Endodontia

Question 1

Indications for Endodontic Tx (7)

Answer 1

Irreversible pulpitis.
PA pathology.
Post retained restoration.
Overdenture.
Teeth with doubtful pulps.
Perio disease.
Pulp sclerosis following trauma.

Question 2

Contraindications to Endo Tx (9)

Answer 2

General:
Inadequate access (2 fingers).
Poor OH status/attitude.
General medical condition.

Local:
Unrestorable tooth (finishing line MUST be supracrestal, preferably supragingival).
Insufficient periodontal support.
Non-strategic tooth (unopposed & non-functional).
Root #s.
Root resorption.
Bizarre anatomy.

Question 3

Factors that Affect the Outcome of Endo Tx (3)

Answer 3

1. Preoperative status of the periapical tissues; 95% success rate in cases where pulp is vital, has pulpitis or is necrotic but unifected. Reduces to 85% in teeth with signs of PA periodontitis. Likelihood of success decreases further when the PA radiolucency is larger than 5mm in diameter.
2. Quality of root canal filling; more likely to be successful when the RC filling is satisfactory (extending to within 2mm of the radiographic apex and well compacted). Likelihood of success lowered when root filling is overextended, underxtended or contains voids.
3. Quality of the coronal restoration.

Question 4

Reasons why Endo Tx Fails (4)

Answer 4

1. Intraradicular infection; persistent infection &/or secondary infection.
2. Extraradicular infection (endo surgery required).
3. True cysts; apical true cysts require endo surgery, pocket cysts will generally heal (lining extends into the RC itself). If pt has suspected cyst then root treat but warn they may need endo surgery in future.
4. Foreign body reaction.

Question 5

Management of Endo Failures (4)

Answer 5

1. No Tx/Monitoring; when outcome not favourable according to strict criteria but tooth stable enough to warrant review.
2. Extraction; when pt doesn’t wish to have future Tx and monitoring is not an option.
3. Endodontic re-treatment; when undertaken properly the success rate can be nearly as high as primary treatment (83% vs. 80%).
4. Apical Surgery/Surgical Endodontics.

Question 6

Indications for Surgical Endodontics (7)

Answer 6

1. When RC re-treatment would have an unfavourable outcome.
2. Obstructions within the canal which cannot be removed/negotiated with orthograde Tx.
3. Teeth with long/wide posts which risk root fracture if removal is attempted.
4. Perforations which require surgical repair.
5. Investigative procedures (e.g. biopsies, confirmation of root #s).
6. Extraradicular infection.
7. True cysts.