Endodontics
Endodontics tests diagnosis, shaping and disinfection, obturation, restoration, and retreatment decisions. The exam rewards a clear pulpal and periapical diagnosis and safe management of complex anatomy.
Core rules
- Pulpal diagnosis: normal, reversible pulpitis, symptomatic or asymptomatic irreversible pulpitis, necrosis; periapical diagnosis: symptomatic/asymptomatic apical periodontitis, acute/chronic apical abscess, condensing osteitis.
- Pulp testing is concordant: cold test and EPT assess different nerve fibers; sensibility testing plus radiographs and history, not one test alone.
- Working length is confirmed with an apex locator and radiograph. Patency, glide path, and crown-down shaping preserve canal anatomy.
- Irrigation matters: sodium hypochlorite dissolves tissue and disinfects; EDTA removes smear layer; avoid extrusion and use rubber dam.
- Coronal seal and cuspal coverage protect the treated tooth. Retreatment is indicated for persistent or new apical periodontitis, not simply because a root filling looks imperfect.
Worked example
A molar has a necrotic pulp, a periapical radiolucency, and a previously placed deep restoration. The diagnosis is necrotic pulp with asymptomatic apical periodontitis. Plan nonsurgical root canal treatment with rubber dam, apex locator, NaOCl irrigation, and a definitive coronal restoration; CBCT is reserved if canals are calcified or surgery is considered.
Traps
- Calling a tooth irreversible pulpitis when the pain is provoked and resolves.
- Relying on a single cold test.
- Overinstrumenting the apical foramen.
- Extracting a restorable tooth without discussing endodontic options.