- Immediately stop procedure
- Check throat and mouth of patient
- Monitor vital signs
- Call emergency services if needed
Dentist:
- Reassure patient
- Take appropriate radiographs
- Monitor patient and seek medical advice as needed
Prognosis depends on:
- Location and size of object
- Time elapsed before removal
- Patient's general health
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
In this lecture I explain in step-by-step fashion the basics of Laws and Tips for Locating Canal Orifices. a photo guide is attached to the guide to aid in better understanding of the topic
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
In this lecture I explain in step-by-step fashion the basics of Laws and Tips for Locating Canal Orifices. a photo guide is attached to the guide to aid in better understanding of the topic
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
The second phase of a root canal treatment.
This presentation covers the most basic techniques of root canal shaping.
provides the reader with a concise overview of the big picture.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
A concise and brief presentation on cleaning and shaping of root canals. Colorful and well pictured. Ideal for UG students and PG students to get a good understanding of BMP techniques.
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
The second phase of a root canal treatment.
This presentation covers the most basic techniques of root canal shaping.
provides the reader with a concise overview of the big picture.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
A concise and brief presentation on cleaning and shaping of root canals. Colorful and well pictured. Ideal for UG students and PG students to get a good understanding of BMP techniques.
VR與AR技術於醫療領域的可能性及案例分析 (VR & AR Technologies in Medical Applications)宇軒 黃
【跨 X 創 產業小聚】#6
VR技術引爆超世代教學革新:從醫療與教育出發
VR and AR Technologies in Medical Applications
據美國研究機構報告,AR/VR的醫療健康市場到2020年將達25.4億美元,主要來自模擬訓練及康復治療。在未來的健康醫療教育融入虛擬及擴增實境應用中,又可以達到什麼境界?
Endodontic Root Perforation: Causes, Identification, and Management LectureIraqi Dental Academy
This lecture present to you the concept of root perforation and its complications in endodontic practice. Management of such situation is also presented briefly.
Anticurvature filling technique should be known by everyone as it prevents breaking of instruments into the canal and it helps to do instrumentation in the narrow canals
Determination of root canal working length /certified fixed orthodontic cours...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Procedural errors in endodontics /certified fixed orthodontic courses by In...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
In this presentation, we will see the different mishaps or errors that we can encounter during endodontic procedure and what can be the various treatment options for them.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Similar to Procedural accidents in root canal treatment last one (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Procedural accidents in root canal treatment last one
1.
2.
3.
4. When an accident occurs during root canal treatment, the
patient should be informed about:
(1) the incident.
(2) procedures necessary for correction,
(3)alternative treatment modalities.
(4) the effect of this accident on prognosis.
5. In addition, the practitioner who
knows his or her limitations will
recognize potentially difficult cases
and will refer the patient to an
endodontist.
6. Accidents During Access Preparation
Accidents During Cleaning and Shaping
Accidents During Obturation
ACCIDENTS DURING POST SPACE
PREPARATION
7. Classification of Procedural Accidents
Accidents During Access Preparation
• Perforations During Access
Accidents During Obturation
Preparation •Underfilling
• Causes •Overfilling
• Prevention •Vertical Root Fracture
• Recognition and Treatment
• Prognosis
Accidents During Post Space
Accidents During Cleaning and Shaping Preparation
• Ledge formation •I ndicators
• Cervical canal perforations •Treatment and Prognosis
• Midroot perforations
• Apical perforations
• Separated instruments and foreign
objects
• Canal blockage
8.
9. Perforations During Access
Preparation
The prime objective of an access cavity is to provide an
unobstructed or straight-line pathway to the apical
foramen.
Accidents such as excess removal of tooth structure or
perforation may occur during attempts to locate
canals.
Failure to achieve straight-line access is often the main
etiologic factor for other types of intracanal accidents.
Perforations must be recognized early to avoid
subsequent damage to the periodontal tissues with
intracanal instruments and irrigants.
