4. Radiographic features affecting treatment
outcome
Assessment of patient’s systemic status
Role of radiographs
Case difficulty assessment form
Levels of difficulty
2
5. Factors affecting healing after endodontic
treatment
Endodontic treatment plan
Indications for extraction
3
6. Single visit / mulitiple visit
Periodontal considerations
Surgical considerations
Restorative and prosthetic considerations
Conclusion
4
9. Proper selection of cases avoids pitfalls
during treatment and helps to ensure
success
22%of failures – errors in case selection
The Washington Study
Ingle & Beveridge
7
15. Hunter’s Focal infection theory
Rosenow’s Elective localization
Rickert & Dixon Hollow tube theory
13
16. Factors to be considered
Sterilization – purest form, impossible
Theories – highly speculative
Hollow tube theory- disproved 1960
Dye leakage studies-static evaluation
14
17. 1950-1960- lack of apical seal
Contemporary studies – root canal
fillings leak over time
Bacterial etiology together with
inflammatory reactions
15
19. Factors – may influence the
treatment outcome
Pulpal status
Procedural accidents
Crown/root fractures
Periodontal status
Occlusal discrepancies
Size of periradicular rarefaction
17
20. Pain threshold
Level of canal obturation
Time of post treatment evaluation
Degree of canal calcification
Accessory communications
Presence of root resorption
18
21. Factors – definitely influence
the outcome
r/g interpretation
Periradicular pathosis
Root canal anatomy
Thorough debridement
Apical seal
Disinfection and asepsis
Systemic status
Clinician’s skill
19
22. Treatment outcome based on clinical
features
Acceptable
No tenderness
Normal mobility
No sinus tract, assc periodontal disease
No swelling
No subjective discomfort
20
23. Uncertain
Sporadic vague symptoms
Pressure sensation
Low grade discomfort
Discomfort when pressure applied by tongue
Superimposed sinusitis
Analgesics to relieve pain
21
25. Treatment outcome based on r/g features
Acceptable
Normal, slight thickened pdl space
Elimination of previous r/l
Normal lamina dura
No evidence of resorption
3-D obturation of canal space
23
26. Uncertain
Increased pdl space
r/l of similar size, slight repair
Irregularly thickened lamina dura
Evidence of progressive resorption
Voids in canal obturation
overfilling
24
27. Unacceptable
Increased width of PDL space >2mm
Lack of osseous repair/ size of lesion
Lack of new ld formation
New osseous r/l
Visible patent canal space
Excessive overextension , voids in the apical
area
Definite progressive resorption
25
34. Pregnancy
X ray exposure
Antibiotics if any- penicillins,
cephalosporins, macrolides – first line
NSAIDs – not preferred
Second trimester – safest for dental
care
32
36. Oral infections and potential problems should be
addressed before initiating radiation
Rx of Symptomatic non vital teeth – 1 week before
chemo/radiation
Asymptomatic - delayed
34
37. Medication related osteonecrosis of the
jaws(MRONJ)
AAOMS
1. Current/ previous Rx with antiresorptive drug
2. Exposed necrotic bone in MF region
3. No h/o radiation therapy to jaws
35
38. Recommendations prior to endodontic
treatment
1 min mouth rinse with CHX
Avoid LA with vasoconstrictors
Asepsis
Avoid gingival damage
Maintain apical patency
Prevent overfilling
Aggressive use of antibiotics - infection
36
39. HIV
long term prognosis on endodontic
therapy- unknown
Minimize the possibility of transmission of
infection – strict adherence to universal
precautions
37
40. CD4+ cell count
>350/mm3 – receive all indicated dental
treatments
<200/mm3- opportunistic infections ,
medicated with prophylatic drugs
38
47. Case selection – dictated by what is seen in the
radiograph
Extent of caries
Periapical lesion
Resorption
Anatomy of root canal
Fracture of tooth
45
54. Use of case difficulty assessment form
Items in minimal difficulty – point 1
Moderate – point 2
High- point value – 5
53
55. Decision to treat or refer
< 20 points – dental student may treat under
facult’s supervision
20-40 points – experienced n skilled dental
student , with close supervision by faculty
> 40 merits - case not treated by predoctural
student
54
67. 6
Management of periodontally compromised mandibular molar with
Hemisectioning: A case report
Bandu Napte, Srinidhi Surya Raghavendra
Department of Conservative Dentistry and Endodontics,
28-Oct-2014
77. 6Restor Dent Endod.
