Success & Failure

1. Success & Failure…
Dr. Ashraf Refai
BDS MSc PhD HMD
Lecturer of Endodontics
Al-Azhar University
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2. When is Endodontics
Successful?
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3. Clinical vs. Radiographic
Evidence
 Success: Is the absence of any
periradicular tissue changes
 Failure: Is the persistence or
development of periapical pathosis
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4. Radiographic Considerations
 Who is reading the radiograph?
 Who performed the primary
treatment?
 Angulations, exposure and processing
settings
 Time of recall
 Physical and emotional condition of
the operator
 Patient - clinician relationship
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6. Methods for Evaluation of
Success
or Failure
Clinical
Radiographic
Histological
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7. Operative
Causes
Post-
Pre Operative
Operative
Causes
Causes
Endodontic
Failure

8. Pre-Operative Causes
 Misdiagnosis
◦ Misinterpretation of oral lesions
◦ Misinterpretation of anatomical landmarks
◦ Misinterpretation of pulpal pain
 Improper treatment planning
 Poor case selection
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9. Operative Causes
 Non-iatrogenic causes
◦ Failure due to anatomic variation
◦ Failure due to altered canal space
 Iatrogenic causes
◦ Failure to attain mechanical objectives
◦ Failure to attain biologic objectives
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10. Non-iatrogenic Causes (Operative
Causes)
 Failure due to anatomic variation
◦ Complex pulpal anatomy
◦ Presence of extra canals
◦ Abnormal curvutares
◦ S-shaped or C-shaped canals
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11. Non-iatrogenic Causes (Operative
Causes)
 Failure due to altered canal space
◦ Canal calcifications
◦ Internal resorption
◦ External resorption
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12. Operative Causes
 Non-iatrogenic causes
◦ Failure due to anatomic variation
◦ Failure due to altered canal space
 Iatrogenic causes
◦ Failure to attain mechanical objectives
◦ Failure to attain biologic objectives
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13. Failure to attain mechanical
objectives Iatrogenic Causes (Operative Causes)
 Access cavity
◦ Underextended access
 Chance of missed canals
 Leaving remnant pulp
 Limited instrument maneuverability
◦ Overextended access
 Weakens tooth structure
 Complicates restoration
 Coronal perforation (Furcation)
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14. Failure to attain mechanical
objectives Iatrogenic Causes (Operative Causes)
 Root Canal Preparation
◦ Ledging
◦ Perforation
◦ Transportation
◦ Canal blockage
◦ Instrument separation
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15. Failure to attain biological
objectives Iatrogenic Causes (Operative Causes)
 Bacterial: Incomplete removal of
irritants from the canal
 Mechanical: Failure to limit
instruments within the canal
(Overextension)
 Chemical: Failure to limit
medicaments in the canal
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16. Failure to attain biological
objectives Iatrogenic Causes (Operative Causes)
 Proper obturation
◦ Proper force during obturation
(Vertical fracture)
◦ Apical microleakage
◦ Coronal microleakage
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17. Operative
Causes
Post-
Pre Operative
Operative
Causes
Causes
Endodontic
Failure
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18. Post-operative Causes
 Periodontal situation
 Poorly designed final restoration
◦ Properly sealed
◦ Support remaining tooth structure
◦ Improperly placed post (Vertical Fracture)
 Overzealous post space preparartion
 Improper post selection (size)
 Forceful post space preparation
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19. Thank You
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