Endodontics
Course Review
Enoch Ng, DDS 2014
Outcomes and Complications
Treatment Factors affecting Healing
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Iatrogenic factors
o
Blocked canals – debris packed into apex
Use rotary motion rather than push/pull motion
Keep canal wet, frequent irrigation – 1-2mL between files
Remove coronal restorations
Recapitulate with small file 0.5-1mm beyond WL
o
Ledges – from incorrect WL and curved canals
Get corrected WL ASAP
Always recapitulate
Use copious irrigation
Caution with gates glidden drills and increased file sizes
o
Separated files – torsional or fatigue failure
Prevention
Prepare adequate glide path
Never force and instrument, control rotary torque
Keep canal wet
Inspect files, don’t overuse files
Proper case selection
Removal
Location affects prognosis
Magnification, ultrasonics
Instruments threaded into dentin are harder to remove
Fatigue failure – friction is less, easier to remove
Legal responsibility to inform patient, documentation in chart
Non-removal
Bypass, leave in place and monitor
Consider how far along instrumentation was when separation occurred, new diagnosis
Prognosis if fractured instrument left in tooth is not significantly reduced
o
Missed Canals
o
Perforation
Mechanical/pathologic communication between root canal system and external tooth surface
Secondary perio inflammation involvement causing attachment loss
Bacterial infection from root canal or perio tissues prevents healing
Most common cause of root canal failure – best prognosis if perforation sealed immediately
Types – coronal, furcal, strip, apical, zip
Prevention
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Know anatomy, carefully assess tooth angulation
and dimensions
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Access slowly, take radiographs as needed
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Caution with crowned, narrow, or calcified teeth
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Explore cervical root morphology
Repair
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MTA – biocompatible, good compressive strength,
less leakage than amalgam or IRM
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Mix powder with sterile water, deliver to site
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Condense with hand pluggers
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Repeat until sealed, place moist cotton pellet and
temporary restoration, allow to set