NATIONAL BOARD EXAMS ENDODONTIC QUESTIONS Submitted by: Dr. Charles Rankin Endodontics Department August 7, 19971. Endodontic therapy is completed on a tooth with a periapical | radiolucency. A marked reduction in the size of the radiolucency can be expected in approxinately rn A. 1 week. B. 3 weeks. c. 1 month. D. 2 nonths. - - , r e& 1 year. Creat = Cp enl” It usually tekes approximately 6 months to see some r reduction in size of an apical radiolucency after endodontic treatment. Answers A thru D are too short a time. Answer E is correct. 2. A dentist is resecting (amputating) a root for periodontal reasons. Which of the following represents the usual treatment sequence? Periodontal therapy followed by root canal therapy. Root canal therapy followed by periodontal therapy. €. Root canal therapy followed by a period of observation. D. Periodontal therapy followed by a period of observation. Endodontic therapy should be performed before a root amputation to avoid symptoms initiated by a vital pulp stump. Endodontic therapy is highly successful and periodontal therapy may be urgent so B is the correct answer. A patient returns 10 days following incision and drainage of a submandibular space abscess. ‘The swelling appears to have r enlarged despite high doses of antibiotic therapy. What should the dentist do next? Insert a larger drain. Order a CBC with differential. Repeat the culture and sensitivity_tests. Use proteolytic enzymes to allow the antibiotic to penetrate the abscess. Persistent swelling after an incision and drainage as well as antibiotic therapy is usually indicative of a resistant microorganism. A larger drain nay be more efficient but it will not eliminate the source of the infection. A CBC with differential will indicate an increase of WEC'S but you already know the patient has an infection| Proteolytic enzymes will not necessarily allow more antibiotic to get to the center of the abscess. The microorganisms involved are not sensitive to the antibiotic being used. A culture and sensitivity test must be taken. c is the answer. 2\4 When root canal therapy is indicated for a vital tooth, which of the following is the MOST biologically acceptable? A. Filing to the radiographic apex and filling to the radiographic apex. Filing 0.5 - 1.0 mm. short of the radiographic apex and filling to the same length. Filing to the radiographic apex and filling 0.5 - 1.0 short of the radiographic apex. b. Filing 0.5 - 1.0 mm. beyond the radiographic apex and filling to the radiographic apex. Both fi ig and filling of a root canal should be terminated at the which is usually .5 - 1 mm. short of the radiographic apex. B is the correct answer. one objective of root canal obturation is to develop a fluid tight Seal. Another objective is to create a favorable biologic. environment for the process of tissue healing. Both statements are TRUE. Both statenents are FALSE. C. The first staténent is TRUE, the second is FALSE. D, The first statement is FALSE, the second is TRUE. This should be pretty obvious. Both statements are true (A). A dentist is restoring an endodontically treated posterior tooth with a pulp chamber-retained amalgam restoration. Ideally, the dentist should place the amalgam to what depth into each root canal to obtain satisfactory retention? nn. hi : mn. dy \, Ge mn sf as Ne mee O aA ve \ Amalgam, used as a core material, should be placed 3 mm. into each canal for retention. Each of the following is a reason for restoring an endodontically treated posterior tooth with a dowel or post EXCEPT one. Which one is this EXCEPTION? A To strengthen the'root. Bh To enhance retention of the core. i€l To enhance the lateral force resistance. A post is placed to retain the core and resist lateral forces. A post will not strengthen the Foot --in fact, if you have to take out a little more tooth structure to accommodate the post, you weaken the root making it nore susceptible to fracture. A is the answer. OL10. ae Where is the orifice to the fourth canal in a maxillary first molar usually found? Under the distofacial cusp. Lingual to the orifice of the mesiofacial canal. on a line running from the palatal orifice to the distofacial orifice. D. Ona line running from the distofacial orifice to the nesiofacial orifice. ghe fourth canal of a maxillary molar is in the MB root, located in your access, lingual to the orifice of the main MB canal. B is the answer. Non-perforating internal resorption is best managed by A. surgical curettage. & incision and drainage. > root canal treatment. D. calcium hydroxide pulpotomy. periodic evaluation and recall. If you can remove the involved pulp tissue which is causing the internal resorption, you can stop the resorption