explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.

1. Good morning

2. ENDODONTIC MISHAPS

3. CONTENTS
• INTRODUCTION
• MISHAPS IN
– DIAGNOSIS
– RADIOGRAHIC INTERPRETATION
– CASE SELECTION
– LA ADMINISTRATION
– ANALGESIA
– ISOLATION
– ACCESS OPENING
– INSTRUMENTATION
– OBTURATION
• MISCELLANEOUS
• CONCLUSION
• REFERENCES

4. INTRODUCTION
• Technical advancements- improved quality
• Technique sensitivity – procedural errors
• Torabinejad – MISHAPS
• Procedural accident- deviation from accepted stand.
When any endodontic mishap occurs during treatment, patient
should be informed about
The incident and nature of the mishap
Procedure necessary to correct it
Alternative treatment modalities and
The effect of this accident on prognosis of the tooth

5. DIAGNOSIS
• Diagnosis is a process of determining the nature of a
disease.
• Correct treatment - correct diagnosis.
• Incorrect diagnosis usually results from a
misinterpretation or lack of information, either
clinically or radiographically.
PREVENTION
Attention to detail
As much info. as possible
BASEBALL RULE
Three strikes and y’er out
3 - EVIDENCE

6. RADIOGRAPHIC INTERPRETATION
• Most important clinical tool
• When not coupled – misinterpretation
Prevention of radiological
interpretation errors
Conditions
inside the
tooth
Conditions
outside
the tooth
Buccal
Object/
SLOB Rule
Location, size and shape
Move anatomic landmarks
Normal anatomy/ shadows
Internal/external resorption
Foreign bodies- trauma

7. CASE SELECTION
FACTORS WHICH INFLUENCE THE DECISION OF
ENDODONTIC TREATMENT:
– Restorability of the involved
tooth.
– Accessibility of apical foramen.
– Strategic importance of the
involved tooth.
– General resistance of the
patient.
POOR CANDIDATES FOR
ENDODONTIC TREATMENT:
Non-restorable teeth
Teeth in which
instrumentation is not possible
Poor accessibility
Untreatable tooth resorption
and tooth fracture
Non-Strategic teeth
Hopeless tooth
Evaluation of oral cavity
will decide

8. L.A.
ADMINISTRATION
NEEDLE BREAKAGE
• CAUSES
 Weakening by
bending
 Sudden unexpected
movements
• MANAGEMENT
• Shira et al, 1979
1.visible
2. invisible
• PREVENTION
• Large guage needles
• Long needles
• Not insert upto hub
PERSISTENT ANAESTHESIA
OR PARASTHESIA
Anaesthesia beyond expected duration
•CAUSES
•Trauma
•Contamination
•haemorrhage
•MANAGEMENT
•Normal – 6 weeks
•Severe - permanent
•PREVENTION
•Injection protocol
•Care and handling
HEMATOMA
FORMATION
•CAUSES
•Inadvertent nicking
•MANAGEMENT
IMMEDIATE
Direct pressure
SUBSEQUENT
Apply ice
No- heat
6-14 days
•PREVENTION
• Knowledge of anatomy
• Modify injec tech
• Minimize penetration
Start of RCT
Medical and dental history
Allergic reactions

9. IMPROPER ANALGESIA
• CAUSES
 Deposition of anaesthetic
solution in the wrong place.
 Incorrect amount
 Incorrect technique
 Intravascular injection
 Variation in individual response
 Variation in pain threshold of
individuals
MANAGEMENT
Sedation of the pulp.
Intrapulpal anaesthesia.
Periodontal ligament
injection.
Sedation or general
anaesthesia.

10. ISOLATION
LEAKING
RUBBER
DAM
UNUSUAL
TOOTH
POSITION
LITTLE
REMAINING
TOOTH
STRUCTURE
SPLIT-DAM
TECHNIQUE
CAUSE
Improper
application
Tearing
MANAGEMENT
Proper tooth &site
prep
Clamp selection
Hole positioning
Placement on
tooth
Final sealing with
floss
Orabase/rubber
base adhesive
CAUSE
Destructed crown
due to caries or
trauma
MANAGEMENT
Deep reaching
clamps
Clamping adjucent
tooth
Crown lengthening
Buildup of tooth

11. ACCESS OPENING
Access related mishaps can be discussed
under following headings:
 Treating the wrong tooth
 Missed canals
 Damage to existing restoration
 Access cavity perforations
 Crown fractures
. In the process of searching for canal orifices, perforations of
the crown can occur either peripherally through the sides of
the crown or through the floor of the chamber into furcation
area.
Several materials have been recommended for perforation repair:
cavit, amalgam,calcium hydroxide paste, super EBA,glass ionomer
cement, gutta-percha, tricalcium phosphate or haemostatic agents
such as Gelfoam.
CROWN FRACTURES
Avoided in many instances
Chisel type: cusp part of
crown
Continue treatment
More extensive- extract

