146 Chapter 6: Endodontics

Q U E ST I O N S

1. A patient received a large MOD composite D. Necrotic pulp, chronic apical periodontitis
restoration 1 week ago. She is now experiencing E. Necrotic pulp, acute apical periodontitis
intense, spontaneous pain, with exacerbation of
symptoms occurring when she applies heat or 5. You have been treating a patient in your practice
cold or when she eats sweets. The pulpal diag- for 20 years. As your patient has aged, numerous
nosis is: changes have occurred in his pulp tissues. All of
the following can be associated with age-related
A. Pulp necrosis changes to the dental pulp except:
B. Acute periapical periodontitis
C. Reversible pulpitis A. Decreased cellular elements
D. Traumatic occlusion B. Pulp stone formation
E. Irreversible pulpitis C. Radiographic obliteration of the pulp space
Endodontics

D. Increased response to electric pulp testing

2. A 12-year-old boy has arrived in your office after E. Decreased vascularity
a fall that fractured tooth #9 up to the gingival
margin on the mesial aspect with a pulp expo- 6. A patient presents to your office with a chief
sure. What is the appropriate treatment? complaint of dull, diffuse pain in the lower right
quadrant. The nerve fibers responsible for this
A. Extraction sensation are:
B. Pulpotomy
C. Direct pulp cap A. Myelinated A fibers
D. Root canal therapy B. Unmyelinated A fibers
E. Apexogenesis C. Myelinated C fibers
D. Unmyelinated C fibers
3. Root canal therapy was completed on a nonvital E. Subodontoblastic plexus of Raschkow
tooth that suffered trauma 5 years prior. At the
time of obturation, the tooth exhibited a periapi- 7. On physical and radiographic examination, your
cal radiolucency on radiographic examination. patient presents with DO decay and a gingival
Radiographically, healing should be visualized swelling at tooth #28. The conical defect on the
in: tooth probes more than 12 mm on the buccal
aspect and does not respond to electrical pulp
A. 1 week testing. There is no mobility, and this condition
B. 6 weeks is localized to the affected tooth. The periapical
C. 1 month radiograph shows destruction of the periodon-
D. 6 months tium from the level of the gingival sulcus to the
E. 1 year apex of the tooth. Proper treatment of this con-
dition includes:
4. A patient presents with a chief complaint of pain
in the upper right quadrant. Cold test produces A. Endodontic treatment only
a response lingering for 1 minute on tooth #4. B. Endodontic treatment followed by periodon-
In addition, tooth #4 is sensitive to percussion tal treatment
with the blunt end of an instrument. What is the C. Periodontal treatment only
pulpal and periapical diagnosis? D. Periodontal treatment followed by endodon-
tic treatment
A. Irreversible pulpitis, normal periapex
E. Extraction
B. Irreversible pulpitis, acute apical perio-
dontitis 8. Your patient presents with diffuse pain in her up-
C. Reversible pulpitis, acute apical perio- per right quadrant. She is unable to determine
dontitis the offending tooth. She states that the pain is
 Questions: 1-15 147

exacerbated when she drinks cold liquids but not 12. An Asian patient presents to your office with pain
with mastication. Tooth #4 has an existing MOD bilaterally in her lower second premolars. Both
amalgam restoration, as does tooth #5. All other teeth are sensitive to percussion and show peri-
teeth in the quadrant are free of restorations and apical radiolucencies on radiographic examina-
caries. What is the appropriate first-line diagnos- tion. The teeth do not respond to either cold or
tic pulp test? electric pulp tests. There is an irregular bulge
on the occlusal surfaces of each tooth. The most
A. Electric pulp test
likely diagnosis is:
B. Heat test
C. Cold test A. Irreversible pulpitis
D. Test cavity B. Dens invaginatus
E. Percussion test C. Dens evaginatus
D. Pulp stones
9. All of the following factors may affect endodontic E. Internal resorption
anesthesia except

