Mishaps Flashcards
Steps in Management
detection: It may be by radiographic or clinical observation or as a
result of a patient complaint.
• Correction: It depends on the type and extent of procedural accident.
• Prevention: Reached by sufficient knowledge “the best ttt”
establishing good patient
communication:
• Inform the patient before treatment
• When a procedural accident occurs, explain to the patient the nature
of the mishap, what can be done to correct it, and what effect the
mishap may have on the tooth’s prognosis and on the entire
treatment plan.
• Referral to a specialist
Mishaps According to Ingle Accessrelated
1.
Treating
the wrongtooth
2.
Missed canals
3.
Damage to existingrestoration
4.
Access cavity perforations
5.
Crown fracture
Instrumentation related
1.
Ledgeformation
2.
Cervical canalperforations
3.
Midrootperforations
4.
Apicalperforations
5.
Separated instruments and foreign objects
6.
Canalblockage
Obturation related
Over or underextended root canalfillings
2.
Nerve paresthesia
3.
Vertical rootfractures
Miscellaneous
Post space perforation
2.
Irrigantrelated
3.
Tissue emphysema
4.
Instrument aspiration andingestion
Treating The Wrong Tooth cause, correction , prevention
Cause Misdiagnosis
isolating the wrong tooth
Recognition Patient continues to have symptoms after treatment
Error may be detected after the rubber dam has been removed.
Correction Appropriate treatment of both teeth.
P revention Misdiagnosis can be avoided by obtaining at-least 3 good
pieces of evidence supporting the diagnosis.
• Marking the tooth before isolating it with rubber dam.
Make access before isolatio
MissedCanals cause, correction , prevention
Cause
lack of knowledge pertaining to root canal anatomy configuration and its variations
failure to externalize the internal anatomy while studying the pre operative radiograph
improper access
Recognition
• an instrument or filling material is clinically or radiographically not centered in
the root.
• Some cases, recognition may not occur until failure is detected.
• Correction Retreatment is appropriate
Prevention
•
Adequate coronal access - Follow principles of access cavitypreparation
aids to detect missed canal
• Magnification and enhanced vision
Magnifying loupes
DOM
Endoscopes & transilliumination
• Evaluate the anatomy of the pulpal floor
Rules of “symmetry-orifice location –color change”
• Endodontic map “dark lines connecting orifices”
• Scouting of the pulpal floor with endo probe
µ opener.
• Radiograph “buccal object rule” CBCT
• Dye staining”1%mythelyene blue”
• Champagne bubble test.
Damage ToExisting Restorations , prevention, correction
Prevention Avoiding placing clamp directly on the margin
Remove permanently cemented crown before treatment
Specialized crown pliers can be used to removerestorations- Metalift Ultrasonic Vibration
Correction Minor porcelain chips can be at times repaired by bonding composite
resin tocrown“not involving margins” otherwise Remake
Access CavityPerforations , recognition,cause, correction, prevention
Can occur either peripherally through the sides of the crown or
through furcation.
Recognition
If the access cavity perforationis
• Above PDLattachment
• Presence of leakage into the access indication of an accidental
perforation.
• IntoPDL
• Bleeding into the accesscavity
Cause Failure to identify the angle of the crown to the root and
the angle of the tooth in the dental arch.
Using a surgical length bur
Correction
Coronal walls above the alveolar crest – can be repaired intracoronallywithout
surgical intervention.
Perforations into periodontal ligament– should be done as early as possible to
minimize injury to the tooth’s supporting tissues.
Materials used for theseperforations
• - GIC, MTA, Super EBA, Tricalcium phosphate, Calcium hydroxide
paste, amalgam or haemostatic agents such as gel foam.
Proper bur alignment with the long axis of the tooth
• Bur penetration for both depth and angulation can be confirmed with radiographs
• Knowledge about themorphology
• Adequate accesspreparation
Prevention
CrownFractures , cause , recognition, treatment , prevention
Cause
• Atooth with a preexisting infraction becomes a true pain when the
patient chews on the tooth
• weakened additionally by an accesspreparation.
Recognition
• When infraction become true fractures, parts of the crown maybe mobile
• Transilliumination or methylene blue.
Treatment
• Extraction of the fracture fragment, if it is of a “chisel type“ in which only the cusp or part of the
crown is involved.
• If the fracture is more extensive, the tooth maynot be restorable and needs to beextracted.
Prevention
• Reduce the occlusion.
• Bands and temporary crowns can beused.
LedgeFormation , cause, recognition, correction, prevention
Causes
Failure to make straight line accesspreparation
Using straight instrument in curved canals
Excessive enlargement of curved canal with
files
Lack of knowledge
R eco g nition
• Root canal instrument can no longer be inserted into the canal to full working length.
• Lossof tactile sensation of the tip of the instrument binding in the lumen.
• Instrument point hitting against a solidwall
• Radiograph with instrument inpla
Correction
• No. 10 or 15 file is sharply bent at the tip &inserted in Watch-winding motion
• Once the file is felt in the lumen ,“Tear shaped” silicone stops can be used.&the
• file is moved in push and pull motion against the ledge wall “ anticurvature filling”
• Irrigate, a larger files are used in the same way
• Confirmed with aradiograph
Prevention
• Proper examination of the diagnosticradiographs.
• Awareness of canalmorphology
• Frequent recapitulation andirrigation
• Precurving the instrument and notforcing it.
• Use crown down or hybrid technique ”avoid large files apically
• Using NiTi files in case of curvedcanals
Canal Blockage / Blockout , cause, recognition, correction, prevention, prognosis
Cause dentin chips
Recognition Working length
CorrectionRecapitulation with small file in quarter turn &copious irrigation.
• Precurving and Redirecting the instrument
• Endosonics can be used to dislodge dentin debris by acousticstreaming.
P revention
• Use of patency file
• copious irrigation
• Recapitulation &Sequentialinstrumentation
Prognosis Depends on the stage of instrumentation,
Root Perforations cause
Perforations in all locations can be caused by 2 mainerrors:
- Creating a ledge in the canal wall during initial preparation and perforating through the
side of the root at the point of obstructions / root curvature. - Using too large or too long an instrument
