ENDODONTICS QUESTIONS AND ANSWERS (BHARATHI NOTES)

1. How would you recognize endodontic perforation

 Immediate continuous hemorrhage
 Early signs of sudden pain during working length determination, when la
was adequate during access preparation
 Sudden appearance of hemorrhage
 Burning pain or bad taste during irrigation with sodium hypochlorite
 Radiographically malpositioned file
 PDL reading from apex locator that is far short of the working length
 Severe post operative pain

2. How do you treat different types of perforations

Defect at or at the height of crestal bone
 Repair potential is favorable
 It can be repaired with standard restorative materials such as amalgam,
composite or GI
 PDL flap or curettage may be required
 Some times best repair is placement of full crown with the margin
extended apically to seal the defect

Perforation below the crestal bone

 Usually has poor prognosis
 Orthodontic extrusion when teeth in the aesthetic zone
 Internal repair of these perforations by MTO seems to provide good seal

Perforation at the furcation area or direct perforation

 Punched Defect – Accessible And This Should Be Immediately Repaired
With Amalgam, Or IRM Or Cavit Or MTA- Prognosis Is Fair To Good

Stripping perforation
 Inaccessible
 Inflammation of PDL pocket
 Long term failure due to leakage of repair materials which results in PDL
break down with attachment loss

Non-Surgical modalities
 Amalgam, Gutta percha, GI, ZOE, Cavit, Ca (OH)2, Freeze dried bone
 Matrix concept – Hydroxyapatite-fill bone defect
 Immediate repair of perforation with MTA

Surgical Modalities
 Hemisection, bicuspidization, root amputation and intentional replantation
 Prognosis depends on
 Location of the defect n relation to crestal bone

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  Length of root trunk
 Accessibility
 Size of the defect
 Presence of PDL communication to the defect
 Time lapse between perforation and repair
 Sealing ability of the restorative material
 Operators ability and skill
 Patient’s compliance with oral hygiene

3. Non-vital tooth do you give antibiotics, if so when do you consider giving

them?

4. What are the causes of perforations and how can you avoid perforation
when preparing access cavity

Causes of perforation
 Anatomic variation
 Lack of attention to the degree of axial inclination of a tooth in relation to
adjacent teeth and to alveolar bone may result in either gouging or
perforation of the
 Searching for the canal orifices from under prepared access cavity
 Inadequate access cavity

Prevention
 The parallel relation ship of the bur to the long axis of the tooth must be
maintained during access preparation
 Know the tooth morphology
 Location and angulations of the tooth must be located to the adjacent
tooth and alveolar bone (x-rays)
 Proper access cavity
 Rubber dam during the RCT is usually mandatory but in the case of tilted
teeth or calcified chambers, initiating access without a rubber dam is
preferred be it allows better crow-root alignment (given in Walton)
 split dam technique
 To orient the access, a bur may be placed in the preparation hole (secured
with cotton pellets and then radiographed
 Use fiber optic light during access preparation with flat access floor may
assist in locating canals
 Magnifying glasses or operative microscope

5. What instruments you use during lateral condensation?

 Instruments used are spreaders (hand and finger operated) and pluggers (hand and
finger operated)
 Spreader should reach the working length without binding, rubber stopper can be
used

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  Spreader is inserted along side of master cone up to the working length or 0.5 to
1mm short, it is rotated in 180 degrees arc to vertically and laterally compact GP
(curved canals less arc of rotation)
 GP is compacted to particular canal wall and space is created for accessory cones
next to the master cone

6. What will you use to prepare the orifice?

 Gates Glidden Drill

7. Why this tooth had a wide canal and it started with file 70 size?
 Reasons could be
 Internal resorption
 Young permanent tooth
 Immature apices
 Anterior tooth

8. When do you use Gates Glidden, how and why?

 Used to enlarge root canal orifices to gain apical access
 To clean and shape the coronal third of root canal before curvature begins
 To remove lingual shoulder during anterior access cavity

 Why – to gain apical access to prevent binding to flare the canal (orifices in
coronal part to determine correct apical size)

 How – flood access cavity with sodium hypochlorite

 Pass rotating no.2 drill into the canal, drill has inward pull be of rotation (inward
to outward
 Use in-out motion with 1-2mm deep
 Irrigating fluids in the chamber
 Keep the drill clean before reinsertion into the canal to the intended depth

9. Indications of endodontic treatments?

 All teeth with irreversible Pulpitis
 Periapical pathology
 Elective endodontics
 PDL disease
 Developmental defective teeth
 Trauma
 Short clinical crowns
 Iatrogenic conditions

