In the normal dental pulp, which of thefollowing histologic features is (are) the lestlikely to appear
:A) Cell-free zone of Weil
B) Palisade odontoblastic layer
C) Lymphocytes and plasma cells***
D) Undiffentiated mesenchymal cells
Which of the following cells arecharacteristic of chronic inflammation of thedental pulp:
a) Neutrophils
b) Eosinophils
c) Lymphocytes
d) Macrophages
e) Plasma cells
1) a,b,c & d
2) a,b, & d only
3) a,b, & e only
4) a, c & e
5) c, d & e only***
Efferent nerves found in the dental pulpare:
- sympathetic post ganglionic fibres
TYPES OF DENTIN
PRIMARY
SECONDARY
TERTIARY
– REACTIONAR
– REPARATIVE
TUBULARY PERITUBULAR
INTERTUBULAR
GLOBULAR
INTERGLOBULAR
SCLEROTIC
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ACCESSORY CANALS
- Studies indicated that patent blood vessels course in lateral or accessory canals connecting the coronal and/or radicular pulp with the PDL
-They appear to be distributed at any level ofthe root as well as on the floor of the pulpchamber
Distribution of lateral canals
– 17% in the apical third
– 8.8% in the middle third
– 1.6% at the coronal portion
ACCESSORY CANALSY A non-carious tooth with deep periodontal pockets that do not involve the apical third ofthe root has developed an acute pulpitis. There is no history of trauma other than a mildprematurity in lateral excursion.
What is the most likely explanation for the pulpitis?
1) Normal mastication plus toothbrushing has driven microorganisms deep into tissues with subsequent pulpinvolvement at the apex.
2) During a general bacteremia, bacteria settled in this aggravated pulp and produced an acute pulpitis.
3) Repeated thermal shock from air and fluids getting intothe deep pockets caused the pulpitis.
4) An accessory pulp canal in the gingival or the middlethird of the root was in contact with the pockets.***
APICAL FORAMEN
Initial instrumentation in endodontictx is done to:
a) Radiographic apex
b) Dentino-enamel junction
c) Cemento-dentinal junction***
d) Cemento-pulpal junction
CEMENTUM
CELLULAR – APICAL THIRD OF ROOT
ACELLULAR
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TOOTH ANATOMY
MANDIBULAR 1st MOLARY
Approximately what per cent of mandibular first molars exhibit two distal canals?
1) 0
2) 0.1
3) 0.3***
4) 0.6
5) 0.75
MAX 1ST MOLAR
- BUCCAL HOOK
PALATAL ROOT
4 CANALS
MB1 (MB);
MB2 (ML)
74% 2nd canal– Half have a separate foramen
The most common curvature of the palatal root of the
maxillary first molar is to the
1) facial***
2) mesial
3) distal
4) lingual
MAX FIRST BICUSPID
- EASIEST TOOTH TO PERFORATE
MESIAL CONCAVITY
CANAL NUMBER: 90% 2, 10% 1
RADIOGRAPHY SLOB / Clark’s Rule/BUCCAL OBJECTRULE
CONE SHIFT
The teeth that are easiest to perforate by slight mesial ordistal deviation from proper angulations of a bur are mandibular incisors and maxillary first premolars
MAX LATERAL INCISOR
POSSIBLE SEVERE DISTALCURVATURE IN APICAL 1/3
CURVE MAY HAVE A PALATAL ASPECT TO IT
MAX LATERAL INCISOR
Which of the following teeth are the least likely to have more than 1 canal
1) Maxillary lateral incisors***
2) Mandibular lateral incisors
3) Mandibular first premolars
4) Maxillary second premolars
5) Maxillary second molars
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MOST CONSISTENT ROOTCANAL ANATOMY
MAXILLARY CUSPID DIAGNOSIS DIAGNOSIS➢ PULP➢ PERIRADICULAR➢ ENDO- PERIO➢ REFERRED PAIN➢ SINUS TRACTS➢ CYST AND GRANULOMA➢ RESORPTION➢ NON-ODONTOGENIC➢ ANKYLOSIS
PULP DIAGNOSIS
NORMAL
REVERSABLE PULPITIS
IRREVERSABLE PULPITIS
NECROTIC
PULP DIAGNOSIS
Which is most likely to cause pulp necrosis:
1)Intrusion
2)Extrusion
3)Lateral displacement***
4)Concussion
Prolonged, unstimulated night pain suggests which ofthe following conditions of the pulp?
