Management of Endodontics failure

Question 1

Are PA lesions always present on radiographs?

Answer 1

No, which creates confusion when diagnosing

Question 2

What are two common reasons for failure of endo treatment?

Answer 2

Generally, the treatment has not veen done correctly. Might look pretty, doesn’t mean it has been done right.

Missed canals are very common

Question 3

What are the stages of treatment planning for failed endo cases?

Answer 3

Decision making – diagnosis

Consider options – non-surgicalretreatment, retreatment, extraction withor without prosthodontic replacement ormonitor

Write in your notes that you have discussed this

Question 4

What are the re-treatment techniques?

Answer 4

Need to find all the canals – know the anatomy

Ensure the roof of the pulp chamber isentirely removed so you can see all ofthe pulpal floor

Question 5

What is a restorability assessment?

Answer 5

First part of endodontic procedure should always be a restorability assessment

Cause of much endodontic ‘failure’ is restorative

This can often be diagnosed at the outset

Question 6

What are the steps when re-treating?

Answer 6

Removal of GP
Best if possible en masse
Braiding technique
Use of reciprocation / rotary
Hand files and solvent

Question 7

List a few re-treatment techniques?

Answer 7

Use Hedström files
End cutting
Engage into the GP, quarter/half turnand remove
Do not screw into dentine
If can’t engage the GP then soften withsolvent
Important to know what you are trying to remove

Question 8

How do you finish off the prep after re-treating?

Answer 8

Solvent useful at the end to remove sealer and persistent bits of GP
Once GP removed, undertake chemo-mechanical preparation as with a primary RCT case

Question 9

What are the risks of forcing re-treatment files or GG drills?

Answer 9

Easy to create ledges or perforations

Question 10

What can you use to help engagement of files in the GP?

Answer 10

You can use heat