10. How important is the restoration that you place after RCT?
 Coronal seal – all restorations must provide a durable, effective seal
 Lack of seal is a major cause for endodontic failure, be oral bacteria can re-infect
the canal space

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  It should provide adequate support to tooth be in endo-extensive tooth loss

11. If the tooth treated with RCT previously had an MOD amalgam how would you
restore it after endodontic treatment?
 Cast gold cuspal overlay is the best to prevent flexure of cusp
 Amalgam overlay
 PFM or all ceramic or gold crowns

12. How do you say that the canal is flared adequately?

 The selected plugger or spreader passes easily to or within 1mm of the working
length with the space left along the side for GP
 From the x-ray, where do you think you should get into the chamber – measure
the distance from the occlusal surface to the roof of the pulp chamber

13. 50-year old patient for RCT, Refuses rubber dam placement, what do you do?
 I will try to explain the role of rubber dam and its all advantages to the patient and
I will let him know that I could not do the treatment without it
 If still he refuses - I would refer the case to endodontist

14. While working or after working on tooth undergoing RCT, patient complains of
pain, what do you do?

 Try to evaluate that the LA was adequate

 Try to rule out any complications like perforations, presence of infection and
overzealous instrumentation
 Give LA if he complains pain
 In between appointments - prescribe analgesics (NSAIDS)
 Irrigate the cavity properly
 Delay restoration
 IRM and follow-up-if signs resolve do filling

15. Would you prefer overfilling or under filling?

 Under filling – Failure with long time and is a less of problem compared to
overfilling, as indicated by prognosis and histological studies by Grossman
 it leads existing and potential irritation in the apical area and periapical
inflammation may develop over a long period of time

16. If you got overfilled RC, what is the prognosis?

 Overfills are undesirable and prognosis is poor
 Failure increases with time
 Obturating material whether cone or sealer, silver point, GP, are toxic as they are
in contact with tissue continuously

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17. What happens if sealer goes into periapical area?
 Sealer evokes a foreign body response and inflammation
 Lack of apical seal – secondary to overfill and may be important
 Inflammation and failure

18. Advantages of vertical condensation?

 Heat softened GP will adapt well to large irregularities and fills lateral canal with
good seal
 Disadvantages – over fillings, it cant be correctable
 Indications – internal resorption

19. Advantages of lateral condensation?

 Uncomplicated relatively
 Simple armamentarium
 Prevent overfilling
 Case of retreatment easy when compared to vertical condensation
 Adaptation to canal walls
 The dimensional stability
 Ability to prepare post space
 Decreased likely of vertical root fracture

20. Why do you use intracanal medicaments?

 Mainly to remove microorganisms from the canal
 Micro-organisms not removed completely from the canal will multiply between
appointments
 Placement of sterile dry cotton pellet may allow growth of bacteria, hence
intracanal medicaments are required
 Types – phenolic compounds like Formocresol and CMCP and other like eugenol
and halide groups
 These medicaments particularly are antigenic and cytotoxic and are effective only
for a short time
 Current Medicaments
 material of choice is calcium hydroxide

21. What will be the medical treatment between appointments?

 If there is a systemic involvement and signs of infection arising from endodontic
treatment, we can give or treat by penicillin
 Penicillin resistant can be treated by clindamycin
 Pain relief provided by NSAIDS like Ibuprofen

22. What size did you prepare apical part of the canal and what size, is the coronal
part of canal
 Gates glidden bur no 2 is used to flare the coronal part of the root up to ½ length
of the root without forcing, then used no 3 with 2mm less length than before

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23. Explain step back technique
 Correct working length determined
 The 1st file to be bind it
 Then increase one or two size of file to create apical seat, the file that binds at
correct working length, now that’s your MAF
 If your apex is already larger than 25 then no need to enlarge it but just instrument
with the first file that binds
 Recapitulation during enlarging is important to ensure the canal is patent
 Taper – created by shortening the working length of each successive larger
instrument by 0.5mm and by performing peripheral filing, this creates step back
 Recapitulation – after each step back is used, recapitulation is performed by
returning to length with the MAF or smaller file, in order to loosen debris, not to
enlarge canal apically
 Irrigation – at least 2mm of irrigation is used between each file size following
recapitulation

