1.1 Tooth does not respond to any sensibility test and there is a buccal sinus tract.
What is the likely
pulpal and periapical diagnosis? (5 marks)
Pulp Necrosis with Chronic Apical Abscess
1.2 What are the desired Endodontic treatment outcomes for a tooth with necrotic pulp? (10 marks)
Clinical Outcomes
Absence of Symptoms: The treated tooth should be asymptomatic, with no pain, swelling, or sinus
tract.
Restoration of Function: The tooth should be restored and functional in chewing without discomfort.
No Signs of Infection: There should be no evidence of inflammation, soft tissue destruction, or isolated
probing defects.
Healing of Sinus Tracts: Any preexisting sinus tract should disappear after treatment.
Radiographic Outcomes
Resolution of Apical Radiolucency: Radiographs should show the healing or disappearance of
preexisting apical radiolucent lesions, indicating successful resolution of periapical pathology with
intact pdl and lamina dura.
No Development of New Lesions: No new apical radiolucencies fractures, root resorption should
appear after treatment.
Proper Root Canal Filling: Radiographic evaluation should confirm adequate length and homogeneity
of root canal filling, ideally reaching the radiographic apex without overextension or underfilling.
Preservation of Tooth Function
Structural Integrity: The tooth should be restored to functional use without evidence of soft tissue
destruction or probing defects.
Longevity: Treatment should extend the lifetime of the tooth by preventing future complications such
as fractures or reinfections.
Increased Root Length and Thickness: Successful regenerative treatments should result in
measurable increases in root wall thickness, root length, and apical closure
2 Why are radiographs important in Endodontics? (5 marks)
Peri-Apical radiographs are indispensable in endodontics for ensuring accurate diagnosis, effective
treatment, and long-term success while minimizing complications.
Diagnosis
Radiographs help identify the tooth involved and the nature of the pathology, such as PARL, caries,
root fractures, or resorptions that may not be visible clinically.They allow visualization of changes in
periradicular tissues, such as apical radiolucencies or loss of the lamina dura, which are indicative of
pulpal or periapical disease.
Treatment Planning
Radiographs provide essential information about root and canal morphology and degree of
calcification, including the number, curvature, and location of canals. Working Length Determination
Ensures that instruments and obturation materials reach the correct length within the canal. Estimate
diagnostic working length by measuring tooth. DWL = Length of tooth - 1mm MAF Radiograph
Confirms proper cleaning and shaping of canals. And if the WL is appropriate A mid Obturation
Radiograph
Postoperative Evaluation
Post-treatment radiographs confirm successful obturation and assess immediate outcomes.
They are used in follow-up visits at 1 week, 3 months, 6 months, 1 year, 2 year to monitor healing of
periapical tissues and detect any recurrence of pathology.
3.1 Sensibility tests are important for pulpal diagnosis. What are 2 signs and symptoms for
Symptomatic Irreversible Pulpitis? (4 marks)
Intense, lingering pain: Pain that persists even after the removal of a stimulus, such as hot or cold.
Spontaneous pain: Pain that occurs without any external trigger
3.2 What are 2 sensibility tests? (2 marks)
Cold test and Electric pulp test
3.3 Why is it important to perform more than 1 sensibility test? (4 marks)
Eliminate false negative and false positive and ensure accurate readings.
3.4 Name a commonly prescribed NSAID for analgesia of odontogenic pain. (4 marks)
Ibuprofen 400-600mg for mild – severe pain, not exceeding 3200mg (with prescription) in 24 hours.
4. What are the radiographic and clinical outcomes of a successful Endodontic treatment? (5 marks)
Clinical Outcomes
Absence of Symptoms: The treated tooth should be asymptomatic, with no pain, swelling, or sinus
tract.
Restoration of Function: The tooth should be restored and functional in chewing without discomfort.
No Signs of Infection: There should be no evidence of inflammation, soft tissue destruction, or isolated
probing defects.
Healing of Sinus Tracts: Any preexisting sinus tract should disappear after treatment.
Radiographic Outcomes
Resolution of Apical Radiolucency: Radiographs should show the healing or disappearance of
preexisting apical radiolucent lesions, indicating successful resolution of periapical pathology with
intact pdl and lamina dura.
No Development of New pathology: No new apical radiolucencies, fractures, root resorption should
appear after treatment.
Proper Root Canal Filling: Radiographic evaluation should confirm adequate length and homogeneity
of root canal filling, ideally reaching the radiographic apex without overextension or underfilling.
5. Working length Using your knowledge on anatomy and dental morphology, explain where you think
the working length should end. (6 marks)
WL is defined as the distance from a consistent coronal reference point to apical terminal point where
C&S should end.
Histologically, a landmark can be the Cemento-Dentinal Junction, however, it is not clinically
verifiable.
Coronal reference point should be any prominent point of the crown - cusp tip, incisal edges
Apical terminal point is a narrowest constriction that provides anatomically natural apical stop 1mm
away from the radiographic apex based on Dummer 1984.
6.1 What are 2 current methods of determining working length? (2 marks)
Measuring a tooth in a diagnostic radiograph
Using an Apex locator
6.2 Explain the steps at which you will take to determine the correct working length. Why is it
important to determine the correct working length? (12 marks)
Using Apex Locator
Preparation:
Ensure proper isolation of the tooth with a rubber dam to prevent interference from saliva.
