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2013-12-14 13:30:49
ABE Prep

ABE Prep
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  1. Pulpal Histology/Pathology Overview
  2. What the cellular elements of the pulp?
    • TenCate – Odontoblasts, fibroblasts, undifferentiated mesenchymal cells, macrophages, Lymphocytes & Dendritic cells
    • Farnoush – found mast cells in both inflamed and normal pulps
    • Reader – mylenated A-delta fibers 28%; unmylenated C fibers 72% of total
  3. How far do the odontoblastic processes extend into the tubules?
    Pashley – 1/3 the length of the tubule
  4. What types of collagen are found in the dental tissues & what cells synthesize collegen?
    • Pulp – type I & III; Dentin – type I (90% of organic component)
    • Synthesized by mainly fibroblasts, but also odontoblasts, osteoblasts & cementoblasts
  5. Are lymphatics found in the pulp?
    Bernick – demonstrated lymphatics in the pulp
  6. Discuss the pulp vasculature and regulation of blood flow?
    • Takahashi & Kim – SEM showed AV anastomosis, VVanastomosis, U-shaped arterioles
    • Kim – PBF increased with C-fiber activation (A-delta insignificant); C-fibers release substance P which increases PBF; the increase in tissue pressure excites both A-delta & C fibers
  7. Describe the ‘strangulation theory’ & does it occur?
    • As pulpal inflammation ↑, pulpal pressure ↑. With this increased pressure, veins and lymphatics collapse at the apex and strangle the pulp – necrosis results
    • Tonder – cat study disproved this theory; localized increase in pressure with no strangulation
  8. Discuss calcific metamorphosis? Is RCT indicated?
    • Pathways - Pulp canal obliteration due to trauma – resembles cememtum or bone
    • Andreasen – 22% of traumatized teeth undergo CM; only 8.5% developed pulp necrosis
    • Walton – canal present histologically, although absent radiographically
    • Holcomb & Gregory – RCT if PARL develops; only 7% require RCT
  9. Discuss the pulpal rxn to caries?
    • Reeves & Stanley – if caries is < .5mm from the pulp or if it invades reparative dentin, there is irreversible damage; if >1.1mm then little pathosis is seen
    • Trowbridge – chronic inflammation occurs long before bacteria penetrates the pulp
  10. What is the effect of restorative dentistry on the pulp?
    • Stanley, White & McCray – tertiary dentin begins to form @ 19 days at 1.49 um/day
    • Abou-Rass – consider RCT for teeth with stressed pulps
    • Zach – heat is capable of causing pulp necrosis
    • Felton & Madison – 13% incidence of pulp necrosis following FCC
  11. How does age affect the pulp?
    Bernick – decreased vascularity, nerves & pulp chamber size; increased calcifications
  12. Describe the hydrodynamic theory of dentinal hypersensitivity. Any solutions?
    • Brannstrom – heat causes inward fluid movement; cold – outward; distortion of odontoblastic processes stimulates nerve response
    • Pashley – occlude tubules with unfilled resins or oxalate salts
    • Kim – K+ ions desensitize nerve ending
  13. How does vital bleaching affect the pulp?
    Ritter – safe for the pulp up to 10 yrs post-op; bleaching effectiveness may decline
  14. Periapical Pathology Overview
  15. Define:
  16. Granulation tissue:
    healing tissue with fibroblasts, collagen, proliferating capillaries and leukocytes
  17. Granuloma:
    chronic inflammatory tissue primarily infiltrated with lymphocytes, plasma cells & macrophages
  18. True cyst (bay cyst – Simon):
    inflammatory lesion with a distinct pathological cavity completely enclosed in an epithelial lining
  19. Pocket cyst:
    lined with epithelium, but communicates with the root canal
  20. Abscess:
    acute inflammation consisting primarily of PMNs
  21. Is it possible to differentiate between a granuloma or cyst?
    Priebe – No, can’t determine from a radiograph
  22. What is the incidence of a granuloma, cyst & abscess?
    • Nair – 50% granuloma; 35% abscess; 15% cyst (distinguishes 9%pocket / 6% true)
    • Rubenstein & Kim – 85% granuloma; 15% cyst
  23. What are the theories of cyst formation?
    • Breakdown theory – (Toller): Osmotic pressure buildup due to semi-permeable membrane (remnants of cellular debris inside lumen leads to increased osmotic pressure due to Starling’s law)
    • Cavitational Breakdown theory – (Ten Cate): Continuous growth of epithelial cells (rests of Malassez) removes central cells from their nutrition; innermost cells die & cyst cavity forms
    • Epithelial Proliferation theory – (Seltzer): epithelial cells proliferate to line the abscess cavity
    • Immunologic theory – (Torabinejad): Immune rxn (to antigens-bacteria in infected RC) responsible for proliferation of epithelium
  24. Do cysts heal following RCT?
    Nair – pocket cysts should heal; true cysts, particularly large ones with cholesterol crystals are less likely to resolve following RCT
  25. What are the histologic features of a sinus tract?
    Baumgartner – lined with either epithelium or granulomatous tissue; 67% lined with epithelium to level of rete ridges; 33% were completely lined with epithelium to the PA lesion
  26. Is condensing osteitis a LEO?
    Eliasson, Halvarsson & Ljungheimer – tx successfully and resolved with RCT 85%
  27. Provide a differential diagnosis for the following:
  28. Unilocular Periradicular Radiolucency:
    • PA Granuloma
    • PA Cyst
    • PA Abscess
    • PA Fibrous Scar – more frequent with thru & thru lesions or S RCT
    • Nasopalatine Duct Cyst – max midline; > 6mm between central incisor roots
    • Traumatic Bone Cyst – not a true cyst; trauma etiology; mand teeth
    • Benign Fibro-osseous lesions (early stages) – periapical cemental dysplasia
    • Lateral Periodontal Cyst – mand and max canine & premolar area
  29. Mutiloculary Periapical Radiolucency:
    • Myxoma
    • Ameloblastoma – aggressive neoplasm; any tooth-bearing area, but mand most common; peak age 30-40
    • Central Giant Cell Granuloma – multinucleated giant cells; rule out hyperparathyroidism
    • Hemangioma
    • Odontogenic Keratocyst – post mand most common but may occur in any tooth bearing area; multiple OKCs associated with Basal cell nevus syndrome
  30. Periradicular Radiopacities
    • Condensing Osteitis - LEO
    • Idiopathic Osteosclerosis – idiopathic dense bone; vital pulps
    • Benign Fibro-osseous lensions – mixed radiolucent/radiopue; ossifying fibroma, cemento-osseous dysplasia, PCD; vital pulps
    • Cementoblastoma – attached to root with radiolucent rim; neoplasm of cementoblasts
    • Osteoblastoma – neoplasm of osteoblasts; may occur in any bone; not attached to root
    • Odontoma - compound (tooth like) or complex