12. INSTRUMENTATION
• LOSS OF WORKING LENGTH
• BLOCKAGE OF THE CANAL SYSTEM
• LEDGE FORMATION
• APICAL TRANSPORTATIONS
• SEPARATED INSTRUMENT AND FOREIGN OBJECTS
• ENDODONTIC PERFORATIONS
• INADEQUATE CANAL PREPARATIONS

13. LOSS OF WORKING LENGTH
causes:
Rapid increase in file size
Accumulation of debris
malpositioned instrument stops
variations in reference points
poor radiographic technique
improper use of instruments
Prevention
Exact, reproducible reference
points
Continually observe the
instrument stops
Use firm or secure rubber stops
Precurve all instruments
use consistent radiographic angles.
copious irrigation and
recapitulation
Always use sequential file sizes
BLOCKAGE OF THE CANAL
SYSTEM
Causes:
 tissue debris restorative materials
packing of dentin chips
cotton pellets
paper points or a fractured
instrument
Management:-
• If the blockage cannot be
penetrated or bypassed,
instrumentation is completed at a
new working length coronal to the
blockage.
•Periodic recall is mandatory after
obturation. surgery may be
necessary to correct the problem.
LEDGE FORMATION
An internal transportation of the canal
is termed as a Ledge (Cohen).
Causes:
•Inadequate straight line access in to the
canal.
•Filing of a curved canal short of working
length
•Over enlargement of a small curved
canal.
•Loss of patency by the debris packed in
the apical canal.
•Use of stiff instruments in curved canals
without precurving.
•Improper lubrication
Management
•The use of a small file #10 or #15, with a
distinct curve at the tip
•curved tip should be pointed towards the
wall opposite the ledge
•“watch-winding” motion often helps
•resistance is met, the file is slightly
retracted, rotated, and advanced again until
it bypasses the ledge.

14. CREATING NEW CANALS
causes:
An exaggerated ledge
Management
negotiation – difficult
Perforation-Reduce WL- 1-2mm
Custom fit master cone
Obturation
No perfo: softened GP technique
Prognosis:
depends on the renegotiability of the
original canal and the remaining amount
of uninstrumented and unfilled portion of
the main canal.
SEPARATED INSTRUMENT
AND FOREIGN OBJECTS
Causes:
 Glass beads from sterilizers, burs,
gates-glidden drills, amalgam, paste
fillers, files and reamers and tips of dental
instruments have all found their way into
canals, complicating treatment.
Chenail and Teplitsky in 1987 listed, in
addition to the above nails, pencil lead,
toothpicks, tomato seeds, hat pins,
needles, pins and other metal objects and
advocated the use of orthograde
ultrasonic for removal.
Management:-
•Efforts should be made to remove
instrument or fragments, as the
initial approach to corrective
treatment.
Different methods were suggested for the
removal of broken instrument
. Broken instruments can often be bypassed
if the canals are oval or irregular in shape.
. EDTA, is helpful as a lubricant
Nehme WB in 2001 suggested that
ultrasonic fine instruments are most
effective in loosening and ‘flushing out’
broken fragments
Suter B in 2005, used cyanoacrylate to bind
and remove the instrument.
Braiding Technique: Several stainless steel
files of medium size (#20-#35) are placed in
the root canal along the exposed instrument
fragment, which has to be at least partly
bypassed and loosened. The complexity of
the files that intertwined the instrument
fragment can be pulled out of the tooth.
Saini D, Saini R in 2009 retrieved the
fractured instrument by two hedstroem files
under copious irrigation with 15% EDTA and
sodium hypochlorite.

15. OBTURATION
• Failure to seat the master cone to estimated full working length
• Failure to achieve “tugback” or “snug fit” of master cone
• Breakage of master cone during trial placement
• Failure to place the compacting instrument to the prepared apical seat
• Pulling obturating material out of the canal by compacting instrument
• Cracking or popping during compaction – excessive pressure
• Overfilling of canals or overextension of the obturating material
• Under filling
• Nerve paresthesia – over instrumentation, extension and neural damage- systemic prednisone.
• Vertical root fractures- lateral and vertical condensation and post placement.

16. MISCELLANEOUS
• POST SPACE PERFORATION
• IRRIGANT RELATED
• TISSUE EMPHYSEMA
• INSTRUMENT ASPIRATION

17. CONCLUSION
• “Failure is the stepping stone to success”.
• Yes, endodontic mishaps are a reality. Rapid advances in Endodontics and
its stupendous success rate has made root canal therapy all pervasive in
modern dentistry and given it a pride of place in therapeutic
armamentarium.
• Thus, it is the duty and responsibility of every dentist to know, understand,
recognize and be able to handle these endodontic mishaps at the exact
time and with required technique and skill so as to achieve the best
possible prognosis and an ideal holistic therapeutic outcome.

18. REFERENCES
• Ingles Endodontics- 5th edition
• Advanced Endodontics- John s Rhodes
• Endodontics- problem solving in clinical practice- Pitt
ford, JS Rhodes
• Diagnosis and Treatment of accidental root perforation,
Endodontic topics 2006
• Ledge Formation : Review of a Great Challange in
Endodontics- J.Endodontics 2007
• Seperated file Removal : Yoshitsugu 2012- Dentistry
Today

19. Thank you