Question 59

Question 1

endo complications explain patient sitation

Answer 1

o Calmly explain to patient that small metal files are used to clean the root canals of your teeth. One of the risks of root canal treatment are that these files can sometimes separate when being used inside the canal, and unfortunately that has happened inside your tooth
o Reassure patient that this can happen, and you will do what is necessary to ensure the issue is resolved

Question 2

management of endo complication

Answer 2

• Management
  o If broken file is placed coronally, retrieval may be possible with Steiglitz tweezers, ultrasonic systems or microtube devices (masserann kit)
  o If not possible, explain to patient that this case would be best seen by an endodontic specialist who has more experience at retrieving separated instruments – ‘best possible hands’
  o Explain need to place a temporary dressing on the tooth and refer
  o The specialist may be able to retrieve the instrument, or if not possible, may decide to bypass the instrument or retain the instrument depending on the individual case
   Retrieval or bypass of the instrument may be more destructive, and there is still a risk that by doing any of these options the root canal treatment may fail
  o If completion of root canal treatment is not possible, unfortunately the tooth may need to be extracted. If this was the case, we could look at potentially replacing the tooth with something like a denture, bridge or implant if that was something you would be interested in
  o Decision is made depending on variety of factors – periodontal status, restorative status, prolonged time in chair, medical conditions suggesting retention of teeth or XLA, cost
• Ask the patient if they have any questions?
• Check understanding and confirm consent to refer if necessary