Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 210 views

    Endodontic Errors

    Uploaded by

    asop06
    1) Endodontic errors can occur during root canal treatment due to inattention to detail or unpredictable occurrences. It is important to recognize, correct, and re-evaluate errors to provide the best prognosis. 2) Common endodontic errors include treating the wrong tooth, missing canals, perforating the root, separated instruments, and overfilling the canal. Prevention involves careful diagnosis, anatomy knowledge, and attention to technique. 3) When errors occur, it is important to inform the patient, correct the issue, and consider alternative treatment options depending on the type and extent of the problem. The goal is to address the mishap while maintaining the best possible prognosis and avoiding litigation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Endodontic Errors

    Uploaded by

    asop06
    210 views50 pages
    1) Endodontic errors can occur during root canal treatment due to inattention to detail or unpredictable occurrences. It is important to recognize, correct, and re-evaluate errors to provide the best prognosis. 2) Common endodontic errors include treating the wrong tooth, missing canals, perforating the root, separated instruments, and overfilling the canal. Prevention involves careful diagnosis, anatomy knowledge, and attention to technique. 3) When errors occur, it is important to inform the patient, correct the issue, and consider alternative treatment options depending on the type and extent of the problem. The goal is to address the mishap while maintaining the best possible prognosis and avoiding litigation.

    Original Description:

    Endodontic error

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1) Endodontic errors can occur during root canal treatment due to inattention to detail or unpredictable occurrences. It is important to recognize, correct, and re-evaluate errors to provide the best prognosis. 2) Common endodontic errors include treating the wrong tooth, missing canals, perforating the root, separated instruments, and overfilling the canal. Prevention involves careful diagnosis, anatomy knowledge, and attention to technique. 3) When errors occur, it is important to inform the patient, correct the issue, and consider alternative treatment options depending on the type and extent of the problem. The goal is to address the mishap while maintaining the best possible prognosis and avoiding litigation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    210 views50 pages

    Endodontic Errors

    Uploaded by

    asop06
    1) Endodontic errors can occur during root canal treatment due to inattention to detail or unpredictable occurrences. It is important to recognize, correct, and re-evaluate errors to provide the best prognosis. 2) Common endodontic errors include treating the wrong tooth, missing canals, perforating the root, separated instruments, and overfilling the canal. Prevention involves careful diagnosis, anatomy knowledge, and attention to technique. 3) When errors occur, it is important to inform the patient, correct the issue, and consider alternative treatment options depending on the type and extent of the problem. The goal is to address the mishap while maintaining the best possible prognosis and avoiding litigation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 50

    Endodontic Errors

    Isra Hijazi
    Definition
    u Endodontic errors or procedural
    accidents are those unfortunate
    occurrences that happen during
    treatment, some owing to inattention
    to detail, others totally unpredictable
    u • Recognize

    u • Correct

    u • Re evaluate the prognosis


    Recognition
    u • First step in the management.

    u  • Clinical observation.

    u • Radiographic observation.

    u  • Patients complaint
    •  Correction:
    u  Dependingon type and extent of the
    procedural accident.

    • Re-evaluation:
    u Effects of the entire treatment plan.
    u  Involve Dento-legal consequences.
    Inform the patient
    u • Incident and nature of mishap.
    u • Procedures to correct it.
    u • Alternative treatment options.
    u • Prognosis of the affected tooth.
    ENDODONTIC MISHAPS
    Access related Instrumentation Obturation related Miscellaneous
    Related
    1.  Treating wrong 1.  Ledge formation 1.  Over- or 1.  Post space
    tooth 2.  Cervical canal underextended perforation
    2.  Missed canals perforations root canal 2.  Irrigant related
    3.  Damage to 3. Midroot fillings 3.  Tissue
    existing perforations 2.  Nerve emphysema
    restoration 4. Apical paresthesia 4.  Instrument
    4.  Access cavity perforations 3.  Vertical root aspiration and
    perforations 5. Separated fractures ingestio
    5.  Crown instruments and
    fractures foreign objects
    6. Canal blockage
    Access related accidents
    Treating a wrong tooth
    REASONS :
    u • Misdiagnosis
    u • Isolating the wrong tooth

    RECOGNITION:
    u • Realizing the mistake after rubber
    dam removal.
    u  • Persistence of symptoms.
    PREVENTION:
    u • Mistakes in diagnosis can be avoided by,
    obtaining at least three good pieces of
    evidence supporting the diagnosis for example,
    u  # Radiograph showing a tooth with an apical lesion.
    u  # Lack of response to electric pulp testing.
    u  # Draining sinus tract leading to the tooth apex proved
    radiographically with a GP point inserted in the tract.
    CORRECTION:
    u  • Includes appropriate treatment of both teeth one
    incorrectly opened and the one with the original pulpal
    problem.
    u  • When a mistake does happen, the safest approach, is
    to explain to the patient what happened and how the
    problem can be corrected.
    u  • The embarrassing situation of opening the wrong
    tooth can be prevented by marking the tooth to be
    treated with a pen before isolating it with a rubber
    dam.
    Missed canal ETIOLOGY:
    u – Lack of thorough knowledge of root canal
    anatomy along with its variations.
    u – Inadequate access cavity preparation.

