Managing Endo Problems Flashcards
What are the reasons for re treating a tooth?
Symptoms
Increasing radiolucency
Coronal restoration needs replacement with inadequate root filling in situ
What Endodontic problems may you come across?
Canals difficult to access
Retreatment
Perio endo lesion
Resorption
How do you manage re treatment?
Establish the possible cause for failure
Identify the type of root filling material
Consider the alternatives: accept,surgery , extrication
What are the resins for failure?
Unfilled canal Loss of coronal or apical seal Root fracture/perforation Periodontal pathology Other pathology
What are the errors relating to canal prep?
Incomplete deridement Lateral perforations Apical perforation Blocked canal Ledging Apical zipping Elbow formation
What causes an apical zip?
Inappropriate rotation of instruments
WHat causes an elbow to form?
Inappropriate pre curving of instruments
Hour glass shape
What are the advantages of orifice enlargement?
Straighter access to apical region
Improved flow of irrigant within the canal
Reduces likelihood of apical extrusion since the bulk of bacteria are removed coronally and Inorganic debris is reduced
What can go wrong during access?
Crown in situ: loss of directional sense
Obstruction: post or fractured instrument
What can you use to get GP out of the canal?
Oil of eucalyptus or chloroform
Use a probe to create a small space down the side of the GP and remove GP using
1. Hedstrom files
2. Specialised files eg. XGP remover and Deep star files
MUST AVOID SPREAD TO APOCAL REGION
How can you remove metal points from the canal? What material are they usually made from?
Silver
- Grip with forceps
- By pass with a file or pathfinder
- use EDTA
- Use a sonic hand piece
When are metal points easier to be removed?
When leakage has occurred and the corrosion products have leached away
What instrument kit can you use remove posts and instruments?
Masserann kit.
- Ultrasonic
- Trepan: which has a diameter of 1.1-2.4mm: this is a hollow tube which is designed to cut troughs around the post/fragrant to be removed.
- Extractor: grip the fragment to allow withdrawal
How can you remove cement fillings ?
This can be very difficult
- Solvent may help eg oil of eucalyptus
- Small round headed burr
- Hedstrom files
How can you identify if a paste or cement has been used the obturate a canal?
Paste Much easier than cement
Cements tend to be much more radiopque
What do you do if you cannot remove all the blockage?
Need to accept before causing any more damage
Fill the patent canal to coronally of blockage and then keep under review
What can Endodontic lesions cause in the periodontium?
Pulpitis: minimal effect on periodontium
Periapal periodontitis: inflammatory lesion may destroy pdl, bone and root. Lesion may occur laterally or in furcation which is associated with lateral canals or associated with a root instrument perforation and this seen anywhere.
Periapical abscess: May discharge through pocket or perforate the PDL and discharge through buccal sinus.
How can periodontal lesions affect the pulp?
Root surface plaque: with an intact cementum this will have little affect on healthy pulp
Exposed dentine: hypersensitivity and loss of attachment to apex of the tooth may cause retrograde pulpitis
How can you diagnose perio endo lesions?
- Radiographs
- Vitality tst
- Tracking sinus
- Colour, mobility, signs and symptoms
What do you do first on a combined perio endo lesions?
Root treat and perio surgery may be required
When is root resorption initiated?now can it be arrested?
Then there has been stimulation of osteoclasts like cells which are in contact with dentine surface
When the stimulus which is activating these CDs is removed
What is internal root resorption? How does it appear radiographically?
This is initiated by bacterial endotoxins
See a symmetrical bubble in the chamber
What is happening to the pulp in internal root resorption?
The pulp is inflamed but vital
What happens when the pulp dies with internal resorption?
This type of reception will cease
What must be done as soon as you notice IRR?
Extirpate pulp and fill with CaOH
What is cervial resorption?
This is a special type of external root resorption which is initiated by damage of the root surface at the cervical portion
What propagates cervical root resorption?
Damage to the root surface and probated by Infected root canal or periodontal micro flora
How can the damage to the root surface occur in CR?
Trauma eg following ortho and non vital internal bleaching
How do you manage cervical resorption?
Surgical exposure
Deridement and curettage all inflammation tissue
Restore external resorption defect
Root canal therapy
What is the success of treating cervical resorption dependant upon?
The degree of resorption that has already taken place and the degree to which the osteoclasts like cells have been eliminated
When does external inflammatory resorption occur?
- Usually following serious injury eg Avulsion and trauma
2. Micro organisms may infect the canal and stimulate osteoclasts like cells
Which tissue initiates the damage in external inflam resorption?
Pdl which is then propagated by an infected root canal seeping to the external surface
Destruction can be very rapid!!!
What is the treatment for EIR?
Protracted CaOH to eliminate osteoclasts like cells
What is replacement resorption?
- This is when there has been necrosis of pdl which has been caused by a dried out tooth
- Tooth them becomes ankylosed and root is replaced by bone
What is the treatment for replacement resorption?
No successful treatment
Which material can be used in resorptife defects?
- CaOH
2. MTA
What is MTA?
Powder which contains hydrophilic particles and sets in presence of water
What is the action of MTA?
Prevents micro leakage
Biocompatible
Promotes regen of the original tissues
What are the uses of MTA?
Furcal repair Perforation repair Pulp Cap Root resorption Apexificatjon Root end filling