11. Causes
1. Failure to direct the bur parallel to the long axis of the
tooth.
2. Searching for canals through an underprepared access
cavity.
3. Access through a small or flattened (disk-like) pulp chamber
in a multirooted tooth.
4. Access through a cast crown often is not aligned in the long
axis of the tooth.
13. Prevention
Clinical examination
1. Thorough knowledge of tooth morphology and outlines of
the access cavities .
2. Identification of tooth angulation according to the adjacent
teeth.
3. Proper reading of the preoperative (diagnostic) radiograph
to get information about the size and extent of the pulp
chamber and internal changes (calcification or resorption).
4. Radiograph from different angles .
15. Operative procedures
1. Access without rubber dam or using “split technique” is
preferred in specific cases
2. Use of fiberoptic light and magnifiers
3. Removal of restorations when possible
Split dam technique
16. Recognition
1. Sudden pain
2. Sudden hemorrhage
3. Radiograph
4. Apex locator
5. Taste of irrigant during irrigation
17. Treatment
Lateral root perforation
A- Perforation at or above the height of crestal bone
Treatment: restorative treatment
Supracrestal perforation repair
18. B- Perforation below the height of crestal bone in the coronal
third of the root
The treatment goal is to position the apical portion of the
defect above crestal bone by orthodontic extrusion or crown
lengthening .
Internal repair by mineral trioxide aggregate (MTA) is also
possible .
19. Furcation perforation
A- Direct perforation
Treatment: immediate sealing using the suitable restorative
material (MTA)
Furcation repair using mineral trioxide aggregate (MTA)
20. B- Stripping perforation
- Usually results from excessive flaring with files or drills
(Gates Glidden)
- Treatment:
non-surgical treatment by immediate sealing using MTA
surgical treatment: hemisection, bicuspidization, and root
amputation
22. Nonsurgical Treatment
1. The site of the perforation must be found,
2. the floor of the preparation cleansed,
3. the bleeding stopped,
4. mineral trioxide aggregate (MTA) applied to the
perforation .
5. Because it takes MTA more than 3 hours to set,
it should be covered with a fast-setting cement.
6. The other canal orifices should be protected by
placing paper points or an instrument in the
canals to prevent blockage.
23. In the event MTA cannot be
immediately applied,
A. it is best to stop the bleeding,
B. place calcium hydroxide over the “wound,”
C. place a good temporary filling,
D. set an appointment with the patient, the sooner
the better.
E. The perforation area will be dry at the next
appointment;
F. MTA can be applied
G. treatment continued.
24. Surgical Treatment
Surgery treatment requires:-
1. more complex restorative procedures .
2. more demanding oral hygiene from the patient.‘
Surgical alternatives are hemisection, bicuspidization,
root amputation, and intentional replantation.
Indicated:
1.when the defect is inaccessible.
2.when multiple problems exist, such as a perforation
combined with a separated instrument.
3. when the prognosis with other surgical procedures is
poor .
25. Dentist and patient must recognize that the
prognosis for treatment of surgically altered
teeth is guarded because of the increased
technical difficulty associated with restorative
procedures and demanding oral hygiene
requirements.
26. PROGNOSIS
Factors affecting the long-term prognosis of teeth after
perforation repair include:-
1. the location of the defect in relation to crestal bone.
2. the accessibility for repair.
3. the size of the defect.
4. the presence or absence of a periodontal communication
to the defect.
5. the time between perforation and repair.
6. the sealing ability of restorative material.
7. subjective factors such as:-
I. the technical competence of the dentist.
II. The attitude and oral hygiene of the patient
27. Treatment of the Wrong Tooth
• Treatment of the wrong tooth can be so easily
prevented. One should make sure through
testing, examining, and radiography that one
has confirmed which tooth requires treatment
• Open the access cavity before applying the
rubber dam
28. Damage to an Existing Restoration
• Porcelain crowns are the most susceptible to
chipping and fracture.
