. straight-line access into the canal
a. tactile sensation b. excess irrigating solution
b. instrument length control c. overenlargement of a curved canal with files
c. fracture potential in curved canals d. constant recapitulation and irrigation into the
d. dentin stress during obturation apical portion of the canal
CHAPTER 18 8. What type of canal is most prone to ledge

Procedural Accidents formation?
a. long, small, and curved
1. What should a patient not be told when there has b. incomplete apex formation, curved
been a procedural accident? c. large, long
a. the incident did occur d. short, straight
452 Appendix B ■
9. What is a possible etiology for an apical (zipping) root a. A large well-fitting post and core is present.
perforation? b. There is a separated instrument present that cannot
a. inability to negotiate canals with ledges be retrieved.
b. working length determination with radiographs c. External resorptive root defects are present.
only d. A negotiable canal was not initially treated.
c. trying to locate canals in a small chamber
d. failure to adjust working length after curved canals 2. Which of the following is not a potential contraindi-
are straightened during cleaning and shaping cation for nonsurgical root canal retreatment?
a. post and core restorations
10. What type of perforation has the poorest long-term b. ledges in the root canal walls
prognosis? c. amalgam core restorations into the chamber
a. zipping (apical third) root perforation d. separated root canal instruments
b. stripping perforation in the apical third of the
root 3. Which of the following is not a potential risk associ-
c. stripping perforation in the coronal third of the ated with nonsurgical root canal retreatment?
root below the crest of bone a. thinning and weakening of the root canal
d. direct floor to furcation perforation in a multi- walls
rooted tooth b. inability to remove the initial root canal obtura-
tion material
11. Which of the following is not a common cause of file c. creating a compromised crown-root ratio
separation? d. loosening of a well-fitting fabricated crown
a. limited flexibility
b. manufacturing defects 4. Which of the following describes removal of coronal
c. amount of use restorations before nonsurgical retreatment?
d. amount of force applied a. Removal may prolong retreatment procedures.
b. Removal complicates removal of post and core
12. What approaches may be used to treat a case with a restorations.
separated instrument? c. Removal may be necessary to assess restorability.
a. attempt to remove d. Removal should never be done if the previous
b. attempt to bypass restoration is a full-coverage crown.
c. prepare and obturate to the level of the segment
d. all of the above 5. What steps are involved in retrieval of a prefabricated
post during retreatment?
13. Which of the following scenarios yields the most a. Section and remove the core material and the post
favorable prognosis in cases with a separated at the level of the chamber floor.
instrument? b. An ultrasonic activated tip is used for 3 to
a. a small instrument short of the working length 5 minutes each at several locations circumferen-
b. a small instrument beyond the apical foramen tially around the post, without water for
c. a large instrument at an early stage of visibility.
instrumentation c. Grasp the post with a hemostat or Steiglitz pliers
d. a large instrument close to the working length to rock it back and forth to break the cement
seal.
14. Which of the following causes extrusion of sodium d. Use ultrasonics, then grasp a threaded screw type
hypochlorite (NaOCl) irrigating solution into periapi- post with a hemostat or small-tipped forceps to
cal tissues? unscrew it from the canal.
a. Fitting irrigation needle loosely in the canal
space. 6. The following steps are used to attempt removal of a
b. Wedging irrigation needle in the canal space. canal ledge during nonsurgical retreatment except
c. Using perforated needles during irrigation. which one?
d. Using regular needles during irrigation. a. remove all obstructions coronal to the ledge
b. bypass the ledge with a flexible nickel-titanium
15. Which of the following occurs after minor extrusion hand file
of obturation materials into the periapical tissue? c. file in a circumferential motion after bypassing the
a. It results in significant swelling ledge
b. It results in significant symptoms. d. proceed from small-size files to larger size files
c. It causes some tissue inflammation.