1)Pulp Necrosis***
2)Mild hyperemia
3)Reversible pulpitis
4)No specific condition
PERIRADICULAR DIAGNOSIS
*ACUTE PERIRADICULAR PERIODONTITIS
*ACUTE APICAL ABSCESS
*CHRONIC PERIRADICULAR PERIODONTITIS
*CHRONIC PERIRADICULAR ABSCESS
– SUPPURATIVE PERIRADICULAR PERIODONTITIS
SUBACUTE PERIRADICULARPERIODONTITIS
* NORMAL
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PERIRADICULAR DIAGNOSIS (contd)
How to differentiate between acute apical abscess and acute periodontal abscess:
- Pulp vitality test***
-Percussion is a dental diagnostic procedure used indetermining whether periodontitis exists!
The pathognomic symptom of chronic apical periodontitisis:
1)Swelling
2)Intermittent pain
3)Tenderness to palpation
4)Tenderness of percussion***
5)None of the above
Radiographs reveal a deep, distal carious lesionon the suspect tooth. The apical periodontal ligament appears normal most probablediagnosis for the condition of the pulp and theapical periodontal ligament is
1)Vital pulp
2)Necrotic pulp
3)Irreversibly inflamed pulp
4)Inflamed apical periodontal ligament
5)Uninflamed apical periodontal ligament
a)1& 4
b)1 & 5
c)3 & 4
d)3 & 4
e)3 & 5***
ENDO PERIO
PRIMARY ENDO
PRIMARY PERIO
PRIMARY ENDO – SECONDARY PERIO
PRIMARY PERIO – SECONDARY ENDO
TRUE COMBINED LESION
PULP TEST - PROBE
--------------------------------------------------------------------------------
ENDO PERIO
REFERRED PAIN
SITE OF PAIN – WHERE IT IS FELT– LOCATION
SOURCE OF PAIN – ORIGIN
REFERED PAIN – THE SITE AND SOURCE ARE NOT THE SAME
SINUS TRACT
•The cone should track back to the source of infection
• This will demonstrate which root of the molar is affected Presence of sinus tract
SINUS TRACT
1. Conventional RCT,antibiotics not needed.
2. Will heal in 2-4 weeks afterconventional RCT
3. If present, post RCT do apical surgery with retrofill
(answer for the board)LATERAL PERIODONTALCYST
Vitality test
Not of pulpal origin
GLOBULO MAXILLARY CYST
Mythical lesion allegedly located between maxillary lateral incisor and cuspid
Vitality test
--------------------------------------------------------------------------------GRANULOMA
Periapical Inflammation•
• An extension of pulpal An extension of pulpal inflammation
• Periapical tissues will become involved before total pulpal necrosis total pulpal necrosis
• Bacteria and inflammation by products leak through AF and start inflammation
Granuloma
APICAL CYST
NON-ODONTOGENIC
CONDENSING OSTEITIS
Confirm vitality
History of tooth or restoration
RCT vs No RCT
CEMENTOMA
Vitality test
Radiolucent/opaque lesion
Calcifying fibroma
Predominant location lower anteriors
Ethnic link observed (Predominantly among African-American)
--------------------------------------------------------------------------------
ANKYOLOSIS
Which is the most important sign ofAnkylosis:
1) Dull sounding
2) Resonant
3) Cessation of eruption***
4) Cross bite
INFECTION
BACTERIA
Kakehashi, Stanley, Fitzgerald
1965
Bacteria are the problem
INFECTION SEVERITY
RESISTANCE OF HOST
VIRULENCE
POPULATION/NUMBER
CHRONIC INFLAMMATION OF THE PULP
*LYMPHOCYTES
*MACROPHAGES
*PLASMA CELLS
FATE OF EXTRA RADICULAR
INFECTION
*SOME PROBLEMS SUCH AS ACTINOMYCOSES ARE EXTRARADICULAR AND MAY REQUIRE SURGERY TO RESOLVE THE INFECTION.
*TRUE CYSTS
*OSTEOMYELITIS
*BIOPSY AND CULTURE
--------------------------------------------------------------------------------
WHY DO WE HAVE A PROBLEM
BACTERIA!!!
CRITERIA for SUCCESS
ELIMINATE BACTERIA
PROTECT AGAINST BACTERIA
➢ Severity of the course of a periapical infection depends upon the :
1) Resistance of the host
2) Virulence of the organism
3) Number of organism present
4) All of the above****
5) Only 1 and 2CRITERIA for SUCCESS
What is the radiographic sign of successful pulpotomy in a permanent tooth?
