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Post Endodontic Treatment Disease

Post Endodontic Treatment Disease. Michael Gossack. Post Endodontic Treatment Disease. vs Endodontic Failure. Topics of Discussion. Diagnosis Etiology Treatment Options Clinical cases. Diagnosis. Patient Complaint ( if any) Clinical Examination

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Post Endodontic Treatment Disease

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  1. Post Endodontic Treatment Disease Michael Gossack ECDS Meeting May 2002

  2. ECDS Meeting May 2002

  3. ECDS Meeting May 2002

  4. ECDS Meeting May 2002

  5. Post Endodontic Treatment Disease vs Endodontic Failure ECDS Meeting May 2002

  6. Topics of Discussion • Diagnosis • Etiology • Treatment Options • Clinical cases ECDS Meeting May 2002

  7. Diagnosis • Patient Complaint ( if any) • Clinical Examination • Radiographic Examination • Elimination of Other Possible Etiologies ECDS Meeting May 2002

  8. Patient Complaint • Can patient localize symptoms to a particular tooth • Temperature sensitivity • Previous swelling or drainage • Sensitivity to pressure chewing ECDS Meeting May 2002

  9. Clinical Examination • Percussion sensitivity • Palpation sensitivity • Swelling • Sinus tract • Periodontal pocketing • Fracture lines ECDS Meeting May 2002

  10. Radiographic Examination • Evaluation of previous endodontic treatment • Periapical radiolucent lesion • Bone loss on lateral aspect of root • Tracing of sinus tract ECDS Meeting May 2002

  11. Eliminate Other Etiologies • Pulpitis from another tooth • Healing in progress • Sinusitis • Perio • TMJ • Neuralgias ECDS Meeting May 2002

  12. Etiology • Inadequate prior root canal therapy • Fractures • Coronal leakage • Complex root canal anatomy ECDS Meeting May 2002

  13. Inadequate Prior Treatment • Canal treated short of apex • Poorly cleaned and shaped canal • Poorly obturated canal • Missed canal-MB root Max Molars most common - D roots Mand Molars, Mand Incisors, Max Premolars • Iatrogenic Errors- perforations, separated instruments, ledged canals, post perforations, transported canals ECDS Meeting May 2002

  14. Treatment Options • Retreatment with possible disassembly • Periapical Surgical Treatment • Extraction • (Intentional Replantation) ECDS Meeting May 2002

  15. Treatment Considerations • Patient’s motivation to save tooth or pursue best long term outcome • Periodontal Status of Tooth • Restorability of Tooth • Strategic Value of Tooth • Costs Involved • Time Constraints • Previous Treatments Performed • Clinician’s Experience, Skill, and Armamentarium ECDS Meeting May 2002

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