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BDS3 - Endodontics > endodontic failure > Flashcards

endodontic failure Flashcards

1
Q

what is success

A
  • the accomplishment of an aim or a purpose

- the good or bad outcome of an undertaking

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2
Q

what are the success rates of root canal treatment

A
  • range from 31% to 100%
  • works most of the time but not always
  • outcomes haven’t changed significantly in recent times
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3
Q

how is success defined

A
  • ESE guidelines define success as a successful outcome
  • success means different things to different people
  • consider technical versus biological outcome
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4
Q

when should root canal treatment be assessed

A
  • at least after 1 year and subsequently as required

- gives enough time for signs, symptoms to subside and radiographic evidence of healing to be present

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5
Q

what would endodontic success look like

A
  • absence of pain, swelling and other symptoms
  • no sinus tract
  • no loss of function
  • radiological evidence of a normal PDL
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6
Q

what is an uncertain outcome

A
  • if radiographic changes remain the same of has only diminished in size
  • if lesion persists after 4 years, the RCT associated with post treatment disease
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7
Q

what are the 4 signs that RCT has an unfavourable outcome

A 
1 = tooth associated with signs and symptoms of infection 
2 = a radiologically visible lesion has appeared subsequent to treatment or pre-existing lesion has increased in size 
3 = lesion has remained the same size 
4 = signs on continuing root resorption
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8
Q

what are the exceptions to uncertain outcomes

A
  • scar tissue

tooth should continue to be assessed

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9
Q

what is loose criteria for success

A
  • don’t need to see complete absence of radiolucency we can see one getting smaller
  • important to recognise that people base success on different things
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10
Q

how can the strictness of criteria have an effect on success rates

A
  • strict criteria gives lower success rates than loose criteria
  • success criteria has big impact on numbers
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11
Q

why must you consider biological and technical failure

A
  • can have technical failure but biological success, or could have technical success but biological failure
  • important that we do follow up on treatment
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12
Q

why do root treatments fail

A
  • haven’t managed infection

- infection could be in an area we can’t get to

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13
Q

what are some pre-op factors that affect success

A
  • presence or absence of a lesion

- if tooth vital or non-vital

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14
Q

what are some operating factors that affect success

A
  • filling extending to within 2mm of radiographic apex
  • well condensed root filling with no voids
  • good quality coronal restoration
  • technical complication leading to biological failure
  • missed canals
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15
Q

what does it mean if the filling is too short

A
  • we haven’t disinfected adequately or created a good apical seal
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16
Q

how does extruding GP affect outcome

A
  • have a negative effect

- indicates other problems with preparation

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17
Q

what technical complications can lead to biological failure

A
  • coronal leakage
  • difficult to establish causality
  • presence of a sinus
  • increased lesion size
  • no perforation
  • getting latency
  • penultimate rinse with EDTA
  • avoiding mixing CNX and NaOCl
  • absence of a flare up
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18
Q

how can you avoid missing canals

A
  • is we miss anatomy, we fail to disinfect
  • have to be careful we don’t miss things on radiograph
  • expect the unexpected
  • careful of how we assess radiographs
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19
Q

what are the laws to help us with success

A
  • law of centrality
  • law of concentricity
  • law of the CEJ
  • law of symmetry
  • law of colour change
  • law of orifice location
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20
Q

what is the law of centrality

A
  • the floor of the pulp chamber is always located in the centre of the tooth at the level of the CEJ
  • pulp chamber lies central of the tooth at the CEJ and concentrate with level of root surface at level of CEJ
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21
Q

what is the law of concentricity

A
  • the walls of the pulp chamber are always concentric to external surface of the tooth at the level of the CEJ
22
Q

what is the law of the CEJ

A
  • the CEJ is the most consistent, repeatable landmark for locating the position of the pulp chamber
23
Q

what is the law of symmetry 1

A
  • except for maxillary molars, the orifices of the canal are equidistant from a line drawn in a mesial distal direction through the pulp-chamber floor
24
Q

what is the law of symmetry 2

A
  • except for maxillary molars, the orifices of the canal lie on a line perpendicular to a line drawn in a mesial-distal direction across the centre of the floor of the pulp chamber
25
Q

what is the law of colour change

A
  • the colour of the pulp-chamber floor is always darker than the walls
  • important feature
  • enhanced with magnified field of view
26
Q

what is the law of orifice location 1

A
  • the orifices of the root canals are always located at the junction of the walls and the floor
  • lies along junction o vertical walls and horizontal floor
27
Q

