Post Endodontic Treatment Disease Michael Gossack
 
 
 
Post Endodontic Treatment Disease vs  Endodontic Failure
Topics of Discussion <ul><li>Diagnosis </li></ul><ul><li>Etiology </li></ul><ul><li>Treatment Options </li></ul><ul><li>Cl...
Diagnosis <ul><li>Patient Complaint ( if any) </li></ul><ul><li>Clinical Examination </li></ul><ul><li>Radiographic Examin...
Patient Complaint <ul><li>Can patient localize symptoms to a particular tooth </li></ul><ul><li>Temperature sensitivity </...
Clinical Examination <ul><li>Percussion sensitivity </li></ul><ul><li>Palpation sensitivity </li></ul><ul><li>Swelling </l...
Radiographic Examination <ul><li>Evaluation of previous endodontic treatment </li></ul><ul><li>Periapical radiolucent lesi...
Eliminate Other Etiologies <ul><li>Pulpitis from another tooth </li></ul><ul><li>Healing in progress </li></ul><ul><li>Sin...
Etiology <ul><li>Inadequate prior root canal therapy </li></ul><ul><li>Fractures </li></ul><ul><li>Coronal leakage </li></...
Inadequate Prior Treatment <ul><li>Canal treated short of apex </li></ul><ul><li>Poorly cleaned and shaped canal </li></ul...
Treatment Options <ul><li>Retreatment with possible disassembly </li></ul><ul><li>Periapical Surgical Treatment </li></ul>...
Treatment Considerations <ul><li>Patient’s motivation to save tooth or pursue best long term outcome </li></ul><ul><li>Per...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Post endodontic treatment_disease

  1. 1. Post Endodontic Treatment Disease Michael Gossack
  2. 5. Post Endodontic Treatment Disease vs Endodontic Failure
  3. 6. Topics of Discussion <ul><li>Diagnosis </li></ul><ul><li>Etiology </li></ul><ul><li>Treatment Options </li></ul><ul><li>Clinical cases </li></ul>
  4. 7. Diagnosis <ul><li>Patient Complaint ( if any) </li></ul><ul><li>Clinical Examination </li></ul><ul><li>Radiographic Examination </li></ul><ul><li>Elimination of Other Possible Etiologies </li></ul>
  5. 8. Patient Complaint <ul><li>Can patient localize symptoms to a particular tooth </li></ul><ul><li>Temperature sensitivity </li></ul><ul><li>Previous swelling or drainage </li></ul><ul><li>Sensitivity to pressure chewing </li></ul>
  6. 9. Clinical Examination <ul><li>Percussion sensitivity </li></ul><ul><li>Palpation sensitivity </li></ul><ul><li>Swelling </li></ul><ul><li>Sinus tract </li></ul><ul><li>Periodontal pocketing </li></ul><ul><li>Fracture lines </li></ul>
  7. 10. Radiographic Examination <ul><li>Evaluation of previous endodontic treatment </li></ul><ul><li>Periapical radiolucent lesion </li></ul><ul><li>Bone loss on lateral aspect of root </li></ul><ul><li>Tracing of sinus tract </li></ul>
  8. 11. Eliminate Other Etiologies <ul><li>Pulpitis from another tooth </li></ul><ul><li>Healing in progress </li></ul><ul><li>Sinusitis </li></ul><ul><li>Perio </li></ul><ul><li>TMJ </li></ul><ul><li>Neuralgias </li></ul>
  9. 12. Etiology <ul><li>Inadequate prior root canal therapy </li></ul><ul><li>Fractures </li></ul><ul><li>Coronal leakage </li></ul><ul><li>Complex root canal anatomy </li></ul>
  10. 13. Inadequate Prior Treatment <ul><li>Canal treated short of apex </li></ul><ul><li>Poorly cleaned and shaped canal </li></ul><ul><li>Poorly obturated canal </li></ul><ul><li>Missed canal-MB root Max Molars most common - D roots Mand Molars, Mand Incisors, Max Premolars </li></ul><ul><li>Iatrogenic Errors- perforations, separated instruments, ledged canals, post perforations, transported canals </li></ul>
  11. 14. Treatment Options <ul><li>Retreatment with possible disassembly </li></ul><ul><li>Periapical Surgical Treatment </li></ul><ul><li>Extraction </li></ul><ul><li>(Intentional Replantation) </li></ul>
  12. 15. Treatment Considerations <ul><li>Patient’s motivation to save tooth or pursue best long term outcome </li></ul><ul><li>Periodontal Status of Tooth </li></ul><ul><li>Restorability of Tooth </li></ul><ul><li>Strategic Value of Tooth </li></ul><ul><li>Costs Involved </li></ul><ul><li>Time Constraints </li></ul><ul><li>Previous Treatments Performed </li></ul><ul><li>Clinician’s Experience, Skill, and Armamentarium </li></ul>
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