Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endodontics 2 > Untoward Outcomes and Solutions > Flashcards

Untoward Outcomes and Solutions Flashcards

1
Q

Diseased Outcome:
■ Solution Options:
(4)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Monitoring DISEASE is a NON OPTION:
“Supervised Neglect”
(2)

A
  • Can be a basis for Legal Action
  • Patient may decline TX recommendations*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Not all periapical lesions are active disease
(3)

A

-Is the lesion still healing, or growing larger?
-Symptomatic or asymptomatic?
-Is the lesion larger on CBCT than the PA shows?
When in doubt, refer!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient may select EXT over any Recc.
(3)

A
  • Lost Faith or Fear of Additional Fees/Failures
  • Weary of Unresolved Issues / Definitive Solution
  • May be the High Prognosis Optio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Extraction:
Always preferable to retain healthy natural tooth for life:
(4)

A

■ Most Efficient Chewing
■ Normal biting force and sensation
■ Natural appearance
■ Protects other teeth from excessive wear or strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sometimes Extraction is the only solution - or

A

■ Patient may demand EXT following unsuccessful initial RCT
■ Educate* – Don’t argue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Concentrate on Replacement
(3)

A

■ Implant
■ FPD
■ RPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

No replacement has a— either!

A

100% success rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non-surgical Retreatment
■ A RCT tooth may not heal as expected
for a number of reasons:
(3)

A

■ Complicated, undetected, or untreated canal
anatomy
■ Delay in placement of definitive coronal
restoration
■ Inadequate previous RCT or Leaking coronal
restoration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

New problems:
(3)

A

■ New decay
■ Loose, cracked, or broken restoration
■ Tooth or root fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If you are going to be successful in
solving the problem, you first must
determine exactly the — of
the problem *

A

etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

AAE suggests that — should generally
be the first option considered

A

NSRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NSRT Prognosis is generally poorer than

A

1st RCT
■ Failure rate of endodontic re-treatment was 16.6%
- R. B. Pekruhn, “Incidence of RETX Failure” JOE, ‘Feb ’86 P70
■ Overall Success Rate for ReTX was 65% with An
Additional Category of Uncertain (18.3%)

■ 90+% v. 60-75 %-?: You call it
■ Endodontist’s experienced best GUESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

REFER
MOST*

A

RETX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

—% retention after 5 years

A

89%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Non-surgical Retreatment:
Technique
■ Problem must be identified:
(3)

A

■ Is it tooth or root FX? (? - hopeless)
■ Missed canal
■ Inadequate previous RCT
- Cleaning & Shaping
- Obturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

— must be done to provide access to previous
obturation material

A

Deconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GP must be softened to facilitate removal of obturation material
■ GP – soften with (2)
■ (3)
■ (3) difficult or impossible to remove
■ All Problems discovered/confirmed
■ All Deficiencies must be corrected & Success documented by recall

A

solvents . . . or heat
Chloroform, Eucalyptol, Rectified spirits of Turpentine
Thermafil, insoluble pastes & Silver Points

19
Q

Some NSRT cases may be done by skilled &
trained generalist

A

■ Obvious, correctable problem
■ Within your competence level
■ Most should be referred

20
Q

Surgical Retreatment
■ Indications:

A

■ 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)

21
Q

Extraradicular
Biofilm
(2)

A

■ 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

22
Q

Endodontic Micro-surgery:

A

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

23
Q

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

A

“Apical Curettage”
(Not often done by itself – followed by RETROFILL)

24
Q

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. — appears to be the current material of choice
for the retrofill

A

MTA

25
Q

This procedure is termed “Apical Resection and
Retrofill”

A

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

26
Q

“Apical Resection and Retrofill”
Desired result is a

A

regeneration of normal tissues
and architecture in the area of surgical intervention
AAE Illustration AAE Illustration

27
Q

Stated another way: Endodontic Micro-
Surgery (Periapical Surgery) is
generally:
A procedure most commonly done to
remove …
— obturation appears to be
adequate but no healing following
reasonable time is an indication for
— 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 …

A

persistent peri-radicular
disease following apparently
adequate endodontic treatment.
Orthograde, Retrograde
reasonable follow-up is exceeded (>24 months)

28
Q

Further:
OR: a procedure that is done when

A

conventional endodontics cannot
reasonably be performed or
conventional endodontics has failed
and conventional RETX would be
prohibitively difficult

29
Q

OR: a procedure that is done when
conventional endodontics cannot
reasonably be performed or
conventional endodontics has failed
and conventional RETX would be
prohibitively difficult.
AAE states that Non-Surgical Retreatment
(NSRT) is the preferred first course of
action for a non-healing RCT if feasible.
BUT

A

RETX cases with easiest access to
apex via surgery may be chosen as most
reasonable course of action

30
Q

Surgical Retreatment
CONTRAINDICATIONS

A

■ 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?)