immediately. This is accomplished by endodontic therapy. © is the answer. ‘The treatment-of-choice for an external resarption on a non-vital tooth is which of flammatory root the following? Extraction. Surgical curettage of the affected tissue. Pulpectomy and obturation with gutta percha and sealer. Renoval of the necrotic pulp and placement of calcium hydroxide. E. Observation since it is a self-limiting process. Every non-vital (necrotic) pulp needs to be removed. In cases of extensive inflammatory resorption, CaoH is placed in the canal in an attempt to neutralize the resorptive process. D is correct. Which of the following is contraindicated for a formocresol pulpotomy on a primary molar? A. Tooth that is sensitive to sweets. & Exposure of pulp during excavation of caries. © Radiographic evidence of internal resorption. D. Radiographic evidence of deep caries approximating the coronal pulp. 812. 13. cresol should be used in minimal amounts, if fact, only ‘the vapors" resol should be entered into a tooth. In no case should formocresol be allowed to leave the confines of the tooth and get into the surrounding tissues. Internal resorption enlarges the pulp space making the surrounding tooth structure thin; possibly even causing a small pathologic perforation which would allow the escape of formocresol. ¢ is the correct answer. Injection of a local anesthetic into an inflamed area usually has a less than optimal result. Which of the following best explains why? The prostaglandins stabilize the nerve membrane. > Minbnnation reduces the availability of the free base. The drug will be absorbed more rapidly because of the increased blood supply. D. ‘The chemical mediators of inflammation will present a chemical antagonism to the anesthetic. The free base from the anesthetic in an environment with a lowered pH, as seen in areas of inflammation, is very low in proportion to the amount of cation which is formed. In the relative absence of the unchanged anesthetic base, fewer anesthetic molecules reach the nerve membrane thereby making the anesthetic less effective. B is the correct answer. Which of the following accounts for sudden relief of severe pain from a dentcalveolar abscess? A. The action of bacteria-produced neurotoxins. B. The walling-off of the infection by the body. ¢. The neutralizing effect of tissue enzymes. (By Rupture through the periosteun into soft tissue. Severe pain from a dentoalveolar abscess is due to the increase in pressure within the alveolus as an acute inflammatory takes place. As the process increases in scope and size, it will frequently break through the periosteum into the soft tissue releasing the pressure and relieving severe pain symptoms. Answer D is correct. the naterials used in the walking bleach technique are)» sodium perborate and . yg) y 3% aqueous hydrogen peroxide. i/o 30% aqueous hydrogen peroxide ,/j”” fix 25% ethereal hydrogen peroxide. 7 ¥ D. 5% phosphoric acid. - The material traditionally used with Na perborate is superoxol or 30% aqueous hydrogen peroxide making B the correct answer. Recently, superoxol has been implicated in bleaching-connectea “cervical resorption so one should be judicious in its use. @4s. Which of the following root surfaces is the most likely to be strip-perforated during canal instrumentation of the mesial root of a mandibular first molar? A. Facial. B. Lingual. Mesial. of Distal. X A strip perforation occurs due to overzealous a instrumentation in an attempt to flare the canals. The mesial root of a lower molar curves toward the distal. A strip perforation would occur at that curve along the distal wall. The correct answer is D. A patient has a mandibular molar with pulp necrosis, pain to percussion, and with no periradicular lesions. The emergency treatment for this tooth is which of the following? Opening the tooth, performing apical trephination, temporizing, and checking the occlusion. Prescribing analgesics and antibiotics and rescheduling the patient. Performing pulpotony, tenporizing, and checking the occlusion. /B) Ddebriding the canals, temporizing, and checking the C’ ccelusion. A necrotic pulp requires a pulpectomy - the canals need to be debrided. Checking and adjusting the occlusion would contribute to relieving pain from percussion. The source of the problem is the necrotic pulp so you must remove it. Trephination, analgesics and antibiotics, a pulpotomy or leaving the tooth open for drainage will not eliminate the necrotic pulp. Dis the answer. A 33 year old female patient states that her mandibular first molar has been hurting since the recent placement of an amalgam restoration. She describes the pain as mild to moderate, which is not spontaneous, but is provoked by cold, heat, and sweets. These symptoms most likely correspond with pulp necrosis. reversible puipitis. internal resorptio irreversible pulpitis. The key to her symptoms is that the pain she has is not spontaneous although it does respond to cold, etc. This tells us the pulp is vital eliminating (A). Internal resorption is usually asymptomatic. Irreversible pulpitis is characterized by dull, throbbing, spontaneous pain. The recent amalgam has caused a transient pulpitis indicating B as the corrett answer.