Post Treatment Disease Flashcards
Why do we use post treatment disease terms rather than treatment failure
Failure seems negative to the PT and they can put them off from further treatments or loss of trust
Correct diagnosis of post treatment disease is achieved by:
1 thorough pain history
2 history of previous treatment - what kind of endo, was rubber dam used,
3 E/O-swellings, abscesses
4 is tooth: TTP, tender to palpation, mobile, has PPD of more than 3 mm
5 sensibility tests/special tests- to cold/hot
6 parallel radiographs due to multiple roots/canals
Diagnostic categories in post treatment disease
- Previously treated and (a) symptomatic periradicular periodontitis
- Previously treated and chronic apical abscess
- Previously treated and acute apical abscess
Aetiology of post-treatment disease
Four main causes
1. Intraradicular microorganisms -flund in canals and causing infection
2. Extracellular microorganisms -from out with the tooth
3. Foreign body reaction-Materials used to restore and obturate canals which were extruded outside of the tooth/apex (root canal system)
4. True cyst
Cause of failure of endo:
1. Leakage around restoration
2. Non treated canals
3. Underfilled canals
4. Complex canal systems
5. Over filled
Intraradicular infections
Happen due to poor access cavity design-
If minor or major canals are left untreated-organic debris is left behind
If canals are poorly prepared or poorly obturated
Any procedural mishaps/complications-Any ledges or perforations, if instrument got separated-allow microorganism proliferation
If newly introduced microorganisms come there
If there is coronal leakage/coronal seal during/after endodontics
Extraradicular infection
Due to microbial invasion and proliferation in the periradicular tissues
Can be due to perio-endo lesion where pocketing extends to the apical foramina
Can be due to extrusion of infected dentine chips during the vigorous instrumentations
Can be due to overextended instrumentation/drying of PDL/filling material
Biofilms can grow through apical constriction and form external apical biofilms
If there is discharging sinus- there are extraradicular microbes (such as actinomyces spp) that can cause re infection of canal system
Foreign body reactions
They are sometimes associated with a chronic inflammatory response (examples are vegetable matter, cellulose fibers, obturation materials, small particles of GP,
True radicular cysts
They form when there is retained embryonic epithelium and it starts to proliferate due to the presence of chronic inflammation (inflammation stimulates that proliferation)
It is impossible to tell from the x-ray if lesion is abscess, granuloma or a cyst
*The bigger the lesion/radiolucency is-more likely it is a cyst
Regardless what it is- treatment is the same- arCT and monitor
How do true radicular cyst develop and what are two types
They develop after periradicular periodontitis and multiplication of epithelial cells
2 types are:
True radicular cyst: enclosed cavity within the bone lined by epithelium, no communication with RCS and does not heal after RCT
Periapical pocket cyst (Bay cyst): epithelium of the cyst is attached to the margins of the apical foramen, it is continuous Cyst lumen is open to the infected canal and hence, can communicate directly with RCS. Pocket cyst will heal after RCT
Red flags in regards to post treatment disease
History of parafunction/bruxism
Occlusal wear facets
Large/wide RCT/posts
Long narrow perio pockets-can indicate perio-endo lesion
Look for vertical root fractures
Microbes in post treatment dosease
Root canal failure usually happens due to persistent (left behind) or secondary infection of the RCS
Even is microbes are not introduced/present in the primary infection, they can be introduced at some later time
Secondary intraradicular infections
In well obturated canal- we can find 1-5 species
In inadequately obturated-up to 30 species
Some of them are -actinomyces, Prevotella, E. Faecalis, Streptococcus, Candida Albicans, Spirochaetes…
If post treatment disease is diagnosis, what are your treatment options
Do nothing (only if no signs or symptoms, radiolucency is not increasing in size, evidence says it is a small chance of getting symptomatic)
Nonsurgical retreatment (re RCT) ( think how to improve previous RCT, it is usually preferred choice, has the lowest risk, less invasive, greatest likelihood of eliminating most common cause of post-treatment disease or intraradicular infection; but it is most costly than surgical, takes longer
XLA (is hopeless outcome)
Surgical retreatment- chosen option when non surgical re-treatment is not possible, or when the risk-to-benefit ratio of nonsurgical is outweighed by those of surgical; if there is overfill- only way to remove it is by surgery
