The root canal system is exposed during root amputation and therefore the patient must immediately

undergo root canal therapy to ensure that no bacteria will enter the canal system.

Resection of a root with a hopeless or questionable prognosis in its periodontal condition will save
the whole tooth from being extracted.

Periodontal therapy should follow immediately after root canal treatment is accomplished in order to
stop or prevent further periodontal damage.

Formation of reparative dentin only occurs when the odontoblasts in the pulp are still vital.

Reparative dentin is laid down by the odontoblasts in the pulp to protect the pulp and keep it away
from the harmful stimuli.

For a 5-year-old, extraction of the primary maxillary central incisor is indicated when the tooth is
associated with a sinus tract and discoloration. It is not advisable to retain this diseased tooth
considering the age of the patient and the proximity of the permanent successor. Retention can lead to
abnormal formation of the permanent tooth

In Turner tooth (Turner hypoplasia), the permanent tooth bud is affected by an infection or a trauma to
a primary tooth. Infection most commonly affects the canine, and trauma most commonly affects the
maxillary central incisor.

 #6 Pink
 #8 Gray
 #10 Violet
 #15 White     
 #20 Yellow    
 #25 Red        
 #30 Blue       
 #35 Green   
 #40 Black     
 #45 White
 #50 Yellow
 #55 Red
 #60 Blue
 #70 Green
 #80 Black

Following the #40 file, the colors repeat from white.

Intrusive luxation occurs when the tooth is pushed into the socket, damaging or severing the vascular
supply of the tooth and resulting in pulpal necrosis. In children, intrusive luxation of permanent teeth
almost always leads to pulpal necrosis.
An avulsed tooth with an open or incompletely formed apex will have a better chance of
revascularization when replanted immediately and will not always result in pulp necrosis. The more time
that passes between injury and replantation, the greater the probability of pulp necrosis and ankylosis.

The distal surface of the mesial root of the mandibular first molar is most likely to undergo strip
perforation during root canal instrumentation.

The mesial surface of the distal root and the distal surface of the mesial root in the mandibular first
molar have a root concavity, making the dentin walls very thin. Overenthusiastic root canal
instrumentation (overcutting) can lead to strip perforations in these areas and should be avoided.

Endodontically treated teeth with cast post-and-core restorations that occlude under heavy occlusal
stresses may end up with a vertical root fracture. Cast post-and-core restorations are solid restorations
that completely adapt into the canal system.

Occlusal and shear forces encountered by the cast post-and-core are immediately transmitted to the
weakened endodontic tooth, resulting in a vertical root fracture.

Apexogenesis is a procedure used in cases involving developmentally immature teeth with open
apices in which the inflamed pulp is partially removed, either by several millimeters locally or the
pulp chamber in the coronal portion of the tooth depending on the situation. A medicament like
mineral trioxide aggregate (MTA) is then placed until the tooth root finishes forming and a full root
canal procedure can be performed. 

Apexification is a procedure in which calcium hydroxide or MTA is placed in the apical end of a tooth
to close the apex of teeth with a necrotic pulp. The MTA or calcium hydroxide creates a barrier to
condense against so that the tooth can be immediately filled with a biocompatible material such as
gutta percha so the tooth will be restored permanently.

Direct pulp capping is a procedure in which a vital pulp that is mechanically exposed is capped with
calcium hydroxide and a base to promote secondary dentin formation.

Indirect pulp capping is a procedure in which a pulp capping material is placed over an area where,
during caries excavation, the clinician leaves affected dentin that is approaching the pulp so that it
can be remineralized, so that a root canal can be possibly avoided.

Pulpotomy is a procedure commonly performed on a carious primary tooth in which the pulp
inflammation extends only in the crown.

The presence of lymphocytes and plasma cells denote infection is present.

The cell-free zone is located within the pulp complex and beneath the odontoblasts.

The undifferentiated mesenchymal cells are also normally present within the pulp. They are reserved
cells that differentiate into another type of cell when it is needed by the pulp.
A depth of at least 3 mm into the root canals is essential for the retention of an amalgam restoration
in an endodontically treated tooth.

Amalgam depends upon mechanical retention because it does not demonstrate chemical bonding
with the tooth structure.

After completion of root canal treatment, roughly 3mm of gutta percha should be removed from the
root canals using a heated instrument.

The space created in the root canal should be filled and condensed with amalgam before carrying
out coronal filling (Nayyar core technique).

A 0.02 taper indicates an increase of 0.02 mm in diameter per 1 mm of file length.

The taper describes the amount the file diameter increases with each millimeter, from the tip of the file
toward the handle.

Recapitulation serves to maintain canal patency.

