04/19/23 ECDS Meeting May 2002 1

Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease

Michael Gossack

04/19/23 ECDS Meeting May 2002 2

04/19/23 ECDS Meeting May 2002 3

04/19/23 ECDS Meeting May 2002 4

04/19/23 ECDS Meeting May 2002 5

Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease

vs

Endodontic Failure

04/19/23 ECDS Meeting May 2002 6

Topics of DiscussionTopics of Discussion

DiagnosisEtiologyTreatment OptionsClinical cases

04/19/23 ECDS Meeting May 2002 7

DiagnosisDiagnosis

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

04/19/23 ECDS Meeting May 2002 8

Patient ComplaintPatient Complaint

Can patient localize symptoms to a particular tooth

Temperature sensitivityPrevious swelling or drainageSensitivity to pressure chewing

04/19/23 ECDS Meeting May 2002 9

Clinical ExaminationClinical Examination

Percussion sensitivityPalpation sensitivitySwellingSinus tractPeriodontal pocketingFracture lines

04/19/23 ECDS Meeting May 2002 10

Radiographic ExaminationRadiographic Examination

Evaluation of previous endodontic treatment

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

04/19/23 ECDS Meeting May 2002 11

Eliminate Other EtiologiesEliminate Other Etiologies

Pulpitis from another toothHealing in progressSinusitisPerio TMJNeuralgias

04/19/23 ECDS Meeting May 2002 12

EtiologyEtiology

Inadequate prior root canal therapyFracturesCoronal leakageComplex root canal anatomy

04/19/23 ECDS Meeting May 2002 13

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

04/19/23 ECDS Meeting May 2002 14

Treatment OptionsTreatment Options

Retreatment with possible disassemblyPeriapical Surgical TreatmentExtraction(Intentional Replantation)

04/19/23 ECDS Meeting May 2002 15

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

04/19/23 ECDS Meeting May 2002 16

04/19/23 ECDS Meeting May 2002 17

04/19/23 ECDS Meeting May 2002 18

04/19/23 ECDS Meeting May 2002 19

04/19/23 ECDS Meeting May 2002 20

04/19/23 ECDS Meeting May 2002 21

04/19/23 ECDS Meeting May 2002 22

04/19/23 ECDS Meeting May 2002 23

04/19/23 ECDS Meeting May 2002 24

04/19/23 ECDS Meeting May 2002 25

04/19/23 ECDS Meeting May 2002 26

04/19/23 ECDS Meeting May 2002 27

04/19/23 ECDS Meeting May 2002 28

04/19/23 ECDS Meeting May 2002 29

04/19/23 ECDS Meeting May 2002 30

04/19/23 ECDS Meeting May 2002 31

04/19/23 ECDS Meeting May 2002 32

04/19/23 ECDS Meeting May 2002 33

04/19/23 ECDS Meeting May 2002 34

04/19/23 ECDS Meeting May 2002 35

04/19/23 ECDS Meeting May 2002 36

04/19/23 ECDS Meeting May 2002 37

04/19/23 ECDS Meeting May 2002 38

04/19/23 ECDS Meeting May 2002 39

04/19/23 ECDS Meeting May 2002 40

04/19/23 ECDS Meeting May 2002 41

04/19/23 ECDS Meeting May 2002 42

04/19/23 ECDS Meeting May 2002 43

04/19/23 ECDS Meeting May 2002 44

04/19/23 ECDS Meeting May 2002 45

04/19/23 ECDS Meeting May 2002 46

04/19/23 ECDS Meeting May 2002 47

04/19/23 ECDS Meeting May 2002 48