d. It causes more apical leakage. 7. Which of the following is not a factor that may affect
the successful removal of a separated instrument
fragment?
CHAPTER 19
a. size of the instrument separated
Nonsurgical Retreatment b. length of the separated fragment
1. Nonsurgical retreatment should be the first treatment c. location of the fragment within the canal
option for correction when d. length of time the fragment has been in place
Appendix B ■
8. What method or methods have been used to success- c. Flare-ups occur less frequently if irrigation is kept
fully remove gutta-percha from root canals? to a minimum.
a. heat d. High incidence dictates that retreatment should
b. ultrasonics generally be treated in two visits rather than one
c. rotary instruments visit.
d. all of the above
15. The prognosis for nonsurgical root canal retreatment
9. When should Hedstrom hand files or regular hand is which of the following?
reamers be the instruments of choice for gutta-percha a. It is increased with periapical lesions.
removal, without the addition of solvents? b. It has the lowest rate of success without a periapi-
a. The root canal is well sealed with gutta-percha. cal lesion.
b. The gutta-percha is well adapted to canal walls. c. It is similar to initial root canal treatment success
c. A space can be created between the gutta-percha rates.
and the root canal. d. It is best if the etiology of failure can be
d. Gutta-percha fills the root canal chamber. identified.
10. What solvent has been shown to be the most efficient CHAPTER 20
(fastest) in softening gutta-percha? Endodontic Surgery
a. chloroform
b. halothane 1. What is the purpose of incision for drainage?
c. methylchloroform a. to evacuate exudates from a soft tissue swelling
d. xylene b. to obtain a biopsy specimen
c. to prevent a postoperative swelling
11. During the removal of a carrier-based gutta-percha d. to avoid emergency cleaning and shaping
obturator which of the following should occur?
a. The first step is to remove the solid core 2. Profound anesthesia is difficult to attain before inci-
material. sion for drainage. What is a preferred approach for a
b. A combination of techniques for removal of gutta- maxillary cuspid with extensive swelling?
percha, silver cones, and posts is employed. a. Start with an infraorbital block and then infiltrate
c. A small rotary file may be used to engage and at the margins of the swelling.
remove the plastic carrier. b. Start with posterior superior alveolar block and
d. Different solvents are used that would routinely then use refrigerant spray.
be used to remove gutta-percha alone. c. Inject buffer and anesthetic directly into the
swelling.
12. What is the key to success in the retrieval of silver d. Use topical anesthetic and then refrigerant spray.
points? No anesthetic is needed.
a. The key is to engage the silver point with the
ultrasonic tip. 3. Which of the following is not an indication for peri-
b. The key is to remove the silver point and core apical surgery?
material simultaneously. a. a nonnegotiable or blocked canal associated with
c. The key is to retain as much of the coronal extent symptomatic periradicular pathosis
of the point as possible. b. gross overextension of obturating material
d. The key is to remove the core material and silver c. obtain a biopsy
point to the level of canal orifices first. d. to resolve any endodontic treatment failure
13. Which of the following is not true regarding the 4. Which of the following would contraindicate periapi-
removal and retreatment of hard-setting pastes? cal surgery?
a. They are more difficult to remove than a soft 1. anatomical structures in the area
paste. 2. medical complications
b. They may be impossible to remove. 3. lip paresthesia
c. Solvents have been shown to soften hard-setting 4. previous malignancies
pastes. 5. unidentified cause of treatment failure
d. Use of ultrasonics is the most predictable a. 1, 2, and 3
method. b. 1, 3, and 5
c. 1, 2, and 5
14. Which of the following is true regarding interap- d. 2, 3, and 4
pointment flare-ups with nonsurgical root canal e. all of the above
retreatments?
a. Flare-ups occur less frequently when compared to 5. Which of the following is true regarding an incision
initial root canal treatments. over a bony defect?
b. Flare-ups occur frequently, even when debris and a. It should be avoided.
microorganisms are confined to the canals. b. It may cause a postsurgical fenestration.
454 Appendix B ■
c. It may prevent healing of the incision. CHAPTER 21

