Endodontics Q&A

Gianina Camille S. Gamboa, DMD

NiTi files are usually composed of:

80% Nickel, 20% Titanium 70% Nickel, 30% Titanium 70% Titanium, 30% Nickel 50% Titanium, 50% Nickel

Who first used the 3-dimensional obturation technique?

Schilder Buchanan Johnson Yee

Nice to know:
Obturation Technique 3D obturation System B Thermafil System Injection moulded thermoplasticized gutta-percha

Schilder Buchanan Johnson Yee

1907 1996 1978 1977

The process of trephination includes a:

b.

c.

d.

surgical opening created in soft tissue for the purpose of releasing exudate or decompressing the area of swelling surgical perforation of the alveolar cortical bone to release accumulated tissue exudate surgical procedure to remove diseased or reactive tissue and/or foreign material from the alveolar bone in the apical or lateral region surrounding an endodontically treated tooth preparation of a flat surface by the excision of the apical portion of the root and any subsequent

Trephination

http://www.scieencedirect.com/science/article/pii/S 0099239905605535

Root resection involves

b.

c.

d.

a biologically acceptable restorative material placed into a root-end preparation surgical removal of a soft and/or hard tissue specimen for histopathologic examination surgical separation of a multi-rooted tooth through the furcation in such a way that a root and the associated portion of the crown may be removed surgical removal of an entire root/s leaving the crown of the tooth intact

Surgical Endodontics

INCISION AND DRAINAGE TREPHINATION PERIRADICULAR CURETTAGE ROOT-END RESECTION (APICOECTOMY) ROOT-END FILLING (RETROFILLING)/ROOT REPAIR

Surgical Endodontics

BIOPSY HEMISECTION ROOT RESECTION (ROOT AMPUTATION) INTENTIONAL REPLANTATION (EXTRACTION/REPLANTATION) SURGICAL REMOVAL OF THE APICAL SEGMENT OF A FRACTURED ROOT

Periradicular Curettage

An objective of incision and drainage is:

b. c.

d.

To evacuate exudates and purulence from a soft tissue swelling Incision for drainage increases discomfort Drainage through the soft tissue accomplished most effectively when swelling is firm and non- fluctuant Incision for drainage is always made horizontally into the swelling

INCISION AND DRAINAGE

Periapical surgery is indicated

4.

5.

Lesion is resolved with non- surgical root canal re- treatment Severe periodontal disease Irretrievable posts and root fillings and therefore removal would result in further damage to the root structure Unidentified cause of conventional root canal failure When there is persistent periapical infection that cannot be

Which of the following is not true about root end resection?

It removes the untreated apical portion of root It should be perpendicular to long axis of tooth It exposes additional canals, apical deltas, or fractures It should be around half of the root structure to make sure no bacteria is left

b.

c.

d.

http://www.durhamendo.com/apicoectomy.asp

Which is an indication for root amputation or hemisection?

Preservation of strategically important roots and its accompanying crown Root fusion or proximity
Severe periodontal disease Inability to complete root canal treatment on either half

b.

c.

d.

Hemisection

http://www.toothiq.com/dental-information/page.aspx?id=b6ab6ee0-fb26-49a4-9324d3d19d3012d7

Which two of the following are true about root end cavity preparation?
a.

Are now made with ultrasonic tips

b.

c.

d.

A thirty year old patient presented to you with a chief complaint of pain on 37 upon chewing. Radiographic examination reveals furcation caries and bone loss that has compromised the distal root. Which surgical procedure will be indicated for management?

a.

Hemisection Apical surgery After root canal treatment, crown will be divided through the furcation Root planing

b.

c.

d.

Management of a broken instrument inside the root canal are the following, except
a. b.

c.
d.

Make an attempt to remove it Attempt to bypass it Fill and obturate it None of these

http://www.welovelmc.com/dentistry/broken-fractured-endodontic-instrument.html

A 10-year-old boy comes to your office with a coronal fracture of tooth #11. The accident happened about 1 hour ago, and there is a large pulp exposure. On x-ray you see the apex of #11 is still not closed. Treatment would consist of

a. b. c.

d.
e.

Direct pulp cap with calcium hydroxide Pulpectomy and later gutta-percha fill Pulpotomy with Ca(OH)2 Pulpectomy and fill with Ca(OH)2 Smoothing edges and placing zinc oxideeugenol over the exposure

A healthy 6 year old child presents with carious maxillary second primary molar with a necrotic pulp. Which treatment would be preferred
a. b. c. d. e.

Extraction Indirect pulp treatment Pulpotomy Pulpectomy Antibiotic coverage

8 years old child who has sustained a fracture of maxillary permanent central incisor in which 2mm of the pulp is exposed; presents for treatment three hours after injury. Which of the following should be considered
a.

b.

c.

d.
e.

Remove the surface 1-2 mm of pulp tissue and place calcium hydroxide Place calcium hydroxide directly on the exposed pulp Pulpotomy using formocresol Pulpectomy and immediate root filling Pulpectomy and apexification

A child has sustained a traumatic exposure of primary central incisor, he presents to you for treatment two days after the injury. Which of the following should be considered
a. b. c. d.

