Endodontics
Course Review
Enoch Ng, DDS 2014
Retreatment
Retreatment Outcomes
Nonsurgical – 73%
Surgical – 57%
2
nd
nonsurgical – 47%
Replantation – 41%
Overall – 65%
Nonsurgical retreatment – 75%
Surgical retreatment – 59%
Surgery after NSRCT retreatment – 80%
Phases I and II
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81% healed
-
93% functional
Phases III and IV
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82% healed
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86% improved
-
94% functional
Etiology of Non-Healing
o
89% of NSRCT teeth by endo specialists retained after 5 years
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Inadequate seal
o
Coronally – leaky crown/filling
o
Apically – poor obturation/condensation, short fill, overextended fill
o
Perforation – untreated/leaky mechanical perforation in chamber floor/canal
o
Resorption
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Untreated/contaminated canal space
o
Non-negotiable canal – dilacerations, ledge, calcification
o
Inadequate instrumentation
o
Lateral canal
o
Missed canal
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Separate instruments/fragments
o
May block cleaning and sealing of canal system
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Vertical root fracture
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Trauma – resorption, fracture, avulsion
Indications of Non-Healing
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Sporadic, vague symptoms
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Widened PDL space
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Static radiolucency/slight repair
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Voids in obturation in apical 1/3
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Overfill beyond anatomic apex
Causes of Non-Healing
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Periodontal involvement
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Host factors
o
Non-odontogenic pathology
o
Systemic conditions (diabetes)
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Misdiagnosis – another tooth is the etiology
Surgical Considerations
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Inability to reach/seal apex through canal
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Unable to remove old canal filling
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Unable to remove post or other canal obstructions
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Severe apical perforation/zip