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.
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
Rehabilitation of endodontically treated teeth : Post & CoreNaveed AnJum
These days we often come across mutilated or badly broken teeth in our practice. However various factors are involved for a better prognosis of such a teeth. This presentation mainly focuses on post and core treatment of such a teeth.
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.
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
Rehabilitation of endodontically treated teeth : Post & CoreNaveed AnJum
These days we often come across mutilated or badly broken teeth in our practice. However various factors are involved for a better prognosis of such a teeth. This presentation mainly focuses on post and core treatment of such a teeth.
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.
A BRIEF INTRODUCTION REGARDING THE SELECTION OF ABUTMENT TOOTH/TEETH IN FIXED PROSTHODONTICS.ALL THE CONTENTS ARE TAKEN FROM THE BIBLE OF FIXED PROSTHODONTICS,SHILLINGBERG
Hi, I am Dr Komal Ghiya, pediatric dentist, I am here to upload my own presentations for educational purposes. I hope this presentation will help you in knowing more about pulpectomy in primary teeth
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
A BRIEF INTRODUCTION REGARDING THE SELECTION OF ABUTMENT TOOTH/TEETH IN FIXED PROSTHODONTICS.ALL THE CONTENTS ARE TAKEN FROM THE BIBLE OF FIXED PROSTHODONTICS,SHILLINGBERG
Hi, I am Dr Komal Ghiya, pediatric dentist, I am here to upload my own presentations for educational purposes. I hope this presentation will help you in knowing more about pulpectomy in primary teeth
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
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.
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.
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.
endodontic Mishaps / /certified fixed orthodontic courses by Indian dental ac...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.
To make your Root canal easy contact Dental Implant India. We are specialized in root canal and other dental problem. We are the best dentist in North Delhi. To book an appointment visit - http://www.dentalimplantindia.co.in/dental-clinic-in-north-delhi.html
this presentation shows different watre soluble vitamins and their role in our daily life and what happens if they become deficient in our body and how we can overcome this deficiency of these vitamins.
this presentation includes different parts of SOM, How it is mounted on the wall or the floor, its advanatges and disadvantages and how a dentist should maintain the microscope for better results.
this presenation includes definition, history, various components of smear layer, importance of smear layer, whether to remove it while doing root canal and restoration or not?
this presentation includes theories for the spread of infection, different portals of entry of microorganisms, fish theory, kronfield's theory and how the pulpal inflammation spreads.
this presentation includes various obturating materials, sealers which are used for binding the gutta percha points inside the root canals, what is difference between standard and non standardized gutta percha and various newer methods for obturation are also included.
this presentation include various types of matrices, retainers like tofflemire, ivory no 1, 8 ,compound retainer and wedges which include plastic as well as wooden.
presentation includes definition of immunity, its various types, cells of immunity in our body and their working and the various diseases associated immunity deficiency
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. The success of RCT depends equally on three stages which
form an endodontic tripod .
Obturation
3. 1.Trouble shooting in anesthesia phase
Painless injection can be obtained by
Preanaesthetising tissue by means of topical anesthesia.
Two stage anesthesia-sure way of painless injection.
5. 2. Trouble Shooting in Isolation
Dental floss tied to rubber dam clamp to prevent
accidental swallowing during placement of rubber
dam for isolation of the tooth
6. 3.Troubleshooting in Access cavity preparation
The major consideration in all access opening is that
coronal tooth structure should not be retained if its
preservation prevents the creation of an accessory opening
with direct pathways to the canal orifice.
7. Calcifications
Pulp stones and irritation dentine formed in response to
caries and/or restorations may make the location of root
canal difficult.
In the absence of a special tip a pointed ultrasonic sealer
In the absence of a special tip a pointed ultrasonic sealer
tip can be used to remove pulp stones from the pulp
chamber.
8. Ultrasonic tips are best used with irrigant.
Occasionally they may be used without, and a Stropko irrigator is then
useful for puffing away dentine chips.
useful for puffing away dentine chips.
