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endo ii > Untoward Outcomes and Solutions Body > Flashcards

Untoward Outcomes and Solutions Body Flashcards

1
Q

what are the solution options for diseased outcomes

A
  • extraction
  • non surgical retreatment
  • surgical retreatment
  • monitoring
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2
Q

what is PA1

A

no lesion in diseased outcome

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3
Q

what is PAI5

A

worst diseased outcome

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4
Q

is the lesion larger on CBCT than the PA shows

A

yes always

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5
Q

why might a patient select extraction over REC

A
  • lost faith or fear of additional fees/failures
  • weary of unresolved issues/definitive solution
  • may be the high prognosis option
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6
Q

why is it always preferrable to retain healthy natural tooth for life

A
  • most efficient chewing
  • normal biting force and sensation
  • natural appearance
  • protects other teeth from excessive wear or strain
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7
Q

what are the replacement options for extraction

A
  • implant
  • FPD
  • RPD
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8
Q

does an implant have a 100% success rate

A

no

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9
Q

why might a RCT not heal as expected

A
  • complicated undetected or untreated canal anatomy
  • delay in placemen of definitive coronal restoration
  • inadequate previous RCT or leaking coronal restoration
  • new problems such as new decay, loose, cracked or broken restoration or tooth or root fracture
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10
Q

if you are going to be successful in solving the problem you first must determine:

A

exactly the etiology of the problem

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11
Q

AAE suggests that _____ should generally be the first option considered

A

NSRT

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12
Q

NSRT prognosis is generally _____ than 1st RCT

A

pooper

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13
Q

what was the failure rate of endo re treatment

A

16.6%

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14
Q

what was the overall success rate for retreatment

A

65%

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15
Q

what is the retention of orthograde endo retreatment after 5 years

A

89%

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16
Q

what is the technique of NSRT

A
  • problem must be identified
  • deconstruction
  • GP must be softened to facilitate removal of obturation material
  • all problems discovered/confirmed
  • all deficiencies must be corrected and success documented by recall
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17
Q

what are the problems to identify that could have caused the re treatment

A
  • is it tooth or root fracture
  • missed canal
  • inadequate previous RCT- cleaning and shaping or obturation
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18
Q

in NSRT deconstruction must be done to:

A

provide access to previous obturation material

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19
Q

how can GP be softened and what is the most commonly used method

A
  • solvents or heat
  • chloroform- most common
  • eucalyptol
  • rectified spirits of turpentine
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20
Q

what obturating agents are impossible to remove

A

thermafil, insoluble pastes and silver points

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21
Q

what should you as a general dentist do with retreatemnts

A

refer

22
Q

what are the indications for surgical retreatment

A
  • NSRT is completed and problem not resolved
  • problem not accessible to NSRCT
  • root perforations or resorptive defects
  • dx experimental flap procedure for VRF identification
  • marked overextension of obturating material interfering with healing
  • biopsy of suspect lesion
  • separated instrument not treatable by NSRT
  • other blockages untreatable by NSRT such as ledges, transportations and zips
  • non- negotiable canals may be retrofilled (MTA)
23
Q

what is extraradicular film

A

sometimes biofilm has matured so much that it grows beyond the apex or lateral canals and onto the root surface

24
Q

what is the issue with extraradicular film

A
  • disinfecting the canal will not reach these bacteria and disease can persist
  • need surgical option to remove bacteria
25
Q

what is endodontic microsurgery

A
  • a clinical procedure intended to remove the root tips, place a biocompatible material and remove the associated diseased soft tissue
26
Q

what is another name for endodontic micro surgery

A

apical curettage

27
Q

what is apical curettage followed by

A

remove and bevel root tip and insure an obturation seal by placing a retrofill to seal the canal. MTA is the current material of choice for the retrofill

28
Q

what is the desired result of an apical resection and retrofill

A

regeneration of normal tissues and architecture in the area of surgical intervention

29
Q

endodontic microsurgery is generally:

A

a procedure most commonly done to remove persistent peri-radicular disease following apparent adequate endodontic treatment

30
Q

orthograde obturation appears to be adequate but no healing following reasonable time is an indication for:

