Most of problems in root canal are fixed, re-establishment of strength in weakened crown or root is impossible. After coronal leakage the most common reason for long term failure of endodontically treated teeth is vertical root fracture, if this fracture extents even a millimeter depth into soft tissue attachment then it must be extracted Term heroic means self reference (treating a tooth with poor prognosis) List of heroic Endodontics –repair of perforation before MTA, Hemi section/root amputation of teeth with vertical root fracture, forced eruption of a tooth with sub crestal caries, cervical resorption or oblique fracture and internal bonding of root fracture The primary reason in considering a tooth unworthy is when structural integrity is gone
- 1. 26-06-2014 YES YES WHY 1 Greetings from URS AS B4 YES YES
WHY Welcome
2. 26-06-2014 YES YES WHY 2 3. LEARNTO SAY NO 26-06-2014 YES YES
WHY 3 4. 26-06-2014 YES YES WHY 4 REAL HERO 5. The Term success or
failures in Endodontics must be defined rigidity, in order to be
meaningful. A clear definition & agreement of what constitute a
failure following Endodontic treatment does not exist among
Endodontists. 26-06-2014 YES YES WHY 5 6. The Dentist had reduced
criteria for success of endodontic treatment to a very narrow
definition to absence of pain. How convenient it would be if this
concept could be totally accepted. Unfortunately absence of pain is
not completely a reliable measure for good health or success in
endodontic treatment. 26-06-2014 YES YES WHY 6 7. Practicing
endodontist should know that lack of pain is not sole criteria of
success of endodontic treatment, but they would be hard pressed to
present universally acceptable criteria for success or failures.
According to seltzer samuel (1988) the use of term adequate
clinical function is more realistic, because the retention of tooth
in function is ultimate goal of endodontic therapy. 26-06-2014 YES
YES WHY 7 8. threaten the credibility of endodontic therapy as the
first choice ? 26-06-2014 YES YES WHY 8 Needless weakening of teeth
Inadvertent treatment results due to clinicians inexpertise
Abandment of surgical treatment alternative Retreating cases with
poor prognosis 9. NEEDLESS WEAKENING OF TEETH This is one we are
totally in control of, and which were are definitely accountable
for. 26-06-2014 YES YES WHY 9 EVOLUTION 10. Most wanted outcome by
most endodontists & prosthodontics is Full Bodied Look .
26-06-2014 YES YES WHY 10 After coronal leakage, the most common
reason for long-term failure of endodontically-treated teeth is
vertical root fracture due to over enlargement of canal space 11.
How to avoid- Use centered condensation warm gutta percha methods
26-06-2014 YES YES WHY 11 Endodontically treated maxillary molar
with vertical root fracture in mesio-buccal root. Maxillary
premolar with narrow root structure and proportionately narrow
coronal preparation, enhancing its long- term prognosis. 12.
26-06-2014 YES YES WHY 12 J Dent. 2004 May;32(4):265-8. Comparison
of mandibular emolars and canines with respect to their resistance
to vertical root fracture. Wu MK, van der Sluis LW, Wesselink PR.
CONCLUSION: The instrumented mandibular premolars have a higher
risk to fracture than the uninstrumented mandibular premolars
Endodontic Topics Volume 13, Issue 1, pages 8494, March 2006
Vertical root fractures in endodontically treated teeth: diagnostic
signs and clinical management AVIAD TAMSE This review emphasizes
the importance of the correct diagnosis of VRF, describes the more
typical clinical and radiographic features of this disorder, and
summarizes its prevalence and multifactorial etiology. 13.
INADEQUATE TREATMENT RESULTS Skill of the clinician Does the
clinician have the training and skill to disassemble this tooth?
Does the clinician have the training and skill to find and treat
additional canals, treat perforations, negotiate ledges, remove old
endodontic filling materials and blockages such as files?
26-06-2014 YES YES WHY 13 14. FILLED INTERNALSPACE WITH PERFECT
CORONAL SEAL Ref:Siqueira JF, Jr.Aetiology of root canal treatment
failure: why well-treated teeth can fail (Literature review).
InternationalEndodontic Journal,34: 110, 2001.26-06-2014 YES YES
WHY 14 15. PENDULUM SWINGS.? 26-06-2014 YES YES WHY 15 CANAL
BLOCKAGE LEDGE SEPARATED INSTRUMENT TRANSPORTED CANAL PERFORATION
VERTICAL ROOT # HARMONIC BALANCE CERVICAL ENAMEL PROJECTIONS
ACESSORY AND LATERAL CANALS 16. Abandonment of Surgical Retreatment
Alternatives Endodontic microsurgery should not be viewed as the
last resort. It should be an integral part of endodontic
retreatment regimens. Kim S, Kratchman S. Modern Endodontic Surgery
Concepts and Practice: A Review. J Endodon 2006;32:601-23.
26-06-2014 YES YES WHY 16 17. As such, we should use it where
indicated to save the form and function of the natural teeth. It is
a predictable method that effectively eradicates the causes of
persistent apical pathosis with little postoperative discomfort.
