Endodontic Complications Self Assessment

Instr. fracture
 TrueFalse
Risk for perforations is greater in teeth with calcified (obliterated) pulp chamber and canals than in normal
Improper use of instruments is a common cause for perforations
Flexible files with non-cutting tip cannot cause apical perforations
Presence of an infection may reduce prognosis of perforation treatment
Above (coronally to) marginal bone level, composite materials must be considered in perforation treatment
As MTA is mixed with water, it is sensitive to additional moisture at the perforation site
Composite materials are sensitive to moisture
Instrument fracture is a potential problem only with NiTi instruments
Instrument fracture is a potential problem only with steel instruments
Instrument fracture is usually a result of faults in the manufacturing process
Hedstroem files fracture easier in filing than in rotary motion
Both small and large diameter instruments may fracture
Instrument fracture always reduces the prognosis of the treatment
It is not always necessary to remove the fractured instrument
Instrument fracture is potentially more harmful in pulpitis than in a necrotic tooth with apical periodontitis
The patient must always be informed about the fracture and its possible consequences
Specially designed, titan or steel ultrasound tips are useful for removal of fractured instruments
If the fractured instrument cannot be removed, surgery is always indicated
Calcification
 TrueFalse
Pulp space becomes gradually smaller during ageing
Calcification of the root canal is an indication for endodontic treatment
Canal obliteration always results in apical periodontitis
Only necrotic teeth may get calcified canals
Formation of secondary dentine is the only possible cause for disappearance of the pulp space
Revascularization often results in the development of osteoid tissue in the root canal
Chronic pulpitis typically speeds up calcification process
When the pulp cannot be detected in the radiograph, it cannot be found and instrumented clinically
Secondary dentine filling the previous canal space has a darker color than surrounding dentine.
Small K-files must be used only with a filing (up-down) motion
Small K-files must be used only with a balanced force technique
Only very light force needs to be used with small K-files
Small K-files in calcified canals must be used with a combination of balanced force and filing
Fiber optic light can be very useful to help to locate calcified canals
Operative microscope is an invaluable tool to locate difficult cases of calcified canals
Overinstrumentation
 TrueFalse
Overinstrumentation may result in bleeding into the canal
Overinstrumentation of ca 1 mm may sometimes help drainage of pus through the root canal in acute apical periodontitis
Multifrequency apex locators are not reliable for determining WL
Overinstrumentation never increases risk for overfilling
Overinstrumentation always increases risk for overfilling
Use of silicone stoppers may help to prevent overinstrumentation
WL radiograph is important in preventing overinstrumentation
Overinstrumentation may result in destruction of the natural apical foramen
Overfilling
 TrueFalse
Overfilling with sealer is a typical cause of severe, post-treatment pain
Sealer surplus will always be resorbed from the periapical tissues by host cells
Too small master GP cone may be one reason for overfilling
In cases of open apex, apexification may be advisable to secure against overfilling
Overfilling with gutta percha is statistically not related to poorer prognosis according to epidemiological studies
Abscess
 TrueFalse
Apical abscess is a result of imbalance between root canal microorganisms and host's defense
Systemic antibiotics should be routinely used with abscesses
Fluctuating abscesses should be incised when no sinus tract is present
No drainage establishment is required after abscess incision
Chemomechanical preparation should be optimally finished at the first appointment in cases with an abscess
Instrumentation techniques can effect the risk of abscess formation (flare-up)
Spreading infections
 TrueFalse
Spreading endodontic infections are common in endodontics
Spreading endodontic infections occur only after beginning of the treatment
Spreading endodontic infections are caused by aerobic bacteria
Spreading endodontic infections are often caused by Fusobacteria and (pepto)streptococci
Spreading endodontic infections are more difficult to detect than local abscesses
Spreading endodontic infections may require treatment in hospital
Spreading endodontic infections may require antibiotics in high doses, sometimes i.v.
Persistent infections
 TrueFalse
The cause of persistent infection may be residual microbes in the root canal system
The cause of persistent infection may be surviving microbes in the periapical area
In periapical actinomycosis the microbes are primarily surviving in the root canal
Persisting infections are always symptomatic
Completing chemomechanical preparation at the first appointment is important for preventing persistent infections
Periapical surgery is always the first choice in persistent infections
Microbial complications
 TrueFalse
Coronal leakage is a typical microbiological complication in endodontics
Inability to use rubber dam is a common cause for microbiological complications
Rubber dam is not important for successful endodontic treatment
Apical preparation is not important for infection control
Canal should be completely filled with calcium hydroxide for best effect
From an antibacterial point of view it is enough to have calcium hydroxide in the pulp chamber and coronal canal
Cotton pellet under temporary filling increases risk for leakage
Part of the pulp chamber in multirooted teeth can be filled with gutta percha and sealer
Aseptic complications always lead to periapical surgery to save the tooth
Tooth discoloration
 TrueFalse
Tooth discoloration after endodontic treatment is typically caused by residual pulp tissue in pulp horns
Paraformaldehyde containing sealers may cause tooth discoloration
Silver containing sealers may cause tooth discoloration
30% hydrogen peroxide is an etiologic factor in cervical resorption
Necrotic tooth without endodontic treatment cannot become discolored
"Walking bleaching" is often effective treatment for discolored endodontically treated teeth