Untoward Outcomes and Solutions Body Flashcards
what are the solution options for diseased outcomes
- extraction
- non surgical retreatment
- surgical retreatment
- monitoring
what is PA1
no lesion in diseased outcome
what is PAI5
worst diseased outcome
is the lesion larger on CBCT than the PA shows
yes always
why might a patient select extraction over REC
- lost faith or fear of additional fees/failures
- weary of unresolved issues/definitive solution
- may be the high prognosis option
why is it always preferrable 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
what are the replacement options for extraction
- implant
- FPD
- RPD
does an implant have a 100% success rate
no
why might a RCT not heal as expected
- complicated undetected or untreated canal anatomy
- delay in placemen of definitive coronal restoration
- inadequate previous RCT or leaking coronal restoration
- new problems such as new decay, loose, cracked or broken restoration or tooth or root fracture
if you are going to be successful in solving the problem you first must determine:
exactly the etiology of the problem
AAE suggests that _____ should generally be the first option considered
NSRT
NSRT prognosis is generally _____ than 1st RCT
pooper
what was the failure rate of endo re treatment
16.6%
what was the overall success rate for retreatment
65%
what is the retention of orthograde endo retreatment after 5 years
89%
what is the technique of NSRT
- problem must be identified
- deconstruction
- GP must be softened to facilitate removal of obturation material
- all problems discovered/confirmed
- all deficiencies must be corrected and success documented by recall
what are the problems to identify that could have caused the re treatment
- is it tooth or root fracture
- missed canal
- inadequate previous RCT- cleaning and shaping or obturation
in NSRT deconstruction must be done to:
provide access to previous obturation material
how can GP be softened and what is the most commonly used method
- solvents or heat
- chloroform- most common
- eucalyptol
- rectified spirits of turpentine
what obturating agents are impossible to remove
thermafil, insoluble pastes and silver points
what should you as a general dentist do with retreatemnts
refer
what are the indications for surgical retreatment
- NSRT is completed and 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 NSRT such as ledges, transportations and zips
- non- negotiable canals may be retrofilled (MTA)
what is extraradicular film
sometimes biofilm has matured so much that it grows beyond the apex or lateral canals and onto the root surface
what is the issue with extraradicular film
- disinfecting the canal will not reach these bacteria and disease can persist
- need surgical option to remove bacteria
what is endodontic microsurgery
- a clinical procedure intended to remove the root tips, place a biocompatible material and remove the associated diseased soft tissue
what is another name for endodontic micro surgery
apical curettage
what is apical curettage followed by
remove and bevel root tip and insure an obturation seal by placing a retrofill to seal the canal. MTA is the current material of choice for the retrofill
what is the desired result of an apical resection and retrofill
regeneration of normal tissues and architecture in the area of surgical intervention
endodontic microsurgery is generally:
a procedure most commonly done to remove persistent peri-radicular disease following apparent adequate endodontic treatment
orthograde obturation appears to be adequate but no healing following reasonable time is an indication for:
retrograde obturation
when is surgery not indicated
if the tooth is asymptomatic and the periradicular defect is not persistent - healing proceeding within reasonable parameters unless reasonable follow up of more than 24 months is exceeded
when else is surgery a good option other than a failed RCT
when conventional endo cannot reasonable be performed or conventional endo has failed and conventional RETX would be to difficult
the first course of action for a non healing RCT stated by the AAE is NSRT unless RETX with surgery if:
easiest acess to apex via surgery
what are the contraindications for surgical retreatment
- dangerous proximity to anatomical entities such as neurovascular bundles and IA canal
- extreme thickness of cortical plate
- periodontally involved teeth
- lack of training, skills, equipment, materials or time
- inability to manage possible complications
- patient health considerations such as active leukemia, neutropenia, uncontrolled DM, bleeding considerations or meds such as anticoagulants, recent MI
- pregnant and in first trimester
- better prognosis from alternate TX option
what is complicated about thickened buccal shelf
makes access, visibility and hemostasis for retrofilling difficult if not impossible
what should be considered in the pre surgical case assessment
- is there a better option for this patinet
- why propose endo micro surgery
- whats the prognosis
- if RETX what is the etiology of failure
- has the tooth been restored properly
- if not can it be
- is the tooth periodontally sound
- is the tooth surgically accessible
- is the tooth strategic and fuctional
- will patients health allow surgery
- is patient on board with tx selection/limitations
- are you competent and prepared
- would referral serve the patients best interrests
what is the surgical technique steps
- anesthesia
- elevation of flap
- location of apical lesion
- osteotomy and curettage
- root bevel and hemostasis
- retrofill preparation and filling
- suturing and PO instructions
how should access in surgery be prepared
- full thickness flap
- vertical incision
- never over boney eminence
how should the osteotomy be done in surgery
6 round bur to gain access to root tip if no lesion has perforated- keep it cool
how should resection be done in surgery
use SL fissure bur to resect apical portion of root
how much apical root should be resected and why
3mm
- this area contains greater number of deltas, isthmuses and iatrogenic blockages
what bevel should be created at the root apex and why and how
- 45 degree bevel
- so the canal can be visualized and accessed
- low speed of 1000-1500 rpm - NOT air turbine
- use sterile saline drip to cool during osteotomy and resection
what can you use to control bleeding during surgery
- Casulfate
-hemodent - astringodent
- racemic epinephrine
- electrosurg unit for bleeders
- crypt management
- telfa sponges with hemodent
how deep to retrofill
minimum of 3mm of amalgam
what instrument is used with retrofill
ultrasonic
the instrument design of the ultrasonic allows us to create ____ of space to retain the material and provide an adequate seal
3-5mm
root resection is completed when:
hemostasis is accomplished and gutta percha is visible
how is apical retroprep done
- removal of gutta percha with ultrasonic
- establishment of parallel walled root end preparation at least 3mm deep
what are the steps in finishing up the surgery
- surgical area is cleaned and inspected and then sutured
- patient should be called evening of surgery to see how well they are doing
- post op patient and suture removal prn - 5 days
what are the post op instructions to the patient
- use ice pack 20 min on and 5 off for the 1st day to reduce pain and swelling, warm saline rinses every 2nd day
- if excess bleeeding occurs place a wet tea bag over incision for 15 minutes to stop bleding
- pain is usually 3/10. # IBU Q4H and narcotic if necessary if excess pain occurs call office
- dont smoke for 3 days after surgery
- suture removal PRn and POT check in 5 days
who does all EMS at UMKC
grad endo
