Success/ failure in endodontic treatment Flashcards
How do we measure success of root canal treatment
How many years should you asses the lesion after the root canal treatment
Describe this radiograph
Poor root filling
Uncercondesned
Overfilled
Large lesion present on the tooth
Post treatment disease or fialure
Describe this radiograph after 3 weeks other radiograph
Treated using biological
Root canal decontaminates
Dress with calcium hydroxides and obturated to the correct length
Good healing
3 weeks post previous radiography
Extraordinary healing - good balanced root canal treatment
No voids
Patient is comfortable
Technical success
Biological success
describe this radiograph
Good root filling
Well condensed
Good white stripes
Lots of irrigation
Describe this radiograph
6 month review
Lesion shrunk down in size
Not completely gone
Both technical and biological success
No swelling or sinus
Describe this radiograph
Radiograph with complex lower first molar
Describe this radiograph
Technical success
Just filled it
Single visit treatment
6-12 months if lesion present
Successful outcome
Describe this radiograph
Thencial approach
Challenging approach
Double
Well condensed well tapered
Distal buccal root
All goen to plan
Considerable manual dynamic
Root canal decontaminated
Small minimal access cavity
Patient should not be experiencing no symptoms
describe definitions of outcome
4 years sufficient to return to normal
Some cases never completely to normal
Granulomatous tissue to apical
No infection within root canal system
Difficult to make decision just on basis of 4 years
Not complete healing
Not uncommon for scar tissue healing to remain
Not returned to normal radiographic appearance
Survival - easy to do big studies - lots of teeth
Meaningful comparisons
Implant - successful in all studies or outcomes
Not strictly true
In patients eyes
Implant might be mobile - gingival recession
Success rate
Implant still present = success
Is the tooth still there
DESCriBE failure or persistence to disease in root canal
Failure post treatment disease
Uncomfortable to bite on
Radiographic issues
Persistence of disease]
How did it fail
Original disease persist
Or coronal restoration wasn’t sealing the tooth / Tooth had fractures = Emergent disease
what are factors contributing to success
- filling extending to within 2mm of radiographic apex
- not extruded
- will condensed root filling with no voids
- good quality coronal restoration
- cusp coverage normally indicated =in posterior teeth especially when marginal ridges are lost
- following RCT uncrowned teeth carry 6X higher fracture rate ]
- presence fo sinus
- increased lesion size
absence of flare up - no perforation
- getting patency
- penultimate rinse with EDTA
- mixing CHX and NaOCI as irritants - NO SUCCESS
- not getting to the end
How does this affect success
Just bc the study shows , the success rate is high
It doesn’t mean anywhere within 2 mm is good enough
Root filling extends exactly to the point
Cleaning disinfectant
Working length
Obturation to the point
Gets within 2mm
Success rates higher
Want to fill exactly to the point - prepare to
problem
Root filling unacceptable in terms of apical extent
Fill hallways down the root- means prepared halfway down the tooth
Preparation of root canal treatment has been insufficient
Denser fill- less chance of leakage
Filled short
Lack of cleaning that caused the problem\
problem
Exturde - foreign body reaction= failure
Reason this has happened - due to faulted preparation
No taper
No resistance or retention
Apex not kept as smalls s reasonably possible
Careful in preparation so it’s easier to obturate
Problem
Extrusion of gutta percha
Heat up gutta percha = no retention or resistance - easy to extrude
Foreign body extruded into tissues
Equally not symptomatic
Healing in apex
Extrude materials = lower success rate
Problem
Not well condensed filling
Look at preparation
Immature tooth = trauma
Root development not completed
Wide canal = obturate
Somebody selected correct obturation technique
Cold lateral impaction = difficult to create taper
Can’t leave the tooth like that
Consequence of leaving -
Need to address
Medical legally asking for trouble
Obturation needs to be correct as it should be
Problem
Closer
Shorter in mesiobuccal root
Distal buccal root
Shorter than radiographic apex
Problem?
No voids in it
Still too heavily prepared
Not prepare teeth heavily
Likely to fracture
describe these factors more
patenty-= success rate (SR) go up
SR Go up with EDTA (dk why )
Mix chlorhexidine and sodium hypochlorite - success rates go down
Form precipitate - parchlorarilene carcinogenic
Mix two things together- penetration of irrigants will reduce
Initial benefits of being tissue dissolution agent
How do ledges affect success of RCT
File to go back down
Iatrogenic- damage canal
Ledge
Root canal; curves onto the screen
Past ledge - lots of blood pus form lesion
Curve of that root is into the screen
Force files to go down
Create ledge - files won’t go further
Not be able to clear if beyond
Failure to instrument is common cause