. A solution of 17% EDTA is excellent for clearing away th area under
exploration, as it removes the smear layer. Flood the pulp chamber with
EDTA solution and allow it to stand for 1-2 minutes. Dentine chips and
other debris can then be washed away with a syringe of sodium
hypochlorite.
9. Sclerosed Canals
Illumination and
magnification are vital for the
location of Sclerosed root
canals. The endodontist
canals. The endodontist
would use a surgical
microscope, while a general
dental practitioner might
have loupes and a headlight
available.
10. A thorough knowledge of the anatomy of the pulp floor and the likely
location of the canal orifices is essential. Chelating agents such as
EDTA are of little use in the location of sclerosed root canals, as the
chelating agent softens the dentine indiscriminately and may lead to
the iatrogenic formation of false canals and possibly perforation.
the iatrogenic formation of false canals and possibly perforation.
If the pulp chamber is filled with irrigant, bubbles can occasionally be
seen appearing from the canal orifice. Occasionally dyes, such as iodine
in potassium iodide or methylene blue, have been used to demonstrate
the location of canal orifices.
11. Unusual Anatomy
Good radiographic technique should alert the practitioner
to unusual anatomy, such as C-shaped canals. The C-
shaped canal may have the appearance of a fused root with
very fine canals .
very fine canals .
If confronted with a pulp chamber that looks unusual the
dentine areas on the pulp floor map should give some idea
of the location of root canals, and of the relationship of the
floor to surrounding tooth structure.
12. Angulation of the Crown
If the extracoronal restoration of the tooth is not at the same angle as
the long axis of the root, or a tooth is severely tilted, then great care
must be taken to make the access cavity
Preparation in the long axis of the tooth to avoid perforation. In teeth
with particularly long crowns it can also be difficult to locate the root
canal. It may be appropriate in some rare instances to make initial
penetration of the pulp chamber without the rubber dam in situ. This
allows correct angulation of the bur, as the operator is not distracted by
allows correct angulation of the bur, as the operator is not distracted by
the angulation of the crown. As soon as the access cavity is fully
prepared the rubber dam should be applied. It is important to make
sure that the rubber dam clamp is positioned squarely on the tooth and
perpendicular to the long axis of the root, as it will give a guide for
access cavity preparation.
This is very important in incisor teeth, where an incorrectly placed
clamp can lead to perforation.
13. Restorations
Unless there are obvious signs of marginal deficiencies or
caries then full crown restorations can generally be
retained, with the access cavity being cut through the
restoration.
Diamond burs are very effective for cutting through
porcelain restorations, while a fine cross-cut tungsten
carbide bur, e.g. the jet Beaver bur, is particularly useful for
carbide bur, e.g. the jet Beaver bur, is particularly useful for
cutting through metal.
14. Posts
Posts should be identified from the preoperative
radiograph. When cutting the access cavity maximum post
material should be retained to make its later removal
easier.
Core material may need to be removed from around a post
to facilitate subsequent removal of the post.
15. The Location of `Extra' Canals
The second mesiobuccal canal of maxillary molars - approximately 60%
16. Four canals in mandibular molars- approximately 38%
17. Two canals in mandibular incisors
Incorrect access
Access should be placed more incisally; straight-line
entry into buccal and lingual canals can then be
achieved
18. Two canals in a mandibular premolar – 11%
The lingual canal can be extremely fine
The lingual canal can be extremely fine
and difficult to locate Use a sharp bend in
the file tip and run it down the lingual wall
The file often catches on the lingual canal
orifice
20. Short
Reading
• Is the file short-circuiting through a metallic restoration?
• Make sure the canals and pulp chamber are relatively dry.
• Is it likely that there may be a perforation in the root?
• Is there the likelihood of a large lateral canal?
• Is there a communication between canals?-for instance, between
mesiobuccal canals of maxillary first molars, or mesial canals of
mandibular molars.
• Is it possible that the apical region has been destroyed by chronic
inflammatory resorption?(For instance, in cases with chronic apical
periodontitis and large lesions; in these cases try a larger file.)