Endodontics
13. When instrumenting and subsequently obturat-
A. Fatigue
ing a root canal, the length should be determined
B. Anxiety
by the:
C. Tissue inflammation
D. Tooth type A. Anatomic apex
E. Previous unsuccessful anesthesia B. Apical foramen
C. Apical constriction
10. You have placed files in all three canals located
in tooth #19 during a root canal procedure to 14. The endodontic access form is triangular in
obtain measurement. Upon taking the first ra- shape for which of the following teeth?
diograph, the two files in the distal canal are
A. Maxillary central incisor, mandibular central
superimposed. For your second radiograph, you
incisor, and maxillary lateral incisor
move the cone to the mesial. The resulting im-
B. Mandibular central incisor, maxillary first
age shows both files in the distal canal. The file
molar, and maxillary first premolar
that has moved to the mesial is positioned:
C. Maxillary canine, maxillary first premolar,
A. Mesially and maxillary lateral incisor
B. Distally D. Maxillary second molar, mandibular first
C. Buccally molar, and maxillary lateral incisor
D. Lingually E. Maxillary central incisor, maxillary first mo-
E. Cannot be determined lar, and maxillary second molar

11. You are instrumenting a canal with a size 30, 15. Root canal therapy is completed on a mandibu-
25 mm k-type file. What does each of the sizes lar first molar and closed temporarily with a cot-
denote, respectively? ton pellet and a temporary sealing material, with
plans for a definitive restoration to be placed as
A. The length of the file and the diameter of the
soon as possible. What is the most important fac-
tip of the file
tor in ensuring the success of the procedure?
B. The diameter of the tip of the file and the
length of the file A. Type of definitive restoration
C. The taper of the file and the length of the B. Marginal integrity of definitive restoration
file C. Type of temporary sealing material
D. The diameter of the tip of the file and the D. Placement of a post
taper of the file E. Type of sealer used during obturation
E. The length of the file and the taper of the
file
 148 Chapter 6: Endodontics

16. A patient presents to your office for an emer- cedural error, you attempt to bypass and remove
gency visit with a chief complaint of constant, se- the instrument. If you are unable to remove the
vere throbbing pain in the upper right quadrant instrument, what should your next step be?
for 2 days that has kept him awake at night and
A. Extract the tooth
is not relieved by over-the-counter pain medica-
B. Perform a root amputation
tions. He is unable to discriminate which tooth
C. Perform a bicuspidation of the tooth
is causing the pain and is visiting your office for
D. Prepare and obturate up to the separated in-
the first time on the basis of the referral of an-
strument
other one of your patients. What is the correct
E. Obturate the distal canals only
sequence for your initial diagnosis?
1. Extraoral examination 20. One of the most serious procedural errors that
2. Elicit details about the history of the chief can occur during root canal therapy is instru-
complaint ment aspiration. What is the most important
3. Pulp vitality testing precaution an operator can take to prevent in-
Endodontics

4. Obtain a full medical and dental history strument aspiration?

5. Radiographic interpretation
A. Proper rubber dam isolation
A. 1, 2, 3, 4, 5 B. Only use rotary files
B. 5, 1, 2, 3, 4 C. Use adequate lubrication during instrumen-
C. 4, 1, 2, 5, 3 tation
D. 4, 2, 1, 3, 5 D. Recapitulate between each file
E. 1, 4, 2, 5, 3 E. Irrigate often with sodium hypochlorite