d. All of the above. Evaluation of Endodontic Outcomes
1. What is the primary determinant for successful end-
6. Which of the following describes a submarginal flap
odontic treatment?
design?
a. selecting the proper obturation technique
a. It is ideal for mandibular posterior teeth.
b. effective elimination of microorganisms from the
b. It causes less scarring.
pulp space
c. It is associated with less gingival recession.
c. using rotary instruments to shape the canals
d. It causes less intraoperative hemorrhage.
d. using an effective irrigation regimen
7. What is the purpose of root end resection?
2. What are the major indicators of successful endodon-
a. removes irritants encased in the apical portion of
tic treatment?
the root
a. lack of discoloration, no tenderness to biting
b. to examine the root
b. no swelling or redness of the gingival area
c. exposes additional canals or fractures
c. absence of symptoms and apical radiolucency
d. all of the above
d. a happy patient who has paid the bill
8. Which of the following is true regarding a root-end
3. A patient presents for a posttreatment examination
cavity preparation?
with no complaint of symptoms except the apical
a. It should be as shallow as possible to preserve
radiolucency that was present before treatment,
tooth structure.
although it appears smaller. Treatment for this patient
b. It should be made to a minimum depth of
would be classified as which of the following?
3 mm.
a. a failure
c. It should only encompass the main portion of the
b. a success
canal.
c. a clinical success but radiographic failure
d. It should be made with a very small bur.
d. a functional tooth with uncertain prognosis
9. An ideal root-end filling material should satisfy all of
the following except which one? 4. Which of the following is not a clinical criterion to
a. The material should be well tolerated by perira- evaluate treatment outcome?
dicular tissues. a. absence of a radiolucency
b. The material should be easily placed. b. no evidence of a sinus tract
c. The material should be absorbable. c. no swelling present
d. The material should be visible radiographically. d. no response to percussion or palpation
10. Which of the following cell types are important in 5. To make valid comparisons between radiographs to
the healing process after periapical surgery? assess healing, which of the following describes how
1. epithelial cells films should be made?
2. macrophages a. in a reproducible manner
3. dendritic cells b. 6 months apart
4. fibroblasts c. at different angles
5. osteocytes d. by the same person to ensure consistency
a. 1, 2, 4, and 5 only
b. 1 and 2 only 6. Which of the following criteria is not considered to
c. 1, 2, and 5 only be a predictor of success or failure?
d. 1, 2, 3, 4, and 5 a. the patient’s medical history
e. 1, 3, and 4 only b. apical pathosis
c. quality of the coronal restoration
11. With root amputation, the factor that most affects d. extent and quality of obturation
success is which of the following?
a. occlusal force patterns 7. The most common preoperative cause of endodontic
b. the type of restoration treatment failure includes all of the following except
c. the length of the root which one?
d. the patient’s oral hygiene a. misdiagnosis
b. leaking coronal restoration
12. All of the following procedures should be referred to c. poor case selection
a specialist with specific training in endodontic d. error in treatment planning
surgery except which one?
a. root-end resection/root-end filling 8. The most common postoperative cause of endodontic
b. incision for drainage treatment failure is which of the following?
c. root amputation a. overextension of obturating material
d. perforation repair b. a separated instrument
Appendix B ■
c. coronal leakage 7. Which of the following is not an indication for inter-

