Post endodontic treatment_disease
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  • 1. Post Endodontic Treatment Disease Michael Gossack
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  • 5. Post Endodontic Treatment Disease vs Endodontic Failure
  • 6. Topics of Discussion
    • Diagnosis
    • Etiology
    • Treatment Options
    • Clinical cases
  • 7. Diagnosis
    • Patient Complaint ( if any)
    • Clinical Examination
    • Radiographic Examination
    • Elimination of Other Possible Etiologies
  • 8. Patient Complaint
    • Can patient localize symptoms to a particular tooth
    • Temperature sensitivity
    • Previous swelling or drainage
    • Sensitivity to pressure chewing
  • 9. Clinical Examination
    • Percussion sensitivity
    • Palpation sensitivity
    • Swelling
    • Sinus tract
    • Periodontal pocketing
    • Fracture lines
  • 10. Radiographic Examination
    • Evaluation of previous endodontic treatment
    • Periapical radiolucent lesion
    • Bone loss on lateral aspect of root
    • Tracing of sinus tract
  • 11. Eliminate Other Etiologies
    • Pulpitis from another tooth
    • Healing in progress
    • Sinusitis
    • Perio
    • TMJ
    • Neuralgias
  • 12. Etiology
    • Inadequate prior root canal therapy
    • Fractures
    • Coronal leakage
    • Complex root canal anatomy
  • 13. Inadequate 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
  • 14. Treatment Options
    • Retreatment with possible disassembly
    • Periapical Surgical Treatment
    • Extraction
    • (Intentional Replantation)
  • 15. Treatment 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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