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Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease
Michael Gossack
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Post Endodontic Post Endodontic Treatment DiseaseTreatment Disease
vs
Endodontic Failure
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Topics of DiscussionTopics of Discussion
DiagnosisEtiologyTreatment OptionsClinical cases
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DiagnosisDiagnosis
Patient Complaint ( if any)Clinical ExaminationRadiographic ExaminationElimination of Other Possible Etiologies
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Patient ComplaintPatient Complaint
Can patient localize symptoms to a particular tooth
Temperature sensitivityPrevious swelling or drainageSensitivity to pressure chewing
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Clinical ExaminationClinical Examination
Percussion sensitivityPalpation sensitivitySwellingSinus tractPeriodontal pocketingFracture lines
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Radiographic ExaminationRadiographic Examination
Evaluation of previous endodontic treatment
Periapical radiolucent lesionBone loss on lateral aspect of rootTracing of sinus tract
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Eliminate Other EtiologiesEliminate Other Etiologies
Pulpitis from another toothHealing in progressSinusitisPerio TMJNeuralgias
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EtiologyEtiology
Inadequate prior root canal therapyFracturesCoronal leakageComplex root canal anatomy
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Inadequate Prior TreatmentInadequate 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
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Treatment OptionsTreatment Options
Retreatment with possible disassemblyPeriapical Surgical TreatmentExtraction(Intentional Replantation)
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Treatment ConsiderationsTreatment 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
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