31
Q

— is
prohibitively
thickened in
some cases,
making
access,
visibility and
hemostasis for
retrofilling
difficult if not
impossible
22

A

Buccal shelf

32
Q

skipped
Pre surgical case
assessment

A

■ Is there a better option for this patient?
■ Why propose Endodontic Micro Surgery?
■ What’s the Prognosis?
■ If RETX, what is the etiology of failure?
■ Has tooth been restored properly?
■ If not, Can it be? If not, why try to save it?
■ Is tooth periodontally sound?
■ Is tooth surgically accessible?
■ Is the tooth strategic and functional?
■ Will patient’s health allow surgery
■ Is patient on board with TX selection/limitations?
■ Are you competent & prepared
■ Would REFERRAL serve the patient’s BEST
INTERESTS***

33
Q

Surgical Technique

A

■ Anesthesia
■ Elevation of Flap
■ Location of apical lesion
■ Osteotomy & Curettage
■ Root bevel & hemostasis
■ Retrofill preparation and filling
■ Suturing and PO instructions

34
Q

Anesthesia & Hemostasis
■ (4)
■ (anesthetic) IF not CI’d,
infiltrated into papilla + regional block. (J
Bahcall, DT Aug ’04 p72>)
■ — also enhances profoundness of LA
“DM/MCP”, Little, 4th ed, p 172 (we produce .007-.014mg
epi/min in unstressed state-@what is in 1carp of LA,w 1/100K.)
If one is stressed, epi can go to @—mg/min!!!
■ Epi for — is a MUST! If epi is contra-
indicated by patient’s MD, do not do surgery

A

Articaine vs Lido vs Carbo vs Marcaine
PLUS Lido 2% w epi 1:50
Epi
.3
Hemostasis

35
Q

Apical Root Resection
How much to resect-
This area contains greatest
# of (3)

  • S Kim “Principles of Endo Surgery”
    DCNA ’97;41:481-497
    Create a – bevel so the
    canal can be visualized &
    accessed. – speed
    (1000-1500 rpm)– NOT —. Use sterile saline
    drip to ..
A

3mm.
deltas, isthmuses and iatrogenic blockages

45º
Low
air turbine
cool during osteotomy & resection

36
Q

Hemostasis and
Identification
■ Control of — is paramount! You must
see what you are doing.
■ (5) for bleeders.
■ Crypt management

A

bleeding
CaSulfate,, Hemodent, Astringodent,
*Racemic Epinephrine, maybe Electrosurg
Unit
Telfa sponges w Hemodent

37
Q

Root End preparation: How deep to retro fill?
■ Mattison, et al concluded that a minimum of — *of
amalgam significantly reduced apical leakage

A

3mm

38
Q

For that matter, any retro filling material should be AT LEAST
—. into the canal space. This instrument design allows us to
create — of space to retain the material and provide an
adequate seal.
■ Amalgam, SEBA, Geristore have been used for retrofill. —
is now the material of choice*

A

3mm
3-5 mm
MTA

39
Q

Apical Retroprep
Removal of Gutta
Percha with —
Establishment of
parallel walled root end
preparation at least —
mm deep.

A

Ultrasonic
3

40
Q

These are apical micro-carriers
(similar to an amalgam carrier)
Used to

A

pick up and deliver the
mixed MTA to the apical
retroprep.

41
Q

The MTA has been
delivered to the
apical retroprep and
now, an instrument is
used to —- the
MTA in the prep.

A

compact

42
Q

Finishing up
■ Surgical area is Cleaned and Inspected and then —
■ Patient should be — evening of surgery to see “how well they
are doing”
■ Post-op patient & suture removal prn (– days)

A

Sutured
called
5

43
Q

POST-OP Instructions:
■ Use
■ If XS bleeding occurs,
■ Pain is usually 3/10. 3
■ Soft diet for – days
■ Do not smoke for – days>surgery
■ Suture removal prn & POT check in – days!

A

ice pack 20” on, 5”off for 1st day to reduce P&S, warm
saline rinses qid 2nd day
place a wet tea bag over incision 15” to
stop bleeding
IBU Q4H + narcotic RX if necessary. If XS
pain occurs, call office
3-4
3
5

44
Q

At UMKC-SOD

A

■ Opportunities poor for Endodontic Surgery in Undergraduate
■ Grad. Endo. does all EMS at UMKC
■ This presentation is designed to acquaint you with the
surgical opportunities available as well as little about the
technique.
■ Try to assist/observe in Grad. Endo. during Surgery
■ With additional training, general dentists may choose
to do less complicated apical surgery in their
practice.

Endodontics 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions