Endo Misadventures Flashcards
What are some factors that contribute to providing wrong tooth/treatment?
- Continue symptoms after dx
- Teeth look alike
- Failure to test vitality
- Non-odontogenic lesion
- Referred pain
- Case difficulty
What are some non-odontogenic causes of pain?
- Musculoskeletal - Myofasical pain, TD
- Neutropathic - Trigeminal Neuralgia, Phantom tooth pain
- Neurovascular - Migraine, Cluster HA
- Inflammatory - Sinusitis
- Systemic Disorders - Cardiac, Herpes Virus, Tumors
- Psychogenic - Munchausens
What are some things you can do to prevent doing RCT on the wrong toth?
- Time Out
- Don’t use RD INITIALLY
- Complete vitality testing
- Refer when necessary
What is canal transportation?
- When the central axis is dislocated from original position
- “Hour-glass appearance”
What is a zip perforation?
- A transportation that leads to perforation apically
What is a ledge?
- Iatrogenically created
- Impedes Instrumentation
- An artificial irregularity created on the surface of the root canal wall that impedes the placement of instruments to the apex of an otherwise patent canal
What are some adverse consequences of ledging?
- Incomplete canal debridement
- Incomplete Obturation
What factors contribute to canal transportation?
- Lack of expertise
- Insufficient access cavity
- Poor control of length
- Lack of coronal flare
- Use of end cutting files
- Excesive axial filing
- Oversized MAF
How do you avoid canal transporation?
- Achieve excellent access
- Control Length
- Have good coronal flare which reduces coronal curvature, improves straight line access, reshapes “C” into “J”
- Avoid end-cutting files
- Use safety-tipped files: Flex-R, Sure Flex, NiTi rotary
- Think small
- Minimize axial filing motions - especially apically
- Used balanced force technique
How do you treat a ledge?
- Attempt to bypass - Short radius bend in file
- If not, obturate, may require root end surgery
Define perforation…
Iatrogenic or pathologic communication between pulp space and oral cavity or attahment apparatus
How do you recognize a perforation?
- Pain short of apex
- Excessive bleeding
- Visually inspect
- Apex locator reads out
- Bleeding on paper point
- Confirm radiographically
What 3 factors influence perforation treatment?
- Level
- Size
- Time
What is the most determinant of success when treateting a perforation?
The distance between the perforation and gingival sulcus
Coronal to attachment = good
Apical to attachment = good
AT LEVEL OF ATTACHMENT = BAD!
Is a small or large perforation easier to seal?
Small eaiser to seal
Large harder to seal
How does time influence perforation?
Seal immediately for best prognosis
What are the 5 Perforation Types?
- Coronal
- Crestal
- Chamber Floor
- Midroot and Strip
- Apical
What factors contribute to coronal and crestal perforations?
Disoriented during access
Calcified canals, etc…
What tooth factors work against you in avoiding a perforation?
- Tipped tooth
- Crown
- Calcified toot
- Crown-root deviations
What can a dentist do to help avoid a perforation?
- Access without RD
- Isolate multiple teeth
- Make check radiograph
- Observe dentin roadmap
- Observe exit angle of file handle
- Study chamber position and dimensions
- Aim for largest pulp space, careful with highspeed round burs!
- Make proper access
How do you treat a perforation?
- Locate and protect canals
- Control bleeding
- External matrix
- Composite, RMGI, Compomer (Geristore)
How do you avoid a chmber floor perforation?
- Be aware of the dark chamber floor
- DO NOT BE TOO AGRESSIVE WITH HIGH SPEED ROUND BURS!
What clues will the canal give you if it’s calcified?
- Sticky with endo explorer
- “Dust spots”
- White calcified dentin
- Dentin road map
- NaOCl chapagne bubbles
How do you treat a perforation?
- Use NaOCl cautiously
- Control hemorrhage
- Internal matrix (prevents material extrusion: ie: Collagen materials, Calcium sulfate, Calcium hydroxide, FDBA)
- MTA or RMGI
- Once repaired, complete RCT