post endodontic treatment disease

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Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease

Michael Gossack

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Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease

vs

Endodontic Failure

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Topics of DiscussionTopics of Discussion

DiagnosisEtiologyTreatment OptionsClinical cases

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DiagnosisDiagnosis

Patient Complaint ( if any)Clinical ExaminationRadiographic ExaminationElimination of Other Possible Etiologies

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Patient ComplaintPatient Complaint

Can patient localize symptoms to a particular tooth

Temperature sensitivityPrevious swelling or drainageSensitivity to pressure chewing

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Clinical ExaminationClinical Examination

Percussion sensitivityPalpation sensitivitySwellingSinus tractPeriodontal pocketingFracture lines

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Radiographic ExaminationRadiographic Examination

Evaluation of previous endodontic treatment

Periapical radiolucent lesionBone loss on lateral aspect of rootTracing of sinus tract

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Eliminate Other EtiologiesEliminate Other Etiologies

Pulpitis from another toothHealing in progressSinusitisPerio TMJNeuralgias

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EtiologyEtiology

Inadequate prior root canal therapyFracturesCoronal leakageComplex root canal anatomy

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Inadequate Prior TreatmentInadequate Prior Treatment

Canal treated short of apex Poorly cleaned and shaped canal Poorly obturated canal Missed canal-MB root Max Molars most common

- D roots Mand Molars, Mand Incisors, Max Premolars

Iatrogenic Errors- perforations, separated instruments, ledged canals, post perforations, transported canals

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Treatment OptionsTreatment Options

Retreatment with possible disassemblyPeriapical Surgical TreatmentExtraction(Intentional Replantation)

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Treatment ConsiderationsTreatment Considerations

Patient’s motivation to save tooth or pursue best long term outcome

Periodontal Status of Tooth Restorability of Tooth Strategic Value of Tooth Costs Involved Time Constraints Previous Treatments Performed Clinician’s Experience, Skill, and Armamentarium

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