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Errors in endodontic cavity preparations & their management.

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Presentation on theme: "Errors in endodontic cavity preparations & their management."— Presentation transcript:

1 Errors in endodontic cavity preparations & their management

2 Endodontic errors are not common problem in our daily endodontic practice but definitely a very embarrassing situation which may occur during endodontic procedures like:

3 Errors are:  Coronal perforation:  Lateral perforation: Cervical perforation Cervical perforation Mid root perforation Mid root perforation Apical perforation Apical perforation  Bifurcation perforation  Ledge formation  Transportation  Gouging :  Zipping :  Elbo

4 Coronal Perforation Causes:  Anatomic configuration  Inclination of tooth  Difficult accessibility  Mis direction of bur Detection:  Saliva comes in the access cavity  Irrigation solution goes into the mouth  Patient notice the unpleasant taste

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7 Needs immediate repair Needs immediate repair Isolation of the tooth Isolation of the tooth Free from contamination Free from contamination Intracoronally repaired by using cavit Intracoronally repaired by using cavit Management

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9 Lateral of perforation (Cervical) Causes Mis direction of bur Mis direction of bur Inappropriate use of Gates Glidden Drill deep in the canal Inappropriate use of Gates Glidden Drill deep in the canal During location of canal orifice During location of canal orificeDetection: Bleeding in the access cavity Bleeding in the access cavity Radiograph (Place a file through the opening and a radiograph is taken for the confirmation that the file is not in the canal) Radiograph (Place a file through the opening and a radiograph is taken for the confirmation that the file is not in the canal)

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12 Lateral of perforation (Cervical)

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14 Management : Isolation of the tooth Isolation of the tooth Free from contamination Free from contamination Control of Bleeding Control of Bleeding Location of perforation Location of perforation Location of the canal orifices Location of the canal orifices Insertion of the thickest file in the canal opening up to 5mm below the level of perforation. Insertion of the thickest file in the canal opening up to 5mm below the level of perforation.

15 Calcium 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.

16 Prevention: In the Anterior teeth the direction of bur should be parallel in the long axis of the tooth in all plans. 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. 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. The use of bur should be limited to the roof of pulp chamber.

17 Bifurcation perforation

18 Bifurcation perforation: Causes : Mis direction of bur Mis direction of bur Careless use of instruments Careless use of instruments Inadequate study of the tooth both clinically and radiographically Inadequate study of the tooth both clinically and radiographically Detection : Profuse bleeding in the pulp chamber Profuse bleeding in the pulp chamber Radiograph (Place a file through the opening and radiograph is taken for the confirmation that the file is not in the canal. Radiograph (Place a file through the opening and radiograph is taken for the confirmation that the file is not in the canal.

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20 Furcation Entrance Entrance: the transitional area between the undivided and the divided part of the root Fornix: the roof of the furcation

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22 Management

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24 Mid root perforation (Striping)

25 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. 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.

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28 Causes : Over zealous instrumentation in the mid-root areas Not use precurved instruments. Identification : Appearance of blood Sudden complain of pain by the patient

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31 precurved instruments

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35 Management: Both internal and external repair may be required. Both internal and external repair may be required. A small area may be sealed from inside the tooth. A small area may be sealed from inside the tooth. A large one required surgical repair. A large one required surgical repair. International re-implantation can be considered. International re-implantation can be considered.

36 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. Prevention :

37 Apical perforation

38 Causes : Uncontrolled instrumentation Uncontrolled instrumentation Ledge formation Ledge formation Identification : Sudden appearance of fresh bleeding from the canal. Sudden appearance of fresh bleeding from the canal. Pain during canal preparation. Pain during canal preparation. Sudden loss of apical stop. Sudden loss of apical stop.

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40 Management : Established a new working length. Established a new working length. Creation an apical seal. Creation an apical seal. Obturation to its proper working length. Obturation to its proper working length.

41 Ledge formation

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43 Causes: Insertion of uncurved instruments. Insertion of uncurved instruments. Large instrument out of sequence. Large instrument out of sequence. Inflexible instrument in curved canals. Inflexible instrument in curved canals. Poorly designed access cavity. Poorly designed access cavity. Over enlargement of the curved canals. Over enlargement of the curved canals.

44 Indefication: 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

45 Management : Location the ledge by a radiograph and verification the depth Location the ledge by a radiograph and verification the depth Irrigate the canal copiously Irrigate the canal copiously Explore 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. Explore 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. The curved tip should be pointed toward the wall opposite the ledge.

46 Once the ledge is bypassed start circumferential filling till be ledge is removed Use a lubricant irrigate frequently to remove the dentine chips If the ledge cannot be bypassed then clean, shape and obturate the canal at that level If endodontic treatment fails then alternative treatment such as roof end filling hemisection may be considered.

47 Accurate radiograph study Accurate radiograph study Awareness of canal morphology Awareness of canal morphology Use of flexible file Use of flexible file pre curved instruments should be used pre curved instruments should be used Working length should be followed Working length should be followed Prevention :

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49 Transportation : 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. 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.

50 Pre curved instruments should be used Use of smaller or flexible files, safety files Anticurvature filling should be done. Prevention :

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52 Transportation :

53 Causes : Rotary action of instruments Rotary action of instruments Due to apical curvature of root Due to apical curvature of root Management : Instruments should be used in a half circle rotary action Instruments should be used in a half circle rotary action Flexible file should be used Flexible file should be used

54 When an instrument is used with complete rotating action in the apical curvature, a cavity is formed is called gouging. Gouging :

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56 Zipping Over preparation of the outer wall of the apical curvature of the canal with inflexible instruments will cause zipping.

57 Zipping : Causes : Failure to used the precurve the instruments Failure to used the precurve the instruments Rotation of instruments in curved canals Rotation of instruments in curved canals Use of large stiff instruments Use of large stiff instruments Treatment : When a zipping is present theremoplasticized GP techniques preferred along with Surgical approach can be consider. When a zipping is present theremoplasticized GP techniques preferred along with Surgical approach can be consider.

58 The narrowest part of the preparation is short of its apical extent & is known as elbow. The 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. In most case, the obturating material will terminate at this elbow, leaving an unfilled zipped canal apical to the elbow. Elbow

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60 Injection of full-strength sodium hypochlorite out of the apical foramen.

61 tissue emphysema caused by injecting hydrogen peroxide irrigant into the tissues

62 Instrument Aspiration and Ingestion

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