1)Open apex
2)That the apex has formed***
3)Loss of periapical lucency
4)No internal resorption
RESORPTION
*PHYSIOLOGIC OR PATHOLOGIC
LOSS OF TOOTH STRUCTURE
SURFACE RESORPTION
A PHYSIOLOGIC PROCESS CAUSING SMALL SUPERFICIAL DEFECTS IN THE CEMENTUM ANDDENTIN THAT UNDERGO REPAIRBY DEPOSITION OF NEW CEMENTUM.
USUALLY NOT DETECTABLE ON A RADIOGRAPH
SURFACE RESORPTION
--------------------------------------------------------------------------------PRESSURE RESORPTION
ORTHODONTIC TOOTH MOVEMENT
TOOTH ERUPTION
TUMORS
Pressure Resorption-Orthodontics
Pressure Resorption-Eruption
INFLAMMATORY RESORPTION
BACTERIA
EXTERNAL
INTERNAL
PATHOLOGIC LOSS OF TOOTH STRUCTURE RESULTING IN A DEFECT IN THE ROOT AND ADJACENT
BONE
-------------------------------------------------------------------------------INFLAMMATORY RESORPTION
REPLACEMENT RESORPTION
ANKYLOSIS
TRAUMA
IDIOPATHIC
PATHOLOGIC LOSS OF TOOTHSTRUCTURE WITH THE INGROWTH OFBONE INTO THE DEFECT
FUSION OF BONE TO CEMENTUM OR DENTIN
External Replacement Resorption
Idiopathic
Extracanal invasive resorption
Cervical resorption-most common name
External invasive resorption
ETIOLOGY OF RESORPTION
*UNKNOWN
*TRAUMA
*ORTHODONTICS
*INTERNAL BLEACHING
*BACTERIA
EXTERNAL RESORPTION
*SURFACE
*PRESSURE
*INFLAMMATORY
*REPLACEMENT
*INFLAMMATORY PERIRADICULAR
LESIONS ALWAYS RESULT INRESORPTION OF BOTH BONE ANDTOOTH
--------------------------------------------------------------------------------
External Invasive Resorption
CERVICAL RESORPTION
INTERNAL RESORPTION
SURFACE
INFLAMMATORY
NECROTIC TEETH ALWAYS HAVE INTERNAL INFLAMMATOR
RESORPTION
PERFORATION
INTERNAL RESORPTION
DIFFERENTIATION OF INTERNAL AND EXTERNAL RESORPTION
INTERNAL
– REGULAR
– ROUND
– CENTERED, USE SLOB RULE
EXTERNAL
– IRREGULAR, MOTH EATEN
– OFF CENTER, USE SLOB RULE
--------------------------------------------------------------------------------
TREATMENT
INTERNAL RESORPTION
✓ ENDODONTIC TREATMENT
✓ MAY BE DIFFICULT
– PERFORATION
– APICAL
TREATMENT CONTINUED
EXTERNAL INFLAMMATORY
✓ CALCIUM HYDROXIDE
✓ CONTROL INFECTION
✓ FILL CANALS
EXTERNAL INFLAMMATORY
RESORPTION
TREATMENT CONTINUED
EXTERNAL REPLACEMENT
- CALCIUM HYDROXIDE
- CONTROL INFECTION
- FILL CANALS
AVULSION
– GUARDED TO HOPELESSY IDIOPATHIC
– PROGNOSIS DEPENDS ON EXTENT ANDLOCATION
--------------------------------------------------------------------------------
ROOT CANAL THERAPY
Access
Irrigants
Files
Sealers
Gutta Percha
ACCESS
The objectives of the accesspreparation are to:
1. Provide unobstructed visibility into all canals.
2. Allow files to be passed into each canal without bindingon the walls of the access preparation (straight line access toavoid ledge)