what is the law of orifice location 2

A
  • the orifices of the root canals are located at the angles in the floor-wall junction
  • if looks wall junction comes to a point the orifices walls lies at the corners
28
Q

what is the law of orifice location 3

A
  • the orifices of the root canals are located at the terminus of the root developmental fusion lines
  • dark lines run across the floor of pulp chamber and lead us to orifice
29
Q

what are some factors that contribute to success

A
  • achieve and maintain latency
  • blockages can be due to sever curvatures - need to manage these carefully
  • lots of irrigation and recapitulation
30
Q

what are some factors that contribute to failure

A
  • iatrogenic = avoid creation of ledges
  • poor planing
  • poor access
  • poor length control
  • forcing instruments
  • failure to observe sequence
  • failure to maintain patency
31
Q

what are some biological reasons for failure

A
  • persistent intra-radicular infection
  • extra-radicular bacteria
  • non-microbial agents
  • cholesterol crystals
  • foreign body reactions = delayed healing
  • scar tissue ‘healing’
32
Q

what are persistent intra-radicular infections

A
  • canal complexities
  • biofilm
  • resistant bacteria
  • enterococcus faecalis has been identified, but role is controversial
33
Q

what are extra-radicular bacteria

A
  • actinomyces

- extruded biofilm = made way out of root canal space so can’t decried/disinfect

34
Q

what are non-microbial agents

A
  • cyst formation = periodical cysts (true and pocket cysts)

- developed from mature granuloma, inflammatory mediators acting on epithelial cell rests

35
Q

what is a true cyst

A
  • are separate from root canal
36
Q

what causes cysts

A
  • granulomas, abscesses, or cysts are primarily caused by root canal infection
  • if manage cause, then should go away but if it is a true cyst then this won’t help
37
Q

what could be the cause of apical pathology

A
  • technical = perforation, separated instrument
  • root fracture = could be untreatable
  • other odontogenic pain = need to discern this cause
  • non-odontogenic pain
38
Q

what may you need to do to assess restorability of tooth

A
  • may need to dismantle to assess if restorable or fracture
  • need good magnification and illumination
  • assess remaining tooth structure
39
Q

what are the options for management

A
  • keep under observation
  • orthograde pretreatment = going from top and down
  • surgical treatment = remove periradicular tissues and root tip and creat a seal from apical region up
  • extraction = typical treatment for endo failure
40
Q

what are most failures due to

A
  • inadequate disinfection of the root canal system, leaving residual bacteria
41
Q

what re-treatment often gives best outcome

A
  • non-surgical re-treatment
42
Q

what can increase the complexity

A
  • if the original anatomy has not been damaged the complexity of the treatment is not high
  • if there are fractured instruments, blockages, ledges, sever curvatures, it is more complex and so consider referral
  • apical surgery is complex and considered a specialist treatment
43
Q

what does the strategy for re-treatment depend on

A
  • the material found within the root canal space
44
Q

what re-treatment do you do for insoluble resin

A
  • ultrasonics
45
Q

what re-treatment do you do for GP

A
  • handles +/- solvent

- proper/ Reciproc

46
Q

what re-treatment do you do for soluble pastes

A
  • handfiles +/- solvent

- proper/Reciproc

47
Q

how do you remove GP

A
  • if poorly condensed then easier = use Hedstroem files

- if well condensed then harder = need to create space to get file in, use solvents

48
Q

how do we use handfuls +/- solvents

A
  • stratified approach and very simple initially then we add complexity
  • use hedstroem file to engage GP and try withdraw first = use C files to allow you to penetrate the GP mass
  • may use eucalyptus oil to help dissolve GP to get files deeper
49
Q

how do we use ProTaper re-treatment

A
  • D files
  • D1 has active tip to allow better initial penetration into material, allows files to penetrate while rotating inGP mass
  • need to be aware of curves = can lead to perforation
  • start with D1 (coronal filing) then work through D2 (middle filing) and D3 (apical filing)
50
Q

how do we use Reciproc system

A
  • files correspond to ISO sizing
  • has a regressive taper = allows for coronal shaping without unnecessary tooth loss
  • single file reciprocating system that is very efficient
  • remove bulk of GP before determining WL
  • use solvent
  • use R25
  • brushing with file (peck motion)
  • increase apical enlargement
  • remove GP and thermal carrier
  • once removed most GP then use Reciproc or Reciproc Blue to finish preparation

BDS3 - Endodontics (10 decks)

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