Recapitulation also prevents the deposition of dentin chips and filings that may cause blockage of the
canal during step back canal preparation.

Performing recapitulation after each file is used prevents canal preparation errors like apical
transportation, incomplete instrumentation, and underfilling during obturation.

Internal resorption in a tooth requires complete pulp removal, followed by a root canal procedure.
Pulpotomy does not completely remove the pulp, so the internal resorption will persist and probably
progress if the pulp is not totally removed.
Endodontically treated teeth are weaker and more prone to fractures when excessive condensation
force is used during obturation.

The width of the prepared root canal compared to the remaining tooth structure also affects the ability
of the endodontically treated tooth to withstand condensation forces.

During the condensation of the gutta-percha, the force exerted during the compaction of gutta-percha is
transmitted back to the walls of the tooth.
Traumatized immature teeth may give a false reading with thermal and electric vitality tests.
Although their blood supply may still be intact, their nerve may not respond. As circulation is restored
to the tooth, responsiveness may return after two weeks. Apexification and pulpectomy are
not indicated at this time because the pulp might still be vital.

An alkaline environment created by the placement of calcium hydroxide helps to mineralize the root
apex.

Apexification induces the closure of the root end of a pulpless tooth by calcifying the root apex.

Calcifying the apex improves the success of the root canal by allowing a firm place against which the
gutta percha can condense.

Ledges can be bypassed by pre-curving a smaller file to probe past the ledge.

The canal coronal to the ledge must also be straightened to allow a file away from the curve.
If the ledge cannot be bypassed, the canal should be cleaned and filled up to the ledge

Chronic apical abscesses present with sinus tracts that eventually drain into the oral cavity although they
may drain into the gingival sulcus (which may imitate a periodontal abscess).

Teeth with sinus tracts do NOT require antibiotics because the infection drains.

Apical periodontitis (acute or chronic) should be treated with root canal therapy.

If the tract does not heal within a month or so, root-end surgery should be performed.

Teeth with chronic apical periodontitis may develop an epithelial lining and form a true periodontal
pocket if they are left untreated.

Barium is added to gutta-percha to make the material opaque on x-ray films. Gutta-percha is an
obturation material that is composed of the following: 

 Zinc oxide (70%)

 Barium sulfates (5%)
 Waxes, resins, and gutta-percha (24%)

Evaluating obturation requires assessment of the following:

 Fit of gutta-percha points

 Density of gutta-percha fill
 Level of gutta-percha in the canal
Root canal treatment is documented to be a low-risk intervention for hemophiliac patients. It is
completely safe to carry out non-surgical endodontic treatment in this patient.

Non-surgical root canal treatment is indicated for treatment of necrotic pulp with apical periodontitis.

Vitamin K administration does not affect hemophilia A and B.

Hemophilia can be treated by the addition of the missing clotting factors.

Maxillary canines demonstrate the most consistent root canal morphology.
Dental pulp is a connective tissue that plays a defensive role through forming reparative dentin in
response to carious insult.

The pulp demonstrates a formative function because it is involved in the formation of the primary and
secondary dentin by odontoblasts.

The pulp demonstrates a nutritive function because it supplies nutrients necessary to maintain the
nerve cells in the pulp as well as maintain the odontoblasts which form the dentin.

The pulp demonstrates a sensory function by perceiving stimuli produced by heat, cold, and pressure
A tooth eliciting no pulpal symptoms and mobility must be reevaluated after eight weeks to ensure that
the tooth is vital and requires no other treatment.

If the tooth tests non-vital due to the horizontal midroot fracture, the prognosis of restoring the tooth
decreases significantly.

If the tooth remains vital, calcific healing might have occurred at the site of the fracture. It is a type of
healing in which calcific calluses develop along the fracture site.\
The success of a pulpotomy procedure lies on the ability of the remaining healthy pulp to remain vital
and not irreversibly inflamed after the procedure.

Partial pulpotomy is a procedure that removes only the portion of the coronal pulp that is infected and
inflamed, which keeps the radicular portion vital.

Covering the pulpotomized tooth with a stainless steel crown (SSC) may increase the chance for success
of treatment.
The fibroblasts in the pulp continue to produce fibrous connective tissue and ground substance,
increasing them compared to the other substances within the pulp.
The size of the pulp decreases as we age due to the continuous formation of secondary dentin and the
formation of reactionary dentin related to caries and other dental trauma.
A decrease in pulp size also decreases the vascular supply, nerve fibers, and overall cellularity of the
pulp.

Apexogensis describes the procedure where a pulpotomy is performed and the chamber is filled with
a layer of mineral trioxide aggregate (MTA), leaving the root intact and still able to finish forming.

A 2+ mm exposure is too large to consider pulp capping.