Establish adequate coronal access to the root canal system.
Remove debris and irrigate the canal to enhance the accuracy of the apex locator.
Instrument Placement:
Insert a small file (e.g., size 10 or 15) into the canal until resistance is felt.
Attach the file to the apex locator, ensuring proper connection between the device and the file,
clipping the other end to the patient’s mouth.
Measurement:
•Slowly advance the file toward the apex while monitoring readings on the apex locator.
The device will indicate when the file reaches the apical foramen (major diameter). Adjust the file
length to terminate at the apical constriction (minor diameter), which is typically 0.5–1.0 mm short of
the foramen.
Using Radiographs
Initial Measurement:
Examine diagnostic radiographs to estimate root length and anatomy.
Set a tentative working length by placing IAF into the canal at 1mm below this diagnostic working
length
Radiographic Verification:
Take a working length PA radiograph.
Evaluate the radiograph to check the position of the file tip relative to the apex.
Adjustment:
If the file tip is too long (beyond apex), subtract 1–2 mm from its length; if too short, add 1–2 mm.
Repeat radiographs as necessary until optimal working length is confirmed at or near the apical
constriction.
Importance of Determining Correct Working Length
Over-instrumentation causes extrusion, damaging periapical tissues, introducing postoperative pain,
or lead to overfilling beyond the apex.
Under-instrumentation leaves infected material, necrotic tissue, and debris in apical regions,
increasing failure risks due to persistent infection.
7.1 Irrigating agent What are the characteristics of an ideal irrigating agent? (6 marks)
Antibacterial activity
Tissue dissolving
Low surface tension
Non-staining
Non-cytotoxic/non-mutagenic
Non-corrosive to dental instruments
7.2 What is the irrigating agent used most commonly? What concentration is it used at? (2 marks)
Sodium Hypochlorite 1%
7.3 Name the intracanal medicament frequently used. Explain how it is effective and how you would
apply it in the root canal. (8 marks)
Calcium Hydroxide – interim intracanal medicament as long a apical prep is achieved.
Alkaline pH 12.5 elicits antimicrobial effects, kills microbes on direct contact
Tissue dissolving
Low solubility in water allows it to be applied as a paste to fill canal space
Synergistic effect with NaOCL
Prevent proliferation of bacteria in the inter appointment period
Armamentarium
Hand files 1-2 sizes smaller than the MAF size at WL or 1mm shorter
Glass slab and spatula
Procedures
Available in diff forms
Powder mixed with sterile water or local anaesthetic solution to form a thick paste
Commercial preparations - Pulpdent and Ultracal
Filling the root canal with CaOH2 paste using lentulo spiral or counterclockwise rotation of hand files
will suffice for canal disinfection
Remove excess using spoon excavator or cotton pellet dipped in NaOCL
If objective is apexification, CaOH2 can be carried with an amalgam carrier to the orifices and packed
into the root canals with an endo plugger
Placed for at least 1 week
CaOH2 paste can be removed from the root canal by copious irrigation and slight circumferential filing
using files 1-2 sizes smaller than MAF
8 List all the dental luxation injuries (5 marks)
Concussion, subluxation, extrusion, lateral luxation, intrusion
Dentine hypersensitivity
Name the nerve fibres in the pulp and explain what are the various types of pain associated with
them. (12 marks)
Myelinated A fibres (25%) Found at the pulp-dentin border, especially in the coronal pulp
10% A Beta: pressure and pulp horns.
90% A Delta: fast, short, sharp, pricking pain
Stimuli: External triggers such as cold, heat, or mechanical stimulation.
Clinical Relevance: Indicates early-stage pulpal irritation or reversible pulpitis.
Unmyelinated C fibres (75%) Found deeper in the pulp core and around blood vessels.:
delayed, lingering, dull, aching, throbbing pain
Stimuli: Internal triggers like inflammation or tissue damage caused by irreversible pulpitis or necrosis.
Clinical Relevance: Often associated with late-stage pulpal inflammation or infection.
9. Explain the theory of dentine hypersensitivity (8 marks) Dentine hypersensitivity - short,
exaggerated, sharp painful response elicited when exposed dentin is subjected to thermal,
mechanical or chemical stimuli
Hydrodynamic theory
Stimuli removes dentinal fluid from outer ends of tubules, activates hydrodynamic fluid movement,
outward flow due to high capillary forces
Mechanical distortion of the tissue stimulating the myelinated Ad fibres in the pulp/dentin border
Cold, air blast/evaporation, tactile/restorative, sweet/hypertonic pulls away while heat expands
Outward excites more than inward flow
Direct innervation (neural theory)
A delta fibres enters inner 1/3 , some may extend all the way to DEJ. Fast conduction, sharp pain -
early detection of nociceptive stimuli
C fibres within pulp core and cell free zone. Slow conduction, dull pain - gives pulpitic (toothache)
symptoms only during pulpal inflammation
Does not respond to hydrodynamic stimulation of dentin Release neuropeptides in inflammatory
reaction - enhance defensive mechanism of promote inflammation
