Complications of
endodontic treatment
Local
Regional
Systemic
Plug of
dentin chips
Ledging
Transportation of the root canal
Via falsa
Zipping a elbow
Local complications
Reasons
Insufficient irrigation and
recapitulation
Loss of the working length
Plug
Solution
Repeated careful
instrumentation
with a thin
instrument
Irrigation is not
effective in this
case!!!
Reasons
The instrument is not bended in advance!
No control of the WL
=
No recapitulationLoss of the WL
Ledging
Solution
The instrument must be
bended in advance
Careful but complete rotation
Finishing with the fine filing
No NiTi!!!
Ledging
Zipping a Elbow
The instrument is not bended in advance!
Rotation in curved canals
Stripping
Reasons
Bad orientation in morphology – no diagnostic xInstruments
are nod bended
Rotary NiTi with a big taper
Dangereous zones
Mandibular molars – mesial roots
Premolars, esp. maxillar
Mandibular incisors
Oblast isthmu
Stripping
Důkladný přehled!
Šetřit oblast isthmu!
Ruční preparace!
Menší kónus NiTi !
Stripping
Bend the instrument and eventually blunt it !
Insufficient
coronal flaring
Old root canal
instrument
Aggresive force
Incorrect
movement of the
root canal
instrument
Fracture of the root canal instrument
Reasons
Solution
Enlargement of the
root canal till the
instrument
Ultrasound tips
Rotating root canal
instrument – caution!
Bypass
Leaving in
Surgical treatment
Bypass
Fractured instrument
Obliteration
Partial
Obliterace
Access!!!
Hand thion
Instrument!
Steel or NiTi
EDTA
Patience
Obliterace
Úplná -
ponechat.
Resorption
Calcium hydroxide
Long term
Middle term
Short term
Via falsa
 Perforation of the bottom of the pulp chamber
or the coronal part of the root canal
 Perforation in the middle part of the root canal
 Apical perforation
MTA composition
 Dicalcium silicate
 Trikalcium silicate
 Trikalcium aluminate
 Tetrakalcium aluminate
 Cuprum sulphate
 Bismuthum trioxide
= Portland cement
MTA
 Umožňuje hojení – dobrý okrajový uzávěr !
Zabraňuje přístupu mikroorganismům,
umožňuje hojení dřeně a periodoncia tvrdou
tkání.
Via falsa - treatment
 No bleeding
 Desinfection
 MTA – moisture (wet cotton pellet)
 Calcium hydroxide
 Filling
Via falsa
 Perforace apikálně
Hydroxid kalcia, kořenová výplň.
MTA
 Umožňuje hojení – dobrý okrajový uzávěr !
Zabraňuje přístupu mikroorganismům,
umožňuje hojení dřeně a periodoncia tvrdou
tkání.
Regional
complications
Píštěl
Systemic
complications
Systemic complications
Periostitis
Inflammation of soft tissues (face, neck)
Gulp of the instrument (X ray, remnant diet,
information)- cough
Aspiration of the instrument -emesis
Caution!
Always find the loss instrument !!!!!!
Medicaments in endodontics
 Irrigants and lubricants
 Calcium hydroxide
 MTA
 Antibiotics and corticoids
 Disinfectants
 Agents for devitalization of dental pulp
Irrigation of the root canal
 Removal of corpuscular material
 Desinfection
Irrigants
 Sodium hypochlorite (2% - 5.5%)
 Chlorhexidine 0,12 – 0.2%
 EDTA (17%)
Lubricants
 Gel EDTA, carbamide peroxide
 Sodiumhypochlorite
 Cannula
Activation of irrigation
Hand
Ultrasound
Hydrodynamic
Laser
Disinfection
 Calcium hydroxide
Antibiotics and corticosteroids
Calcium hydroxide
Alcaline
Antibacterial
Stimulation of hard tissue formation
Haemostatic and antiphlogictic
Calcium hydroxide
Temporary root canal filling
Subbase
Component of sealers
Dressing
Calcium hydroxide
 Short term action
1 – 2 weeks
Desinfection, haemostasis
Calcium hydroxide
 Middle term action
2 – 3 months
Apexification
Chronic form of apical periodontitis
Calcium hydroxide
 Long term action
3 months and more
Prevention of resorption
Magistraliter
The powder is mixed with destilled water
Lentule 2 mm less than WL !!!!!
Apexit® Plus
ApexCal®
MTA composition
 Dicalcium silicate
 Trikalcium silicate
 Trikalcium aluminate
 Tetrakalcium aluminate
 Cuprum sulphate
 Bismuthum trioxide
= Portland cement
MTA
 Umožňuje hojení – dobrý okrajový uzávěr !
Zabraňuje přístupu mikroorganismům,
umožňuje hojení dřeně a periodoncia tvrdou
tkání.
Fenolické látky
Chlumského roztok
Chlorophenol kafr mentol (ChCM)
Chlorophenol kafr thymol
Iodoformová pasta
Aldehydy
Formaldehyd
Formokresol
Trikresolformalin
Caution!
Toxic, alergenic, mutagenic !!!!!
Phenolic agents and aldehyds
Antibiotics and corticoids
 Ledermix
 Septomyxin
Antibiotics, corticoids, Zinoxid eugenol,
Paraformaldehyd
Exceptionally 1 -3 days.
Agents for devitalization
 They causes necrosis of dental pulp
As2O3
Cobalt paste
Parafphormaldehyd paste (Depulpin, Caustinerf)