24. How did you measure working length for each canal and what is your reference
point for each canal
 Using a diagnostic radiograph and estimate apical constriction to be 1 to 2 mm
short of the apex
 To confirm, the stops are placed on the file and an working length radiograph is
taken
 Reference: is the site on the occlusal or incisal surface from which measurements
are made
 This point should be used throughout your canal preparation and obturation
 Reference point should be easily visualized and stable (never use undermined
ridges and cusps and floor of the chamber)
 Should be highest point on the incisal edge and buccal cusp tip on the posterior
teeth
 Same reference point is used in multicanal and multi cuspid tooth
 Posterior teeth – mesiobuccal cusp tip is preferred
 No 8 or 10 file too small, tips fade out and not visible so do not use
 On molar No-15 file obscure tip so don’t use
 Electronic Apex Locator – when file approaches the foramen – there is resistance
or impedance changes and visual display indicate the file touches the periapical
tissue
 Disadvantages of EAL are the pulp chamber must be dry. fluid cause short circuit
from gingival tissue and causes false reading
 problem in heavily restored tooth and crowned tooth due to fluid from the
gingival tissues
 open apex and perforation cases

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25. What is straight line access and its importance?
 It is important that instrument pass through the chamber without touching the
walls and through the straight point of the canal undetected
 This will improve
 Improved instrumentation
 Improved obturation
 Prevents clogging of instruments
 Decreases procedural errors like ledge formation, apical perforation, furcal
stripping

26. Will you remove all caries and restoration before starting endo treatment, if so
why?
 Caries – all caries must be removed prior to access opening
 This prevents introduction of bacteria into the pulp system
 If removal of caries compromise isolation or lacerate gingiva, it is permissible to
leave a small remnants of caries temporarily
 Thin band of caries should be remained until RC completed, and then it should be
removed before post obturation and temporary is placed
 Ideal restoration – ideally entire restoration or full crown should be removed
 Not removed if same crown is considered as permanent restoration of RCT
 Proximal part of Class II is compromised isolation
 Defective restoration – Open margins, recurrent caries may lead to
communication with the pulp space, so it should be removed before access
preparation

27. What if GP goes beyond apical foramen, how long does it take to resorb?
 GP does not resorb
 If sealer is unset, remove root filling and redo the entire filling
 If sealer has set, monitor the case
 Analgesics
 Periapical surgery
 Referral

28. What would you advice the patient if the sealer went through? What type of
analgesics you would give?
 Reassure the patient and explanation of the situation through radiograph
 Tell him there might be little pain and discomfort and might resolve within a week
 Prescribe analgesics and monitor the case
 Ask the patient to come back immediately if the pain is severe and intense
 Referral to endodontist (might do periapical surgery)

29. Ledermix Composition

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  Ledermix Cement
 Powder
 Triamcinolone acetonide – 0.67%
 Demeclocycline HCL or chlortetracycline 3%
 Zinc oxide - 45%
 Calcium Hydroxide – 33%

 Liquid
 Eugenol – 85%
 Rectified turpentine Oil – 13%

 The pH of the powder is 9 and the liquid is 6.5 but the mixture has neutral Ph
when set

 Ledermix Paste
 Components
 Triamcinolone acetonide – 1%
 Demeclocycline HCL or chlortetracycline 3%

 In a water soluble cream containing

 Triethanolamine Polyethylene glycol
 Calcium chloride Distilled water
 Zinc oxide Sodium sulphate

 Advantages
 Reduces inflammation (Triamcinolone acetonide)
 Bactericidal properties (chlortetracycline)
 Inhibits osteoclastic activity
 Promotes repair
 Excellent obtundent effects on acutely inflamed pulp tissue (Eugenol)

 Disadvantages
 No availability of long term clinical trials

 Indications
 Cavity liner
 Pulp capping
 Partial pulpotomy
 Pulpotomy
 Pulpectomy procedure (ledermix paste is used)

30. How much time you wait for post after RCT?

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  When ever possible, GP should be removed during obturation
 At this stage the dentist is most familiar with the features of canal including its
shape, length and size and curvature

31. What is ferrule effect?

 Ferrule is an encircling band of metal usually provided by the coronal restoration
 Ferrule effect – parallel walls of dentin surrounded by a metal collar are essential
to protect the tooth against fracture in function
 It greatly increase resistance against tooth fracture
 Ferrule should be
 Minimum 1 to 2mm in height
 Parallel to axial wall
 Totally encircling the tooth
 On sound tooth structure
 Should not encroach attachment apparatus of tooth
 Ferrule is a band of metal collar with completely encircle the tooth which is 1 to
2mm of coronal tooth structure and guard against longitudinal fracture

32. Would you be happy to use composite a permanent restoration to seal access
after obturation?
 No, it can be considered as a long term restoration due to aesthetic considerations
 Coronal seal can be compromised because of polymerization shrinkage, so
ultimately we need complete cast restoration or amalgam, minimal cuspal overlay,
cast gold cuspal overlay and full coverage crown are options

33. Why will you take a mid obturation x-ray?

 To ascertain the root canal filling for correct length and condensation and to check
for presence of any voids, before the sealer sets and coronal restoration placed.

