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5th ICP - Endo > Management of Endodontic Failure > Flashcards

Management of Endodontic Failure Flashcards

1
Q

Aim Endodontics tx?

A

Prevent/ cure periapical periodontitis

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2
Q

How assess outcome of endo?

A

Has aim been met - absence/ resolution periapical periodontitis

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3
Q

Strict sign of success?

A

No symptoms, no clinical sign disease and no PA radiolucency

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4
Q

Loose sign of success?

A

No symptoms and no clinical sign of disease

Decrease (no increase) size pre-op PA lucency

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5
Q

Best way to grade outcome of endo success?

A

Favourable
Uncertain
Unfavourable

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6
Q

What does survival of tooth mean?

A

Tooth present in arch and is asymptomatic and functional

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7
Q

Main 3 factos affect endo success?

A
  1. Pre-op status PA tissue
  2. Quality root canal filling
  3. Quality coronal restoration
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8
Q

What makes success more likely when considered pre-op status PA tissue?

A

Vital pulp - pulpitis/ necrotic but uninfected

Success = 95%

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9
Q

What sign when assessing pre-op status PA tissue would make success less likely?

A

Periapical periodontitis - PA radiolucency
Because canal heavily infected
Success = 85%

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10
Q

Does size of PA radiolucency affect success?

A

If larger 5mm diameter further reduction chance success

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11
Q

What defines a good quality root filling?

A

Extends within 2mm of apex and is well compact

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12
Q

What decrease chance of success when assessing filling?

A

Overextended/ underextended

Voids in filling

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13
Q

What looking for in coronal restoration?

A

No marginal deficiencies/ defects/ recurrent caries -route for bacteria to re-infect

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14
Q

Best coronal restoration provide post-RCT?

A

Full-coverage

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15
Q

Why are full-coverage restoration adv after RCT?

A

Improve coronal seal

Improve structural durability

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16
Q

When should success RCT be assessed?

A

9-12 months following - clinical and radiographic assessment
Earlier if continued symptomas

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17
Q

Should new PA be taken less 9-12 months if pt have symptoms?

A

Only if suspect further dx e.g root fracture

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18
Q

How long should RCT be assessed for?

A

Depending outcome of review up to 4 years

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19
Q

What symptoms should ask pt about when assessing RCT?

A

Pain, swelling and function

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20
Q

Does lack of symptoms = success?

A

Not always

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21
Q

What are other reasons for symptoms if RCT not unfavourable?

A

Occlusal interferences
Food trapping
Tooth fracture
Neurogenic pain

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22
Q

What should be assessed in clinical exam?

A 
Look swelling/ sinus tract
Tenderness palpitation soft tissue
Tenderness percussion of tooth
Presence fractures
Presence caries
Periodontal status - depth/ mobility
Quality restoration
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23
Q

What assess post-op radiograph?

A 
Quality filling
Presence/ absence PA lucency
Size PA lucency - compare pre-op
Quality restoration
Caries and perio
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24
Q

When would CBCT be indicated to assess RCT?

A

Persistent pain w/ no sign conventional radiograph

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25
Q

What is favourable outcome?

A

Symtom free
Functional tooth
Clinically associated tissue health
Radiograph - PA tissues healthy

26
Q

When is there an uncertain outcome?

A

No signs or symptoms
BUT
Radiograph - PA lucency persist - same size/ reduced within 4 year assessment period

27
Q

When is outcome unfavourable?

A

Pt symptoms
Tooth not functional
Clinical sign infection
Radiograph: new lucency, increase size lucency, lucency persisted at/after 4 year assessment

28
Q

How does outcome affect further review?

A

Review 9-12 months

Favourable - no further review
Uncertain - annual review 4 years
Unfavourable = further tx

29
Q

When should indirect restoration be placed?

A

After resolution clinical signs and symptoms

Don’t need wait resolution radiographic lesion

30
Q

4 reasons endo can fail?

