Untoward Outcomes and Solutions Flashcards
4 Solution Options if a tooth is bothering them following a RCT
■ Extraction
■ Non-surgical Retreatment
■ Surgical Retreatment
■ Monitoring ?
Monitoring DISEASE is a or is not an option?
“Supervised Neglect”
- Can be a basis for Legal Action
- Patient may decline TX recommendations*
NON OPTION:
Patient may select ______ over any Recc.
- Lost Faith or Fear of Additional Fees/Failures
- Weary of Unresolved Issues / Definitive Solution
- May be the High Prognosis Option
EXT
T/F: ■ Always preferable to retain healthy natural tooth for life:
■ Most Efficient Chewing
■ Normal biting force and sensation
■ Natural appearance
■ Protects other teeth from excessive wear or strain
True
T/F: If you are going to be successful in
solving the problem, you first must
determine exactly the etiology of the
problem *
True
AAE suggests that ____should generally be
the first option considered*
NSRT non surgical retreat
NSRT Prognosis is generally _____ than 1st
RCT
poorer
_____ must be done to provide access to previous
obturation material
Deconstruction
GP must be softened to facilitate removal of obturation material
- what is used?
Chloroform
■ Indications:
■ NSRT is completed & problem not resolved
■ Problem not accessible to NSRCT
■ Root Perforations or Resorptive Defects
■ DX Experimental Flap Procedure for VRF identification
■ Marked overextension of obturating material interfering with healing.
■ Biopsy of suspect lesion
■ Separated Instrument not treatable by NSRT
■ Other blockages untreatable by NSRCT e.g. Ledges, Transportations
and Zips
■ Non-negotiable canals may be retrofilled (MTA)
Surgical retreatment
■ Sometimes biofilm has matured so much that it grows beyond the apex or lateral canals and onto the root surface ■ Disinfecting the canal will not reach these bacteria and disease can persist
Extraradicular
Biofilm
What is the success rate of endodontic microsurgery?
94%
A clinical procedure intended to remove the root tips,
place a biocompatible material, and remove the
associated diseased soft tissue
Apical Curettage”
Most Endodontists today would think it prudent to follow-up apical
curettage @ time of surgery by removing and beveling root tip and
insuring an obturation seal by placing a “retrofill” to seal the canal. MTA
appears to be the current material of choice for the retrofill.
“Apical Resection and Retrofill”
A procedure most commonly done to remove persistent peri-radicular disease following apparently adequate endodontic treatment.
Orthograde obturation appears to be adequate but no healing following reasonable time is an indication for Retrograde obturation
If the tooth is asymptomatic and the peri-radicular defect is not persistent (i.e. healing proceeding within reasonable parameters), surgery is not indicated unless reasonable follow-up is exceeded (>24 months)
Endodontic Micro-
Surgery (Periapical Surgery)
a procedure that is done when conventional endodontics cannot reasonably be performed or conventional endodontics has failed and conventional RETX would be prohibitively difficult.
Endodontic microsurgery
CONTRAINDICATIONS:
■ Dangerous Proximity to anatomical entities
(ie) neurovascular bundles, IA canal
■ Extreme thickness of cortical plate
■ Periodontally involved teeth
(2 disciplines involved: ? Prognosis of outcome)
■ Lack of Training, Skills, Equipment, Materials or Time
■ Inability to manage possible complications
■ Patient health considerations (ie) active leukemia, neutropenia, uncontrolled diabetes, bleeding considerations, on meds such as anticoagulants, recent MI
■ Pregnant and in first trimester
■ Better prognosis from alternate TX option (Implant?)
Surgical Retreatment
\_\_\_\_\_ is prohibitively thickened in some cases, making access, visibility and hemostasis for retrofilling difficult if not impossible
Buccal shelf
SHould we refer most cases of surgical retreats?
Yes
What must be used if pt can handle it so that hemostasis is adequately achieved in endodontic microsurgery?
Epi
Full thickness flap
Vertical incisions
(never over boney
eminence)
Access:
#6 RB to gain access to root tip –if no lesion has perforated (keep it COOL)
Osteotomy:
Use SL fissure bur to
resect apical portion
of root
Resection:
How much to resect-____ for retrofills
This area contains greatest #
of deltas, isthmuses and
iatrogenic blockages
3 mm
What are the 3 hemostatic agents most commonly used?
Racemic Epinephrine, Hemodent, Astringodent
What is the retrofill of choice?
MTA
What is used to remove the gutta percha?
Ultrasonic
What is used to deliver MTA in the end of the root?
Microcarriers
When is the post op follow up done?
5 days later
Are narcotics typically prescribed for endodontic microsurgery?
Not typically
Tylenol and Ibuprofen
What does the blue staining in the endodontic microsurgery show?
Bacteria that needs to be cleaned