Apicoectomy(root-end surgery) is contraindicated because there is a vital pulp.

Apexification involves the addition of calcium hydroxide to the canal after the pulpal tissue is
completely removed. Application of calcium hydroxide induces calcification across the apex and
formation of a calcific barrier. Root canal therapy is completed following calcification of the apex.

Apexification is contraindicated in cases where there is the following:

 A vital pulp
 Very short roots
 Marginal periodontal breakdown

Apical perforation during endodontic instrumentation can result in the following:

Trauma to the periapical ligament

Trauma to the apical tissues
Enlargement of the apical perforation
Patient discomfort
The most important factor for developing an aseptic root canal is the complete debridement of the
canal and removal of the diseased dentin.

The mechanical debridement of the canals is provided by files and reamers.

Sodium hypochlorite irrigation has a secondary role to disinfect the canals, but the primary method for
disinfection is mechanical removal of diseased tissues.

The apical foramen of the root canal does not usually lie along the long axis of the tooth but is usually
situated approximately 0.5–1 mm short of the root apex.
Periapical radiolucencies can only be visualized after the cortical bone surrounding the root apex is
destroyed and the infection extends into the cancellous bone of the periosteum.
Prolonged unstimulated pain is associated with cases involving pulpal necrosis or irreversible pulpitis.
Pulpal necrosis describes the death of pulpal cells.
The pain associated with pulpal necrosis is often periapically derived. In cases of reversible pulpitis, the
pain subsides after removal of the stimulation.
Accessory canals that are not obturated may lower the chances of a successful root canal treatment.

It is best to observe and evaluate the root canal-treated tooth prior to re-obturating the canal even if
the accessory canal was not included during obturation. Observation is best because the complete
sealing of the main root canal might be sufficient to prevent bacterial reinfection.

The only way to know whether the root canal treatment has been successful is by having recall and
radiographic evaluation to assess bone healing and absence of active infection.
When the apical seat is accidentally removed, the ability to create a hermetic seal at the apex is
compromised. In order to avoid this procedural error, a shorter length of file should be used to establish
a correct working length.

The correction of working length eventually helps re-establish the apical seat. Then adequate flaring of
the apical portion of the canal can be done with the use of larger-sized hand files.
Replacement resorption of the root in its final phase is seen on the radiograph as a root without a
surrounding lamina dura. It occurs in response to dental trauma or severe damage to the periodontium.
The bone grows and attaches to the root, causing ankylosis.

Replacement root resorption happens more commonly among patients who suffered severe cases of
avulsion and luxation.
Cells found in the dental pulp include fibroblasts (the principal cell), odontoblasts, defense cells like
histiocytes, macrophages, granulocytes, mast cells, and plasma cells.

The nerve plexus of Raschkow is a plexus of myelinated nerve fibers located in the cell-rich zone
between the core of the pulp and the cell-free zone. Axons of the Raschkow plexus lose their myelin
sheath (but not their Schwann cells) as they penetrate the cell-rich and cell-free zones to make synaptic
contact with the odontoblast cell body in the pulp or odontoblastic process within the dentinal tubule.

The plexus of Raschkow monitors painful sensations as well as mediation of inflammatory events and
subsequent tissue repair.

Two types of nerve fibers that mediate the sensation of pain as follows:

A-fibers: myelinated nerves that conduct rapid, sharp pain sensations

C-fibers: thinner, non-myelinated nerves involved in dull, aching pain
The A-fibers (mainly A-delta type) are located in the periphery of the pulp where they are in close
association with the odontoblasts and extend fibers to many but not all dentinal tubules.

The C-fibers typically terminate in the pulp tissue proper, either as free nerve endings or as branches
around blood vessels.
During a vitality test, the lack of pulpal response in a tooth that recently experienced trauma can be
attributed to the injury within the tooth’s nerve fibers. An immediate vitality test might be inaccurate,
so subsequent vitality tests should be conducted to evaluate pulp status. At least eight weeks might
pass before the tooth displays normal pulp response.
EDTA is a chelating solution used to remove inorganic components.

Sodium hypochlorite is used to do the following:

 Dissolve the organic matter

 Kill bacteria
 Lubricate the canal
 Irrigate the canal

Root canal therapy is indicated to treat cases involving internal resorption.

When a carious lesion approximates or extends into the pulp chamber of a deciduous tooth, removal
of coronal pulp is performed to prevent the spread of the infection into the radicular pulp.

Pulpotomies are performed on deciduous teeth to prevent premature tooth loss and potential loss of
space.

Careful clinical and radiographic assessment, along with the child’s medical and dental history, are
necessary before performing a pulpotomy.