d. placement of a post unnecessarily nal bleaching?
a. defective enamel formation
9. The prognosis for nonsurgical retreatment depends b. intrapulpal hemorrhage-induced stain
primarily on which of the following? c. tetracycline-induced stain
a. identification and correction of the cause of d. sealer stain
failure
b. using a different obturation technique 8. One potential complication of internal bleaching is
c. placing the definitive restoration at the obturation external root resorption, which has been associated
appointment with which of the following?
d. all of the above a. high concentration of hydrogen peroxide
b. heat
c. damage to cementum and periodontal tissues
CHAPTER 22 d. all of the above
Bleaching Discolored Teeth: Internal and
9. What is the most common agent employed in exter-
External
nal bleaching?
1. Which of the following is not considered a natural or a. sodium perborate
acquired discoloration source? b. hydrochloric acid
a. tetracycline stain c. carbamide peroxide
b. intrapulpal hemorrhage d. sodium hypochlorite
c. stain from amalgam
d. calcific metamorphosis 10. Which of the following describes the microabrasion
technique?
2. Which of the following is not part of the mechanism a. It is not a true bleaching technique.
of staining caused by fluorosis? b. It uses hydrochloric acid.
a. Hypoplastic defects are produced in enamel by c. It requires meticulous soft tissue isolation.
excess fluoride. d. All of the above.
b. Stain is acquired from chemicals in the oral
cavity.
CHAPTER 23
c. Stain is present in the enamel.
d. Stain is solely caused by fluoride deposits in the Geriatric Endodontics
enamel. 1. Which of the following are changes that occur in the
pulp with age?
3. Which of the following describes tetracycline stain? 1. decreased vascular elements
a. It is classified into three groups based on 2. decreased amount of collagen
severity. 3. increase in numbers of fibroblasts
b. It is often associated with a “banding” pattern. 4. decrease in numbers of odontoblasts
c. It is located in the dentin. 5. increase in occurrence of calcifications
d. All of the above. a. 1, 2, and 3 only
b. 1, 3, and 5 only
4. What is the most common iatrogenic etiology related c. 1, 4, and 5 only
to tooth discoloration? d. 2, 3, and 5 only
a. incomplete removal of pulp tissue e. 1, 2, 3, 4, and 5
b. incomplete removal of obturating material from
the chamber 2. Which of the following statements are true regarding
c. the use of intracanal medicaments calcifications in the pulp space?
d. intracanal irrigants a. Pulp stones are usually found in the radicular
pulp.
5. Which of the following restorative materials can con- b. Pulp stones can increase the incidence of odonto-
tribute to staining? genic pain.
a. amalgam c. Calcifications increase with both age and
b. pins and posts irritation.
c. composite d. Diffuse calcifications are most commonly found in
d. all of the above the pulp chamber.
e. All of the above.
6. What is the most common agent used for internal
bleaching? 3. With age, which of the following describes the pulp
a. carbamide peroxide chamber in molars?
b. sodium perborate a. decreases primarily in a mesiodistal dimension
c. hydrogen peroxide b. decreases primarily in an occlusal-apical
d. sodium peroxyborate monohydrate dimension
456 Appendix B ■
c. remains the same in volume b. increased cementum deposition, modifying the