35. Where do you finish your root filling?

 Root filling should be finished near dentino-cemental junction just 0.5 to 2mm
short of radiographic apex
 Anatomic apex is shorter than radiographic apex, but real constriction (DCJ) is at
short to the radiographic apex

36. What are the consequences of RC sealer extending apically?

 ZOE – they release free eugenol and after loss of volume during hydrolysis after
setting
 AH26 – they release accelerator which causes irritation and they are inert after
setting
 It may cause irritation and inflammation and also may cause delayed healing of
periapical areas
 Patient may have pain and discomfort

37. Purpose of rubber dam?

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  Infection control and moisture control
 Improved access and better vision
 Prevents accidental swallowing of instruments
 In retraction of tongue and lips and cheek
 Operators efficiency is improved and saves time
 Increase physical properties of the materials

38. What is the composition of the RC preparation and its uses?

 Composition – EDTA (Ethylene diamine tetra acetic acid), and urea peroxide and
carbwax base
 Uses – lubricating property
 It facilitates movement of instrument within the canal
 Removal of smear layer
 Negotiating calcifications
 chelating agent
39. How to remove post?
 Ultrasonic vibration
 Masserian kit
 Eggler post removal
 Gonon post removal instruments

40. Why tug back is important?

 Tug back is important in order to get the apical fit to prevent over extension of GP
 When you can’t get tug back, it means loose GP so you need more sealer and
sealer breakdown as time goes and bacterial will grow there and also leakage of
sealer and extension of GP periapically causing problems

41. Gouging in the incisor, why do you think it happens?

 Gouging leaves a thin layer of dentin at the cervical area, particularly seen in
lower central incisor
 It happens due to removal of too much tooth structure from cervical area
 Gouging due to tilted or misoriented casting or calcified canals – while searching
canals even without adequate access cavity

42. What happens if you do not precarve files in curved canals?

 Transportation
 Ledge formation
 Perforation
 Zipping at apical foramen area

43. What is Apexification and apexogensis and procedure?

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Apexification is defined as a process of creating an environment with in RC and PA
tissue after pulp death that allows calcific barrier to form across the open access against
which root filling can be done
Apexogenesis is defined as a treatment of vital tooth in immature tooth to permit
continued growth of root and apical closure
 Procedure
 Preoperative radiograph
 La
 Rubber dam
 Create access under rubber dam
 Extirpate necrotic pulp tissue
 Mechanically prepare the canal 1mm short of the radiographic apex
 The canal should be carefully instrumented with maximum preservation of tooth
structure be apical root is very thin and weak
 Place Ledermix for 1 to 2 weeks followed by calcium hydroxide non setting
 Change dressing every 2 to 3months
 Allow contact with apical tissue with cotton wool pellet
 Place temporary restoration IRM or GIC
 REVIEW – 3 to 6months (Cameron and Widmer), assess for the formation of
calcific bridge and it may take up to 18 months and according to Cohen,
anywhere from 6 to 24 months

44. Contraindication of endodontic treatments?

 Unrestorable tooth
 Vertical root fracture
 Bizarre Anatomy
 Non functional tooth
 Tooth with inadequate PDL support
 Medical condition that contraindicate endodontic treatments
 Terminal illness
 Patients attitude
 Poor oral hygiene
 Inadequate mouth opening
 Infective endocarditis

45. If sodium hypochlorite goes periapically what will happen and how do you treat it,
how will you prevent it (we use 1% Naocl Milton) and how will you prevent it?

 Careful irrigation with light pressure and do not force the irrigant periapically
 The needle tip must not bind in the canal, careful insertion and slight withdrawal
 Slight pumping action during irrigation
 Place rubber stop on the needle to get some guidance
 If it goes apically, it may be irritating, and there will be pain and discomfort to
patient
 It may provoke foreign body reaction and may cause diffuse swelling

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  It may also lead to delayed healing of periapical area
 Case – it was inadvertently expressed through a perforation in maxillary root,
during irrigation
 Reaction was rapid and diffuse resulting in swelling at the same appointment
 A sub orbital hematoma formed quickly owing to hemorrhage into the tissue
spaces
 No treatment was necessary, the swelling and hematoma disappeared within a few
days
 Treatment –
 Palliative
 Analgesics
 Reassurance