A

retrograde obturation

31
Q

when is surgery not indicated

A

if the tooth is asymptomatic and the periradicular defect is not persistent - healing proceeding within reasonable parameters unless reasonable follow up of more than 24 months is exceeded

32
Q

when else is surgery a good option other than a failed RCT

A

when conventional endo cannot reasonable be performed or conventional endo has failed and conventional RETX would be to difficult

33
Q

the first course of action for a non healing RCT stated by the AAE is NSRT unless RETX with surgery if:

A

easiest acess to apex via surgery

34
Q

what are the contraindications for surgical retreatment

A
  • dangerous proximity to anatomical entities such as neurovascular bundles and IA canal
  • extreme thickness of cortical plate
  • periodontally involved teeth
  • lack of training, skills, equipment, materials or time
  • inability to manage possible complications
  • patient health considerations such as active leukemia, neutropenia, uncontrolled DM, bleeding considerations or meds such as anticoagulants, recent MI
  • pregnant and in first trimester
  • better prognosis from alternate TX option
35
Q

what is complicated about thickened buccal shelf

A

makes access, visibility and hemostasis for retrofilling difficult if not impossible

36
Q

what should be considered in the pre surgical case assessment

A
  • is there a better option for this patinet
  • why propose endo micro surgery
  • whats the prognosis
  • if RETX what is the etiology of failure
  • has the tooth been restored properly
  • if not can it be
  • is the tooth periodontally sound
  • is the tooth surgically accessible
  • is the tooth strategic and fuctional
  • will patients health allow surgery
  • is patient on board with tx selection/limitations
  • are you competent and prepared
  • would referral serve the patients best interrests
37
Q

what is the surgical technique steps

A
  • anesthesia
  • elevation of flap
  • location of apical lesion
  • osteotomy and curettage
  • root bevel and hemostasis
  • retrofill preparation and filling
  • suturing and PO instructions
38
Q

how should access in surgery be prepared

A
  • full thickness flap
  • vertical incision
  • never over boney eminence
39
Q

how should the osteotomy be done in surgery

A

6 round bur to gain access to root tip if no lesion has perforated- keep it cool

40
Q

how should resection be done in surgery

A

use SL fissure bur to resect apical portion of root

41
Q

how much apical root should be resected and why

A

3mm
- this area contains greater number of deltas, isthmuses and iatrogenic blockages

42
Q

what bevel should be created at the root apex and why and how

A
  • 45 degree bevel
  • so the canal can be visualized and accessed
  • low speed of 1000-1500 rpm - NOT air turbine
  • use sterile saline drip to cool during osteotomy and resection
43
Q

what can you use to control bleeding during surgery

A
  • Casulfate
    -hemodent
  • astringodent
  • racemic epinephrine
  • electrosurg unit for bleeders
  • crypt management
  • telfa sponges with hemodent
44
Q

how deep to retrofill

A

minimum of 3mm of amalgam

45
Q

what instrument is used with retrofill

A

ultrasonic

46
Q

the instrument design of the ultrasonic allows us to create ____ of space to retain the material and provide an adequate seal

A

3-5mm

47
Q

root resection is completed when:

A

hemostasis is accomplished and gutta percha is visible

48
Q

how is apical retroprep done

A
  • removal of gutta percha with ultrasonic
  • establishment of parallel walled root end preparation at least 3mm deep
49
Q

what are the steps in finishing up the surgery

A
  • surgical area is cleaned and inspected and then sutured
  • patient should be called evening of surgery to see how well they are doing
  • post op patient and suture removal prn - 5 days
50
Q

what are the post op instructions to the patient

A
  • use ice pack 20 min on and 5 off for the 1st day to reduce pain and swelling, warm saline rinses every 2nd day
  • if excess bleeeding occurs place a wet tea bag over incision for 15 minutes to stop bleding
  • pain is usually 3/10. # IBU Q4H and narcotic if necessary if excess pain occurs call office
  • dont smoke for 3 days after surgery
  • suture removal PRn and POT check in 5 days
51
Q

who does all EMS at UMKC

A

grad endo

52
Q
A

endo ii (11 decks)

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