Flashcards in Endodontic Failure: Post Treatment Disease Deck (21)
What two diagnosis is required when diagnosing a primary root canal disease?
A pulpal dx
What should be included in diagnostic description of post-treatment disease?
Partially treated pulp canals
How do you diagnose post treatment disease? I.e. what would you ask pt, what would you examine for e/o and i/o
Take a thorough pain history
Ask when root canal treatment was done and where there any problems?
O/E examine for:
Periodontal probing depths >3mm
Tenderness on buccal palpation
Why may upper canines have ongoing tenderness to buccal pressure after RCT?
Upper canines can have a buccal fenestration that gives ongoing tenderness to buccal pressure after RCT
How would you distinguish which root is lingual and which is buccal in multi-rooted teeth?
Same lingual (furthest)
Opposite buccal (moves the opposite way)
I.e. if you move the x-ray head mesially, the two roots will move distally but the buccal one will be the opposite direction of the movement and the lingual will be the one in the same direction
In post-treatment disease, what are the 3 diagnostic categories?
Previously treated and asymptomatic PRP
Previously treated and chronic apical abscess
Previously treated and acute apical abscess
In image 1, the causes of post treatment disease is labelled 1-4.
Name all of them.
1. Intraradicular microorganisms
2. Extraradicular infection
3. Foreign body reaction
4. True cysts
What are some causes of intra-radicular infections?
- poor access cavity design
- untreated major and minor canals
-poorly prepared canals...poorly obturated canals
- newly introduced micro-organisms
- coronal leakage during or after endodontics
What is extraradicular infection and how can it occur?
Microbial invasion and proliferation in the periradicular tissues.
Can occur in perio-endo lesion where pocketing extends to the apical foramina, extrusion of infected dentine chips during instrumentation, overextended instrumentation/drying.filling materials (through apex), biofilms which grow through the apical constriction and form an external apical biofilm.
What is a foreign body reaction?
Foreign materials in the periradicular tissues that are associated with chronic inflammatory response. Can be caused by obturation materials, sealer, small particles of GP.
How does a true radicular cyst occur?
Form when retained embryonic epithelium begins to proliferate due to presence of chronic inflammation
What are the 2 types of radicular cyst described by simon 1980?
True radicular cysts
Periapical pocket cysts
What are the features of true radicular cysts?
An enclosed cavity totally lined with epithelium
Has no communication with the RCS
Does not heal after a RCT
What are the features of periapical pocket cysts?
The epithelium is attached to the margins of the apical foramen.
The cyst lumen is open to the infected canal and hence can communicate directly with it
Pocket cysts heal after RCT.
What are some red flags before going into post-treatment disease endodontics?
History of parafunction/bruxing
History of frequent post decementing
Occlusal wear facets
Long narrow perio pockets (can also indicate perio-endo lesion)
Vertical root fracture
What reasons are most common for a failed root canal?
Is often due to persistent or secondary infection of the RCS.
Secondary intraradicular infections.
Microbes are not present in the primary infection but have been introduced at some time later i.e. sometimes no mictobes are left after the primary RCT, but can come in by leaking seal or fracture.
How many species is expected in canals when well obturated and in inadequate obturation?
Well-obturated: 1-5 species
Inadequate obturation: up to 30 species
In secondary intraradicular infections, what species of microbes can be found?
Propionibacterium, actinomyces, prevotella, E faecalis, streptococcus, caninda albicans, fusobacterium nucleatum.
E faecalis frequently found.
Having diagnosed post-treatment disease, what are the four options for treatment?
When is surgical treatment considered when treatment planning for post-treatment disease?
Surgery is chosen when non-surgical retreatment is not possible or when the risk to benefit ratio of non-surgical retreatment is outweighed by that of surgery