17. You have initiated root canal therapy on a pa- 21. A patient presents to your office for initial exam-
tient when he suddenly experiences sudden pain ination. A root canal procedure had been com-
during working length determination, begins pleted on tooth #3 a year prior. Upon clinical
to hemorrhage, and detects a burning sensa- examination, you observe a narrow periodontal
tion when you attempt to irrigate with sodium pocket measuring the full length of your probe
hypochlorite. What is the most likely cause of in the area of the mesial root. Upon radiographic
these symptoms? examination, you detect a J-shaped radiolucency
A. Inadequate straight line access surrounding the mesial root. Your initial diagno-
B. Root canal contamination sis is:
C. Root perforation A. Incomplete debridement of the mesial root
D. Incomplete canal debridement B. Ledging of the mesial root
E. Ledging C. Underobturation of the mesial root
D. Periodontal abscess
18. During instrumentation of tooth #19, you real- E. Vertical fracture of the mesial root
ize that you are unable to negotiate your file to
the complete working length. The procedural 22. You completed a root canal procedure on tooth
error that has occurred is most likely: #9 approximately 6 months ago. Your patient is
A. Ledging still reporting persistent symptoms of acute api-
B. Instrument separation cal pathosis including sensitivity on mastication
C. Vertical root fracture and a dull ache, and the periradicular radiolu-
D. Inadequate straight line access cency that was visible on your obturation radio-
E. Furcation perforation graph has not appeared to decrease in size. The
most likely reason for the persistence of these
19. During instrumentation of the mesial root of symptoms is:
tooth #30, your file separates and remains stuck A. Phantom tooth pain
in the canal. In an attempt to remedy this pro- B. Root canal failure
 Questions: 16-29 149

C. Trigeminal neuralgia 26. A 4-year-old child has fallen and hit his central
D. Traumatic occlusion incisor. Over time, the tooth has become increas-
E. Myofascial pain ingly more discolored and does not resolve. The
most likely cause of the discoloration is:
23. After completion of root canal therapy, you recall
your patient to evaluate the treatment outcome. A. Endemic fluorosis
What are the criteria for successful root canal B. Systemic drugs
therapy? C. Enamel hypocalcification
D. Intrapulpal hemorrhage
1. Absence of pain E. Amelogenesis imperfecta
2. Absence of swelling
3. Sinus tract healing 27. Following obturation, sealer was left in the
4. No residual probing defects coronal pulp chamber of tooth #9, and the con-
5. Resolution or healing of periapical lesions servative access was filled with a composite
A. 1, 3, 5 restoration. This could most likely result in:

Endodontics
B. 1, 2, 4, 5 A. Root canal failure
C. 2, 3, 4 B. Discoloration of the tooth
D. 1, 2, 3, 4, 5 C. Vertical root fracture
E. 1, 2, 3, 4 D. Inadequate coronal seal
E. Bacterial leakage
24. Retrograde (apical resection surgery) treatment
is considered over orthograde treatment (root 28. A patient presents to your office with a discolored
canal retreatment) for patients by their dentist tooth #24 that was treated with root canal 4 years
after their root canal therapy is considered to before. The material of choice for an internal
have failed. When should retrograde treatment bleaching procedure is:
be performed over orthograde treatment?
A. Hydrogen peroxide
A. When an expensive, yet coronally sealed B. Carbamide peroxide
restoration would have to be refabricated to C. Sodium perporate
accommodate orthograde treatment
B. When a patient is anxious about traditional 29. Incision for drainage will release exudates from
retreatment procedures a soft tissue swelling, reducing irritants and pain
C. If the goal of treatment is to eliminate mi- from pressure buildup. What are the ideal con-
croorganisms from the root canal system ditions under which to perform an incision for
D. When the root canal filling materials are easy drainage?
to remove
A. A tooth with reversible pulpitis and pain on
E. If the treating dentist prefers surgical inter-
mastication
vention
B. A necrotic tooth with an indurated swelling
25. An 8-year-old patient presents to your office for at the apex
an emergency visit with a traumatic exposure of C. A necrotic tooth with a fluctuant swelling at
tooth #9. The treatment of choice for this patient the apex
is: D. A tooth with irreversible pulpitis and pain on
percussion
A. Root-end closure procedure/apexification E. A necrotic tooth with spontaneous pain but
B. Traditional root canal therapy no swelling
C. Vital pulp therapy/apexogenesis
D. Partial pulpectomy
E. Temporization and reevaluation in 1 week
 150 Chapter 6: Endodontics

