Endodontic complications
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This document discusses common mistakes that can occur during root canal treatment and ways to correct them. It is divided into sections on access-related mistakes, instrumentation mistakes, obturation mistakes, and other miscellaneous issues. Some key points include: treating the wrong tooth can be corrected by treating both teeth; ledges can be corrected with small files and lubricants; perforations should be repaired immediately with materials like MTA; fractured instruments may require surgery if unable to bypass. Proper access cavity preparation, gentle instrumentation, and avoidance of overfilling are emphasized to minimize complications.
Endodontic complications
- 2. Access related Instrumentation related Obturation related Miscellaneous
- 3. Access related mistakes • Treating the wrong tooth • Missed canals • Failure to remove all caries and unsupported structures • Damage to existing restoration • Access cavity perforations • Crown fractures
- 4. Treating the Wrong Tooth • misdiagnosis • a tooth adjacent to the one scheduled for treatment was inadvertently opened. Causes • appropriate treatment of both teeth: the one incorrectly opened and the one with the original pulpal problem Correction
- 5. Failure to remove all caries as well as weak and unsupported tooth structure Leads to contamination and re infection of the prepared root canal with saliva and bacteria conducting to endodontic failure. Correction: According to the case, sometimes retreatment may be needed.
- 6. Damage to existing restoration In preparing an access cavity through a porcelain or porcelain-bounded crown, will sometimes chip. Correction: Minor porcelain chip can at time be repaired by bounded composite resin to the crown.
- 7. • Peripherally through the side of the crown • or at the Floor of the chamber Access cavity perforations
- 8. Access cavity perforations The first sign of an accidental perforation will often be the presence of leakage: either saliva into the cavity or irrigating solution into the mouth. To confirm the perforation place a small file through the opening and take a radiograph
- 9. Correction Perforations should repaired as soon as possible to minimize the injury to the tooth’s supporting tissues. materials used for the repair amalgam, calcium hydroxide paste, glass ionomer,gutta-percha, hemostatic agents.
- 10. CROWN FRACTURE Causes: Preexisting infraction Recognition: By direct observation Treatment: supported the infarcted tooth with circumferential bands or temporary crowns
- 12. • Ledge formation • Canal blockage • Cervical canal perforations • Midroot perforations • Apical perforations • fractured Instruments and Foreign Objects
- 13. Ledge is an internal transportation of the canal which prevents positioning of an instrument to the apex in an otherwise patent canal. LEDGE FORMATION
- 14. Causes 0f Ledge formation 1-Using straight instruments in curved canal. 2-Packing debris in the apical portion of the canal. 3-Rapid advancement in files sizes or skipping file size.
- 15. Use of a small file, No. 10 or 15 with a small bend at the tip of the instrument. penetrate the file carefully into the canal. Correction of the Ledge
- 16. Fractured Instruments and Foreign Objects : Instrument breakage is a common problem in endodontic treatment which occurs by improper or overuse of instruments.
- 17. Attempt to bypass it with a small file or reamer. Bypassing is made easier with a lubricant. If successful, the canal preparation can be completed and the canal filled. [thus the instrument segment becomes part of the filling material. If the fragment extends past the apex and efforts to remove it non surgically are unsuccessful, the corrective treatment will probably include apical surgery by apicectomy Treatment of fractured Instruments
- 19. Root perforation • cervical • midroot • apical
- 20. causes of root perforation • Creating a ledge and persisting until a perforation develops • Wearing a hole in the lateral surface of the midroot by overinstrumentation (canal stripping) • Using too long instrument and perforating the apex.
- 21. Treatment of root perforation • Recognition: Sudden appearance of blood in the cavity Correction:- The bleeding is stopped and Mineral Trioxide Aggregate (MTA) is applied to the perforation. Cotton should be placed in the chamber and a good temporary filling is placed to allow time for the MTA to set (> 3 hr). Preparation is continued at a subsequent appointment.
- 22. Obturation – Related complications Overextended fillings If the overextended filling can not be removed through the canal ,it will be necessary to remove the excess surgically Underextended root canal fillings Treated by removal of the old filling followed by proper preparation & obturation of the canal.
- 24. • Irrigant-Related Mishaps • Instrument Aspiration and Ingestion MISCELLANEOUS COMPLICATIONS
- 25. • Forcibly injecting NaOCl or any other irrigating solution into the apical tissue can be a disastrous • The patient may immediately complain of severe pain. • Swelling can be violent and alarming. Irrigant-Related Mishaps
- 26. Management: • Antihistamines, ice packs, intramuscular steroids, even hospitalization and surgical intervention may be needed. Prevention: • using passive placement of a modified needle. • The needle must not be wedged in the canal.
- 27. Patient should reffered to ENT specialist or cardiovascular surgeon Instrument Aspiration and Ingestion