Long
Reading
periodontitis and large lesions; in these cases try a larger file.)
• Check the battery power.
No Reading
• Is the unit switched on?
• Are the leads all connected and is the lip hook in place?
• Are the batteries fully charged?
22. Transportation
Precurving files reduces the restoring force that is applied to the root
canal wall, and consequently reduces the chance of transportation.
Using the balanced force instrumentation technique with non-end
cutting, flexible files will produce less transportation of the canal.
Ledges can also be created with Gates- Glidden burs during coronal
flaring; this can be avoided if the bur is used to plane the wall of the
flaring; this can be avoided if the bur is used to plane the wall of the
root canal as it is withdrawn, rather than being forced apically as if
drilling down the root canal.
23. Perforation
Perforation is the iatrogenic damage to the tooth or root canal wall that
results in a connection being made with the periodontal ligament or
oral cavity.
Perforation can be avoided by:
1. Using the pulp floor map to locate root canal orifices
2. Gradually working up the series from small files to larger sizes, always
2. Gradually working up the series from small files to larger sizes, always
recapitulating with a smaller file between sizes
3. Using an apex locator and radiograph to confirm root canal length
4. Minimizing overuse of Gates-Glidden burs, either too deep or too large,
in curved canals where a strip perforation may occur. Try and direct the
cutting action into the bulkiest wall of dentine; this also helps
straighten the first curvature of the root canal and improves straight-
line access.
24. 5. Restricting the use of 'orifice openers' to small sizes in narrow canals
6. Using an anticurvature filing technique to remove dentine selectively
from the bulkiest wall
7. Never forcing instruments or jumping sizes
S. Irrigating copiously; not only will this disinfect the root canal and
dissolve organic material, but it will also keep dentine chips in
dissolve organic material, but it will also keep dentine chips in
suspension and prevent blocking. If dentine chips are packed into the
apical region of the root canal then the preparation can become
transported internally. This could eventually lead to perforation.
25. Blockage
What To Do If Blockage Occurs ?
If a blockage occurs suddenly during root canal preparation, place a
small amount of EDTA lubricant on a fine precurved file (ISO 10) &
introduce it into the root canal. Use a gentle watchwinding action to
work loose the dentine chips of the blockage.
When patency is regained, irrigate the canal with sodium hypochlorite.
This will flush out the dentine chips (effervescence may possibly help in
the process). Whatever happens do not try to force instruments through
a blockage; this will simply compact the dentine chips further and make
the situation worse
26. . If the blockage is persistent, endosonics may help to dislodge the
dentine chips. Ultrasonic irrigation systems used at low power with full
irrigant flow can sometimes dislodge blockages by the action of
acoustic microstreaming around a vibrating file. Another method to
bypass a ledge is to put a sharp curve at the tip of the file so that it
overcomes the defect.
27. Blockage can be avoided by:
Using copious amounts of irrigant & keeping the pulp chamber
flooded. This will keep dentine chips suspended in the irrigant so that
they can be flushed from the root canal system during preparation.
Solutions such as EDTA are particularly useful, as they act as chelating
Solutions such as EDTA are particularly useful, as they act as chelating
agents, causing clumping together of particles.
28. Fractured Instrument
Unfortunately the occasional instrument may fracture unexpectedly;
but this should be a rare occurrence. Fracture is perhaps more frequent
with nickel-titanium instruments. The risk of instrument fracture can
be reduced by:
1. Always progressing through the sizes of files in sequence, and not
jumping sizes. Forcing an instrument will inevitably lead to fracture.
2. Discarding all damaged files. Any that are overwound or unwound
2. Discarding all damaged files. Any that are overwound or unwound
should be discarded, as should those that have been used in very
tightly curved canals.
3. Taking particular care with nickel-titanium files. The files should be
used for only a limited number of times and then discarded..
