Presentation on theme: "Errors in endodontic cavity preparations & their management"— Presentation transcript:
1Errors in endodontic cavity preparations & their management Dr. hadil abdallah altilbani
2Endodontic errors are not common problem in our daily endodontic practice but definitely a very embarrassing situation which may occur during endodontic procedures like:Access cavity preparation.Biomechanical preparation of the root canal system.
4Coronal Perforation Causes: Anatomic configuration Inclination of tooth Difficult accessibility Mis direction of burDetection: Saliva comes in the access cavity Irrigation solution goes into the mouth Patient notice the unpleasant taste
9Lateral of perforation (Cervical) CausesMis direction of burInappropriate use of Gates Glidden Drill deep in the canalDuring location of canal orificeDetection:Bleeding in the access cavityRadiograph (Place a file through the opening and a radiograph is taken for the confirmation that the file is not in the canal)
14Management : Isolation of the tooth Free from contamination Control of BleedingLocation of perforationLocation of the canal orificesInsertion of the thickest file in the canal opening up to 5mm below the level of perforation.
15Calcium hydroxide paste (Dycal) is packed into the perforation and allowed to set Soft mix of amalgam is gently packed over the calcium hydroxide paste.After Initial setting of the filling material the file is gently removed.RCT should be perform as conventional method.
16Prevention:In the Anterior teeth the direction of bur should be parallel in the long axis of the tooth in all plans.In molar teeth bur should be directed towards the large canal orifice.The use of bur should be limited to the roof of pulp chamber.
18Bifurcation perforation: Causes :Mis direction of burCareless use of instrumentsInadequate study of the tooth both clinically and radiographicallyDetection :Profuse bleeding in the pulp chamberRadiograph (Place a file through the opening and radiograph is taken for the confirmation that the file is not in the canal.
22ManagementImmediate repair to minimize of the injury tooth and supporting tissue.Control of BleedingLocation of perforationCalcium hydroxide paste (Dycal) should be packed into the perforation area and allowed to set.
23Soft mix of amalgam is gently packed over the calcium hydroxide paste. RCT should be perform as conventional method.Prevention :Through study of the anatomic configurationThe use of bur should be limited within the pulp chamber
25Mid root perforation (Striping) Stripping is a lateral perforation caused by over instrumentation through a thin wall in the root canal & is most likely to happen on the inside or concave wall of a curved canal.
35Management: Both internal and external repair may be required. A small area may be sealed from inside the tooth.A large one required surgical repair.International re-implantation can be considered.
36Prevention : Careful exploration and instrumentation. Straight line access to orifice.The flexible files (Ni-Ti files) should be used.Large diameter instruments should be avoided.Use precurved instrument.
38Apical perforation Identification : Causes : Uncontrolled instrumentationLedge formationIdentification :Sudden appearance of fresh bleeding from the canal.Pain during canal preparation.Sudden loss of apical stop.
43Ledge formation Causes: Insertion of uncurved instruments. Large instrument out of sequence.Inflexible instrument in curved canals.Poorly designed access cavity.Over enlargement of the curved canals.
44Indefication:Instrument should be no longer be inserted into the canal to the full working length.Loss of normal tactile sensation of the tip of instrument binding in the lumen which confirm hitting a solid wall
45Management :Location the ledge by a radiograph and verification the depthIrrigate the canal copiouslyExplore the ledge area with a small file No 6, 8, 10, 15 in which a precurvature has been made form the tip extending about 3 mm up the blade.The curved tip should be pointed toward the wall opposite the ledge.
46Once the ledge is bypassed start circumferential filling till be ledge is removed Use a lubricant irrigate frequently to remove the dentine chipsIf the ledge cannot be bypassed then clean, shape and obturate the canal at that levelIf endodontic treatment fails then alternative treatment such as roof end filling hemisection may be considered.
47Prevention : Accurate radiograph study Awareness of canal morphology Use of flexible filepre curved instruments should be usedWorking length should be followed
49Transportation :It may be defined as removal of canal wall structure on the outside curve in the apical half of the canal due to the tendency of the files to restore themselves to their original linear shape during canal preparation.
50Prevention : Pre curved instruments should be used Use of smaller or flexible files, safety filesAnticurvature filling should be done.
56ZippingOver preparation of the outer wall of the apical curvature of the canal with inflexible instruments will cause zipping.
57Zipping : Causes : Failure to used the precurve the instruments Rotation of instruments in curved canalsUse of large stiff instrumentsTreatment :When a zipping is present theremoplasticized GP techniques preferred along with Surgical approach can be consider.
58ElbowThe narrowest part of the preparation is short of its apical extent & is known as elbow.In most case, the obturating material will terminate at this elbow, leaving an unfilled zipped canal apical to the elbow.