3. Allow obturation instruments to fully enter each canalwithout binding on the walls of the access preparation
4. Include removal of all caries and defective restorations.
5. Make possible the removal of all pulp tissue.
6. Removal of the roof of the pulp chamber.
--------------------------------------------------------------------------------
ACCESS
OVAL
TRIANGULAR
TRAPEZOIDAL- Mandibular molar with 4 canals
.ACCESS
Which of the following can cause a ledgeformation:
1) Infection
2) Remaining debris within the canal
3) No straight line access***
A mandibular molar has 4 canals. How should the access opening be:
1) Round
2) Oval
3) Trapezoidal***
4) Triangular
IRRIGANTS
EDTA
SODIUM HYPOCHLORIDE
Ethylene Diamine Tetric Acetic Acid
EDTA- 16-20% solution
Chelating agent
Decalcifies dentin
Removes smear layer
SODIUM HYPOCHLORITE
5.25% NaOClY
Dissolves organic material
Kills bacteria
Sterilize GP, (wipe with alcoholafterwards)
--------------------------------------------------------------------------------
FILES
PRECURVE FILES
Precurve all stainless steel files prior to placement in a canal
Precurving files is indicated
1 for files sizes #35 and over.
2 in canals that are even slightly curved.
3 as a way to negotiate past canal obstructions.
4 All of the above
5 Only (1) and (2) above***
6 Only (2) and (3) above
SEALERS
Zinc oxide eugenol – Kerr Sealer
Resin – AH26Paste fill
Which of the following represents thebasic constituents of most root canal sealers:
Answer: Zinc oxide
Other Root Canal Therapies
Apexification
Pulpotomy
Apexogenesis
Apicoectomy
Pulp Cap
APEXIFICATION
--------------------------------------------------------------------------------APEXIFICATION
NECROTIC IMMATURE TOOTH
CONFIRM DIAGNOSISY
ACCESS - DEBRIDMENT
SODIUM HYPOCHLORITE - INSTRUMENTATION
PLACE CALCIUM HYDROXIDE
PLUGGER, LENTULO SPIRAL, COMPACTOR,MESSING GUN
What kind of procedure should be performed on atooth with necrotic pulp and unfinished root tip- apexification***
DIAGNOSE ACCESS
DEBRIDE
INSTRUMENT
DISSOLVE
APEXIFICATION
--------------------------------------------------------------------------------APEXOGENESIS
-A vital pulp therapy procedure performed to encourage continued physiological development andformation of the root end. This term is frequently used to describe vital pulptherapy performed to encourage thecontinuation of this process.
APEXOGENESIS
What is best sign for success of apexogenesis
- Continuous completion of apex****
MTA – Mineral Trioxide Aggregate
Dr Mahmoud Torabinejad, Loma Linda
Modified Portland Cement
Bismuth oxide
Very good seal
Expands slightly when sets with moisture
Long setting time
--------------------------------------------------------------------------------
Uses for MTA
Pulp cap
Perforation repair
Pulpotomy
Apexification
Apical barrier
Other products
White MTA
SOC – Silicate Oxide Compound
USC – Universal Silicate Cement
PULPOTOMY
Pulp cap
Partial/Cvek pulpotomy
Pulpotomy
Deep pulpotomy
Pulpectomy
PULP CAP
WHY PULP CAP ???
MAINTAIN NORMAL PULP VITALITY
RETURN PULP TO NORMAL
AVOID ENDODONTIC TREATMENT
AVOID EXTRACTION
AVOID EXTENSIVE TREATMENT
POSTPONE ENDODONTIC TREATMENT
--------------------------------------------------------------------------------
PULP CAP
DIRECT
Pulp capping and pupotomy can be more successful in newly erupted teeth than in adult teeth because :
1. a greater number ofodontoblast are present
2. incomplete developmentof nerve endings
3. open apex allows forgreater circulation***
PULP CAP DIRECTY Calcium hydroxide is generallythe material of choice in vitalpulp capping because :
1) Encourages dentin bridge formation****
2) Is less irritating to the pulp
3) Seals the cavity better
4) Adheres well to dentin
**To ensure better thermaland protective insulationof the pulp during acapping procedure ,CaOH should be covered with stronger base
Pulp cap traumatic exposure
INDIRECT PULP CAP
-------------------------------------------------------------------------
INDIRECT PULP CAP
REPLANTATION
WHEN BOTH SURGERY AND RETREATMENT ARE DIFFICULT THEN EXTRACTION AND REPLANTATION MAY BE THE TREATMENT OF CHOICE
ENDODONTIC SUCCESS – FAILURES
--------------------------------------------------------------------------------
FAILURE – SUCCESS REASONS
Poor condensation, incomplete fill
Inadequate disinfection
The most frequent cause of failure in endodontics is
1. split roots.
2. root perforation.
3. Incomplete obturation.***
4. separated instruments.
5. filling beyond the apex.