29. Loss of Length
Length of preparation can be lost if dentine chips are compacted into
the apical part of the root canal system during preparation. This occurs
if the root canal is devoid of irrigant. When patency is lost the canal
may be transported. A crown-down technique will help to reduce the
chances of this happening by allowing more irrigant into the canal
chances of this happening by allowing more irrigant into the canal
during preparation; the use of lubricant may also prevent packing of
dentine chips.
30. Over-preparation
Over-preparation can be avoided by restricting
use to smaller instruments. Over-flaring coronally
should be avoided, as strip perforation
can occur in the danger areas of a root canal
system and the tooth is unnecessarily weakened,
compromising subsequent restoration.
31. Wine-bottle Effect
Not the consequence of drinking too much, but the shape that is
created from overuse of Gates-Glidden burs to flare coronally! The
wine-bottle effect can make obturation difficult, will increase the risk
of strip perforation and weakens the tooth. These problems will be
avoided if Gates- Glidden burs are used sequentially to plane the walls
avoided if Gates- Glidden burs are used sequentially to plane the walls
of the root canal, and larger sizes are used to progressively shorter
distances, or they are substituted by orifice openers.
32. Master Cone Will Not Fit to Length
Dentine chips packed into the apical extent of the root canal
preparation will lead to a decrease in working length, and consequently
the master cone will appear to be short. This can be avoided by using
copious amounts of irrigant during preparation
.
A ledge in the root canal wall can prevent correct placement of the cone
A ledge in the root canal wall can prevent correct placement of the cone
& cone appear crinkled. It may be possible to remove or smooth a ledge
by refining the preparation with a greater taper instrument.
33. If the canal is insufficiently tapered, the master cone may not fit
correctly because it is binding against the canal walls coronally or in
the mid-third. The completed root canal preparation should follow a
gradual taper along its entire length. Further preparation may be
required with Gates-Glidden burs, orifice shapers or a greater taper
required with Gates-Glidden burs, orifice shapers or a greater taper
instrument.
34. Inability to Place the SpreaderlPlugger to Length
• If the root canal preparation is inadequately tapered the spreader or
plugger may bind in the coronal or mid-third. In this case there will not
be enough room to place the instrument to the desired length. The
preparation should be refined with Gates-Glidden burs, orifice shapers,
or a greater taper instrument.
or a greater taper instrument.
35. Removing Cones during Condensing
If a cone has poor tug-back because it does not fit correctly, then it is
more likely to beremoved during condensation.
Too much sealer acts as a lubricant; only a light coating is required.
Sticky deposits of sealer on the spreader may dislodge the gutta percha
cones.Instruments must be wiped clean after each use.
Spreaders that have damaged tips or bent shanks should be discarded.
Sufficient space should be made during lateral condensation to
Sufficient space should be made during lateral condensation to
compact the gutta percha cones before attempting to remove the
spreader.
When using an electrically activated spreader to heat the gutta percha
during warm lateral condensation the tip should be allowed to cool
before removing it from the root canal. Removing the tip while it is hot
will result in gutta percha being removed from the canal. Continue
laterally condensing as the tip cools, thereby creating space before
removal.
36. Voids in the Obturating Material
Poor penetration of a finger spreader will prevent accessory cones from
fitting correctly. Voids will be created between the cones. A smaller
spreader may be required.
When using a vertical compaction technique, a void may appear
between the downpack and backfill if the Obtura tip is not placed deep
enough into the canal. The tip should be inserted until it just sinks into
the apical mass of gutta percha, before injecting thermoplasticized
the apical mass of gutta percha, before injecting thermoplasticized
gutta percha.
It is tempting to withdraw the Obtura tip prematurely during
backfilling as gutta percha is delivered, resulting in a void. Slight apical
pressure must be applied as gutta percha is extruded from the Obtura
tip. Pressure created within the root canal will gently force the needle
back out of the canal.