46. Uses of irrigation?

 Lubricate the canal walls
 Remove debris (flushing action)
 Act as a solvent and dissolve organic and inorganic matter
 Acts as antimicrobial agent
 Aid in cleansing in areas that are not accessible to mechanical cleansing methods

47. What technique do we use in instrumentation and why?

 We are using modified step back technique
 Advantages
 Easy to fill canal
 Created a smoother flow and more taper preparation from apical to coronal
 Superior over standardized technique
 Canal preparation taper or flare coronally
 Also easy to fill the canal
 Easy to clean the canal by irrigation materials
 No ledges and transportation
 Less chance of pushing the debris
 Periapically – easy to negotiate canal, remove dentinal debris and easy to from
apical stop
 It will not damage the apical constriction
 Decrease the risk of over pushing the GP point
 Disadvantage – breakage of the instrument

48. If cement is left in the pulp chamber what will happen and how to solve the
problem?
 It will lead to discoloration of the tooth
 It will also affect the bonding with restoration
 It is removed by wiping the pulp chamber with cotton pellet soaked in alcohol

49. Do you always take x-ray to confirm GP-Yes?

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50. Bacteria in endodontics
 Actinomyces and lactobacillus (Israeli, odontolyticus – gram positive rods
anaerobic)
 Phorphyromonas and prevotella species (intermedia and denticola – gram
negative rods –anaerobic)
 streptococcus (gram positive cocci –anaerobic-s intermedius)

51. Agents used in removal of smear layer

 EDTA Aqueous 17% and ultrasonics and micro brushes
 Alternating use of EDTA or weak acid 10% citric acid followed by thorough
rinsing with3 to 5% Sodium hypochlorite

52. Difference between files and diameters

 K-FILES - Manufactured by ground - twisting

 Raw wire is ground the geometric blanks which could be square, triangular or
rhomboid
 Twisted counter clock wise to produce cutting edges.

 K-FILES – Manufactured from square and triangular blank

 K-Flex File - Rhomboidal cross section

 Uses – Rasping or push – pull motion.

 H-File
 Is machined instruments like?
 Nickle – titanium instrument
 Grinding on lathe
 Spiral shape
 High cutting efficiency
 Used with filling motion
 Less torsional resistance to breakage (more chance to fracture)
 Separation when locked and twisted

 Types according to materials

 Stainless steel – Hand instruments
 Nickel titanium – Rotary

 Two groups
 First group -
 Those that resembles conventional files but have varying taper eg: Profile – 0.004
and 0.06 taper
 Rotary GTs (0.12, 0.11., 0.08, 0.06)
 Quanters

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  Second Group
 Light speed, developed from the canal master series of instruments and resembles
gates glidden

53. What are the advantages of nickel titanium files?

 Advantages of Ni-Ti
 More flexible, negotiate the curved canal
 Increases debris removal be of ___rotation
 Decrease canal transportation
 Smoother the faster canal preparation with less operator fatigue
 Two categories of rotary files
 Orifice shapers
 Standard files (middle and apical 1/3rd preparation)

 Stainless steel files

 Too stiff work hardens and Cannot be negotiated
 Difficult in complex curved canals
 Niti instruments
 More flexible
 Much greater fatigue resistance
 Adv-increased debris removal from canal
 Preserve canal contour and centering
 Tends to conserve tooth structure especially coronally

54. How the diameter changes on a file as it tapers?

 Three available lengths - 21mm, 25mm, 31mm

 File tip diameter increases in 0.05mm increments up to the size 60file and then by
0.10 increments by size 140

 Diameter at the tip is know as D0

 D0= Length
100 mm

 Size 20=0.2mmD0

 Spiral Cutting Edge Should Be At least 16mm Long

 File diameter increases at the rate of 0.02 mm per running mm of length

 D16=D0+0.32MM
 Tip angle of file should be 75 (plus/minus 15 degrees)

55. CROWN DOWN PREPARATION

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  ADVANTAGES
 It removes coronal debris and improves canal irrigation
 It provides better access to apical area
 It improves tactile perception
 In the apical area decreases chances of breakage of instrument
 Working length is more accurate
 And is more direct path to the canal terminus

56. AH-26 composition

 Powder: Silver powder 10%
 Bismuth oxide 60% (Radio opacity)
 titanium oxide 5%
 Hexamethylene tetra amine 25%
 Liquid: Bisphenoldiglycidyl ether
 Properties - Biocompatible
 Good adhesion
 Effective sealing
 Low solubility
 Mix easily
 Flows well
 Radiopaque
 Good compressive strength

