NATIONAL UNIVERSITY OF SINGAPORE

FACULTY OF DENTISTRY
ENDODONTICS
Final Year Term I Tutorial
Weeks 3-5
Topic: Endodontic case selection and treatment planning
Specific Learning Objectives:
1. To apply knowledge of Oral Microbiology to Treatment Decision-making and Canal
Instrumentation
2. To perform pretreatment evaluation for optimal case selection
3. To identify potential challenges of instrumentation
Reading list:
1. Walton RE & Torabinejad M
Chapter 3 Endodontic Microbiology by Siqueira & Fouad
Principles & Practice of Endodontics 5th Edition 2015
2. Bergenholtz G, Hrsted-Bindslev P, Reit C
Chapter 7 Apical Periodontitis by Metzger Z, Abramovitz I & Bergenholtz G
Textbook of Endodontology 2nd Edition 2010
3. Bergenholtz G, Hrsted-Bindslev P, Reit C
Chapter 18 Endodontic Decision-making by Reit C
Textbook of Endodontology 2nd Edition 2010
4. Walton RE & Torabinejad M
Chapter 22 Evaluation of Endodontic Outcomes by Torabinejad & White
Principles & Practice of Endodontics 5th Edition 2015
Style: Interactive and learner-centred. Students decide how much they want to learn.
Recommended preparation:
1. Read the recommended text and critically review the content in view of the specific
learning objectives.
2. Examples from past Final BDS exams have been included for individual and/or group
exercise. If the group so desires, answers may be prepared by the group for
presentation and discussion at the seminar. From past experience, this is only possible if
the group comes prepared to participate in the main seminar.

2016/May

Past Final BDS Exam Questions:

April 2014
1. In a meta-analysis to quantify the influence of the clinical factors on the efficacy of primary
root canal treatment entitled Outcome of primary root canal treatment: systematic review of the
literature -- Part 2. Influence of clinical factors. (Int Endod J. 2008 Jan; 41(1):6-31.), the
authors, Ng et al. concluded that four conditions were found to improve the outcome of primary
root canal treatment significantly. These four conditions were:
Absence of periapical radiolucency. The odds of success of vital teeth was 2.35
(95% CI: 1.77-3.13) times higher than nonvital teeth with pre-operative periapical
lesions. The odds of success of nonvital teeth without periapical lesions was 1.95
(95% CI: 1.35-2.81) times higher than nonvital teeth with periapical lesions.
Root filling with no voids had odds of success 3.92 (95% Cl: 2.26-6.78) times
higher than root fillings with voids.
Root filling flush (defined as up to 2 mm from the radiographic apex) had odds of
success 1.56 (95%CI: 1.26-1.94) times higher than teeth with short root filling (>
2mm from the radiographic apex) but only in teeth with pre-operative periapical
lesions. There were no significant differences if the teeth had no periapical lesions.
Satisfactory coronal restoration - the odds of success were 1.82 (95%CI: 1.482.25) times higher than unsatisfactory coronal restoration.
a)
Use your knowledge of the pathogenesis of pulpal disease, microbiology, root canal
anatomy and current root canal treatment protocols to evaluate the possible reasons for lower
success of root canal treatment in teeth with periapical lesions than when performed in teeth
without periapical lesions.
(70 marks)
b)
Discuss how the quality of the coronal restoration and the quality of the root filling could
affect the success of root canal treatment. (30 marks)

2016/May

May 2016
2.

The
above
micro-CT images are annotated with numbers that describe the number of main canals in the
root canal system at the coronal, middle and apical thirds. The 4th digit at the apex indicates the
number of main foramina. Main foramina had a minimum diameter of 0.2mm. Micro-CT images
of the mandibular 1st molars and excerpt are taken from Wolf et al., 2016 (J Endod 2016; 42:
610-14).
a) Discuss the impact of root canal configuration on biological and mechanical goals of root
canal treatment.
[60 marks]
b) Explain how contemporary instruments like nickel-titanium and stainless steel files are
effectively used by clinicians to achieve the goals of root canal debridement. [30 marks]
c) Explain the role of sodium hypochlorite in biomechanical root canal debridement.
[10 marks]

2016/May