-
Dental pulp and periodontium are connected in three ways:
1. Exposed dentinal tubules
2. Smaller portals of exit
3. the apical foramen
-
Number of dentinal tubules varies from approx ______mm2 at the CDJ to _______mm2 at the pulpal end.
-
Cervical area of the root the number of dentinal tubules is about _____mm2
15000
-
Dentinal exposure at the CEJ occurs in about __% of the teeth in general and in __% of anterior teeth in particular.
-
It is estimated that __-__% of all teeth have ancillary canal systems, and the majority are found in the _______.
- 30-40
- apical third of root
-
De Deus reported what?
17% of teeth presented multiple canal systems in the apical third
about 9% middle third
2% coronal third
-
Kirkham reported what?
1000 teeth studied with perio disease
2% of ancillary canals assoc. with perio pocket
-
Incidence of accessory canals?
23%-76%
connect to periodontium with connective tissue and vasculature
-
How can periodontal disease be degenerative on the pulp, findings of pulp?
Increase in calcification
Fibrosis
Collagen resorption
-
Kakehashi, Moller, and Korzen?
Kakehashi: Rats
Moller: monkeys
all three found that microorganisms key to pulpal and periradicular infections
-
What did Jansson find?
Denuded dentin had 20% more epithelium downgrowth in necrotic canals, augments periodontal disease, deeper pocketing around necrotic teeth
-
Jansson in 3 year retrospective study findings?
Patients with endondontic treatment failures had 3 times greater marginal bone loss, assoc with more attachment loss in furcation
-
Change of microbiota in root canal over time, from what to what?
Proteolytic to anaerobic
-
Where are spirochetes usually found?
subgingival plaque
-
What spirochete species are usually found in root canals?
T denticola and T maltophilum
-
What is the main virulence factor of maltophilum?
its rotating flagella
isolated in patients with rapidly progessing periodontitis
-
Bacteria without cell walls named?
L-form bacteria
-
Prevalence of fungi in untreated root canals and in previously treated canals?
26%
- 33%
- highest incidence at 55%
-
C albicans has been detected in __% of infected root canals.
21
-
Name some factors affecting colonization of root canals by fungi
Immunocompromised
certain IC meds
local or systemic abx
Previous unsuccessful endo
poor asepsis during tx
-
__% of patients with adult periodontitis also harbor subgingival fungi
20
presence in root canal directly assoc with presence in mouth
-
Human CMV was observed in __% of period pockets and __% of gingival tissues.
65
85
-
EBV Type I observed in __% period pockets and in __% of gingival tissues
40
80
-
Biofilm microcolonies are composed of __% cells embedded in __% matrix material.
15
85
convective flow, water channels carry bulk fluid
-
Describe foreign body reaction microscopically?
giant cells surrounding foreign material in a chronic inflammatory infiltrate.
Mechanical or surgical removal is tx
-
What is an epitheliated granuloma?
rests of Malassez that begin making epithelium attempting to wall off irritants, all surrounded by chronic inflammation
-
What is a bay cyst?
Chronic inflammatory lesion in which an epithelial lining surrounds lumen that has DIRECT communication with apical foramen
a true cyst does not communicate, meaing needs surgery, only 10%
-
What did Valderhaug find?
No cyst formation until tooth was 6 months necrotic
-
Incidence of cholesterol clefts?
18-44%
-
How are the cholesterol crystals formed?
released by dieing blood cells from stagnant BVs, by lymphocytes, plasma cells, plasma lipids, dieing macrophages
-
What are russel bodies, incidence?
80%
spherical accumulations, esinophilic substance within or near plasma cells and other lymphoid cells
caused by production of excess amts of secretroy protein
-
What are rushton hyaline bodies? Incidence?
3-10%
different appearances
keratinous or blood origin, secreted by odontogenic epithelium, degenerated blood cells
-
What are charcot-leyden crystals?
Naturally occuring hexagonal pyramidal crsytals
intracellular granules of eosinophils and basophils
activated macrophages may have role
-
What did Madison and Wilcox find?
root canals exposed to environment allowed coronal leakage
-
What did Ray and Trope find?
Defective restoration and good endo had a high incidence of failure
AR and GE 9% failure
PR and PE 82% failure
-
What did Saunders and Saunders find?
Packing excess GP and sealer over the floor of pulp chamber did not provide a better seal
-
Long-term prognosis of endo treatment review of lit factors:
- 1. post prep/cement RDI
- 2. heated plugger use for post space
- 3. min of 3mm material beneath post
- 4. irrigate post space/ dressing
- 5. leak-proof restoration ASAP
- 6. Retx if coronal seal broken >3 months
-
Root fracture splinting?
flexible splinting up to 12 weeks. RCT not necessary until vitality testing shows otherwise
-
Extrusive luxation treatment?
repositioning and splinting for 2 to 3 weeks
-
Lateral luxation with bone fragment movement, time of splinting?
up to 8 weeks
-
Intrusive luxation?
Metallic sound, open apex may reerupt
closed apex, initiate RCT
-
Prognosis of perforation factors?
depends on location and size
degree of perio damage
time of dx and tx
sealing ability and biocomp of material used
-
Pathogens found in CAP and Chronic adult periodontitis
Actinobacillus actinomycetemcomitans
Bacteroides forsythus
Eikenalla corrodens
Fusobacterium nucleatum
Porphymonas gingivalis
Prevotella intermedia
Treponema denticola
-
Why are biofilms hard to cultivate using standard methods?
Prolonged starvation induces loss of culitvability
-
Presence of viruses in pulp was reported by who with what virus?
AIDS, Glick 1989
|
|