57. Difference in setting time between AH26 AND ZOE

 Setting time of ZOE is 24 hrs at 37 degree centigrade, but in RC it is 10 to 30
minutes
 AH26 – 24 hrs, but it is cytotoxic in first 24 hrs

58. Composition of Formocresol?

 Formocresol

 Burkelys formula Mitis (1:5 dilutions of Burkelys)

 Formaldehyde 19% Glycerine 3 parts
 Tricresol 35% Distilled water 1 part
 Glycerine 15% Burkelys formula 1part
 Water 31%

o Investigations
 Fixation - Coronal 1/3rd root
 Inflammation - Middle third
 Vital tissue -Apical third

 Advantages

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  Success rates of 70 to 90% as pulpotomy agent in primary tooth
 Application over 4 to 5 minutes

 Disadvantages
 Concerns over systemic toxicity
 Immunogenic and carcinogenic potential

58. What will happen if the patient did not come back and have the bleaching
material removed from the pulp?
 The material continue to be active once if has been sealed in the chamber
 External cervical invasive resorption can occur
 Weaken the tooth due to pulp necrosis, loss of tooth structure, endo access then
patient have no final restoration and cavit (at least 3mm) is temporary (2week)
only-possible lost and seepage

59. Difference between finger pluggers and spreader – pressure

Pluggers and spreaders
 Smooth tapered metal instrument (chrome plated, stainless steel or nickel
titanium)
 16mm cone shaped part
 Available as long – handled or finger instruments
 Size corresponds to ISO sizing and taper of k-file and reamers
 Color coded

Differences

Finger plugger Finger spreader

Used for vertical compaction Used for lateral condensation
Has blunt or flat end Has pointed tips or more
Tapered Finger spreader has less force
Less chances of vertical root fracture
When compared to long handle spreader

Finger spreader or plugger is preferred over hand spreader because of

 Better control
 Potential for reduced dentin stress during obturation
 Fewer subsequent root fracture
 May be inserted more deeply than standard hand spreader

Urvi (according to Walton)

 Finger spreaders and pluggers behave similarly and are used interchangeably in
lateral condensation
 Just change in tips
 Spreader – pointed
 Pluggers – flat – also use for vertical condensation

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  In Lateral Condensation It Is Used In Adapting GP, Condensing And Creating
Space For Accessory Cones

 Do not leave accessory GP point in the sealer while working as reaction may
occur between Zno in the point and eugenol in sealer, softening the GP and
making insertion difficult

 Leave the spreader in site for 30seconds. this is important as continuous pressure
from the spreader is required to deform GP point against the canal wall and to
over come its elasticity

 Tug back – once the master point is fitted to length and demonstrates a slight
resistance to withdrawal is know as tug bag

LENTULO SPIRAL
 Used to deliver sealer or paste to the root
 Tightly wound safety spiral at the beginning of shaft decreases risk of fracture
 ISO sizes 25 and 40
 Length 21, 25 and 29 mm

59. What is the expected length of the root canal of a lower molar 20 – 22 mm

60. Where you use intra coronal retention – root canal itself
61. Rubber dam clamps
 Anterior teeth – 00, 9, 21, 25A
 Premolar – 2A, 1A, 0
 Molar – 7A, 8A, 14A, 26N, 27N, 56
 13 – 1&3 quadrant
 12 – 2&4 quadrant
 For simulation clinic – WO, W2A, 26N

62. What would you do if there is extrusion of material from the apex?
 It depends, if my master cone is extruded to the apex and I find that, I will retract
it. But if the material cement is set after the obturation, I will inform the patient,
and I will keep under observation, since it can act as irritant in initial stages, I
would prescribe analgesics. Small over fillings is gently tolerated. if patient has
severe symptoms of pain and discomfort, I will advise him to immediately come
back and I will assess the situation and will give an further referral to endodontist

63. What is more dangerous overfilling or under filling?

 Tell the examiner study shows overfilling has better result than under filling
 Tell advantages and disadvantages of both
 In case of over filling

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  Disadvantages – no apical seal – over instrumentation and chances of pushing
debris into pa
 Patient feels mild discomfort
 Sometimes inflammatory reaction or fibrosis
 Advantages – as we are doing instrumentation through whole canal, disinfected
canal will be there

 In case of underfilling
 Advantages – you will get apical seal which is necessary for success of endo
 Disadvantage – as there is ledge formation in the canal and you are not able to
clean the whole canal up to apical area, chances of remaining bacteria into canal –
re-infection of canal and signs of failure of endo
 According to Walton – overfills are undesirable and failure occurs with time
 Histologically it shows increased inflammation with delayed or impaired healing
 Patient feels more post obturation discomfort
 Lack of apical seal
 under fills – Contribute to treatment failure, particularly in long term, periapical
inflammation may develop over an extended period of time, depending upon the
volume of irritant or balanced established between irritants and the immune
system