• When one is present, use a water-
cooled, smooth diamond point and do not
force the bur, let it cut its own way .
• Also, do not place a rubber dam clamp on the
gingiva of any porcelain or
porcelain-faced crown
29. Missed Canals
• Additional canals in the mesial roots of
maxillary molars and the distal roots of
mandibular molars are the most frequently
missed.
• Second canals in lower incisors, and second
canals in lower premolars, as well as third
canals in upper premolars are also missed.
• One must be prepare adequate occlusal
access.
30.
31. Ledge Formation
Definition
a ledge has been created when the working length can
not longer be negotiated and the original patency
of the canal is lost.
32. Causes
1. inadequate straight-line access into the
canal.
2. inadequate irrigation or lubrication.
3. excessive enlargement of a curved canal with
files.
4. packing debris in the apical portion of the
canal.
34. Technical procedures:
Straight line access.
Accurate working length measurement .
Frequent recapitulation and irrigation.
Use of lubricant like RC-PREP.
Use of flexible Ni-Ti files in curved canals .
Each file must be used until it is loose before a larger size is
used .
Avoid application of severe forces during instrumentation .
35. Management of ledge
• A ledge is difficult to correct.
• An initial attempt should be made to bypass the
ledge with a No. 10 steel file to regain working
length.
• The file tip (2 to 3 mm) is sharply bent and
worked in the canal in the direction of the canal
curvature.
• Lubricants are helpful.
• If the original canal is located, the file is then
worked with a reaming motion and occasionally
an up-and-down movement to maintain the
space and remove debris
• If the original canal cannot be located by this
method, cleaning and shaping of the existing
canal space is completed at the new working
length.
36. Prognosis
The failure depends on the amount of debris left
in the uninstrumented and unfilled portion of the
canal.
The amount depends on when ledge formation
occurred during instrumentation.
In general, short and cleaned apical ledges have
good prognoses.
Future appearance of clinical symptoms or
radiographic evidence of failure may require
referral for apical surgery or retreatment.
38. B- Apical perforation through the body of the root in the
apical third
Ledge apical perforation
39. Etiology
a. Apical perforation through the apical foramen:
- It is caused by instrumentation of the canal beyond the
apical constriction (incorrect working length)
b. Apical perforation through the body of the root in the
apical third:
- It is caused as a result of operator insistence to manage a
ledge in the apical third (especially in curved canals)
40. Indicators
1. Hemorrhage in the canal
2. Bleeding at the tip of paper point
3. Sudden pain
4. Sudden loss of the apical stop
5. Radiograph
Bleeding at the tip of paper point
41. Prevention
To prevent apical perforation, proper
working lengths must be established and
maintained throughout the procedure.
42. Treatment
- In case of overinstrumentation, corrective treatment includes
reestablishing tooth length short of the original length and
then enlarging the canal, with larger instruments, to that
length.
- Placement of MTA as an apical barrier can prevent extrusion of
obturation material
- In case of apical perforation through the body of the root in the
apical third, try to negotiate the original canal .
43. - One is now dealing with two foramina: one natural, the other
iatral. Obturation of both of these foramina and of the main
body of the canal requires the vertical compacting techniques
with heat-softened gutta-percha
45. Prognosis
• Success of treatment depends primarily on
the size and shape of the defect. An open apex
or reverse funnel is difficult to seal and also
allows extrusion of the filling materials.
46. Lateral (midroot) perforations
Etiology
- There are two types of midroot perforations:
a. Direct perforation as a result of pressure and force applied
to a file during negotiation of ledged canals, or through post
space preparation using cutting-end bur
b. Stripping perforation is a lateral perforation caused by
overinstrumentation using files or drills like Gates-Glidden
through a thin wall in the root and is most likely to happen
on the inside (inner) wall of a curved canal, such as the
distal (inner) wall of the mesial roots in mandibular first
molars
49. Indicators
- They are similar to those of apical perforation
The area of hemorrhage on the point indicates the area where the
strip has occurred.