37. 6. Post preparation
(a) Inadequate length
(b) Perforation
(c) Fracture of root
(c) Fracture of root
(d) Fracture of instrument
39. Troubleshooting in apical surgery
Manage or prevent potential problems
1. Anesthesia
2. tissue flap design for surgical entry
3. Curettage of granulamatous tissue
3. Curettage of granulamatous tissue
4. root end resection bevel
5. Apical preparation
6. Retro filling
7. closure
40. Management of Problem related to anesthesia
Clinician should use combination of anesthetic solution –
to provide profound anesthesia & thorough homeostasis.
Injecting slowly will prevent balloning of tissue; palatal
anesthesia should be used in maxillary arch.
anesthesia should be used in maxillary arch.
Tissue should appear blanched from action of
vasoconstrictor before procedding.
41. Root end resection bevel
Apex exposed during curettage is resected at an angled or
flat, cross sectional.
In case of failed surgical procedure, resection will eliminate
previous retro fill.
previous retro fill.
Any remaining material will be eliminated during apical
(root end) cavity preparation.
42. Contraction of the mucoperiosteal flap may occur through
scarring as it heals, leading to unsightly recession around
the gingival margin
A judicious approach to fl ap design, reflection, retraction
and careful suturing of the flap after surgery should avoid
this problem
43. Trauma to the infraorbital, inferior alveolar or mental
neurovascular bundles during surgery may result in
temporary or permanent nerve damage. This may manifest
as paraesthesia (a ‘pins and needles’ sensation),
as paraesthesia (a ‘pins and needles’ sensation),
anaesthesia (absence of sensation) of the soft tissues
served by the neurovascular bundle or hyperaesthesia
(pathological increase in sensitivity of the skin). The
problem is most likely to occur with the mandibular
premolar or molar teeth. Damage to a neurovascular
bundle can have profound medicolegal consequences; loss
of sensation may markedly affect quality of life.
44. If the maxillary antrum is breached (this may occur when
operating on a maxillary second premolar or first molar)
and the antral lining is inadequately anaesthetized, there
and the antral lining is inadequately anaesthetized, there
may be discomfort when coolant spray enters the antrum
during removal of bone. Additional local anaesthetic
solution applied to the infraorbital, middle and posterior
superior alveolar nerves should relieve the pain.
45. Root-filling material may enter into the maxillary
antrum. This can precipitate a chronic infection (sinusitis)
or create a chronic oroantral fistula.
A patient’s signed, written consent should be
A patient’s signed, written consent should be
obtained for all surgical endodontic procedures
(with written evidence of an outline of potential
complications discussed).
46. It can be difficult to identify the apex during bone removal, especially if
there is persistent oozing of blood from adjacent bone. Haemostatic
material (e.g. oxidized regenerated cellulose) or a gauze swab soaked in
local anaesthetic solution, packed gently into the bony cavity, may help
to control bleeding if left in place for 30–60 seconds. The apex of the
to control bleeding if left in place for 30–60 seconds. The apex of the
root may then be identified more easily.
Once haemorrhage is under control, blood will ooze gently from the
cut surface of the bone but not from the surface of the root, thus aiding
its identification.
47. Temporary obturation of the bone cavity
It is especially important to obturate the bone cavity when the lining of
the maxillary antrum has been breached, to prevent ingress of foreign
material into the antrum.
Ribbon gauze (1/4 in.) is packed into the bone cavity, leaving the
retrograde cavity preparation exposed. However, ribbon gauze is easily
retrograde cavity preparation exposed. However, ribbon gauze is easily
displaced; bone wax is as an acceptable alternative
. All traces of bone wax should be removed before wound closure
because it can delay healing and cause infection and chronic pain due
to a foreign body giant cell reaction.
Cotton wool is unsuitable to obturate the bone cavity; cotton fibres
may remain in the wound and incite a chronic infl ammatory (foreign
body) reaction.
48. Discharge of pus
.
Radiographic examination of the tissues is undertaken with a gutta
percha point passed through the sinus to identify its origin.