64. If you have corrected the working length by 1mm would you take another X-
ray?
 Yes I would like to take the x-ray to confirm that (paralleling technique)

65. Objectives of BMP (Bone morphogenic proteins)

 BMP is an unique factor with osteoinductive activity
 Belong to a family of proteins consisting of at least 15 different members

 Objectives
 Has direct effect on osteoblasts by stimulating the differentiation of osteoblasts
precursor cells into more mature osteoblasts
 Induces chondrocytic differentiation and matrix mineralization
 Induces the production of new bone through endochondral pathways when bmp is
implanted in ectopic site or bone

66. What is biomechanical preparation?

 It is the systematic procedure of cleaning and shaping of the root canal system in
order to remove the microbiological component and debris and infected material,
to receive three dimensional hermetic filling of the entire root canal space.

67. What is chlorhexidine gluconate?

 It is antimicrobial agent, antifungal, and some studies shown antiviral properties
 Effective in surpragingival plaque control and reducing gingival inflammation
 Reduce plaque, gingivitis scores and gingival bleeding

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  Sodium lauralsulphate in tooth paste interacts with chlorhexidine and decreases its
binding capacity
 Available as 0.2% and 0.12% (peridex or periogaurd)
 effective against gram positive and gram negative organisms and yeast organisms

 Indications for use

 Treatment of gingivitis
 Periodontal cases
 People taking orthodontic treatments
 Rampant caries
 Medically disabled people
 Trauma cases
 As an irrigant in root canal system
 In patients who had radiation therapy

 Side effects of chlorhexidine

 Staining of teeth, tongue and restorations
 Impairment of taste – it will last for few days and temporary (its own taste is
bitter)
 Excessive surpragingival calculus formation
 Mucosal irritation and desquamation
 Bilateral salivary gland swelling (rare)
 Alternative to this is Listerine, essentially oil based mouthwash for 30seconds. it
is alcohol based, and should be considered in burning mouths and patients having
ulcers

68. What is the normal height of alveolar crest?

 Alveolar crest may be covered with a thin layer of cortical bone and lie at a level
within 1-1.5mm of CEJ of adjacent tooth

69. What materials would you use to obturate and prepare the canal?
 Gutta percha
 Obturation is to seal the canal and eliminate portal of entry
 Files, GG, irrigation solutions, RC prep, sealer, accessory cones and spoon
excavator, spreaders, pluggers, lentulospirals, etc

70. What is the cause of ledging?

 Failure to recapitulate/recapitulation. Canal patency must be maintained at all
times. Done by after each successively large file, each one about 0.5 to 1mm
shorter that previous one

71. How do you sharpen the instruments?

 Most commonly with flat Arkansas stone in conjunction with small drop of oil
 Instrument held at appropriate angle and run carefully forward across the surface
(spoon excavator-Rotating cuttle disc)

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72. EDTA – Used in negotiating blocked canals, and when you suspect breakage of
files or danger in the integrity of instrument breakage – it is chelating agent,
lubricant and facilitate instrumentation

73. In case of both root has curve at the apical end how to identify which is mesial
and which is distal?
 In case mesial root it is shorter than distal root and it has bed from CEJ means
crown and root they are not in one line like seen in figure
 In case of distal side, distal root will be larger and crown and root line will be
once without separation

 Draw a vertical axis in the center of the tooth and check the curvature where it is
going more. Generally mesial root will be more curved towards distally

74. What are the various instrumentation methods and what are their advantages or
disadvantages?

GP instrumentation Technique
SINGLE CONE METHOD
 Not generally recommended
 Does not seal laterally
 Can be used when custom point used (but ideally still should combine with some
condensation to effectively seal the total canal)
LATERAL CONDENSATION METHOD
 Recommended method for most situation
 Useful in nearly all cases
 Best seal obtained if spread tip reaches to within 1mm of WL during the 1 st
seating
VERTICAL CONDENSATION
 Also called warm gutta-percha method
 Used a red hot instrument then a cold plugged to condense the gp
 Uses minimum seals
 Very good for lateral canals
COMBINATION TECHNIQUE
 Lateral condensation in apical third
 Vertical condensation in coronal 2/3rd
SOLVENT TECHNIQUE
 Uses chloroform, or eucalyptus to soften the GP
 Either soften entire point or just apical 2mm
 Combine with lateral and vertical condensation
 This technique not recommended due to toxicity or solvent

