Iatrogenic Misadventures

Question 1

Even though attempting to help the patient, we MAY create a
bigger problem which may NOT be correctable.
This is _________ (our bad) and should be largely
preventable with education, focus, care and experience.

Answer 1

an iatrogenic error

Question 2

___ is always better than repair

Answer 2

Prevention

Question 3

If you can’t look at the case and be
certain of an excellent result in your
hands, you are honor bound to _____ the
case to the appropriate specialist*

Answer 3

refer

Question 4

Honest explanation of all
possible misadventures _____
treatment is started (use non-
technical terms)

Answer 4

before

Question 5

Patient must have all
questions answered ____ TX
is accepted

Answer 5

before

Question 6

Explaining away mishaps \_\_\_\_ they 
occur destroys credibility and voids the 
consent and your permission to 
proceed. 
Creates distrust & additional 
LIABILITY.

Answer 6

AFTER

Question 7

The BIGGEST 
problems ALWAYS 
occur when you have the 
\_\_\_\_\_\_ time to deal with 
them

Answer 7

LEAST

Question 8

• Entry into the _____ often becomes a prelude to an expensive tour of our Court system.
• Be certain you can prove and document your Diagnosis and Treatment Plan
• Be sure you make a mark on the tooth you want to work on BEFORE you place the rubber dam*** Access w/o rubber dam when indicated – except for Board Exams.
• Reconfirm all information one more time.It’s always your fault and there is NO EXCUSE*

Answer 8

wrong tooth

Question 9

What do you do if you enter the wrong tooth?

Answer 9

Plan on free work
Take Responsibility
Do the Right thing

Question 10

Missing a Canal will guarantee a ________ (sooner or later)

Answer 10

FAILURE

Question 11

What 2 populations are 4th roots common in ?

Answer 11

Asian and Native American populations

Question 12

What are the 4 approaches take for file separation?

Answer 12

1. remove the instrument (REFER)
2. bypass the instrument
3. apical surgery & retrofill
4. TE + alternate treatment option

Question 13

What do you do if blockage happens?

Answer 13

Stop
Irrigate
Recapitulate

Question 14

What are the 3 things that you can do in case of blow out?

Answer 14

a. Back off (shorten) WL & 
Enlarge IF possible*  OR
b. Surgical Resection & 
Retroseal OR
c. Extract and Replace

Question 15

If a fill is anemic or short, what do you do?

Answer 15

– Remove old GP or other filling material
– Re-shape to correct length and shape IF POSSIBLE
– Obturate correctly N/C B4 someone else sees it!

Question 16

______ are the MOTHER of all iatrogenic misadventures. The most damaging to prognosis and the most difficult to repair –
• As always . . . PREVENTIONis by far the best solution. . .
• are a serious challenge to successful completion of the RCT and retention of the tooth.
• is the most common iatrogenic injury @ UMKC undergrad. Clinic

Answer 16

Perforations

Question 17

T/F:
- Anything through a crown is dangerous (usually Grad. Endo).
- Posts are very productive for perfs.
- No crown on the tooth is not as easy as you might think.
ALl these are easy to perf

Answer 17

true

Question 18

To confirm perf
Use \_\_\_\_\_\_\_ with small 
file (if it immediately pegs, it’s 
a perf. - not a canal) It is 
indicating the resistance of a 
PDL = outside the tooth.

Answer 18

Apex locator

Question 19

If you perf, how do you modify the NaOCl?

Answer 19

Dilute it 10:1

Question 20

If the perf is supra gingival, is the prognosis better or worse?

Answer 20

Better; closer to attachment is bad

Question 21

What is the best timing of repair?

Answer 21

Immediate

Question 22

How does the endodontist fix the perf?

Answer 22

Collacote is used as a matrix
MTA is placed over perf and allowed to set with water
Don’t occlude canals

Question 23

The closer the perf. To the attachment, the ____ the prognosis.

Answer 23

worse

Question 24

If perf occurs above alveolar crest, what do you pack with? Below crest?

Answer 24

Geristore; MTA

Question 25

A \_\_\_\_\_ is caused when a 
large instrument is misdirected, or used 
aggressively 
• This is the most difficult perf. to repair 
favorably
• Matrix is not practical.
• Maybe apical surgery: resection and 
MTA retrofill – maybe Extraction ***

Answer 25

Strip Perforation

Question 26

• Problem starts with a ledge
• Added pressure leads to a root 
perf. well below attachment.
• Try to bypass ledge re-enter canal 
& obturate canal 
• Fill perf. with GP or MTA
Orthograde (or Surgical ?)
Then SEAL canal permanently 
Vitrebond, etc.

Answer 26

Apical perf

Question 27

An __________is required at the school if an iatrogenic error occurs (Must be on Rosie’s desk w/in 48 hrs)

Answer 27

INCIDENT REPORT