30. A patient presents to your office for an initial B. Severe pain that disappears 1 to 2 seconds
maintenance visit and you prescribe a full se- after removing the cold
ries of radiographs. During interpretation, you C. Mild to moderate pain that disappears 1 to
note as an incidental finding a periapical radiolu- 2 seconds after removing the cold
cency on the mesial root of tooth #19. The tooth D. Moderate to severe pain that lingers after
is restored with an intact amalgam MO restora- removing the cold
tion with intact margins and no signs of leakage
or recurrent caries. The tooth is asymptomatic 34. You are doing a deep occlusal preparation on
and responds normally to all vitality testing. Your tooth #30. The tooth was asymptomatic prior to
patient has indicated a history of cancer in his treatment. All caries have been removed, but you
medical history. The proper course of action in notice a pinpoint mechanical pulpal exposure.
this case is: Hemorrhage is easily stopped. The treatment of
choice is:
A. Pulpotomy
B. Biopsy the lesion A. Pulpotomy
Endodontics

C. Root canal therapy B. Indirect pulp cap

D. Extraction C. Root canal therapy
D. Direct pulp cap
31. When making a diagnosis, the primary goal of E. Amalgam restoration
your diagnostic tests is to reproduce the chief
complaint. You test the suspected tooth for per- 35. The outline form of the access cavity of which
cussion sensitivity and palpation sensitivity. Your of the following teeth is trapezoid in shape?
positive percussion findings can be interpreted A. Maxillary first molar and mandibular first
as follows: molar
A. The tooth is nonvital and should be treated B. Mandibular first molar and maxillary second
with root canal therapy. molar
B. There is inflammation in the PDL. C. Maxillary first molar and maxillary second
C. There is inflammation in the PDL and the premolar
surrounding periodontium. D. Mandibular second premolar and maxillary
D. There is a root fracture present. second molar
E. The tooth is necrotic. E. Mandibular first molar and mandibular sec-
ond molar
32. When making a diagnosis as to the vitality of a
tooth, you employ the electric pulp tester. You 36. A patient presents to your office with a fractured
obtain a measurement that suggests the tooth is tooth #9. The fracture involves enamel, dentin,
necrotic. With this information alone, you can and pulp. This fracture can be classified as:
determine that: A. Root fracture
A. The tooth is necrotic. B. Crown–root fracture
B. Further testing is necessary to make a defini- C. Complicated crown fracture
tive diagnosis. D. Uncomplicated crown fracture
C. The tooth needs root canal therapy.
D. The tooth has an inflamed PDL. 37. You are halfway through the root canal treat-
E. The tooth has calcified canals. ment on tooth #30. To prevent bacterial growth
in the canal between appointments, you decide
33. A patient presents to your office with pain in to use an intracanal medication. The interap-
tooth #12. You perform a cold test with Endo Ice pointment medicament of choice is:
to determine vitality. If the tooth has irreversible A. Sodium hypochlorite
pulpitis, the cold test will result in: B. Ethylenediaminetetraacetate
A. No response to the cold test C. Chlorhexidine
 Questions: 30-43 151

D. Calcium hydroxide C. Tracing the fistula with a gutta percha point

E. Gutta-percha in conjunction with the radiograph
D. Periodontal probing of all teeth in the area
38. A 9-year-old patient has avulsed tooth #8 in a E. Take radiograph from two different angles
playground accident. His mother has recovered
the tooth and has called to ask how it should be 42. A 35-year-old woman was in a horse back rid-
stored while she gets her son to your office. The ing accident less than 1 hour ago. On clinical
best way to store an avulsed tooth for the best examination, the tooth is painful to palpation
prognosis is: and has slight mobility. The tooth is fractured
in the occlusal third and there appears to be no
A. Dry
exposure. A periapical radiograph reveals frac-
B. Tap water
ture above the pulpal space and no periapical
C. Saline
radiolucency. The treatment of choice for the
D. Saliva
asymptomatic maxillary central incisor is:
E. Milk