75. What do you think about your access cavity?

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  Access cavity is done to have an entrance to the pulp and also to remove the
remaining caries that may result to undermine the remaining tooth structure
 It gives straight line access, conservation of tooth structure and minimal
weakening of tooth structure
 Prevents perforation
 Ledge formation
 No apical perforation
 Facilitate easy obturation and instrumentation

76. What are files, reamers and broaches, types and what are the dimensions and
how does a diameter changes as in a file as it rapels?
77. How would you treat an endodontically treated tooth with previous amalgam
fillings in it?
 Restoration of an endodontically treated tooth is dictated by the extension of
coronal destruction and by the type of tooth involved
 Traditionally a pulp less tooth received a dowel to reinforce it and a crown to
protect it
Treatment options in anterior teeth
 If a moderate sized anterior tooth is intact except for the endodontic access and
one or two small proximal lesions, composite resin restoration would be sufficient

 Placement of a dowel will more likely weaken in this tooth than strengthened it,
that is an unlikely reinforcement

 If such a tooth becomes discolored following Devitalization, bleaching is

preferred to cover placement, a laminate veneer offers a less destructive
alternative

 If lots of tooth structure damaged centrally and peripherally and a metal ceramic
crown is required a dowel core is probably needed.

 A dowel is placed to provide the retention for crown ordinarily gained from
coronal tooth structure

 Length of dowel – length of crown or 2/3 rd the length of root which ever is greater
for optimum stress

 A minimum length of 3 to 4mm of gutta percha or more at the apex to prevent

dislodgement and subsequent leakage

 Longer the dowel better the retention

Treatment options for posterior tooth

 MOD overlay (onlay) or crown (cast gold, porcelain, PFM)
 Teeth with access opening +caries+previous restoration – core preparation

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  No remaining tooth structure –
 Post and core
 Crown lengthening
 Ortho extrusion
 Ferrule effect

 Endo treated tooth should not use as abutment for distal extension removable
partial denture

 A pulp less molar with moderately damaged crown

 Composite build up
 Pin/slot with amalgam
 Use of two dowels for molar with little or no coronal tooth structure

78. What is the importance of access preparation?

 Main objectives
 Attainment of straight line access which achieves following
 Improved instrumentation
 Improved obturation
 Decreases procedural errors
 Gives an idea of tooth structure removal and also caries removal
 Conservation of tooth structure there by preventing weakening of tooth
 Unroofing of chamber and exposure of pulp horns gives following
 Maximum visibility
 Location of canals
 Improve straight line access
 Exposure of pulp horns

79. Purpose of sterilization?

 Prevents the introduction to RC system of extraneous microorganism eg:
pseudomonas
 To prevent cross-infection between patients
 After using them – cleaning is carried out by scrubbing in warm water and
detergent
 Ultrasonic cleaning
 Wash it and dry it
 Keep in sterile bags
 Autoclave (disadvantages – corrosion of metallic instruments and sharp
instruments become dull)

80. What is smear layer and what does it contain and what are its effects on
endodontic treatments

A fine layer which is formed during the endodontic instrumentation with reamers
and files

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It mainly contains
Refer Paul about

81. CAVIT
Composition
 Zno
 Calcium sulphate
 Triethanolamine
 Glycol acetate
 Polyvinyl acetate
 Polyvinyl chloride acetate
 Red pigment

Advantages
 Good seal
 Simple to apply
 Quick to set

Disadvantages
 Lack strength
 Won’t stand up to masticatory stress
 Shape of the endo cavity won’t retain
 Leakage, reinfection

82. Gutta percha as filling material?

 It is the dried resin of taben tree exist in two forms

 Alpha phase – natural form
 Beta phase –when heated and cooled

Composition
 75% Zno
 20%GP
 2 to 3% wax and resins
 Metal sulphates

 Shapes available in two basic shapes

 Standard and conventional forms

Advantages
 Easily placed and easy to manipulate
 Easy to remove
 Little toxic
 Does not encourage bacterial growth

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  Least irritant to tissues
 Radiopaque
 Easily available and inexpensive

Disadvantages
 Lack of adhesion to dentin
 Slight elasticity which causes rebound and pulling away from canals
 Warmed GP, shrinks little bit during cooling
 It is distorted by pressure
 Sealer is necessary to fill the space around the filling material

 GP is indicated in all cases except where there is very curved canal or inaccessible
canals in which GP or obturating instrument would be difficult or impossible to
manage

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