d. increases in size in response to irritation apical anatomy
c. differences in tissue electrical resistance, making
4. The healing capacity of older patients is significantly apex locators less accurate
less than younger patients because of a decrease in d. patients unable to sit still for radiographs
periradicular vascularity. The vascularity of the
periradicular tissues is a critical determinant in
healing. Chapter Review Questions Answer Key
a. The first statement is false, and the second state-
ment is true. CHAPTER 1
b. The first statement is true, and the second state- 1. b 4. b 7. c 10. a 13. a
ment is false. 2. d 5. d 8. b 11. d 14. a
c. Both statements are true. 3. b 6. c 9. c 12. d 15. d
d. Both statements are false. CHAPTER 2
1. c 4. a 7. a 10. c 13. b
5. Which of the following medical conditions may 2. b 5. c 8. d 11. a 14. d
influence healing in geriatric patients? 3. c 6. c 9. c 12. c 15. d
a. osteoporosis
CHAPTER 3
b. hypertension
c. immunosuppression 1. d 3. b 5. b 7. a 9. a
d. diabetes 2. c 4. c 6. c 8. b 10. d
CHAPTER 4
6. Which of the following describes bisphosphonates? 1. b 4. c 7. c 10. d 13. b
a. They are used in treatment of osteoporosis. 2. d 5. b 8. c 11. c 14. d
b. They are used in treatment of malignancies. 3. c 6. d 9. a 12. d 15. c
c. They are linked to idiopathic osteonecrosis of the
CHAPTER 5
jaws.
1. d 4. c 7. b 10. b 13. b
d. They interfere with osteoclast function.
2. c 5. a 8. b 11. b 14. c
e. All of the above.
3. b 6. a 9. d 12. a 15. a
7. Which of the following is a common finding on CHAPTER 6
examination in geriatric patients? 1. d 4. c 7. c 10. c 13. a
a. extensive restorative experience with multiple 2. a 5. c 8. b 11. a 14. d
large restorations and crowns 3. d 6. a 9. a 12. a
b. lower incidence of periodontal disease
CHAPTER 7
c. exaggerated symptoms associated with pulp
1. d 4. c 7. c 9. c 11. d
pathosis
2. c 5. d 8. d 10. b 12. b
d. excessive salivation
3. a 6. d
8. Which of the following is a consideration between CHAPTER 8
geriatric and younger patients that may affect the 1. b 5. c 8. c 11. c 14. a
ability to make a diagnosis? 2. c 6. d 9. d 12. a 15. b
a. Older patients are more stoic. 3. c 7. a 10. d 13. b 16. d
b. Decreased response to pulp testing is common. 4. c
c. Symptoms of pulpitis are not as acute in older
CHAPTER 9
patients.
1. a 4. a 7. c 10. d 12. c
d. All of the above.
2. a 5. c 8. d 11. b 13. b
3. c 6. c 9. c
9. A common modification in performing root canal
treatment for older patients is which of the CHAPTER 10
following? 1. b 4. c 7. c 10. c 13. b
a. treatment planning for a shorter lifespan 2. c 5. d 8. b 11. d 14. d
b. access cavity without a rubber dam to locate a 3. c 6. d 9. d 12. c
smaller chamber
CHAPTER 11
c. greater need for anesthetic
1. d 4. c 7. b 10. c 13. a
d. larger restorations make isolation easier
2. d 5. b 8. c 11. c 14. b
3. c 6. b 9. c 12. d 15. a
10. Working length determination in elderly patients
may be more difficult because of which of the CHAPTER 12
following? 1. d 4. c 7. b 10. d 13. d
a. increased bone density, making radiographs harder 2. c 5. a 8. c 11. d 14. c
to interpret 3. b 6. c 9. d 12. d

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APPENDIX B Chapter review questions

Chapter review questions

5. What is the diameter at point D0 and at point D16 for a

4. Which design variable is used to provide greater flexibility ANS: d

10. How are broaches intended to be used in the canal? ANS: d

Chapter review questions

5. Alterations in the anatomy of the pulp space occur because

Chapter review questions

3. What is the recommended rubber dam weight for end-

ANS: b 15. Which of the following is not a major canal

be left in place during working length determination to ensure ANS: b

Chapter review questions

4. To prevent extrusion of obturating material, cleaning and

Chapter review questions

5. Which of the following is crucial to a definitive restoration

Chapter review questions

CHAPTER 18 5. What factors should be considered in determining the

Chapter Review Questions

CHAPTER 1 a. Root canal diameter increases in size.

c. periodontal disease b. are more resistant to antimicrobial treatments

8. What is reversible pulpitis? CHAPTER 5

9. How does electrical pulp testing determine the degree CHAPTER 6

8. What is the preferable restoration of a cracked 4. What is a two-stage injection?

c. patient management a. more common than flare-ups following cleaning

7. What is the emergency treatment of choice for pulp

7. Which is a stronger metal alloy: carbon steel or stain- CHAPTER 13

c. It is a projection of the internal tooth anatomy CHAPTER 15

b. if the patient is unable to pay for the restora- CHAPTER 17

4. Which of the following is not an early sign or indica-

CHAPTER 18 8. What type of canal is most prone to ledge

c. It may prevent healing of the incision. CHAPTER 21

c. coronal leakage 7. Which of the following is not an indication for inter-

c. remains the same in volume b. increased cementum deposition, modifying the

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