This document discusses the classification and management of various endodontic mishaps that can occur during treatment. It classifies mishaps as access related, instrumentation related, obturation related, or miscellaneous. For each type of mishap, it describes specific incidents like ledge formation, perforations, separated instruments, and over/under obturation. It then provides recommendations for managing each incident, such as using smaller instruments, repair materials like MTA, attempting retrieval, or extraction. The conclusion emphasizes that knowledge of causes and management techniques can help minimize procedural accidents.

1. MANAGEMENT OF ENDODONTIC MISHAPS
DR. MEENAKSHI CHOUDHARY
FINAL YEAR P.G.
DEPT. OF CONSERVATIVE DENTISTRY AND ENDODONTICS

2. Contents
• Introduction
• Classification
• Management
• Conclusion
• References

3. Introduction
Definition :
Endodontic mishaps or procedural accidents are those
unfortunate occurrences that happen during treatment, some
owing to inattention to detail, others totally unpredictable. -
Torabinajed-1990

4. CLASSIFICATIONAccess Related Mishaps
Miscellaneous
Obturation Related
Instrumentation Related

5. Access Related
Mishaps
Treating Wrong Tooth
Damage To
Existing
Restoration
Missed Canal
Access Cavity
Perforation
Crown Fracture

6. Management of
Access Related Mishaps

7. MISHAP MANAGEMENT
Treating Wrong Tooth Appropriate treatment of both teeth
Missed Canals Retreatment
Damage To Existing Restorations Minor porcelain chips can be at times
repaired by bonding composite resin to
crown
Access Cavity Perforations GIC
MTA
Super EBA
Tricalcium phosphate
Crown Fractures Extraction of the fracture fragment -
“chisel type“
Crown with infarction - supported with
circumferential bands /temporary
Fracture more extensive - extraction

8. Instrumentation
Related
Ledge Formation
Cervical Canal
Perforation
Canal Blockage
Mid Root
Perforation
Apical Perforation
Separated Instrument
And Foreign Object

9. Management of Instrumentation Related
Mishaps

10. Mishap Management
Ledge Formation Locating the ledge
Irrigate
smaller instruments are preferred
Mid- Root Perforations Repair - immediate, to protect the perforated site from saliva and
contaminants
Barrier material of choice is MTA
Apical Perforation Apical barrier: Ca(OH)2, MTA, Dentin Chips, Hydroxyapatite
Instrument Separation 1. Attempt to remove the instrument
2. Attempt to by pass it
3. Prepare and obturate up to the separated segment
Canal Blockage Using smaller instrument with copious irrigation

11. Retrieval Is Possible Removal is Difficult Removal Impossible
Instrument lie in the
straight portion of the
canal
• Instrument lies partially
around the canal
curvature and if access
can be established to its
most coronal extent
Entire segment of the
broken instrument is
apical to the canal
curvature and safe
access cannot be
accomplished

13. Instrument Retrieval System (IRS)

15. Obturation
Related
Nerve
Paresthesia
Over Or Under
Obturation
Vertical Root
Factures

16. Management of Obturation Related
Mishaps

17. • Retreatment
• More difficult
• Successful if entire GP is removed in one
tug
• GP & many sealers - generally well
tolerated and do not automatically require
surgical removal
• If symptoms persist - surgical removal
Underextension Overextension

18. Most cases - extraction
Hemisection / Root Amputation of the fractured root
Extraction and replantation after bonding
VRF

19. Nerve Paraesthesia
• Non-intervention and observation
• Systemic prednisolone
• Surgical decompression

20. Miscellaneous
Instrument aspiration
and ingestion
Tissue emphysema
Irrigant related
mishaps

21. Irrigant related mishaps Instrument Aspiration &
Ingestion
Tissue emphysema
Antibiotics, Analgesics & Antihistamines
Ice packs, then warm saline soaks
Intramuscular steroids
o Hospitalization and surgical
intervention
o Constant Monitoring
o Sodium hypochlorite injected into
maxillary sinus - immediate lavage
with sterile water or saline
In the dental operatory –
Removal of accessible
objects
High-volume suction
Hemostats and cotton
pliers
Once aspirated –
Emergency Medical
Attention
Antibiotics
Administration of 100% Oxygen
More severe- hospitalization

22. Natl J Maxillofac
Surg. 2015 Jul-
Dec; 6(2): 144–
151.

23. Conclusion
• Instrumentation - unforeseen circumstances
• Good practitioner - minimize procedural accidents
• Knowledge of etiologic factors – essential
• Methods of recognition and treatment - learned

24. References
• Endodontic practice - Grossman
• Textbook of Endodontics – Ingle
• Pathways of the Pulp – Cohen
• Natl J Maxillofac Surg. 2015 Jul-Dec; 6(2): 144–151
• Journal of Clinical and Diagnostic Research. 2015 Sep, Vol-9(9): ZE09-
ZE13
• Google images

25. THANK YOU