Pulpotomy is contraindicated where the following are found:

 Internal resorption (root canal therapy indicated)

 Perforation of pulp chamber floor
 Over one-half root resorption
 Cellulitis
 Localized abscess
 Draining sinus
 Inability to isolate the tooth
 Inability to properly restore the tooth after the procedure

The walking bleach technique is an intracoronal bleaching technique which utilizes a mix of sodium
perborate and anesthetic or sterile water to create a paste to be sealed into the pulp chamber for 14-21
days.

The walking bleach technique should be repeated as necessary until the desired tooth color is attained.

The walking bleach technique is used on teeth that have already undergone endodontic therapy and
does not lighten staining due to previous amalgam placement.

External root resorption may occur if the canal is NOT obturated properly or if 30% hydrogen peroxide
(superoxol) is used.

Superoxol (30% hydrogen peroxide) was used for many years for internal bleaching, but was
discontinued due to the high incidence of external root resorption.

Carbamide peroxide is used for vital tooth bleaching (external bleaching).

Electric pulp testing within an hour of a luxation injury is contraindicated because of the inconsistent
findings.
A positive response from electric pulp testing is indicative of retained vitality and does not differentiate
between the following:

Normal pulps
Reversible pulpal inflammation
Irreversible inflammation
A negative response may not always indicate pulpal necrosis, because many teeth take about two
months to respond to electric pulp testing again.

Electric pulp testing gives the status of the pulpal nerve fibers, not the blood supply of the tooth. Pulpal
response to electric current only suggests the presence of some viable nerve fibers that are capable of
responding to electric current.

Irreversible pulpitis is easier to determine through sensitivity tests like the heat and cold tests.

The pain perceived by a healthy vital pulp during a cold test or heat test is usually short in duration,
and it does not linger.

The pain perceived by a tooth with irreversible pulpitis during a cold test or a heat test is more
intense and lingers even after the stimulus is removed.

Calcific metamorphosis is a common condition observed in teeth that have experienced trauma and is
characterized by an abnormal hard tissue formation and deposition in the pulp space that either
partially or completely fills it.

Calcific metamorphosis occurs when trauma induces odontoblasts to rapidly form extensive amounts of
reparative dentin, causing the pulp to appear smaller and at some point to be obliterated entirely.

Calcific metamorphosis may occur when the fragments of fractured roots are in tight contact with one
another if the apical portion of the tooth is still vital. The calcification closes the fracture line and
stabilizes the connection of the two fragments of the root.

The key cells involved in tooth resorption are odontoclasts. Pathologic resorption can occur following
traumatic injuries.
Debris is forced in a coronal direction when rotating intruments are used in a clockwise direction and
vice versa.

K-files have both reaming and filing actions when used during root canal preparation. Reamers only
cause enlargement of root canals, producing a round shape. Reamers cannot be used in a filing motion.

To prevent broken or separated instruments, an instrument that is locked into the dentin should not be
rotated.
When a permanent tooth is intruded, the most probable result is pulpal necrosis, because the blood
vessels supplying the pulp are impeded.

Intrusion of primary teeth does not typically result in necrotic pulp, because the blood flow is better
because of the open apex.

90% of intruded primary teeth re-erupt after two to six months.

Calcific metamorphosis (CM) of the dental pulp is a common reason teeth appear yellow after
trauma occurs and is recognized clinically as early as three months following injury.

CM is characterized by the deposition of hard tissue within the root canal space of a tooth, causing
yellow discoloration of the clinical crown. Approximately 3.8% to 24% of teeth that experience
trauma exhibit varying degrees of C

The most common side effect of internally bleaching a tooth with superoxide is external cervical root
resorption.

Resin root canal sealers typically do not demonstrate antimicrobial properties.

Root canal sealers are typically used during root canal procedures to fill canal irregularities between
the root canal wall and gutta-percha.

Sealers also acts as lubricants to facilitate the accessory gutta-percha points to slide into the canal.

Sealers may express into the accessory or lateral canals that are too small to be instrumented.

The access preparation design for the mandibular first molar is trapezoidal and follows the position
of the cusp tips.

The mandibular first molar possesses five cusps with pulp horns underneath each cusp. The access
preparation must expose the whole pulp chamber, so the position of cusps is used as a guide for the
access prep outline.

Mandibular first molars usually have two roots: a mesial and distal root. The mesial root has
mesiobuccal and mesiolingual canals that are both located under the cusps’ tips that bear the same
name. The distal root typically has one very large canal or two root canals.

Barbed broaches are instruments with sharp points that are used to engage and remove pulp tissue.

The broach should be slightly smaller than the canal because it would otherwise engage the dentin walls
and become stuck and possibly separate.

K-files are used to engage the dentinal walls of the canals and to remove the diseased dentin.