Recurrent apical infection may arise through failure to curette
adequately the apical tissues before wound closure, or failure to remove
adequately the apical tissues before wound closure, or failure to remove
the apex of the tooth after apicectomy. It may also be due to an
inadequately sealed root canal. In some cases the cause is not clear. If
pus continues to discharge, the prognosis is poor. A repeat apicectomy
might be indicated to explore and debride the apical tissues.
49. Perforation of the lining of the maxillary
antrum
This may occur during surgical endodontics on the root of a maxillary
canine, premolar or molar that is related closely to the maxillary
antrum.
The patient may experience pain if coolant spray from the handpiece
contacts an inadequately anaesthetized maxillary antral lining. This is
contacts an inadequately anaesthetized maxillary antral lining. This is
usually resolved by additional local anaesthetic nerve blocks.
If the lining of the maxillary antrum is breached during surgery, the
apicected root tip or retrograde filling material might be displaced into
the antrum. The perforation must be temporarily occluded during
surgery to avoid this.
50. Haemorrhage
Haemorrhage may occur at any time during the surgery,
e.g. during fl ap incision, bone removal or during excision
of granulation tissue or a cyst in the apical tissues.
Haemorrhage is less likely to be problematic if local
Haemorrhage is less likely to be problematic if local
anaesthetic solution with vasoconstrictor is administered
51. Pain during curettage of granulation tissue
The options are to:
● inject local anaesthetic solution directly into the soft-tissue
mass (this is not ideal, because most of the solution is
spilled)
spilled)
● pack the cavity with ribbon gauze soaked in local
anaesthetic solution for 1–2 minutes.
52. Damage to adjacent tooth
It is occasionally difficult to identify the apex of the tooth
to be apicected, particularly if there is extensive
hemorrhage from the cut surface of the alveolar bone.
Damage to an adjacent tooth root is possible. However, this
may be avoided by judicious sectioning of the root surface
may be avoided by judicious sectioning of the root surface
after it has been identified, ensuring that the bone cut does
not extend too far laterally
53. Failure to apicect the tooth completely
This may occur if haemorrhage restricts the surgeon’s view
of the apical tissues. Control of haemorrhage is important
at all times, and is usually achieved by following the
techniques described earlier. A fibreoptic light source used
techniques described earlier. A fibreoptic light source used
in conjunction with loupes usually ensures satisfactory
illumination and magnification of the surgical field.
54. Surgical emphysema
Surgical emphysema is a rare complication of surgical
endodontics; it is characterized by a marked and sudden
swelling of the soft tissues. Crepitus may be elicited on
palpation. Surgical emphysema occurs through entrapment
of air within the soft tissues, and may be caused:
1. by the use of a forward-vented air-driven handpiece (such
1. by the use of a forward-vented air-driven handpiece (such
as an air rotor for restorative procedures) instead of a
slowspeed electric motor. A conventional high-speed
handpiece should never be used during oral surgery
55. 2. If an oroantral communication has been created. Air may
enter the tissues via the maxillary antrum if the patient
blows his/her nose or sneezes.
blows his/her nose or sneezes.
Surgical emphysema may be distressing for the patient,
and reassurance is required. There is a risk of infection
spreading through the tissue planes, and antibiotics are
prescribed to prevent this from happening
56. Inadequate placement of the retrograde
filling
A root-end filling may inadvertently be deposited
in adjacent alveolar bone, particularly if the apical
tissues are obscured by haemorrhage at the time of
placement of the retrograde filling. This complication
typically arises through inexperience, and further
surgery may be required to provide a satisfactory apical seal. For this
reason, it is appropriate to take
a postoperative radiograph immediately prior to
wound closure.
57. Recession of the gingival margin
Recession of the gingiva may arise because of inadequate
repositioning of the mucoperiosteal flap, a compromised
circulation to the flap during surgery through excessive
retraction or poor design, or contraction.
The recession may leave an unsightly cosmetic result,
which may require correction by crown lengthening and
provision of a porcelain veneer or crown. The patient
provision of a porcelain veneer or crown. The patient
should be made aware of the possibility of gingival
recession as part of informed consent.