    RECOGNITION :
    u  – During treatment, an instrument or
    filling material may be noticed to be other
    than exactly centered in the root,
    indicating the presence of another canal.
    u  • Well angulated periapical film taken with
    cone directed straight on, mesioblique and
    distoblique reveals 3-D morphology of the
    tooth.
    u  • In addition to standard radiographs, digital
    radiography
    u  • Computerized digital radiography - hidden
    calcified, or untreated canals.
    u  • Magnifying loupes, Microscope
    u  • Accurate access cavity preparation .
    u  • Use of ultrasonics
    u  • Use of dye such as methylene blue
    u  • Use of sodium hypochlorite- “champagne bubble” test.

    Prevention
    u  • Good radiographs taken at different horizontal
    angulations.
    u  • Good illumination and magnification.
    u  • Adequate access cavity preparation.
    u  • Clinician should always look for additional canals in every
    tooth being treated
    u White line test: In necrotic teeth,
    dentinal dust moves into orifices, fins and
    isthmus when performing Ultra sonic
    procedure without water. This dust can form
    white dot/ line that provides a visible road
    map.
    Red Line test:
    u  • In vital teeth, blood emanates from orifices,
    fin and isthmus area and serves to map and
    visually aid in identifying anatomy below the
    pulpal floor
    Perio probing:
    u  • Circumferentially probing the sulcus around
    the tooth is an important strategy for locating
    canal.
    u  • Gives information as to emergence profile of
    clinical crown and orientational alignment of
    underlying root
    u  Not all MB2 orifices lead to a true canal, a true MB2
    orifice Was present in only 84% of molars in which a
    second orifice Was identified
    u  Magnificationhas been found to increase the detection
    rate of MB2 canals from 17.2% with the naked eye, to
    62.5% with loupes and 71.1% using the surgical
    operating microscope
    Mandibular premolar – 3 canals
    Maxillary molar with 2 DB canals
    Maxillary molar with 3 MB canals
    Maxillary molar with 4 MB canals
    Fast break guideline
    u  A “fast break” is a term used to describe a situation where a root
    canal disappears on a radiograph as you move apically. This
    happens when the main canal splits into multiple smaller canals
    that are not discernible on a radiograph. CBCT axial views are
    indispensable determining the number and location of these
    canals
    Damage to existing restoration
    u  •An existing porcelain crown presents the dentist
    with its own unique challenge.

    • PREVENTION:
    u  – Clamp adjacent tooth
    u  – Remove all temporary crowns.

    u  • To remove existing permanently cemented crown


    before treatment.
    u  TheMetalift Crown and Bridge Removal
    System removes inlays, three-quarter crowns, full
    crowns, and fixed bridges without destroying them, thus
    allowing them to be reused.
    CORRECTION:
    u  Minor porcelain chips can be repaired by bonding
    composite resin to the crown.
    • Crown Disassembly Devices:

    u a. Grasping instruments


    u b. Percussive instruments
    u c. Active instruments
    Conservative Semi Destructive
    conservative
    1. Richwill crown 1. Wamkey 1. Tungsten carbide
    and bridge 2. Metalift crown and burs
    remover bridge removal 2. Burs and
    2. Ultrasonics system Christenson crown
    3. Pneumatic (KaVo) 3. Higa bridge remover
    CORONA flex remover
    4. Sliding hammer
    5. Crown tractors
    6. Matrix bands.
    Ultrasonics:
    u  Indirectly helps in breaking cement seal
    u  ACT4 tip (Sybron endo) can be used to remove
    cement lute from around the margins of a
    poorly fitting crown
    u  TheKaVo CORONAFLEX pneumatic crown and
    bridge remover:
    The WamKeys
    Access cavity perforations
    RECOGNITION:
    Access cavity perforation:
    u  • Above pdl attachment: Presence of leakage
    u  • Into the pdl space: Presence of bleeding
    CONFIRMATION:
    u  • Place a small file through the opening and take
    a radiograph
    Materials recommended for perforation
    repair:
    u  1. Cavit,
    u  2. Amalgam,
    u  3. Calcium hydroxide paste,
    u  4. Super EBA,
    u  5. Glass ionomer cement,
    u  7. Tricalcium phosphate,
    u  8. MTA
    u  9. Biodentin
    u PROGNOSIS:
    • Sinai proposed that the prognosis depends on:
    – Location of perforation
    – Length of the time the perforation is open to
    contamination
    – The ability to seal the perforation
    – Accessibility to the main canal
    Prevention
    u  •Thorough examination of diagnostic preoperative
    radiographs
    u  •Checking the long axis of the tooth and aligning the
    long axis of the access bur with the long axis of the
    tooth
    u  •The presence, location, and degree of calcification of
    the pulp chamber noted on the preoperative radiograph
    u  •A close attention to the principles of access cavity
    preparation: adequate size, and correct location, both
    permitting direct access to the root canals.
    Crown fractures
    Recognition:
    u  • Usually by direct observation.
    u  • Infractions are often recognized first after removal of
    existing restoration in preparation of the access.

    Treatment:
    u  • If the fracture is more extensive, the tooth may not
    be restorable and needs to be extracted.
    u  • Crowns with infractions should be supported with
    circumferential bands
    Prognosis:
    u  • Is likely to be less favorable than for an intact
    tooth, and the outcome is unpredictable.
    u  • Crown infractions may lead to vertical root
    fractures.

    Prevention:
    u  • is simple. i.e. reduce the occlusion
    u  • -Bands and temporary crowns are also valuable.

    You might also like