Related to operative dentistry

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Causes of
endodontic
failure
Dr.Taj Mahmood

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INDICATIONS
• Failure of root canal treatment is indicated in
following conditions
a)Post treatment persistent lesion
b)An increase in size of pre-existing lesion
c)Pain, swelling and loss of function
d)Sinus tract
e)Signs of root resorption and hypercementosis

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CAUSES OF FAILURE OF
ENDODONTICS
• EXTRA RADICULAR
• INTRA RADICULAR

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EXTRA RADICULAR FACTORS
1.Microbial cause
Abcess periapical periodontitis
Overinstrumentation
Infected periapical pocket cyst

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EXTRA RADICULAR FACTORS
2.Non microbial causes
Foreign bodies
Gutta percha
Temporary filling material
Broken instrument
Sealers
Cotton fibrils
Treatment ; surgical removal of irritant
Cholestrol crystals
True cyst
Scar tissue healing

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INTRARADICULAR FACTORS
They may be
1. Preoperative
2. Operative
3. Post operative

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• PREOPERATIVE
Misdiagnosis
lack of information
Poor case selection
Un-negotiable canal, resorption,
unrestorable tooth, secondarily
periodontal involvement
occlusal trauma
apical abscess or cyst
Poor prognosis
avulsed tooth, unsuccessful
treatment of endo-perio lesion

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• OPERATIVE FACTORS
1.Failure to obtain biologic objective
a)improper removal of irritant
b)debris pushed beyond the apical foramen
2.Failure to obtain mechanical objectives
a)improper access cavity preparation
b)mishaps during canal preparation
short or excess preparation
ledge
perforation
transportation
missed canals
zipping, elbow formation
apical blockage
separated instrument

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OPERATIVE FACTORS
c)improper obturation
underobturation or overobturation
3.other causes
irrigant related mishaps
tissue emphysema

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POSTOPERATIVE FACTORS
• Post operative
Trauma
Fracture
Super imposed non-endodontic lesion
Poorly designd final restoration

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Ledge formation

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TREATMENT OPTIONS
• Best is prevention in each and every step of root canal
preparation
• Proper diagnosis and treatment planning
• Predecide the curving of canals and the number of
root canals
• Adequate access cavity and avoid perforation and too
much destruction of structure of tooth
• Proper control of instruments and avoid excessive
force

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TREATMENT OPTIONS
• Work in a proper sequence while filing
• Avoid in exerting too much force
• Go to surgical removal of lesion and irritant if
necessary or medicate the patient
• Always be relax and comfortable to handle the
complication
• If very poor prognosis is indicated then go for
extraction