By

Dr.Mohamed Rahil Ali

Endodontic complicationsAccess related

Instrumentation related

Obturation related

Miscellaneous

Access related mistakes

• Treating the wrong tooth• Missed canals• Failure to remove all caries and unsupported

structures• Damage to existing restoration• Access cavity perforations• Crown fractures

Treating the Wrong Tooth

• misdiagnosis• a tooth adjacent to the one scheduled for

treatment was inadvertently opened.Causes

• appropriate treatment of both teeth: the one incorrectly opened and the one with the original pulpal problem

Correction

Failure to remove all caries as well as weak and unsupported tooth structure

Leads to contamination and re infection of the prepared root canal with saliva and bacteria conducting to endodontic failure.

Correction: According to the case, sometimes retreatment may be needed.

Damage to existing restoration

In preparing an access cavity through a porcelain or porcelain-bounded crown, will sometimes chip.

Correction: Minor porcelain chip can at time be repaired by bounded composite resin to the crown.

• Main cause is the searching for canal orifices

• It occure either• Peripherally through the

side of the crown

• or at the Floor of the chamber

Access cavity perforations

Access cavity perforations

The first sign of an accidental perforation will often be the presence of leakage: either saliva into the cavity or irrigating solution into the mouth.

To confirm the perforation place a small file through the opening and take a radiograph

Correction

Perforations should repaired as soon as possible to minimize the injury to the tooth’s supporting tissues.

materials used for the repair amalgam, calcium hydroxide paste, glass ionomer,gutta-percha, hemostatic agents.

CROWN FRACTURE

Causes: Preexisting infraction Recognition: By direct observation

Treatment: supported the infarcted tooth with

circumferential bands or temporary crowns

Instrumentation related mistakes

• Ledge formation• Canal blockage• Cervical canal perforations• Midroot perforations• Apical perforations• fractured Instruments and Foreign

Objects

Ledge is an internal transportation of the canal which prevents positioning of an instrument to the apex in an otherwise patent canal.

LEDGE FORMATION

Causes 0f Ledge formation

1-Using straight instruments in curved canal.

2-Packing debris in the apical portion of the canal.

3-Rapid advancement in files sizes or skipping file size.

Use of a small file, No. 10 or 15 with a

small bend at the tip of the instrument.

penetrate the file carefully into the canal.

Correction of the Ledge

Fractured Instruments and Foreign Objects :

Instrument breakage is a common problem in endodontic treatment which occurs by improper or

overuse of instruments.

Attempt to bypass it with a small file or reamer. Bypassing is made easier with a lubricant. If successful, the canal preparation can be completed and the canal filled.

[thus the instrument segment becomes part of the filling material.

If the fragment extends past the apex and efforts to remove it non surgically are unsuccessful, the corrective treatment will probably include apical surgery by apicectomy

Treatment of fractured Instruments

Root perforation

• cervical

• midroot

• apical

causes of root perforation

• Creating a ledge and persisting until a perforation develops

• Wearing a hole in the lateral surface of the midroot by overinstrumentation (canal stripping)

• Using too long instrument and perforating the apex.

Treatment of root perforation

• Recognition: Sudden appearance of blood in the cavity

Correction:- The bleeding is stopped and Mineral

Trioxide Aggregate (MTA) is applied to the perforation.

Cotton should be placed in the chamber and a good temporary filling is placed to allow time for the MTA to set (> 3 hr). Preparation is continued at a subsequent appointment.

Obturation – Related complications

Overextended fillings

If the overextended filling can not be removed through the canal ,it will be necessary to remove the excess surgically

Underextended root canal fillings

Treated by removal of the old filling followed by proper preparation & obturation of the canal.

MISCELLANEOUS COMPLICATIONS

• Irrigant-Related Mishaps

• Instrument Aspiration and Ingestion

MISCELLANEOUS COMPLICATIONS

• Forcibly injecting NaOCl or any other irrigating solution into the apical tissue can be a disastrous

• The patient may immediately complain of severe pain.

• Swelling can be violent and alarming.

Irrigant-Related Mishaps

Management:

• Antihistamines, ice packs, intramuscular steroids, even hospitalization and surgical intervention may be needed.

Prevention:• using passive placement of a modified needle.• The needle must not be wedged in the canal.

Patient should reffered to ENT specialist or cardiovascular surgeon

Instrument Aspiration and Ingestion