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Endo II > Iatrogenic Misadventures > Flashcards

Iatrogenic Misadventures Flashcards

1
Q

what is the most important key to success and prevention of predictable errors/incidents

A

case selection

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2
Q

______ always beats repair

A

prevention

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3
Q

what are the other way to prevent errors

A
  • honest apprasisal of skills and experience levels
  • thorough knowledge of morphology
  • realistic apprasisal of shaping objectives
  • proper straight line access- good technique
  • magnification/lighting/specialized equipment and supplies
  • time available to do a decent job
  • patient able to cooperate
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4
Q

what should you start with with patients

A

-proper case presentation
- present tx options - risks and benefits
- honest explanation of all possible misadventures before tx is started
- pt must have all questions answered before tx is accepted
- pt must understand and sign informed consent before tx begins

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5
Q

what are the possible iatrogenic misadventures and are they errors or omission or commision

A
  • wrong tooth: commission
  • missed canals: omission
  • separated instrument
  • ledging, blockage, and transportation, apical perforation
  • blow outs
  • short and long fills
  • perforation and strip perfs
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6
Q

what should you do to prevent operating on the wrong tooth

A

make a mark on the tooth before you place the rubber dam

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7
Q

what do you do if you operated on the wrong tooth

A
  • leave the room and compose yourself
  • plan on free work
  • take responsibility
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8
Q

missing a canal will guaruntee:

A

a failure

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9
Q

what do you do if you see you had a missed canal

A

fix it now

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10
Q

what can the 4th root on mandibular molars look like on radiograph

A

bulls eye

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11
Q

what population are 4th roots common in

A

native american and asian

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12
Q

what are the 4 approaches to file separation

A
  • remove the instrument - reefer
  • bypass the instrument
  • apical surgery and retrofill
  • TE and alternate tx option
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13
Q

in file separation tx decision and prognosis depend on:

A
  • the location of the separated instrument
  • if the canal has been or can be adequately cleaned and shaped, disinfected and filled
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14
Q

which transportation is the worst to repair

A

zipping

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15
Q

what causes a blow out

A

over instrumenting beyond apex

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16
Q

why are blow outs bad

A

you have no apical control zone- cannot pack GP tightly against nothing

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17
Q

what do you do if you have a blow out

A
  • make a new apical stop within the root
  • back off shorten Wl and enlarge OR
  • surgical resection and retroseal OR
  • extract and replace
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18
Q

what do you do if you have an anemic and short fill

A
  • remove old GP or other filling material
  • re-shape to correct length and shape if possible
  • obturate correctly before someone else sees it
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19
Q

what is the prognosis of long fills

A
  • defective apical control zone
  • cannot predictably retrieve GP beyond apex
  • no good non surgical RCT option
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20
Q

what is the “mother” of all iatrogenic misadventures and the most damaging to prognose and difficult to repair

A

perforations

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21
Q

what is the most common iatrogenic injury at UMKC

A

perforation

22
Q

what are very productive for perfs

A

posts

23
Q

what are the common causes of perfs

A
  • failure to recognize the angulation of the long axes of the root
  • failure to accurately measure and stay short of the furcation
  • failure to remove adequate extra coronal restoration in order to clearly visualize pulpal landmarks
  • spatial disorientation with inadequate access
24
Q

what is the sequence in dealing with perforations

A
  • disclosure at consent
  • recognition
  • confirmation
  • notification of the pt
  • control hemorrhage
  • assessment
  • treatment and follow up
25
Q

how do you recognize a perforation

A
  • unexpected hemorrhage
  • no mark at 7mm on the bur
  • suddetn loose drop through
  • unusual file angle
26
Q

what is not a reliable clue in perf recongition

A

pain

27
Q

what do you do to confirm the perf

A
  • stop and do not enlarge- the smaller the defect the better prognosis
  • use apex locator with small file- if it immediately pegs its a perf not a canal
28
Q

what does the apex locator measure in a perforation

A

the resistance of a PDL

29
Q

how do you control the hemorrhage in a perf

A
  • dry with paper points or cotton
  • use hemostatic agent if necessary
  • direct non-invasive observation
  • determine extent of damage
  • dilute your NaOCl now 10:1
  • be careful - no pressure
30
Q

what does the prognosis of a perf depend on

A
  • extent
  • location
  • timing of repair
31
Q

how does extent effect prognosis in a perf

A

smaller the better. less than 1 mm

32
Q

how does location affect the perf prognosis

A
  • closer to attachment = worse
  • supra gingiva: good prognosis
  • subgingival: bad prognosis
  • apical or strip: okay prognosis
33
Q

how does timing effect the prognosis of perf

A

immediate = best chance

34
Q

why does immediate repair of a perf increase the prognosis

A

infection and loss of bone occur very rapidly = loss of natural matrix = difficulty of repair = decreased prognosis - direct salivary contact

35
Q

what can happen with an undetected or untreated perf

A

it can become a serious infection within days or hours

36
Q

what is the outcome of a perforation within a few weeks

A

rapid spread of infection and greatly increased loss of bone structure

37
Q

if you perf and youre going to refer to an endodontist how do you close the tooth

A
  • carefully disinfect with 0.8% NaOCl
  • protect found canals with easily removable material (cotton, paper point, GP, file)
  • create an easily removable temporary seal over the perf using Cavit at the very least or IRM
  • seal the tooth with a secure temporary filling over cotton
  • refer
38
Q

what material can be used to fix a perf

A

MTA

39
Q

how does the endodontist repair the perf

A
  • collacote (sulzer dental) is useful as a matrix for repair
  • MTA is placed over the perforation and allowed to set with water
  • do not occlude any of the canals
  • unfound canal is identified with DOM and negotiated to completion
40
Q

what do you do with a supragingival perf

A
  • isolate, disinfect place standard matrix, protect found canal and restore with amalgam or composite
  • find unfound canal and complete RCT
41
Q

the closer the perf to the attachment the _____ the prognosis

A

worse

42
Q

what do you do with a subgingival perf

A
  • matrix, isolate. protect found canals and pack with MTA if below alveolar crest or Geristore if above alveolar crest
  • periodontal defect may persist and require perio TX
43
Q

when is a strip perforation caused

A

when a large instrument is misdirected or used aggresively

44
Q

what is the most difficult perf to repair favorable

A

apical strip perforation

45
Q

do you use a matrix in apical strip perf

A

no

46
Q

what is the tx for apical strip perf

A

maybe apical surgery: resection and MTA retrofill
- maybe extraction

47
Q

how does an apical perforation happen

A
  • problem starts with a ledge
  • added pressure leads to a root perforation well below attachment
48
Q

what do you do with an apical perforation

A

fill perf with GP or MTA orthograde or surgical
- then seal canal permanently with vitrebond

49
Q

what do you do at UMKC if you have a misadventure

A
  • an incident report is required within 48 hours
  • failure to generate the incident report in a timely manner is a serious problem
  • any attempt to hide an incident may result in automatic loss of clinical privledges
50
Q

true or false: the standard of care is the same for a generalist as for a specialist

A

true

51
Q
A

Endo II (11 decks)

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