Endodontic Complications

Question 2

medical complication definition

Answer 2

a secondary disease or condition aggravating an already existing one

Question 3

3 areas of complications in endo

Answer 3

access
instrumentation
post-op complications

Question 4

perforation

Answer 4

an artificial or iatrogenic communication between root canal system and the PDL

Question 5

how to avoid perforation

Answer 5

plan pre-op, inspect internal surfaces, knowledge of anatomy, measure pre-op radiograph, rubber stopper as depth gauge, correct EWL/WL

Question 6

how much of the pulp chamber is needs to be removed

Answer 6

all of it
needed to gain access to the canals
provides a reservoir for irrigants during instrumentation

Question 7

complications with instruments

Answer 7

blockages, ledges, apical damage, perforation, fractured instrument

Question 8

blockage

Answer 8

caused by dentine debris getting packed into apical portion of root
attempts to remove can result in false canal being cut and possible perforation

Question 9

ledges

Answer 9

internal transportation of the canal
occurs with short WL
by-passed by placing curve at tip of file
if curved canals are instrumented as if they are straight, elding will occur and apical few mms will remain uninstrumented and infections stays

Question 10

apical zipping/transportation

Answer 10

occurs as a tendency of instrument to straighten inside a curved canal

results in over-enlargement along outer side of curvature, under prep of inner apical end, main axis of canal is transported and teadropshape created

avoid by precurving initial hand files, dont skip instruemnts and never rotate instruments in curved canals

Question 11

diagnosis of root perforation

Answer 11

persistent bleeding into canal, multiple radiographs, electronic apex locators, dental operating microscope

Question 12

prognosis of root perforation

Answer 12

depends on location, time elapsed, size, periodntal irritation and material used for repair

Question 13

torsional stress

Answer 13

extensive instrument surface encounters excessive friction on canal walls
if instrument tip is larger than canal section to be shaped, tip may lock, torque extends to critical level

Question 14

flexural stress

Answer 14

repeated cylic metal fatigue
cannot be influenced by clinician

Question 15

cyclic fatigue

Answer 15

freely rotating in curvator, generation of tension/compression cycles
results in failure

Question 16

types of issues leading to instrument separation

Answer 16

torsional stress
flexural stress

Question 17

post-op complications

Answer 17

pain
swelling
need for pain control
failure
prosthetic replacement

Question 18

common pitfalls of endo tx

Answer 18

access = too big/small, roof of pulp chamber not adequately removed, perforation
mechanical preparation = blockage, separated file, ledge
obturation = too short/long, voids, too much GP in pulp chamber, GP in other canals

Question 19

how to avoid blockages

Answer 19

dont skip files, dont force files, ensure file is passive prior to using bigger file size, recapitulate and patency file, irrigate, have a reservoir of irrigant in pulp chamber while instrumenting

Question 20

how to avoid fractures

Answer 20

know limits of instruments, use a recognised technique, pay attention to degrees of rotation, lubricate canal, know rotary setting

Question 21

deviations in canal anatomy can lead to….

Answer 21

ledges, apical zipping, over-instrumentation, repeated placement to a given length with extended working

Question 22

how to avoid obturation loss of control

Answer 22

obturate one canal at a time, use of super endo alpha to remove access, use of buchanan plugger to condense/control, practice and magnification