~———— —18. An adult healthy patient has a marked indurated swelling. He has a temperature of 100°F and has been in considerable pain for 24 hours. Percussion of the maxillary right central incisor causes discomfort as does palpation at its apex. Pulp vitality tests are negative for this tooth, while adjacent control teeth test within normal limits. A radiograph reveals that the maxillary right central incisor has a deep unbased restoration and a widened apical periodontal ligament space. Which of the following is the best emergency treatment for this patient? A. Extracting the maxillary right central incisor, B. Administering an antibiotic and analgesic and initiating ~ root canal therapy when symptoms subside. (€) debriding the root canal of the maxillary right central incisor and prescribing antibiotics and analgesics. D. Incising and draining the swelling and prescribing antibiotics and analgesics. Again, the source of the problem is the necrotic pulp which has to be removed. ‘That leaves only C as a viable answer. Prescribing antibiotics and analgesics is indicated due to the swelling, temperature and significant pain. 19. Which of the following is most likely to cause a yellow discoloration in a prinary maxillary incisor following trauna? A. Blood pignents. - ew B. Pulp hyperemia. — 2 3. _Jacute apical periodontitis. Putt chronic apical periodontitis.¥ / 5. suppurative apical periodontitis. Y- vo fine Tut q aa38. 39. 40. You must judge what your testing tells you both in regard to the pulp and to apical periodontium. ‘he tooth does not respond to heat, cold or EP? which indicates that the pulp is necrosis (eliminating answers 1 and 2). No sinus tract is noted eliminating answer S. Percussion elicits severe pain indicating an acute rather than a chronic problen. Answer 3 is the correct answer. Apexification for an incompletely formed root of a tooth with a necrotic pulp is based on the theory that 1. necrotic pulp material will enhance normal radicular development. 2. Ca(OH), placed in the apical portion of the root canal will stimulate hard tissue formation. 3. maintenance of tissue within the root canal of an ncompletely developed tooth will permit eventual root- end closure. 4. None of the above. Apexification implies a necrotic pulp with an incompletely formed apex. Ca OH, is the nedication of choice to enhance hard tissue formation. (answer 2 is correct). ‘The pulp is necrotic eliminating answer 3 and a necrotic pulp will not stimulate anything but pathology (eliminates answer 1). After endodontic therapy is completed on a tooth with periapical rarefaction, marked reduction in the size of the rarefaction should be evident in about 5-6 days. 2-4 weeks. + 6-8 weeks. 2-4 months. 6-12 nonths. 3-5 years. Answer 5 is the best answer. You need time for enough bone deposition to take place to see it on a radiograph, usually, at least 6 months. An endodontic instrument was broken in the apical third of a root canal. ‘The fragment is 3 mm. long and is lodged tightly. No radiographic changes at the apex are evident. The procedure of choice is to 1. extract the tooth. 2. perform an apicoectomy and place a reverse filling. 3. resect the apical section of the root containing the broken instrument. 4. perform a routine root canal filling in the remaining root canal space and place the patient on recall. 12 qe41. If you cannot remove the separated fragment, you incorporate it into your routine root canal filling and then follow-up on it by checking on any subsequent symptoms or changes radiographically. At this point, answers 1- 3 are extreme and are not indicated. Answer 4 is correct. After obturation of a traumatized central incisor, a horizontal line of material in the midroot area extending both mesially and distally from the canal to the periodontal ligament space is noted. This indicates the presence of 1. accessory canals. 2. a midroot fracture. 3. internal resorption. 4. external resorption. hen you consider trauma, a possible fracture should be kept in mind. A horizontal line of material in one direction may be a lateral canal but extending in both directions will most likely be a root fracture. Resorptive areas do not present themselves radiographically as lines but as areas. Answer 2 is correct. Internal resorption should be treated by pulpotony. 