جزء منال ف الاندو #أسنان #أسنان #برومترك_السعوديه #برومترك_قطر #برومترك_دبي ...لازم ف الامتحان

Differentiating pulpal and periodontal abscesses: pulpal abscesses are associated with a non-vital tooth, while periodontal abscesses are not. A metallic sound on percussion indicates ankylosis, internal resorption, or lateral luxation. Ledermix, an intracanal medicament with a corticosteroid (triamcinolone), reduces pain and inflammation. Gates-Glidden drills, used for coronal flaring, come in sizes 1-6 (size 1 is 0.5mm, increasing by 0.2mm increments). Rotary files have a standard taper of 0.02, but specialized rotary files can have 0.04 or 0.06 tapers. Open apex teeth with poor prognosis (over 24 hours out of socket) are treated similarly to severely compromised teeth. Over-preparation of the apex is called zipping or transportation. Ledges are false canals formed by improper instrumentation. NaOCl accidents cause severe pain, swelling, and bleeding, requiring immediate control measures like cold compresses (first day) and warm compresses (second day). Maxillary premolar access openings are oval.

Various gutta-percha obturation techniques include: thermomechanical compaction (using a hot metal compactor), thermoplastic injection (using an Obtura II system for internal resorption), thermoplastized gutta-percha (used for open apices or external resorption), continuous wave compaction (layer-by-layer filling), and carrier-based gutta-percha (pre-prepared gutta-percha on a carrier, like Thermafil, ProTaper, Success-fill). The Ellis Classification of trauma also includes Class 8 (crown fracture) and Class 9 (trauma to primary teeth). The specific fiber type (C-fibers) is absent in children aged 6-12 years.

Removal of gutta-percha uses cold (e.g., Endo-Ice at -26.2°C), while silver points require specific pliers. Perforations near the crown or in the cervical third have a poor prognosis. An electrical pulp test can give false positives (partial necrosis) or false negatives (obturation). A 'tooth slooth' is a diagnostic tool for cracked teeth. Cavit, a strong temporary restorative material for root canals, is not used with vital teeth due to fracture risk and difficulty of removal. Chloroform is the most effective gutta-percha solvent. Nickel-titanium files are highly flexible, preventing ledging and transportation. Ledermix (antibiotic and corticosteroid paste) is pH 8.1-13. The pH of calcium hydroxide is 11-12, formocresol is 12.45, and sodium hypochlorite is 11-12. Triple antibiotic paste (metronidazole, minocycline, and ciprofloxacin) is an intracanal medicament. Regenerative endodontic procedures aim to re-establish blood supply in non-vital, immature teeth by inducing bleeding from the periapical bone. In necrotic pulp, polymorphonuclear leukocytes and histiocytes (macrophages) are present. To prevent ledging, pre-curving files is essential. Irrigant should be delivered 2mm short of the working length, preferably using a side-vented needle to prevent NaOCl accidents.

The discussion begins by highlighting the importance of understanding inflammation in the root, primarily due to PDF fibers, which possess a certain 'pressure'. It also touches upon why acute conditions often go undetected in X-rays, requiring 30-50% bone loss to be visible, making such detection more common in chronic cases. Different file shapes like K-files (square) and FlexoR (square) are also mentioned, along with their uses. The role of RC Prep (a urea-based compound) in removing organic debris and proteins (chelating agents) is explained. Tissue pH balance is crucial, with a normal pH of 7.4; a drop to 4.5 signifies acidity and the onset of resorption.

Chlorhexidine (CHX) is introduced as an antibacterial agent effective against *E. faecalis*, a common bacterium causing endodontic failure. The concept of 'MTAD' (Microdentin Tubule Appliance Disinfection) is briefly mentioned. The difference between primary and failed endodontic treatment is discussed: primary cases involve obligate anaerobic bacteria, whereas failed cases are often characterized by facultative anaerobic bacteria like *E. faecalis*. Treatment for orofacial infections of endodontic origin typically involves penicillin with Augmentin (due to clavulanic acid inhibiting beta-lactamase). For penicillin-allergic patients or resistant cases, clindamycin and metronidazole (Flagyl) are alternatives. Clindamycin's side effect, pseudomembranous colitis, leading to diarrhea, is noted. The impact of antibiotics on birth control pills (decreasing their effect) and birth control pills on local anesthetics (decreasing their effect) is highlighted.