Pulpotomy and Ca(OH)2 Pulpotomy and formocresol Direct pulp capping Pulpectomy (RCT)

The emergency treatment for painless necrotic pulp is

Pulpotomy and Ca(OH)2 Direct pulp capping Drainage through canals None

The ideal length of RCT is

At the apex As far as you can obturate 0.5 to 1.5 mm from the apex 0.5 mm beyond apex

Tugback in endodontics is related to

e.

Tensile strength of the gutta percha Consistency of gutta percha Size of the cone Fit of the cone in the apical 1 or 2 mm Length of the cone

A new patient comes to you for total dental care. During treatment planning you find a radiolucency associated with the apex of the tooth #23. Endodontic therapy was performed on the tooth 1 year ago, and the patient has had no symptoms or problems with the tooth since then. You are unable to locate previous x-rays. Your

a.

b.

c.

d.

Perform endodontic surgery as the persistent radiolucency presents a failure Wait and observe, checking for clinical signs or symptoms of pathology, or changes in the radiolucency at recall visits Retreat the endodontic fill and observe for 6 months Adjust the occlusion because continual trauma to the tooth may cause the lesion to persist

During the excavation of a very deep lesion on tooth #46 on an 8-year-old patient, you initially find large amounts of mushy, decayed tooth structure over a leathery, demineralized dentin. The tooth is asymptomatic and has given all signs that it is vital. Treatment contemplated should include

a.

b.

c.

d.

e.

Total excavation; if no exposure is present, apply a base and restore Total excavation; if a pulp exposure is present, do a direct pulp cap Total excavation; if a pulp exposure is present, perform a pulpotomy Application of a cavity sealer over the leathery dentin, followed by restoration with amalgam Application of calcium hydroxide over the leathery dentin, and restoration with amalgam

A 21-year-old female presents with slight discomfort on tooth #12. She complains that it is tender to biting and occasionally gives her an ache near the apex. A radiograph reveals a previous root canal filling (silver cone) which extends 1 mm past the apex. Around the silver cone is a 3x5 mm periapical lesion. The crown of the tooth is partially broken down, and you can see the coronal end of the silver cone. Treatment of choice is:

a.

b.

c.

d.

e.

Periapical sugery, retrofilling and restoration of the tooth with a synthetic material Extraction of the tooth and replacement with a three unit fixed partial denture Trephination of the lesion and prescription of antibiotics Retreatment, removing the silver point, and preparation of the tooth for a post-core restoration Periapical curettage and simple cutting off of

Yesterday you did a pulpotomy on an emergency patient with pain on tooth #46 caused by irreversible inflammation of the pulp. Today the patient has called with moderate severe type pain. You should a. Prescribe antibiotics b. Prescribe antibiotics and analgesics c. Inform the patient it will probably go away d. Have patient return and perform complete pulpectomy e. Have patient return, open the tooth, leave it open

You have completed all the biomechanical preparation of the root canal of tooth #11. The patient returns in 24 hours with severe pain to biting on #11. You open the tooth and upon x-ray you find that your final file size (#55) is right at the radiographic apex. Treatment of choice is to

a.

b.

c.

d.

e.

Enlarge the canal one or two sizes, irrigate, and close the tooth Trephinate at the apex Enlarge the canal two or three sizes to remove any pulpal remnants Decrease your working length, open, irrigate, and close the tooth, reduce the occlusion, and prescribe analgesics Open the tooth for drainage and leave

The most frequent cause of failure in endodontics is:

b.
c. d. e.

Split roots Root perforation Inadequate obturation Separated instruments Filling beyond the apex

Which condition is an apical lesion that develops as an acute exacerbation of a chronic apical abscess (also called a suppurative apical periodontitis)?
a. b.

c.
d.

Cyst Phoenix abscess Granuloma None of the above

In order to localize two canals which are superimposed on the radiograph one must:
a.
b. c.

d.

Insert two files of different sizes Insert two files of the same size Shift the xray cone either mesially or distally Shift the xray cones vertical angulation

Radiographic techniques:

Frankshift: Changing the vertical angulation of the xray beam

to localize the IAN

Clarkshift: Changing the mesiodistal position of the xray beam

to determine the number of root canals

The root of the maxillary lateral incisor is most often curved:

b.
c. d.

Mesiopalatally Distopalatally Mesiobucally distobucally

Predominant bacteria inside the root canal system are:

Facultative anaerobic microorganisms Obligate anaerobic organisms Aerobic organisms Gram positive aerobic organisms

The principal advantage of using sodium hypochlorite is that it:

b.
c. d.

e.

Is a good chelating agent It is a strong germicidal agent Acts a local anesthetic agent Is a good solvent for necrotic tissue All of the above

The best flap design to be used when doing apicoectomy:

b.
c. d.

Three-cornered flap Semilunar flap Four-cornered flap Ochsenbein-Leubke flap

Pathognomonic sign of acute apical periodontitis:

d.

Tenderness to percussion Extraoral swelling Hypersensitive to heat Intermittent throbbing pain