50. Prevention
To avoid these perforations some factors should
be considered:
1. degree of canal curvature and size .
2. inflexibility of the larger files, especially
stainless steel files.
51. Treatment
- The main goal is to instrument and obturate the entire root
canal system
- Perforation repair surgically or non-surgically using suitable
restorative material (MTA)
Repair of stripping perforation using MTA
52. Prognosis
It depends on several factors:
- Remaining amount of undebrided and unobturated canal.
- Perforation size.
- Surgical accessibility.
• Obturation is difficult because of lack of a stop , and gutta-percha
tends to be extruded during condensation.
• Teeth with perforations close to the apex after complete or partial
débridement of the canal have a better prognosis than those with
perforations that occur earlier.
• In addition to the length of uncleaned and unfilled portions of the
canal, size and surgical accessibility of perforations are important.
• In general, small perforations are easier to seal than large ones.
53. Coronal root perforation
Etiology
- Direct perforation happens during access preparation while
the operator attempts to locate the canals
- Stripping perforation happens during flaring procedures by
files or Gates-Glidden
Prevention
- It is similar to what described earlier in the prevention of
perforation during access preparation
- Careful and conservative flaring, especially during using
Gates-Glidden, is also recommended
54. Treatment & Prognosis
• Repair of a stripping perforation in the coronal third of the
root has the poorest long-term prognosis of any type of
perforation.
• The defect is usually inaccessible for adequate repair. An
attempt should be made to seal the defect internally, even
though the prognosis is guarded. Patency of the canal system
must be maintained during the repair process.
MTA is a promising material to repair
almost all types of perforations
56. Etiology
- Limited flexibility
- Over use
- Excessive forced applied to files
- Improper use
Notice: any instrument may break either steel, NiTi, hand or
rotary
57. Recognition
- Removal of shortened file from the canal
- Loss of canal patency
- Radiograph is essential for confirmation.
58. Prevention
• limitations of files is critical.
• Continual lubrication with either irrigating solution or
lubricants is required.
• Each instrument is examined before use ( flutes distortion).
• Small files must be replaced often.
• To minimize binding, each file size is worked in the canal until
it is very loose before the next file size is used.
• Nickel-titanium files usually do not show visual signs of fatigue
similar to the “untwisting” of steel files, they should be
discarded before visual signs of untwisting are seen .
60. Treatment
- There are three approaches:
1. Attempt to remove the instrument (using small file to
bypass the instrument then retrieve it, using ultrasonic tips,
or using especially designed pliers)
Pliers
61. 2- attempt to bypass it.
3- prepare and obturate to the segment coronal to the
instrument.
The operator should attempt to bypass the separated
instrument. After bypassing the separated instrument,
ultrasonic files broaches, or Hedstrom files are used to
remove the segment.
If removal of the separated piece is unsuccessful, then the
canal is cleaned, shaped, and obturated to its new working
length.
If the instrument cannot be bypassed, preparation and
obturation should be performed to the coronal level of the
fragment.
62. A, Arrow pointing to a separated instrument in the mesiolingual canal
B, Postobturation film with an arrow identifying “tunneling” that was created with an
ultrasonic instrument to remove the separated instrument
64. Prognosis
It depends on how much undbrided and unobturated canal
remains.
The prognosis is best when separation of a large instrument
occurs in the later stages of preparation close to the working
length.
Prognosis is poorer for teeth with undébrided canals in
which a small instrument is separated short of the apex or
beyond the apical foramen early in preparation.
For medical-legal reasons, the patient must be informed of
an instrument separation.
If the patient remains symptomatic or there is a subsequent
failure, the tooth can be treated surgically.
