iatrogenic events Flashcards
(26 cards)
induced inadvertently by a physician or surgeon
iatrogenic
complications or errors that occir during root canal treatment
endodontic iatrogenia
examples of endo iatrogenia
perforation
ledges
blockage of canals
instrument breakage
unaddressed anatomical complexities
sodium hypochlorite accident
management of perforation in the middle third
place MTA
instrument canals
fill canals
fill defect and rest of canals with MTA
management of crown, pulpal loor and furcal perforation
material of choice is MTA
canals must be instrumented first
cover orifices
debride defect
control bleeding
place a portion of MTA, remove excess moisture, compact material
place wet cotton on top
an iatrogenic error created during instrumentation of the root canal system ….. result in the creation of an artificial step within the root canal wall that prevents file placement beyond the irregularity
ledge
if the radiograph revels that the tip of the instrument “deviates away from the canal curvatues” then it is highly likely that a ____ formation has occured on the canal wall
ledge
management of ledge formation
use the shortest file possible to bypass the ledge
a rubber stopper with a directional indicator is valuable in this situation because the indicator can be pointed in the same direction as the bend placed in the instrument
bypassing a ledge
how to bypass a ledge formation
precurve file 8 or 10
slight rotation with a “pecking” motion
retract slightly, rotate, and then advance again with the precurved tip facing in a different direction
formation of dentine mud due to inadequate irrigation
blockage of canals
% incidence of file separation
stainless steel file 0.7-7.4%
Niti rotary files by continuous rotation 0.4 - 5%
NiTi files driven by reciprocation 0.14%
Self Adjusting File : 0.6%
repetitive compressive and tensile stresses acting on the outer portion of a file rotating in a curved canal
cyclic fatigue
occurs when the tip of the instrument binds but the skank of the file
torsional failure
performed when all other therapeutical options (NS and S) have proved unseccessful or are considered to be a failure
tooth extraction
commonly missed canal in endodontic treatment
MB2 of max first molar
what can be expected from a sodium hypochlorite accident?
pain
bleeding/haemorrhaging
swelling
tickly cough - if extruded to max sinus
irrigant discharge from the nose - acute sinusitis
bruising (ecchmyosis)
paresthesia - if near mental foramen
cellulitis - may close the ipsilateral eye
trismus
ophthalmologic symptoms - blurred vision, pain, diplopia
drug prescribe for pain management in sodium hypochlotite accidents
1000mg paracetamol 4 times a day and 400-600mg ibuprofen up to 4 times a day
swelling management
treat mainly with NSAIDS
cold compress on the first day, hot compress on the following days
steroids may be considered if the swelling is rapid
immediate management if infected tooth with a pre-op swelling i.e systemic involvement
amoxicillin 25-500mg 3 times a day
if allergic ti pernicillin
metronidazole 200-400mg
principles of conduct
management of pain
managment of swelling
management of serious sequelae
Is the mechanical communication between the root canal system and the periodontium
Perforation
An obturation of the canal extending more than 2mm beyong radiographic apex. Filling material acts as foreign body which may generate irritations and periapical disease
Overfilling