TRAUMA – FRACTURES
TRAUMA
AVULSION: Milk, replant ASAP, open apex,splint 7-10 days, endo tx 1wk, Ca(OH)2 ,resorption, replacement, inflammatory
CONCUSSION: least damaging
LUXATION: pulp necrosis likely, 60%immature apex teeth become nonvital Intrusive luxation, necrosis, ankylosis
FRACTURES TRAUMA
An 8-year-old boy received a traumatic injury to a maxillary central incisor. One day later,the tooth failed to respond to electric andthermal vitality tests. This finding dictates
1. pulpectomy.
2. apexification.****
3. calcium hydroxide pulpotomy.
4. delay for the purpose of re-evaluation.
One year ago, a 9-year-old boy fractured acentral incisor. A current radiograph of thetooth is adjacent. There are no symptoms. Thetooth does not respond to pulp testing;however, control teeth do respond. What is the preferred treatment?
1. Pulpotomy with Ca(OH)2
2. Pulpotomy with formocresol
3. Conventional root canal treatment
4. Debridement of the pulp space andapexification****
TRAUMA
INTRUSION
Management
Immature teeth– A tooth with an open apex is likely to re -erupt spontaneously– Monitor the progress of re-eruption– No treatment is needed if tooth re-erupts into normal positionand there is no evidence of pulpal involvement
Mature teeth– Intruded mature teeth need to be repositioned immediately– Initial extrusion will be made orthodontically or surgicallydepending on degree of intrusionPrognosis
High risk of pulp necrosis; Endodontic therapy is often indicated; possibility of resorption shows the need to follow upRecallsY Evaluate 4-6 weeks after trauma and after 6 months; after thatyearly recall are indicated
--------------------------------------------------------------------------------
Tavitian/USC EndoRoot Fractures Limited to fractures involving roots only;cementum, dentin, and pulp
FRACTURED ROOTS
CORONAL THIRD: ENDO AND ORTHOEXTRUSION
MIDDLE THIRD: SPLIN TAND OBSERVE
APICAL THIRD: ENDO TO THE FRACTURE LINE IF NECROTIC, APEX USUALLY REMAINS VITAL
FRACTURED ROOTS
There is a root fracture in the apical third of the root of a mandibular tooth. What will be the most likelyresult?
1)Root resorption
2)Ankylosis
3)Vitality will be preserved***
4)Teeth will show internal resorption
There is a root fracture in the middle third of theroot in an 11 year old patient. The tooth is mobile and vital. What will you do?
1)Extract
2)Pulpectomy
3)Splint and observe***
4)Do nothing
VERTICAL ROOT FRACTURES
Failure of tooth with recently placed post and core :Vertical root fracture
Majority of vertical root fractures of endo tx teethresult from:
Condensation forces during gutta -perchafilling***
Diagnose with perio probe, narrow periodontal pocketwidthY Tx is extraction
SEPARATED INSTRUMENTS
APICAL 3RD & VITAL – fill andobserve, temporize, no permanentrestoration for 3-6 months
NON-VITAL – refer to endodontist
MIDROOT – refer to endodontist
In all cases inform patient
--------------------------------------------------------------------------------
SURGERY AND HEALING
INDICATIONS FOR SURGICAL ENDODONTIC TREATMENTY Failing RCT where it is not possible (orpractical) to retreatY Disassemble?Y Post ? Is it practical???SURGICAL ENDODONTIC TREATMENT
A patient has a draining sinus tract apical to amaxillary lateral incisor. The tooth, which is restoredwith a post and crown, received a root canal filling andapicoectomy one year ago. Radiographically, the toothmeasures 19 mm. in length. Adjacent teeth respondnormally to pulp testing. The patient is asymptomatic.Which of the following is the most acceptabletreatment?
1. Retreat and refill the canal with gutta-percha.
2. Retreat and refill the canal, then perform anapicoectomy.
3. Retreat by surgery using a retrofill amalgam.***
4. No treatment is necessary unless the patient develops symptoms.
APICOECTOMYY REVERSE FILLY CURETTAGE
APICOECTOMY
EXPECTED HEALING TIME
3-6 months for radiographic evidence
Asymptomatic
2-4 weeks sinus tract goneY Prognosis of a tooth with a broken instrument located 3mm. from the apex is probably best if the tooth has a
1) vital pulp with a periapical lesion.
2) vital pulp without a periapical lesion.
3) necrotic pulp with a periapical lesion.
