Untoward Outcomes and Solutions Body Flashcards
1
Q
what are the solution options for diseased outcomes
A
- extraction
- non surgical retreatment
- surgical retreatment
- monitoring
2
Q
what is PA1
A
no lesion in diseased outcome
3
Q
what is PAI5
A
worst diseased outcome
4
Q
is the lesion larger on CBCT than the PA shows
A
yes always
5
Q
why might a patient select extraction over REC
A
- lost faith or fear of additional fees/failures
- weary of unresolved issues/definitive solution
- may be the high prognosis option
6
Q
why is it always preferrable to retain healthy natural tooth for life
A
- most efficient chewing
- normal biting force and sensation
- natural appearance
- protects other teeth from excessive wear or strain
7
Q
what are the replacement options for extraction
A
- implant
- FPD
- RPD
8
Q
does an implant have a 100% success rate
A
no
9
Q
why might a RCT not heal as expected
A
- 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
10
Q
if you are going to be successful in solving the problem you first must determine:
A
exactly the etiology of the problem
11
Q
AAE suggests that _____ should generally be the first option considered
A
NSRT
12
Q
NSRT prognosis is generally _____ than 1st RCT
A
pooper
13
Q
what was the failure rate of endo re treatment
A
16.6%
14
Q
what was the overall success rate for retreatment
A
65%
15
Q
what is the retention of orthograde endo retreatment after 5 years
A
89%
16
Q
what is the technique of NSRT
A
- 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
17
Q
what are the problems to identify that could have caused the re treatment
A
- is it tooth or root fracture
- missed canal
- inadequate previous RCT- cleaning and shaping or obturation
18
Q
in NSRT deconstruction must be done to:
A
provide access to previous obturation material
19
Q
how can GP be softened and what is the most commonly used method
A
- solvents or heat
- chloroform- most common
- eucalyptol
- rectified spirits of turpentine
20
Q
what obturating agents are impossible to remove
A
thermafil, insoluble pastes and silver points
21
Q
what should you as a general dentist do with retreatemnts
A
refer
22
Q
what are the indications for surgical retreatment
A
- 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)
23
Q
what is extraradicular film
A
sometimes biofilm has matured so much that it grows beyond the apex or lateral canals and onto the root surface
24
Q
what is the issue with extraradicular film
A
- disinfecting the canal will not reach these bacteria and disease can persist
- need surgical option to remove bacteria
25
what is endodontic microsurgery
- a clinical procedure intended to remove the root tips, place a biocompatible material and remove the associated diseased soft tissue
26
what is another name for endodontic micro surgery
apical curettage
27
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
28
what is the desired result of an apical resection and retrofill
regeneration of normal tissues and architecture in the area of surgical intervention
29
endodontic microsurgery is generally:
a procedure most commonly done to remove persistent peri-radicular disease following apparent adequate endodontic treatment
30
orthograde obturation appears to be adequate but no healing following reasonable time is an indication for:
retrograde obturation
31
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
32
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
33
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
34
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
35
what is complicated about thickened buccal shelf
makes access, visibility and hemostasis for retrofilling difficult if not impossible
36
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
37
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
38
how should access in surgery be prepared
- full thickness flap
- vertical incision
- never over boney eminence
39
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
40
how should resection be done in surgery
use SL fissure bur to resect apical portion of root
41
how much apical root should be resected and why
3mm
- this area contains greater number of deltas, isthmuses and iatrogenic blockages
42
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
43
what can you use to control bleeding during surgery
- Casulfate
-hemodent
- astringodent
- racemic epinephrine
- electrosurg unit for bleeders
- crypt management
- telfa sponges with hemodent
44
how deep to retrofill
minimum of 3mm of amalgam
45
what instrument is used with retrofill
ultrasonic
46
the instrument design of the ultrasonic allows us to create ____ of space to retain the material and provide an adequate seal
3-5mm
47
root resection is completed when:
hemostasis is accomplished and gutta percha is visible
48
how is apical retroprep done
- removal of gutta percha with ultrasonic
- establishment of parallel walled root end preparation at least 3mm deep
49
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
50
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
51
who does all EMS at UMKC
grad endo
52