Endodontics
A. Root canal treatment in the occlusal segment
39. A 20-year-old male patient presents to your office B. RCT in the occlusal segment and 2 weeks of
with tooth #9 in his hand. It had been avulsed passive splinting
the day before during a camping trip and was C. RCT in both segments
stored dry in a plastic bag. Your treatment plan D. RCT in the occlusal segment and surgical
should be: removal of the apical segment
A. Perform root canal therapy and replant the E. No treatment at this time and continued ob-
tooth servation
B. Give your patient all of his options to replace
43. You are playing a soft ball game in Central Park.
the tooth
Your good friend is the catcher. He is not wearing
C. Clean the tooth and socket and replant the
a mask. A foul tip hits him in the mouth and the
tooth
left central incisor is avulsed and lands in the dirt
D. Clean the tooth and socket, replant the tooth,
behind the home plate. Your office is 10 minutes
and splint it for a week
away. The best treatment for the tooth is:
40. A primary tooth has an exposed vital pulp. The A. Scrape off all the debris and remove the
tooth has less than two-third of its root remain- contaminated periodontal ligament; then re-
ing and caries perforating the furcation. There plant immediately
is a succedaneous tooth forming normally api- B. Gently clean the tooth of debris and replant
cal to the tooth. The treatment of choice for this C. Gently clean the tooth and carefully remove
tooth is: the periodontal ligament and initiate en-
A. Indirect pulp cap dodontic therapy
B. Pulp cap D. Gently clean the tooth of debris with saline;
C. Pulpotomy carefully remove several millimeters of the
D. Extraction apex so as not to disturb the remaining peri-
E. Root canal therapy odontal ligament

41. The most effective method of diagnosing the

origin of fistula is:
A. Visually locating the closest tooth to the fis-
tula
B. Percussing all of the teeth in the area of the
fistula
 152 Chapter 6: Endodontics

44. A new patient comes to your office. He has no A. Both the statement and the reason are correct
adverse symptoms. On routine radiographic ex- and related
amination, you notice apical radiolucency on a B. Both the statement and reason are correct
root-canal–treated lateral incisor, which was ad- but NOT related
equately restored with a post and a PFM crown. C. The statement is correct, but the reason is
The RCT was completed 2 years ago. The radio- NOT
graph shows an adequate widening and filling of D. The statement is NOT correct, but the rea-
the canal. The patient has no contributory med- son is correct
ical history. The tooth is asymptomatic. What is E. NEITHER the statement NOR the reason is
the likely diagnosis? correct
A. Chronic apical periodontitis 48. During an intracoronal bleaching procedure the
B. Foreign body reaction surface to which bleaching agent is applied is
C. Apical radicular cyst the?
D. Scar tissue
Endodontics

E. Irreversible pulpitis A. Mesial

B. Distal
45. What should the treatment plan be? C. Facial
D. Lingual
A. Replace the crown; retreat the canal.
B. Perform another surgery and place another 49. A Hedstrom file is made by twisting a tapered or
root end material. square wire into elevated cutting edges.
C. Place the patient on antibiotics to resolve the
lesion. It produces its cutting effect on pulling strokes
D. No treatment is needed. only.
E. Extraction A. Both statements are TRUE
B. Both statements are FALSE
46. When performing an endodontic re-treat pro- C. The first statement is TRUE, the second is
cedure, gutta percha may be plasticized using FALSE
each of the following except, which one is the D. The first statement is FALSE, the second is
exception? TRUE.
A. Xylol
B. Sodium Hypochlorite 50. Which of the following best illustrates the rea-
C. Eucalyptol son why calcium hydroxide is not used endodon-
D. Chloroform tic procedures involving the primary denti-
tion?
47. Transportation in the apical portion of canal A. Can cause external resorption
walls may occur on the inner curve BECAUSE B. Promotes the formation of reparative dentin
files have the tendency to return to their linear C. Has an alkaline pH
shape. D. Produces no anti-microbial effect