4) necrotic pulp without a periapical lesion.
HEALING
BONE - yes
PDL - yes
DENTIN – no
CEMENTUM – yes
ENAMEL - no
--------------------------------------------------------------------------------
HEALING
Severity of the course of a periapical infection depends upon the :
1) Resistance of the host
2) Virulence of the organism
3) Number of organism present
4) All of the above***
5) Only 1 and 2
What is the radiographic sign of successful pulpotomy in a permanent tooth?
1) Open apex
2) That the apex has formed***
3) Loss of periapical lucency
4) No internal resorption
HEALING
Once the root canal is obturated, what usually happens to the organism that had previously entered periapical tissues from the canal:
a) They persist and stimulate formulation of granuloma
b) They are eliminated by the natural defenses of the body***
c) They re-enter and re-infect the sterile canalunless periapical surgery is performed
d) They will have been eliminated by various medicaments that were used in the root canal
BLEACHING
TOOTH DISCOLORATION
PULP NECROSIS
RESTORATIVE MATERIALS
SYSTEMIC MEDICATIONS– FLOURIDE– TETRACYCLINE
GENETIC
ENVIRONMENTALBLEACHING
INTERNAL BLEACHING
WALKING BLEACH
DO NOT USE STRONG, 30%, H2O2(Superoxol) – RESORPTIONY SODIUM PERBORATEY Need to put cement barrier betweengutta percha and bleaching materialMISCELLANEOUS
--------------------------------------------------------------------------------
PULP TESTING
DUPLICATE SYMPTOMS
ADJACENT AND CONTRALATERAL TEETH
COLD
HEAT
CAVITY TEST PREPEMERGENCY TX
SEE PATIENT
DIAGNOSE TREAT APPROPRIATELY
EMERGENCY TX
A patient of record calls late Saturday night becauseof severe, throbbing pain aggravated by "heat, bitingand touching" in a mandibular premolar. Whatprocedure is recommended?
1. Instruct the patient to apply ice intermittently, takeaspirin, and call Monday for an appointment.
2. See the patient at the office and initiate endodontic treatment.****
3. See the patient at the office, remove the carious dentinand place a sedative zinc oxide-eugenol cement.
4. Prescribe an analgesic and refer the patient to anendodontist.
5. Refer the patient to the hospital oral surgerydepartment for extraction.
PERFORATIONS
MESIAL ROOT OF MANDIBULAR1ST MOLAR
– DISTAL OF MESIAL ROOT
CORONALPRETREATMENT
REMOVE CARIES
PREVENT LEAKAGE
SECURE POSITION FOR CLAMP
ROOT SENSITIVITY
EXPOSED DENTIN
RECESSION
SURGERY
DESENSITISE
--------------------------------------------------------------------------------
SYSTEMIC DISEASES
Premedication- RHEUMATIC FEVER
AHA Guidelines
OSTEOMYELITIS
Pt has large carious lesion, toothache,submandibular facial swelling, fever of102F. Continuous exudate throughgingival sulcus, moth eaten radiolucentappearance.Most probable diagnosis: ***Acute osteomyelitis
Endodontically treated posterior teeth aremore susceptible to fracture than untreatedposterior teeth. The best explanation for this is
1. moisture loss.
2. loss of root vitality.
3. plastic deformation of dentin.
4. destruction of the coronal architecture.***
5. increased susceptibility of the enamel to fracture.
MISCELLANEOUS
TEMPORARY RESTORATION
ZOE is a good temporary restoration because:
1) less irritant
2) Increased strength
3) Good seal***
4) Antibacterial
PULP TEST
Which of the following is lest useful in children
1) Percussion
2) Palpation
3) Electric pulp test***
4) Thermal test
SLOB Rule
On a radiograph, the facial root of amaxillary first premolar would appear distalto the lingual root if the
1) vertical angle of the cone were increased.
2) vertical angle of the cone were decreased.
3) x-ray head were angled from a distal positionrelative to the premolar.
4) x-ray head were angled from a mesialposition relative to the premolar.***
--------------------------------------------------------------------------------
SLOB Rule
A radiograph shows a lucency that does not appear to move with application of the Clarke’s Principle/Rule.
Where is the lucency situated?
1)No way of telling
2)Lingual
3)In the canal
4)Buccall
CONCLUSIONS: Try and maintain pulp vitality
Young pulps respond better than old pulps to trauma
Disinfect
Seal
