Untoward Outcomes and Solutions

Question 1

4 Solution Options if a tooth is bothering them following a RCT

Answer 1

■ Extraction
■ Non-surgical Retreatment
■ Surgical Retreatment
■ Monitoring ?

Question 2

Monitoring DISEASE is a or is not an option?
“Supervised Neglect”
- Can be a basis for Legal Action
- Patient may decline TX recommendations*

Answer 2

NON OPTION:

Question 3

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

Answer 3

EXT

Question 4

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

Answer 4

True

Question 5

T/F: If you are going to be successful in
solving the problem, you first must
determine exactly the etiology of the
problem *

Answer 5

True

Question 6

AAE suggests that ____should generally be

the first option considered*

Answer 6

NSRT non surgical retreat

Question 7

NSRT Prognosis is generally _____ than 1st

RCT

Answer 7

poorer

Question 8

_____ must be done to provide access to previous

obturation material

Answer 8

Deconstruction

Question 9

GP must be softened to facilitate removal of obturation material
- what is used?

Answer 9

Chloroform

Question 10

■ 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)

Answer 10

Surgical retreatment

Question 11

■ 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

Answer 11

Extraradicular

Biofilm

Question 12

What is the success rate of endodontic microsurgery?

Answer 12

94%

Question 13

A clinical procedure intended to remove the root tips,
place a biocompatible material, and remove the
associated diseased soft tissue

Answer 13

Apical Curettage”

Question 14

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.

Answer 14

“Apical Resection and Retrofill”

Question 15

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)

Answer 15

Endodontic Micro-

Surgery (Periapical Surgery)

Question 16

a procedure that is done when conventional endodontics cannot reasonably be performed or conventional endodontics has failed and conventional RETX would be prohibitively difficult.

Answer 16

Endodontic microsurgery

Question 17

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?)

Answer 17

Surgical Retreatment

Question 18

\_\_\_\_\_ is 
prohibitively 
thickened in 
some cases, 
making access, 
visibility and
hemostasis for 
retrofilling 
difficult if not 
impossible

Answer 18

Buccal shelf

Question 19

SHould we refer most cases of surgical retreats?

Answer 19

Yes

Question 20

What must be used if pt can handle it so that hemostasis is adequately achieved in endodontic microsurgery?

Answer 20

Epi

Question 21

Full thickness flap
Vertical incisions
(never over boney
eminence)

Answer 21

Access:

Question 22

#6 RB to gain 
access to root tip –if 
no lesion has 
perforated (keep it 
COOL)

Answer 22

Osteotomy:

Question 23

Use SL fissure bur to
resect apical portion
of root

Answer 23

Resection:

Question 24

How much to resect-____ for retrofills
This area contains greatest #
of deltas, isthmuses and
iatrogenic blockages

Answer 24

3 mm

Question 25

What are the 3 hemostatic agents most commonly used?

Answer 25

Racemic Epinephrine, Hemodent, Astringodent

Question 26

What is the retrofill of choice?

Answer 26

MTA

Question 27

What is used to remove the gutta percha?

Answer 27

Ultrasonic

Question 28

What is used to deliver MTA in the end of the root?

Answer 28

Microcarriers

Question 29

When is the post op follow up done?

Answer 29

5 days later

Question 30

Are narcotics typically prescribed for endodontic microsurgery?

Answer 30

Not typically

Tylenol and Ibuprofen

Question 31

What does the blue staining in the endodontic microsurgery show?

Answer 31

Bacteria that needs to be cleaned