Lec 5 Endodontic mishaps for dentists study level 4.5

Dentist

1. Endodontic Mishaps Part - 2 Assis.Prof.Dr.Nashwan AlAfifi

2. Root canal perforation A) Cervical canal perforation:

3. B) Mid-root perforation: Lateral perforations at mid-root level tend to occur mostly in curved canals . Fig. 9. A perforating along the inside curvature of the root as the canal is straightened out is often referred to as canal “stripping”.

4. Fig. 10. Anticurvature filling

5. C) Apical root perforation: Fig. 11. Radiograph showing apical root perforation. A B

6. Prognosis : Less adverse effect than coronal perforations.

7. Technique of treatment of Apical root perforation with MTA: Apply rubber dam and debride the root canal system. Dry the canal system with paper points and isolate the perforation site. Prepare the MTA material according to manufacturer’s instructions. Using the carrier provided, dispense the material into perforation site. Condense the material using pluggers or paper points. While placing MTA, instrument is placed into the canal and moved up and down in short strokes till the MTA sets. It is done to avoid file getting frozen in the MTA. Place the temporary restoration to seal chamber. In next appointment, one sees the hard-set MTA, the obturation can be done against it.

8. Instrument Separation (Fig. 12): Files & Reamers – most commonly involved. Fig. 12. Instrument Separation.

9. Different situations related to Remove a separated instrument : Removal or Retrieval Is Possible : If one third of the overall length of an obstruction (broken file) can be exposed and /or Instrument that lie in the straight portion of the canal. Removal is Difficult But Still Possible : Instrument lies partially around the canal curvature and if access can be established to its most coronal extent. Removal or Retrieval is Impossible : If the entire segment of the broken instrument is apical to the curvature / or if the canal and safe straight access cannot be accomplished.

10. Prevention : Examine each instrument before placing it into the canal. One should always discard instrument when there is: Bending of instruments. Corrosion of instrument. Excessively heating of instrument. Always use the instruments in sequential order. Never force the instrument into the canal. Canals should be copiously irrigated during cleaning and shaping procedure. Always clean the instrument before placing it into the canal. Why? Because debris collected between the flutes retard the cutting efficiency and increase the frictional torque between the instrument and canal wall.

11. Canal blockage (sometimes referred to as a “ blockout ”) :

12. C. Obturation-related mishaps Under Filling / Incompletely Filled Root Canals Under filling of the root canals is more than 2 mm short of radiographic apex.

13. Prognosis: If a lesion is present or the apical canals have necrotic or infected material in them, the prognosis decreased considerably without re-treatment.

14. Over Filling of the Root Canals Overfilling of the root canals is filling more than 2 mm beyond the radiographic apex.

15. Prognosis if the overextended filling provides an adequate seal, treatment may still be successful.

16. D. Miscellaneous Mishaps Irrigant -Related Mishaps. Tissue Emphysema. Instrument Aspiration and Ingestion Aspiration or ingestion of a foreign object is a complication that can occur during any dental procedure. It occurs especially in absence of rubber dam. Foreign body aspiration or ingestion can be a potential complication or a life-threatening emergency situation.

17. Big Stick Pharyngeal Suction Tip, 25in L

18. Thank You