The video covers nerve blocks, specifically the inferior alveolar nerve block (IANB) and solutions for its failure. For a failed IANB, an intraosseous or Gow-Gates block can be used. If the patient has trismus and cannot open their mouth, an Akinosi block (extraoral technique) is recommended. To reverse local anesthesia quickly, as in a media personality's case, phentolamine (OraVerse/Stibudine) is used. Different scalpel blade numbers (11 for abscess drainage, 12 for surgical access in specific areas like upper 7s, and 15 for general incisions) are detailed. Referred pain to the ear from a lower molar is mentioned. Cold testing uses dichlorodifluoromethane/fluorimethane at -30°C on the middle third of a dry tooth for five seconds. Electrical pulp testing relies on sensory fibers, not vascularity, making thermal tests generally more reliable.

The discussion moves to materials, including sodium hypochlorite for organic debris removal, EDTA for inorganic debris, and chloroform for gutta-percha removal. Gutta-percha itself is noted for containing zinc oxide-eugenol to ease patient discomfort. Abscess management involves incision (gingiva), apex modification (tooth), or surgical intervention (retrograde filling). Strip perforation, particularly in curved canals due to improper instrumentation, is described, with the disto-lingual aspect of lower sixes being a dangerous area. Ellis classification of tooth fractures (Class 1-4, affecting enamel, dentin, pulp, and root respectively) is explained. Color changes in teeth can indicate conditions like pink for internal resorption, yellow/brown for pulp obliteration, and grey for necrosis.

Different types of dental trauma are discussed: concusssion (mobility increase, no displacement), subluxation (mobility, bleeding, no displacement), extrusion (partial displacement from socket), lateral luxation (displacement in any direction except apical), and intrusion (apical displacement, highest risk of pulp necrosis). Avulsion refers to complete tooth displacement. Splinting protocols are crucial: two weeks for subluxation and avulsion (if reimplanted within an hour), and four weeks for concussion, lateral luxation, intrusion, and avulsion (if reimplanted after an hour). The importance of correct splinting time is emphasized for exam success.

Calcium hydroxide and MTA (Mineral Trioxide Aggregate) are mentioned for their high pH (12.5), making them antibacterial. Apexogenesis (preserving vital pulp) and apexification (inducing root end closure) are differentiated. Cracked teeth often fracture mesio-distally. The dentin, unlike other tissues, does not regenerate. Centrosilicic acid (a paste carrier) is used for sealer placement in root canals post-obturation. Cross-sections of various files (K-file: triangular, K-Flex: rhomboid, FlexoR: triangular, H-file: round) are reviewed. The detection of bacteria in pulpal cysts and sinus tracts is also covered. The correct procedure for tracking a sinus tract involves inserting a #25 or #30 file soaked in local anesthetic onto an X-ray.

The minimum gutta-percha length to leave is 4-5mm or one-third the root length, while a post should be two-thirds the root length. Root amputation should be done perpendicular to the long axis of the root. Mixing irrigants: NaOCl with chlorhexidine forms an orange-brown precipitate; CHX with EDTA forms a white precipitate. EDTA concentration is 17%. Silver points, an older obturation material, are prone to corrosion and are removed with specific pliers. Oxygen saturation in blood is measured by oximetry, while blood flow in the pulp is measured by laser Doppler flowmetry. For open apex irrigation, a diluted NaOCl (0.5-1.5%) is used. Cervical/coronal perforations have a poor prognosis and always require repair. In mid-root fractures where the apical segment is vital, the coronal segment undergoes root canal treatment.

For avulsed teeth (over an hour out of socket): closed apex teeth are soaked in 2.4% sodium hypochlorite (pH 5.5) for 20 minutes; open apex teeth are soaked in doxycycline or minocycline for 5 minutes. Symptomatic irreversible pulpitis requires pulp extraction and pain relief. AH Plus and AH26 are epoxy resin sealers used when patients are allergic to zinc oxide-eugenol. AH Plus has a working time of 4 hours and a setting time of 8 hours. AH26 has a longer setting time (15-24 hours) and releases formaldehyde, so it is generally not recommended.