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Endotontics > Retreatment > Flashcards

Retreatment Flashcards

1
Q

success rate of endodontic therapy

A

has been reported all over the place
from 94.8% to as low as 53%

follow up in years in the studies is an important aspect

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2
Q

success of retreatment

A

80 ish(83%)

so re-treatment can have a lower success rate

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3
Q

follow up period for retreatment

A

better results if longer because sometimes healing is longer

healing in progress –> healing complete

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4
Q

how to/ ways to evaluate endodontic success

A
  1. clinical success
  2. radiographic success
  3. histological success
  4. follow-up period
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5
Q

clinical success is represented by?

A

ABSENCE OF SIGNS AND SYMPTOMS

  • no spontaneous pain
  • negative o percussion
  • negative to palpation
  • absence of sinus tract
  • absence of swelling
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6
Q

radiographic success

A

contours, width, and structure of PDL are normal
- follow PDL space and want intact lamina dura

cannot be success on its own

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7
Q

follow-up period importance

A

how long endodontic treatment should be followed up?

1 year is minimum!! -

follow up period up to 4 years is desirable

(2-3 weeks if dealing with sinus tract )

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8
Q

when assessing tooth that ay need re-treatment what is important to ask and do?

A

ask when it was treated

PROBE– eliminate perio as reason

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9
Q

etiology of failure

A

presence of infection in root canal system

(Usually limited to root canal space) – but if established can extend

BACTERIAL INFECTION

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10
Q

triad of success

A
  1. diagnosis
  2. cleaning, shaping, and 3-D obturation, (good treatment)
  3. coronal restoration
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11
Q

diagnosis importance

A

radiographs and make sure this is right

  • clinical and radiographic examsm

like signs and sympoms point to endo but actually could be something like a palatal groove and localized bone loss – which is a perio problem

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12
Q

radiogrpahic importance of diagnosis after treatment

A

look back at radiographs – could think failing but actually getting better when compared to old radiographs

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13
Q

goal of cleaning shaping and obturating

A
  1. eliminate organic material and bacteria from root canal system
  2. prevent future bacterial contamination and infection
  3. seal any remaining bacteria within the root canal system (place a restoration as soon as practically possible)

have to get all canals

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14
Q

number one failure for RTC

A

missed a canal

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15
Q

breakdown of post endodontic coronal restroration

A
  1. temp restoration
  2. post preparation
  3. proper coronal restoration
  4. quality of coronal restoration
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16
Q

temporary restoration requirements and breakdown

A
  1. must have divergent access prep
  2. thickness must be 4mm (depth - inside access cavity)
  3. cavit temporary recommended
  4. immediate permanent restoration
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17
Q

describe post preparation

A
  1. use of rubber dam
  2. maintain 5mm of apical gutta percha – so dont compromise the apical seal
  3. heat carrier followed by rotary instrument (gates glidden burs)
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18
Q

amount of gutta percha to leave if preparing for a post space

A

maintain 5mm of apical gutta percha – so dont compromise the apical seal

(ideally) to establish a good apical seal

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19
Q

failure to adequately and properly restore endodontically treated teeth may result in what?

A

vertical fracture of tooth structure

20
Q

clinical success rate with maxillary anteriors with crown and no crown

A

ateriors
crown
- 87.5%

no crown
85.4%

21
Q

clinical success rate of maxillary premolars with crown and no crown

A

crown
- 93.9%

no crown
- 56%

22
Q

clinical success rate of maxillary molars with crown and no crown

A

crown
- 97.8%

no crown
-50%

23
Q

why is the success rate go down so much without crown restoration

A

FRACTURE – so all restoration teeth with endo need cuspal coverage

24
Q

coverage requirements in anterior vs posterior

A

all posterior teeth that have received endodontic treatment require CUSPAL COVERAGE

not all anterior teeth require crowns

25
Q

what is more important the quality of endo treatment or the quality of coronal restoratino? exaplain

A

literature points towards need for restoration

technical quality of restoration is more important than the technical quality of the endo for the apical periodontal health

26
Q

good endo and poor restoration? vs poor endo and good restoration?

A

success rate with poor endo and good resto = 66.7%

success rate with good endo and poor restoration is 44.1%

27
Q

coronal leakage

A

likely due to insufficient coronal coverage

28
Q

a tooth with previous RCT 2 years ago and comes in asymptomatic until 1 week ago with percussion, palpation and swelling could be due to?

A

coronal leakage

29
Q

biological factors affecting endodontic success

A
  1. apical pathosis (radiolucency)
  2. pulp vitality
  3. apical resorption
  4. patient’s general health
  5. pre and post -operative pain
30
Q

therapeutic factors affecting prognosis

A
  1. obturation quality
  2. intra-canal medication
  3. number of treatment sessions
  4. procedural periapical disturbances
  5. type of filling material
31
Q

debatable importance of what factors affecting prognosis?

A
  1. tooth type
  2. age
  3. gender
  4. ethnicity
  5. size of lesion
32
Q

pulp vitality in terms of success?

A

vital teeth have higher success rate than necrotic teeth

33
Q

apical pathosis in terms of success?

A

teeth with peri-apical lesions have lower success than teeth without lesions

radiolucency!! – means pulpal infection

34
Q

T/F bacteria present at the time of obturation with decerase the success rate

A

TRUE

35
Q

number of appointments best? why?

A

2 – for necrotic cases

use of calcium hydroxide paste as an intra-canal medicament between visits helps eliminate infection from root canal system

(vital cases can be done in one visit)

36
Q

calcium hydroxide?

A

placed after first appointment in root canal treatment

37
Q

number one reason for endo failure

A

missed canal

38
Q

main reasons for endo failure

A

inadequate treatment

  1. missed canals
  2. calcified canals
  3. presence of obstructions
  4. perforations
  5. coronal leakage
  6. combination of factors
39
Q

two types of retreatment

A
  1. surgical

2. conventional

40
Q

if endo was failure and you cannot access the canals what is treatment?

A

SURGERY

41
Q

if endo was failure and you can access the canals what is treatment?

A

retreatment

42
Q

most commonly missed canals in mandibular and maxillary?

A
  1. mandibular molar 2nd distal canal (and sometimes there is a rd one here too)
  2. 3rd mesial canal in the mandibular molar

maxillary
- maxillary molar 2nd mesio-buccal canal
and 2nd disto-buccal canal

43
Q

major reasons as to why endo surgery would be needed?

A
  1. anatomical reasons (complex)
  2. bacteriological reasons (advanced infections) - established bacterial infection in root canal system and beyond
  3. histological reasons (like a cyst maybe) – like radicualr cysts
44
Q

minimum follow up period?

A

ONE year

45
Q

t/f conventional retreatment should be attempted whenever possible before surgical intervention

A

TRUE

Endotontics (21 decks)

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