ComplicationsComplications ofof endodonticendodontic treatmenttreatment LocalLocal RegionalRegional SystemicSystemic Plug of dentin chips Ledging Transportation of the root canal Via falsa Zipping a elbow LocalLocal complicationscomplications 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 StrippingStripping 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 StrippingStripping Důkladný přehled! Šetřit oblast isthmu! Ruční preparace! Menší kónus NiTi ! StrippingStripping Bend the instrument and eventually blunt it ! Insufficient coronal flaring Old root canal instrument Aggresive force Incorrect movement of the root canal instrument FractureFracture ofof thethe rootroot canalcanal instrumentinstrument 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 ObliterationObliteration Partial ObliteraceObliterace Access!!! Hand thion Instrument! Steel or NiTi EDTA Patience ObliteraceObliterace Úplná - ponechat. ResorptionResorption Calcium hydroxide Long term Middle term Short term Via falsaVia falsa PerforationPerforation ofof thethe bottombottom ofof thethe pulppulp chamberchamber oror thethe coronalcoronal partpart ofof thethe rootroot canalcanal PerforationPerforation inin thethe middlemiddle partpart ofof thethe rootroot canalcanal ApicalApical perforationperforation MTAMTA compositioncomposition DicalciumDicalcium silicatesilicate TrikalciumTrikalcium silicatesilicate TrikalciumTrikalcium aluminatealuminate TetrakalciumTetrakalcium aluminatealuminate CuprumCuprum sulphatesulphate BismuthumBismuthum trioxidetrioxide = Portland cement= Portland cement MTAMTA Umožňuje hojeníUmožňuje hojení –– dobrý okrajový uzávěr !dobrý okrajový uzávěr ! Zabraňuje přístupu mikroorganismům,Zabraňuje přístupu mikroorganismům, umožňuje hojení dřeně aumožňuje hojení dřeně a periodonciaperiodoncia tvrdoutvrdou tkání.tkání. Via falsaVia falsa -- treatmenttreatment NoNo bleedingbleeding DesinfectionDesinfection MTAMTA –– moisturemoisture ((wetwet cottoncotton pelletpellet)) CalciumCalcium hydroxidehydroxide FillingFilling Via falsaVia falsa Perforace apikálněPerforace apikálně Hydroxid kalcia, kořenová výplň.Hydroxid kalcia, kořenová výplň. MTAMTA Umožňuje hojeníUmožňuje hojení –– dobrý okrajový uzávěr !dobrý okrajový uzávěr ! Zabraňuje přístupu mikroorganismům,Zabraňuje přístupu mikroorganismům, umožňuje hojení dřeně aumožňuje hojení dřeně a periodonciaperiodoncia tvrdoutvrdou tkání.tkání. Zdroj: Manuál firmy Maillefer RegionalRegional complicationscomplications Píštěl SystemicSystemic complicationscomplications SystemicSystemic complicationscomplications PeriostitisPeriostitis InflammationInflammation ofof softsoft tissuestissues (face,(face, neckneck)) GulpGulp ofof thethe instrument (Xinstrument (X rayray,, remnantremnant diet,diet, informationinformation))-- coughcough AspirationAspiration ofof thethe instrumentinstrument --emesisemesis CautionCaution!! AlwaysAlways findfind thethe lossloss instrument !!!!!!instrument !!!!!! IrrigationIrrigation ofof thethe rootroot canalcanal RemovalRemoval ofof corpuscularcorpuscular materialmaterial Desinfection Výplachové roztokyVýplachové roztoky NatriumNatrium hypochloritehypochlorite –– 0,5%0,5% –– 5,25%5,25% (1%(1% -- 2%)2%) ChlorhexidinChlorhexidin (0,12(0,12 –– 0,2%)0,2%) EDTA 17%EDTA 17% solutionsolution oror lubricationlubrication gelgel HydrogenHydrogen peroxide 3%peroxide 3% PeraceticPeracetic acidacid –– 1%1% CannulaCannula Activation of irrigation Hand Ultrasound Hydrodynamic Laser DesinfectionDesinfection CalciumCalcium hydroxidehydroxide AntibioticsAntibiotics andand corticosteroidscorticosteroids CalciumCalcium hydroxidehydroxide AlcalineAlcaline AntibacterialAntibacterial StimulationStimulation ofof hardhard tissuetissue formationformation HaemostaticHaemostatic andand antiphlogicticantiphlogictic CalciumCalcium hydroxidehydroxide TemporaryTemporary rootroot canalcanal fillingfilling SubbaseSubbase ComponentComponent ofof sealerssealers ModeMode ofof actionaction RealeaseRealease ofof hydroxylhydroxyl ionsions LongLong termterm alkalinizationalkalinization StimulationStimulation ofof hardhard tissuestissues formationformation Koçkapan, C.:Curriculum Endodontie, p. 377-385, Quintessenz, Berlin 2003 Dressing CalciumCalcium hydroxidehydroxide ShortShort termterm actionaction 11 –– 22 weeksweeks DesinfectionDesinfection,, haemostasishaemostasis CalciumCalcium hydroxidehydroxide MidleMidle termterm actionaction 22 –– 33 monthsmonths ApexificationApexification ChronicChronic formform ofof apicalapical periodontitisperiodontitis CalciumCalcium hydroxidehydroxide LongLong termterm actionaction 33 monthsmonths andand moremore PreventionPrevention ofof resprptionresprption Magistraliter The powder is mixed with destilled water Lentule 2 mm less than WL !!!!! 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