Iqbal M, Kratchman S, Guess G, Karabucak K, Kim S. Microscopic
Periradicular Surgery: Perioperative Predictors for Postoperative
Clinical Outcomes and Quality of Life Assessment. J Endodon
2007;33:239-44. . Penarrocha M, Barcia B, Mart E, Balaguer J. Pain
and inflammation after periapical surgery in 60 patients. J Oral
Maxillofac Surg 2006;64:429-33. 26-06-2014 YES YES WHY 17 18.
According to Nair 15% of all periapical radiolucency's are some
type of cyst. The radiograph shown does not correspond to the
histological section, but illustrates the relationship in general
Nair PN, Pajarola G, Schroeder HE. Types and incidence of human
periapical lesions obtained with extracted teeth. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 1996;81:93102. 26-06-2014 YES YES
WHY 18 19. "ISYODONTICS" A NEW TERMINOLOGY "ISYODONTICS"~ (from the
Greek Isyo - - "around":and odons "tooth") The Endodontist works
within the tooth "Endodontics"~ (from the Greek endo "inside"; and
odons "tooth") But UNFORTUNATELY NO SCHOOL/UNIVERSITY/ TEACHERS are
laying less emphasis on "KEYHOLE ENDODONTICS Why during ROOT CANAL
TREATMENT one has to disassembly the whole Coronal or/and Radicular
tooth structure & Fillings to RETREAT a MINISCULE % of LEAKAGE?
IS ENDODONTICS MORE CONSERVATIVE OR ISYODONTICS A BETTER OPTION?
26-06-2014 YES YES WHY 19 20. Some selected cases requiring
Microsurgery: A. Persisting PAR despite adequate endodontic
treatment. B. Calcification, C. Apical transportation of the mesial
root, D. Large post without endodontic and a large PAR in anterior
teeth, E. Broken file at apical one-third and PAR, F. Failed
traditional technique apical surgery, G. Excellent endodontic
treatment with post but persistent PAR in maxillary anterior, H.
Overfilled root canal with large persisting PAR. 26-06-2014 YES YES
WHY 20 21. Retreatment of the teeth with poor prognosis Say NO to-
Vertically Fractured Roots, Non-restorable Teeth And Hopeless
Periodontally Involved Teeth 26-06-2014 YES YES WHY 21 22.
26-06-2014 YES YES WHY 22 23. FAILURE OF ENDODONTICALLY TREATED
TEETH The most common extracted tooth profile was the mandibular
first molar without permanent coronal restoration, which was lost
due to caries destruction. Endodontically treated teeth were prone
to extraction mainly due to non restorable carious destruction and
to a lesser extent to endodontic-related reasons such as endodontic
failure, VRF, or iatrogenic perforation. Analysis of factors
related to extraction of endodontically treated teeth Yehdua
Zadik,Vadim Sandler, et al Volume 106, Issue 5, e31-e35 26-06-2014
YES YES WHY 23 24. 26-06-2014 YES YES WHY 24 MAIN REASONS FOR
EXTRACTION 25. ENDODONTIC TREATMENT OR RETREATMENT VERSUS AN
EXTRACTION In deciding whether to extract or retain a tooth who is
more qualified than an Endodontist? Endodontists successfully treat
teeth that other practitioners condemn. Only endodontists have the
skills and experience necessary for successful endodontic treatment
of complex cases. 26-06-2014 YES YES WHY 25 26. When considering
endodontic treatment or retreatment versus an extraction some
factors to consider include: Is the tooth restorable? What function
does this tooth provide? What is the expected functional lifetime
of the resultant restoration? Are the patients desires and
expectations realistic? What are the number, types and duration of
the procedures required? What are the surgical risks and potential
complications? Of course, no treatment can claim 100% success and
even endodontics has its limitations. 26-06-2014 YES YES WHY 26 27.
26-06-2014 YES YES WHY 27 28. 26-06-2014 YES YES WHY 28 29.
CONCLUSION The retention of a restored or Periodontally compromised
tooth, as opposed to tooth extraction and subsequent prosthetic
replacement, is one of the most difficult and multifactor-dependent
decisions that dental professionals must make. Different factors
associated with a compromised tooth may play a role in this complex
process. We have attempted to list all of the significant factors
and provide a rationale of how we used these criteria in making the
decision to save or retain a tooth. 26-06-2014 YES YES WHY 29 30.
All of these factors have to be weighed and analyzed before a
decision is made. There are no absolutes universal rules that can
be applied to every case. Clinicians may make a sound clinical
judgment by referring to this decision-making chart, but it is
important to understand its limitations and the random involvement
of some risk factors. The experience and clinical criteria, along
with the common sense of the professional, are still the most
important tools available to be used as a guide in deciding whether
to extract or retain a tooth. 26-06-2014 YES YES WHY 30 31. Whats
our CHOICE? IMAGINARY UNREALISTIC STALLONE HEROISM OR A HERO WHO IS
A VERY COMMON MAN RELIABLE, SURE OF WHAT R THE NEEDS OF THE SOCIETY
. AND KNOWS THE NEED OF THE HOUR. 26-06-2014 YES YES WHY 31 32.
Have the C reativity c the Y. be a real life endodontic hero
26-06-2014 YES YES WHY 32 33. Thank u the floor is open for
questions 26-06-2014 YES YES WHY 33 Contact; +919849027909:
[email protected]: [email protected]
