Endodontics

Endodontics
• Pulp Biology and Tooth Pain
• Pulpal and Periapical Diagnoses
• Root Canal Treatment
• Surgical Treatment
• Procedural Complications
• Traumatic Injuries
• Adjunctive Endodontic Treatment
#1

An 8-year old patient presents with an Ellis class

II fracture of tooth #8. In an effort to attain a
pulpal diagnosis, which of the following tests is
least reliable?
A. Cold test
B. Electric pulp test
C. Percussion
D. Palpation
#1

An 8-year old patient presents with an Ellis class

II fracture of tooth #8. In an effort to attain a
pulpal diagnosis, which of the following tests is
least reliable?
A. Cold test
B. Electric pulp test
C. Percussion
D. Palpation
#2
#1

Radiographic examination shows a horizontal fracture of

the apical third of the root. The best treatment is which
of the following?
A. Root canal treatment
B. Splint and re-evaluate the tooth for pulpal vitality at a
later time
C. Apexification
D. Apicoectomy to remove the fractured apical section
of the root followed by root canal treatment
E. Extraction
#2
#1

Radiographic examination shows a horizontal fracture of

the apical third of the root. The best treatment is which
of the following?
A. Root canal treatment
B. Splint and re-evaluate the tooth for pulpal vitality at
a later time
C. Apexification
D. Apicoectomy to remove the fractured apical section
of the root followed by root canal treatment
E. Extraction
#3

Pulpal anatomy dictates which of the following

access openings for a maxillary first molar?
A. Circular
B. Ovoid
C. Blunted triangle
D. Trapezoidal
#3

Pulpal anatomy dictates which of the following

access openings for a maxillary first molar?
A. Circular
B. Ovoid
C. Blunted triangle
D. Trapezoidal
#4

Symptomatic irreversible pulpitis pain in which

of the following sites is most likely to radiate to
the ear?
A. Maxillary premolar
B. Maxillary molar
C. Mandibular premolar
D. Mandibular molar
#4

Symptomatic irreversible pulpitis pain in which

of the following sites is most likely to radiate to
the ear?
A. Maxillary premolar
B. Maxillary molar
C. Mandibular premolar
D. Mandibular molar
#5

Which of the following statements most likely

applies to a cracked tooth?
A. The direction of the crack usually extends
mesiodistally
B. The direction of the crack usually extends
faciolingually
C. Radiographic examination is the best way to
detect a cracked tooth
D. A and C
E. B and C
 Cracked Tooth
Syndrome
• Pain on biting and on release
• Sensitive to cold and hot
• Sometimes completely asymptomatic
• Cracks usually extend deep into dentin and
propagate mesiodistal, often on the marginal
ridge
• Dyes and transillumination are more helpful than
radiographs
• Tooth slooth on each cusp can aid in location of
crack
• Healthy pulp à splint with band and observe or
crown
• Diseased pulp à conservative RCT and crown
#5

Which of the following statements most likely

applies to a cracked tooth?
A. The direction of the crack usually extends
mesiodistally
B. The direction of the crack usually extends
faciolingually
C. Radiographic examination is the best way to
detect a cracked tooth
D. A and C
E. B and C
#5

Which of the following statements most likely

applies to a cracked tooth?
A. The direction of the crack usually extends
mesiodistally
B. The direction of the crack usually extends
faciolingually
C. Radiographic examination is the best way to
detect a cracked tooth
D. A and C
E. B and C
#6

What is the clinical hallmark of a chronic

periradicular abscess?
A. Large periradicular lesion
B. Sinus tract drainage
C. Granulation tissue in the periapex
D. Cyst formation
#6

What is the clinical hallmark of a chronic

periradicular abscess?
A. Large periradicular lesion
B. Sinus tract drainage
C. Granulation tissue in the periapex
D. Cyst formation
#7

Which of the following tissues will not

regenerate after a root canal treatment?
A. Dentin
B. Cementum
C. PDL
D. Bone
#7

Which of the following tissues will not

regenerate after a root canal treatment?
A. Dentin
B. Cementum
C. PDL
D. Bone
#8

While performing nonsurgical endodontic

therapy, you detect a ledge. What should you
do?
A. Use a smaller instrument and get by the
ledge
B. Fill as far as you have reamed
C. Use a small round bur and remove the ledge
D. Continue working gently to remove the ledge
#8

While performing nonsurgical endodontic

therapy, you detect a ledge. What should you
do?
A. Use a smaller instrument and get by the
ledge
B. Fill as far as you have reamed
C. Use a small round bur and remove the ledge
D. Continue working gently to remove the ledge
#9