2D bulpectony. =x. extraction. _-4> pulp capping. 43. "S.- periodic recall. Internal_resorption is cauged by resorptive cells within the pulp. If you remove the pulp, you renove these cells elininating the resorptive process. Answer 2 is correct. The wall of mandibular molars that is most prone to perforation during access cavity preparation is the 1. mesial. 2! distal: 3, facial. @ Ungual. The crown of a mandibular molar has a slight tile toward the lingual. If you do not account for that tilt, you will be preparing your tooth toward the lingual. Answer 4 is correct. ~ QB 1344, 45. Endodontic therapy is contraindicated for a single rooted tooth that has 1. discoloration. 2. an acute apical abscess. 3. a chronic abscess and a draining sinus tract. 4. a horizontal fracture of the apical third of the root 5. a vertical fracture of the root and an associated deep periodontal defect. Endodontic therapy is definitely indicated in answers 2 and 3 and may be in l and 4. If a tooth is not restorable, such as seen in most vertical root fractures and in severe periodontitis, then endodontics should not be performed. Knswer 5 is correct. The nost invortent principle governing the location and outline of the lingual or occlusal opening into the pulp chamber is preservation of tooth structure. direct access along straight lines. complete removal of the roof of the pulp chamber. | removal of all caries and defective restorative ghe main objective of an access is to establish a direct opening to the canal orifices. Along the way, you will make sure the pulpal roof is completely removed as well as caries and any defective restorative material. Direct line access is imperative naking answer 2 correct. A negative response to the vitalometer immediately after severe luxation or displacement of a tooth indicates that the . pulp is inflamed. vitalometer is giving a false reading. pulp is necrotic and should be removed. blood supply is interrupted, and the negative response may be temporary. 5. neural transmission is interrupted, and the negative response may be temporary. Pulp testing is not reliable immediately after trauma so you cannot say if the pulp is vital, inflamed or necrotic. It is the neural transmission not the blood supply which gets interrupted. (If the blood supply is interrupted, pulpal necrosis would begin and the negative response would not be temporary). Answer 5 is correct. 44 a448. 47, Sterilization of instruments by autoclaving requires (a) a temperature of 71°C. (160°F). (b) a temperature of 121°C. (250°F.) (c) direct contact between steam and items to be sterilized. + (a) only. KO be pbc + (a) and (c). 3. (b) only. 4®. (b) and (c). 5. (c) only. s is a straight forward question you should know. Answer is correct. n accompanying the tissue reaction called inflanmation y result from (a) bradykinin release. (b) pressure of the tissue exudate (c) histamine rélease _(éy loss of function. (e)_ direct nerve damage. (4) increased body ter @ (2) (5), (5) and (0). ee < (a),(b),(c) and (£). Bag tan ae BG) ana: | Sthaebat (a) ‘and’ (e) only. _S< (b),(c) and (£) only. All of the above. S Pain from inflammation can be due to released mediators of inflammation including bradykinin and histamine. Direct nerve damage as well as the build-up of pressure due to increased tissue exudate could also cause pain. Answer i is the best answer. 49. A periapical lesion was discovered 1 1/2 years after an uncondensed, single-cone root canal filling was placed in a maxillary central incisor] Two years after careful periapical curettage, the'lesion is larger than it was before surgery. What was the most likely cause of failure? 17 systemic involvement. —2r Inadequate curettage. —T. Failure to resect the apex. 4s An undiagnosed periodontal lesion. Leakage from a poorly filled canal. 7 A qa oC50. The source of the periapical pathology is the leakage occurring inside the root canal. Careful periapical curettage will not cure the "leaky" root canal. The inadequate single cone root canal filling should be removed, the canal instrumented, cleaned and sealed with a good dense three-dimensional root canal filling. Answer 5 is correct. Which of the following is most useful in differentiating between an acute apical abscess and an acute periodontal abscess? * = - 1. Palpation. 2. Radiograph. 3. Anesthetic test. Percussion test. Pulp vitality test Ofis& brs tok opt be Ko pmtl! 6hn 1 acute apical abscess occurs due to a nécrotic pulp while an acute periodontal abscess is periodontal in origin and therefore have a vital pulp. Pulp vitality testing would distinguish between the two. Answer § is correct. X 16