Dr Browne Re Treatment.pdf

Methods of Evaluation • Histological • Clinical (signs and symptoms) • Radiographic Examinations A radiographic lesion that is unchanged or has increased in size after a year is not likely to resolve eventually; therefore, the treatment is a failure. Success Clinical Criteria for Success • • •...

Methods of Evaluation • Histological • Clinical (signs and symptoms) • Radiographic Examinations A radiographic lesion that is unchanged or has increased in size after a year is not likely to resolve eventually; therefore, the treatment is a failure. Success Clinical Criteria for Success • • • • Absence of pain and swelling Disappearance of sinus tract No loss of function No evidence of soft tissue destruction Causes of Endodontic Failures • Errors in Diagnosis and Treatment Planning • Operative Errors • Inadequate Restorative Protection • Vertical Root Fracture Why endodontic treatment fails? Why endodontic treatment fails? Diagnosis History Taking Listen to the Patient • When did the pain start • Describe the pain • What makes it hurt • The ability to obtain the right information from the patient • Listen to what the patient is telling you -When did the pain start? -Do you know which tooth it is? -Describe the pain? Sharp or dull Throbbing Mild or Severe Localized or radiating -What makes it hurt? Medical History • Allergies • Bleeding tendencies • Cardiac disease (lower left molar pain) • Immune defects or patients taking drugs acting on the endocrine or CNS system. • Biophosphonates (Fosamax, Zometa, Aredia) • Radiation Treatment Radiographs Diagnostic Procedures • • • • • • • • • • Percussion Biting Thermal Stimulation Palpation Electrical Stimulation Periodontal Examination Trans-illumination Tracing a fistula Selective Anesthesia Test Cavity Cracked Tooth Syndrome • Sharp non-lingering pain to cold • Pain upon releasing cuspal pressure Periodontal Exam • • • • Extensive Pocketing Periodontal or Endodontic Swelling Perio/Endo or Endo/Perio Is Tooth Salvageable? Endo-Perio / Perio-Endo? Tracing a Fistula • Insert a size 40 gutta percha point gently into sinus tract until resistance is met • Take a direct angle radiograph Failure of Root Canal Therapy  Bacterial Bacterial contamination contamination  When When does does itit occur? occur?  Coronal Coronal leakage leakage  Fractures Fractures  Post preparation Post preparation  Interim Interim restorations restorations  3mm 3mm cavit cavit Operative Causes • Inadequate Anesthesia • Improper Access • Overextended Access • Maintaining proper canal curvature • Separated Instruments Practical Problems • Unable to achieve profound anesthesia: Infiltration: Thick bone; Acidic environment Major Nerve Block: Anatomical variations • Severe pain during Hitting a nerve Injecting into an artery • Paresthesia Failure of Root Canal Therapy  Bacterial contamination  Incomplete cleaning and shaping  Missed Canals  Nonsurgical Failure of Root Canal Therapy Bacterial Bacterial contamination contamination Incomplete Incomplete cleaning cleaning and and shaping shaping Missed Missed Canals Canals Incomplete Incomplete obturation obturation Occlusal Adjustment • Occlusal reduction should prevent postoperative pain in those patients whose teeth initially exhibit pulp vitality, percussion sensitivity, preoperative pain, and/or the absence of a periradicular radiolucency Endodontic Retreatment Conventional Versus Surgical Retreatment  Conventional retreatment is treatment of choice  Good foundation for future restorative procedures  Most post removals can be performed predictably with minimal risk  Surgery becomes last resort procedure  Has pendulum has gone to far? Conventional Retreatment Treatment of Choice  Ultrasonics to remove cements  Clean chamber  Specialized ultrasonic tips  Diamond coated ultrasonic tips  Mueller Burs  Clean down canals  Visibility with microscope Conventional Retreatment Instrument Removal  Masserann Kit Conventional Retreatment Instrument Removal Conventional Retreatment Instrument Removal  Masseran Kit  SIR Kit Separated Instrument Retrieval System  Dead soft bondable tubes  Bonding agent  Accelerator  Fulcrum props Conventional Retreatment Instrument Removal   Masseran Kit SIR Kit Separated Instrument Retrieval System  Stiglitz Forcepsgrasping devicesFacilitates Silver Point Removal Conventional Retreatment Instrument Removal  Masseran Kit  SIR Kit Separated Instrument Retrieval System  Stiglitz Forceps-grasping devices  Ultrasonics  Straight Line access  Cancellier  Headstrom Files  Instrument  Silver point removal Post Removal  Previously the benefit-risk balance weighed toward surgery  Ultrasonics  Specialized tips  Microscope  Minimize tooth removal Surgical Treatment of Endodontic Failure         Anatomical considerations Posts Calcified Canals Restorative considerations Separated Instruments Fistulas Drainage Symptomatic tooth Clinical applications of CBCT technology in endodontics include the following: Detection and diagnosis of pathology at the root end of the teeth Pre-operative assessment of the dental surgical area and treatment planning Assessment and management of traumatic dental injuries Evaluation of root canal anatomy and complex morphology Detection of root fractures and root resorption Evaluation of previously endodontically treated teeth Dental implant work-up