The ideal treatment option for a vertical root

fracture is:
A. Pulpotomy
B. Root canal treatment
C. Apicoectomy
D. Extraction
Vertical Root Fracture
• Starts apically and progresses coronally
• Can occur after cementation of a post or
excessive condensation forces on an
overprepared canal (most common)
• Isolated probing defect at site of fracture
• J-shaped or teardrop radiolucency
• Single rooted tooth à extract
• Multi-rooted tooth à extract or resect
affected root
#9

The ideal treatment option for a vertical root

fracture is:
A. Pulpotomy
B. Root canal treatment
C. Apicoectomy
D. Extraction
#9

The ideal treatment option for a vertical root

fracture is:
A. Pulpotomy
B. Root canal treatment
C. Apicoectomy
D. Extraction
#10

Which of the following conditions indicates a

periodontal problem rather than an endodontic
problem exists?
A. Acute pain to percussion with no swelling
B. Pain to lateral percussion with a wide sulcular
pocket
C. A deep narrow sulcular pocket to the apex with
exudate
D. Pain to palpation of the buccal mucosa near the
tooth apex
#10

Which of the following conditions indicates a

periodontal problem rather than an endodontic
problem exists?
A. Acute pain to percussion with no swelling
B. Pain to lateral percussion with a wide sulcular
pocket
C. A deep narrow sulcular pocket to the apex with
exudate
D. Pain to palpation of the buccal mucosa near the
tooth apex
Perio vs. Endo Lesions
• Endo= originates in pulp
• Perio= originates in sulcus
• Perio-endo= true combined lesion
– Treat endo first, then perio
#11

Endodontic infection usually is polymicrobial.

What is the predominant type of microorganism
found in a tooth that requires endodontic
therapy?
A. Aerobic bacteria
B. Facultative bacteria
C. Obligate anaerobic bacteria
D. Yeast microorganisms
#11

Endodontic infection usually is polymicrobial.

What is the predominant type of microorganism
found in a tooth that requires endodontic
therapy?
A. Aerobic bacteria
B. Facultative bacteria
C. Obligate anaerobic bacteria
D. Yeast microorganisms
#12

The “danger zone” of mandibular molars for

perforations during canal instrumentation is:
A. Mesial area of mesial root
B. Distal area of mesial root
C. Mesial area of distal root
D. Distal area of distal root
#12

The “danger zone” of mandibular molars for

perforations during canal instrumentation is:
A. Mesial area of mesial root
B. Distal area of mesial root
C. Mesial area of distal root
D. Distal area of distal root
#13

What constitutes the largest portion of gutta-

percha obturation material?
A. Gutta-percha
B. Zinc oxide
C. Waxes and resins
D. Heavy metal salts
#13

What constitutes the largest portion of gutta-

percha obturation material?
A. Gutta-percha
B. Zinc oxide
C. Waxes and resins
D. Heavy metal salts
#14

Which of the following statements most accurately

describes the manufacturing process for a K-type
hand instrument?
A. Grinding a stainless steel wire to a tapered
square or rhomboid cross section
B. Twisting a square or rhomboid non-tapered
silver metal blank
C. Grinding a nickel titanium wire to a triangular
cross section
D. B and C
E. All of the above
#14

Which of the following statements most accurately

describes the manufacturing process for a K-type
hand instrument?
A. Grinding a stainless steel wire to a tapered
square or rhomboid cross section
B. Twisting a square or rhomboid non-tapered
silver metal blank
C. Grinding a nickel titanium wire to a triangular
cross section
D. B and C
E. All of the above
#15

This emergency patient presents with

symptomatic irreversible pulpitis and
symptomatic apical periodontitis of tooth #12.
Which of the following is the best treatment
protocol for this patient?
A. Anesthesia followed by incision and drainage
B. Anesthesia followed by extraction
C. Anesthesia followed by pulpectomy
D. Prescribe antibiotics for 1 week and follow
with nonsurgical endodontic treatment
#15

This emergency patient presents with

symptomatic irreversible pulpitis and
symptomatic apical periodontitis of tooth #12.
Which of the following is the best treatment
protocol for this patient?
A. Anesthesia followed by incision and drainage
B. Anesthesia followed by extraction
C. Anesthesia followed by pulpectomy
D. Prescribe antibiotics for 1 week and follow
with nonsurgical endodontic treatment
#16

When you follow-up with this patient to perform

the RCT, you use EDTA to lubricate the canal.
What is this material best categorized as?
A. Emulsifying agent
B. Intracanal medicament
C. Irrigant
D. Chelating agent
#16

When you follow-up with this patient to perform

the RCT, you use EDTA to lubricate the canal.
What is this material best categorized as?
A. Emulsifying agent
B. Intracanal medicament
C. Irrigant
D. Chelating agent