2013 May;38(2):59-64
Sin-Yeon Cho and Euiseong Kim
6-year follow up case of horizontal root fracture.
(a) Horizontal root fractures were found on teeth #11 and #21
at the first visit in 2006; (b) The tooth #11 became necrotic and
Received non-surgical root canal therapy in 2007;
(c) 3-year follow up radiograph in 2009; (d) 6-year follow up radiograph in 2012.
78. 6
Figure 1: (a) The initial radiograph was showing the horizontal root
fracture.
(b)The periapical radiograph of the teeth was taken 3 months later.
(c) Six month follow-up radiograph.
(d) One-year follow-up radiograph. (e) Two-year follow-up
radiograph
Year : 2013 | Volume : 1 |
Issue : 1 | Page : 19-23
Treatments of
horizontal
root fractures:
Four case reports
Ebru Kucukyilmaz,
Murat Selim Botsali
Journal of Pediatric
dentistry
79. 6
Figure 4a. Schematic of class III fracture:
incomplete vertical fracture
involving the attachment apparatus.
Figure 4b. Pretreatment radiograph
of mandibular first molar
demonstrating a class III fracture.
Figure 4c. The mesial root has been
amputated and the fracture is observed.
Figure 4d. A 10-year recall of
hemisection and restoration.
Courtesy: Dentistry Today
80. 6
No treatment – the gingival tissue
can be retracted during crown preparation
Gingivectomy using electrosurgery
- Crown lengthening including osseous recontouring
Sub-epithelial connective tissue graft
Mesial root amputation ??
Reattachment with RMGIC followed by
crown placement / extraction ??
91. Reasons for extraction
Symptomatic tooth with non negotiable
canals/ iatrogenic errors whose surgical
management – not possible
Failed rct not amenable to
retreatment
58
93. Single visit vs multiple visit Rx
6
No:of
roots,
time
Severity
of pt’s
symptoms
Clinician’s
skill
94. 61
Single visit vs multiple
visit Rx
Post treatment obturation
discomfort
Post treatment flare up
Radiologic success
Healing rate
JOE 2008 Figini, Lodi, et al
IEJ 2008, Sathorn et al
JOE 2008 , Figini
et al
JOE 2011 , Su, Wang et al
98. Surgical considerations
Lesions – non odontogenic
Biopsy – definitive means , osseous pathosis
Retreatment - approach ?
Apical surgery – failed nsrct
Cause should be corrected first
64
99. Endodontic surgery – primary procedure
- Non surgical
treatment is
not possible
65
100. Pts with preoperative pain – lower
healing rate // pts without pain
Periodontal condition – interproximal
bone levels, marginal bone loss
Isolated endodontic lesion – better
prognosis than endoperio lesion
66
101. Advent of microscope, endoscope ,
ultrasonics, retrograde filling instruments
–improved surgery
CBCT – 3-D image of tooth , pathosis,
localizing mandibular canal, maxillary
sinus
67
103. Reduced coronal tooth structure beneath a
full crown – difficult access & lack of idea
about pulp chamber
When possible , remove restorations before
starting endodontic Rx
Quality of coronal restoration – imp as the
root filling
69
104. Conclusion
Thus, according to Torabinejad and Goodacre,
the decision to retain or remove teeth should
be based on
Thorough assessment of risk factors affecting
long term prognosis of endodontic treatment
70
105. The clinician should consider
Patient related factors
Tooth and periodontium related factors
Treatment related factors
71
106. The use of rotary instruments, ultrasonics,
microscopy as well as new materials
Made it possible to predictably reatin teeth
that previously would have been extracted
72
107. In addition, even teeth
that have failed following
nsrct can often be
retreated using
non surgical or
surgical approach.
73
