Managing Endodontic Failures

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Name the 4 options for managing endodontic failures
No treatment, extraction, re-treatment and surgery
1 of 17
What are the indications for no treatment?
-If the outcome of retreatment would not be favourable - if the tooth is stable - asymptomatic -non-healing PA radiolucency
2 of 17
What are the indications for extraction?
- patient does not want further treatment - restorability of tooth is doubtful - tooth is non functional or has no strategic value - tooth has untreatable disease e.g. fracture
3 of 17
What are the indications for re-treatment?
When there is post-treatment disease but the patient is keen to save the tooth - tooth is restorable
4 of 17
What are the indications for surgery?
- retreatment would have an unfavourable outcome - obstructions in canal can't be removed - perforations of canal require surgial repair - the canal contains a wide or long post that risks fracturing the tooth if removed - extraradicular infection - true
5 of 17
What is the advantage of monitoring the tooth ?
It avoids the risks of reintervention
6 of 17
What is the advantage of extracting?
It is the quickest solution
7 of 17
What is the aim of endodontic retreatment and what is the success rate?
The aim is the same as initial endodontic treatment - to eradicate microbes and provide a good apical and coronal seal. Success rate is 80% compared to 83% for inital
8 of 17
What should you advise the patient before starting retreatment?
the tooth may be deemed unrestorable during treatment, there are risks such as perforation and it may be impossible to fully instrument the canals if they are blocked. The latter 2 reduce prognosis
9 of 17
How do you remove gutta percha
1) GG and hand files 2) Retreatment rotary files 3) Solvent technique 4) Combination
10 of 17
How do you remove endodontic posts?
Remove the crown and reduce core down to width of post, ensuring the post still extends out of the canal. Break the cement with trephining (ultrasonic tips). Threaded posts can simply be unscrewed. Fibre posts need to be removed with diamond burs or ultra
11 of 17
How do you remove thermafil carriers?
Remove coronal GP. Braid 2 handfiles around the carrier then pull coronally
12 of 17
How do you remove silver points?
The disintegrate. Can grab with fine forceps, braid, trephining or trough around with ultrasonics
13 of 17
How do you remove fractured instruments?
Need a microscope and good lighting. The fragment must be loosened and removed using a combination of techniques eg handfiles, ultrasonics or Masseran
14 of 17
Factors affecting success of removing fractured instruments
Where it has fractured, what instrument has fractured, length of the fragment and how accessible the fragment is
15 of 17
How do you repair perforations?
Internally or externally using either MTA or Biodentine
16 of 17
What affects the success of repairing perforations?
Size, location, condition of remaining tooth and how infected it is
17 of 17

Other cards in this set

Card 2

Front

What are the indications for no treatment?

Back

-If the outcome of retreatment would not be favourable - if the tooth is stable - asymptomatic -non-healing PA radiolucency

Card 3

Front

What are the indications for extraction?

Back

Preview of the front of card 3

Card 4

Front

What are the indications for re-treatment?

Back

Preview of the front of card 4

Card 5

Front

What are the indications for surgery?

Back

Preview of the front of card 5
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