ENDODONTICS

QNO.16. Write short notes on:

A)reactionary and Reparative dentine

b)Pulp sensitivity tests

c)Cracked tooh syndrome

Key:A)Reactionary and reparative dentine are both types of tertiary dentine.Reactionary dentine is a
response to mild noxious stimulus;reparative dentine is deposited directly beneath the path of the
injured dentinal tubules as a response to strong noxious stimuli.

B)are grouped into thermal & electrical.their purpose is to identify the offending tooth.Thermal tests are
most useful & give an indication about pulp if it is alive and how healthyis it?cold tests include Endoice
or ethyl chloride spray on cotton pledget,ice or dry ice,hot tests include hot gp point or hot
water.Electric pulp tests are less useful though they provide an indication if there is any vital nerve
tissue.They don’t give an indication of different levels of degeneration.

C)cracked tooth syndrome is an increasingly common problem and can be very difficult to diagnose in its
early stage.Pain is of short duration but can be very sharp especially on releasing of biting pressure.A
plastic bite stick(tooth sleuth) may be used over individual cusps in an effort to find the offending
one.Lower second molars and upper premolars are frequently affected. Extensively cracked tooth
require extraction;if the crack is less severe then extracoronal restoration may prevent further
progression.
ESTHETICS AND DISCOLORATION OF TEETH

Qno17. A 35 years old female patient attends complaining of gradual discoloration of an upper right
central incisor tooth over the last two years.It is presently symptom free,but she is unhappyabout its
appearance and wishes this to be improved.

1.what questiond would you ask in relation to the history?

2.what investigations would you carry out?

3.what treatment options exist?

KEY:1.-History of trauma:its nature,severity,timing.

-incidence and timing of previous symptoms:sensitivity,pain,gingival swelling,discharge,mobility

-history of previous treatment:restorations,endodontic treatment

-Patient’s views on appearance and improving appearance

2. Investigations would include:

Clinical examination in good light,assessment of degree and nature of discoloration including

comparison with shade guide as necessary,quality of existing restorations,periodontal
status,mobility,presence of gingival sinus

Pulp vitality tests

Radiographs to identify the morphology of the root canal system and the presence of any apical
pathology

Assess the previous dental treatment nature and quality

3.Treatment could include bleeching(internal/external),a veneer or a crown.

Alternatively the tooth could be extracted and replaced with a fixed bridge or RPD.
Q no.18:A 50 years old male patient attends complaining of intermittent discomfort from a lower molar
tooth,mainly on chewing or biting on the tooth in one position.The tooth has ben restored a few years
back with a large MOD amalgam.The pain is sharp in nature,related to one tooth and each episode lasts
only a few minutes at most.

1-What investigations mighy you carry out?

2-What is the differential diagnosis?

3-How would you treat it?

KEY; Clinical examination: assessment of existing restoration(presence of fracture,recurrent

caries,occlusal contacts),assessment of remaining tooth structure(caries,fracture lines,transillumination
and removal of filling if required)

Vitality testing

Radiographs to identify caries,deficient restoration,possible fracture

Occlusal tests

2-Differntial diagnosis includes cracked cusp/tooth syndrome,recurrent caries,reversible pulpitis,possibly

dentine hypersensitivity and less commonly trigeminal neuralgia or atypical facial pain or odontolgia.

3-Treatment will vary with diagnosis:

Most likely cause is a cracked tooth syndrome.Where it simply involves a cusp and fracture is
supragingival,best is to remove the cusp and the fracture line and restore the tooth,with a cuspal
coverage restoration in amalgam or gold,composite or porcelain.

Where the fracture is not immediately evident,but tooth has large restoration,the restoration should be
removed and the cavity floor and walls carefully examined to identify any fracture line.If the fracture
runs longitudinally through the root or subgingivally,the only option will be extraction.
Qno.19;A 20 years old female patient attends with a complaint of severe sensitivity of many
teeth,especially to thermal stimulus(hot & cold).She looks frail and underweight.

1-What might you expect to see intraorally?

2-What might be its etiology?

3-How woul you deal with the patient?

4-How would you deal with her dentition?

KEY: 1-In such cases,extensive erosive tooth wear may be seen affecting almost all natural tooth
surfaces and resulting most commonly from frequent vomiting.

The tooth surfaces may be eroded through to dentine and if condition is severe sensitivity will result
from thermal stimuli from cusp wear.Cusps will be rounded and tooth surface will tend to be smooth
and glossy.

The patient may be dehydrated and have a dry appearance to the skin and oral tissues.

2-A patient of this age who appears very underweight may well suffer from an eating disorder such as
anorexia or bulimia.If this is the case,sensitivity is required in eliciting a history,as the patient may be
reluctant to admit to this.

3-It is important,where possible,to identify the etiology to liaison with patient’s physician to investigate
and treat the case.Failue to do so will make dental treatment more difficult leading to failure.

4-Treatment depends on the extent of erosion and patient’s cooperation.Full or partial veneer
restorations,with minimal preparations(to avoid further loss of tooth tissue) and utilizing dentine and
enamel bonding technology is likely to be required.

Fluoride supplements and oral hygiene advise will be beneficial.

Q no20.Describe nightguard vital bleeching technique.

KEY: Armamentarium

-Upper impression and working model

-Sft mouth guard,avoiding gingival

-Carbamide peroxide gel 10%

Technique:

1-Take alginate impression of the arch to be treated and cast a working model in stone.Re

2-Relieve the buccal surfaces of the teeth by about 0.5mm and make a soft pulldown vacuum formed

Splint as a mouthguard.The splint should not be more than 2mm in thickness and should not cover the
gingival.

3-Instruct the patient how to floss the teeth thoroughly.Perform full mouth prophylaxix and instruct
patient how to apply the gel into mouthguard.

4-Review the patient about 2 weeks later to check that there is no sensitivity and then at 6 weeks,by
which time 80% of any color change should have occurred.