A

Intraradicular infection
Extraradicular infection
True cyst
Foreign body reaction

31
Q

What is intraradicular infection?

A

Persistant infection due residual microbes left in canal

or microbes re-enter (due coronal leakage/ fracture)

32
Q

What can cause extraradicular infection?

A

Periapical actinomycosis

33
Q

Why can endo fail due cyst?

A

Apical cysts are self sustaining and won’t heal with satisfactory RCT

34
Q

How assess outcome RCT if you didn’t do it?

A

Hx - where and when performed
Ideal if have original diagnosis
Did tx initially remove symptoms
What technique used - was rubber dam used, hypochlorite etc

35
Q

4 main options if endo failed?

A

No tx - monitor
XLA
Endo re-tx
Apical surgery

36
Q

What should pt be advised if endo fail and have decided no further tx?

A

Tooth will require regular review
To return if signs/ symptoms develop
Acute flare up may occur

37
Q

When are XLA considered after failure RCT?

A

Pt doesn’t wish have further tx
Tooth restorability doubtful
Non-functional tooth w/ no strategic value
Untreatable disease - root fracture/ advanced bone loss

38
Q

What is tx of choice if have post-tx disease and pt keen to save tooth?

A

Endo re-tx

39
Q

What must a tooth be to consider re-tx?

A

Restorable

40
Q

Is success of re-tx good?

A

Success = 80%

Success normal RCT = 83%

41
Q

What should pt be advised of prior re-RCT?

A

Tooth may be deemed unrestorable - fracture/ gross caries

Complex w/ associated risks - perforation, unable instrument canal

42
Q

When can surgical endo be carried out?

A

Not possible to carry out re-rct

43
Q

Indications surgical endo (re-tx)?

A

Re-RCT would be unfavourable
Obstructions in canal can’t be removed/ negotiated
Posts - risk fracture if removed
Perforation - need surgical repair
Investigative procedure - biopsy/ confirmation fracture
True cyst

44
Q

What does endo-re-tx comprise of?

A

Removing content canal following by disinfection and cleaning
Can include repair perforation

45
Q

What are ways to remove GP?

A

GG bur followed hand file (K and H files)
Re-tx rotary NiTi
Solvent technique

46
Q

How are GG and hand files used in re-tx?

A

GG removes coronal GP
Hand files remove apical GP
Use tactile sensation of rubbery GP

47
Q

Why use hedsrom files for re-tx?

A

Grip GP as it engages in the cutting flutes

48
Q

Adv using rotary NiTi re-tx files?

A

More resistant fracture and dislodge GP coronal direction

49
Q

Examples of solvent?

A

Chloroform, eucalyptus and orange oil

50
Q

Ideal time to use solvent?

A

Following bulk removal

51
Q

How can endo posts be removed?

A

Use ultrasonic - break cement lute
Using fine forceps
Post removal kits

52
Q

Stage of removing endo post?

A

Remove crown and core material - leave post

Loosen post

53
Q

How remove threaded post?

A

Can often be unscrewed

54
Q

What technique can be helpful to remove therma-fil carriers?

A

Using braiding technique - braid.2 hand files around carrier

55
Q

Issue with silver points?

A

Corrode over time - can disintegrate during removal

56
Q

What changes success of removal fractured instrument?

A 
Where instrument fractures
What type instrument it is 
How long fragment is
Accessibility 
Ability bypass if can't be removed
57
Q

How remove fractured instrument?

A

Good access and vision - microscope

Use ultrasonic/ modified GG

58
Q

What assess when perforation made?

A

Size
Location
Condition remaining tooth

59
Q

Types of perforation?

A

Internal and external

60
Q

Choice of material for repair perforation?

A

MTA

Biodentine

61
Q

What are pt options in general practice for re-tx?

A

Refer to dentist - specialist/specialist interest - private

Refer hospital - not all will accept

5th ICP - Endo (7 decks)

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