67. Indicators
- Instrument disappearance followed by severe coughing or
gagging by the patient
- Radiograph
Treatment
- When the lost instrument is readily accessible, high volume
suction, hemostat, or cotton pliers may help to retrieve the
instrument. Otherwise, referral to a medical service is
required and major surgical intervention may also be
required
68. Swallowed endodontic file ended up in appendix and led to acute appendicitis
and appendectomy. Rubber dam would have prevented this tragedy.
69.
70. Extrusion of Irrigant
• Wedging of a needle in the canal or out of a
perforation with forceful expression of irrigant causes
penetration of irrigants into the periradicular tissues
and inflammation and discomfort for patients.
• Loose placement of irrigation needles and careful
irrigation with light pressure or use of a perforated
needle precludes forcing the irrigating solution into the
periradicular tissues.
• Sudden prolonged and sharp pain during irrigation
followed by rapid diffuse swelling (the “sodium
hypochlorite accident”) usually indicates penetration of
solution into the periradicular tissues.
72. A B
A, Hemorrhagic reaction caused by NaOCl accident
B, Healing within few weeks
73. Treatment
- Because of the potential for spread of infection related to
tissue destruction, it is advisable to prescribe antibiotics in
addition to analgesics for pain
- Antihistamines can also be helpful
- Ice packs applied initially to the area, followed by warm
saline soaks the following day, should be initiated to reduce
the swelling
- In more severe cases, hospitalization and surgical
intervention with wound débridement, may be necessary
- Patient reassurance
74. Prognosis
- Generally is favorable
- In some cases, the long-term effects of irrigant injection into
the tissues have included paresthesia, scarring, and muscle
weakness
75.
76. Undefilling
Causes
- Natural barrier in the canal.
- Ledge.
- Insufficient flaring.
- Poorly adapted master cone.
77. Prevention
- Confirmatory MAC radiograph .
- If displacement of the MAC is suspected, a radiograph is
made before excess gutta-percha removal .
Treatment
- Re-treatment
79. Prevention
- Avoid overinstrumentation.
- Prepare apical matrix (seat).
- Confirmatory MAC radiograph.
- If displacement of the MAC is suspected, a radiograph is
made before excess gutta-percha removal.
- In case of wide (open) apex, a solvent customized cone
technique is preferred .
80. Treatment
- In case of endodontic failure, apical surgery may be required
to remove the extruded material
Prognosis
- It depends on some factors: quality of the apical seal, amount
and biocompatibility of extruded material, and host response
81. Usually, slight over extension of GP cone beyond the apex
(around 2 mm) doesn’t cause problem and doesn’t need
further treatment.
85. Causes
- Overflaring
- Screw post placement
- Post cementation
- Excessive applied forces during gutta-percha condensation
Prevention
- Appropriate (conservative) canal preparation
- Balanced applied forces during condensation
- Finger spreaders produce less stress than hand fingers during
obturation
87. Treatment
- Removal of the fractured root in multi-rooted tooth and
extraction of single-rooted tooth
88.
89. Root Perforation
Prevention
- Gutta-percha removal using heated pluggers.
- Good knowledge of root canal anatomy, location of the
root, and its direction in the alveolus.
- Gates-Glidden and Peeso reamer are safe, however, they can
lead to excessive removal of tooth structure and therefore can
potentially lead to “stripping” perforation or root fracture.
- High speed burs shouldn’t be used at all in post space
preparation
90. Indicators
- Bleeding during preparation
- Sinus tract or pocket extended to the post base
- Lateral radiographic radiolucency
radiographic radiolucency caused
root perforation during post space preparation
91. Treatment
- Non-surgical repair if the post can be removed (as stated in
management of root perforation)
- Surgical repair if the post cannot be removed and the
perforation is accessible
- Otherwise extraction is required
93. Prognosis
- It depends on: perforation size, surgical accessibility, and
perforation location ( apical perforation has better prognosis
than that close to the gingival sulcus)