Complications of endodontic treatment Local Regional Systemic komplikace komplikace1 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!!! > penka okacschudek bajer0604 Ledging • • Zipping a Elbow The instrument is not bended in advance! Rotation in curved canals • • stullerovazip Stripping n Reasons Bad orientation in morphology – no diagnostic x-ray Instruments are nod bended Rotary NiTi with a big taper Dangereous zones Mandibular molars – mesial roots Premolars, esp. maxillar Mandibular incisors Oblast isthmu Stripping n Důkladný přehled! Šetřit oblast isthmu! Ruční preparace! Menší kónus NiTi ! Stripping klusakovapopl 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 n Partial Obliterace n Access!!! Hand thion Instrument! Steel or NiTi EDTA Patience > n klobas2 klobas klobasupr Obliterace n Úplná - ponechat. Resorption Calcium hydroxide * Long term * * Middle term * * Short term chalabalova chalabalova1 stikova11 stikova3 stikovapo stikova11poko stikova12 stikova12po stikova12poplneni tomandlovavych tomandlova po para tomandlovapo6 tomandlovapoendo Via falsa n Perforation of the bottom of the pulp chamber or the coronal part of the root canal n nPerforation in the middle part of the root canal n nApical perforation n P1010002 P1010002 mtabahno MTA composition n Dicalcium silicate nTrikalcium silicate nTrikalcium aluminate nTetrakalcium aluminate nCuprum sulphate nBismuthum trioxide n= Portland cement n vachaor vachaorupr MTA nUmožňuje hojení – dobrý okrajový uzávěr ! nZabraňuje přístupu mikroorganismům, numožňuje hojení dřeně a periodoncia tvrdou n tkání. mta7 mtafurkace mtafurkace1 mtafurkace1 mtaklinika1 mtaklinika2 mtaklinika3 Via falsa - treatment n No bleeding nDesinfection nMTA – moisture (wet cotton pellet) n nCalcium hydroxide nFilling stullerovazip bocekvych bocek s MTA bocekpopl bocekkontrola1 bocekpochir bocekkorunka bocek uprav Via falsa n Perforace apikálně n nHydroxid kalcia, kořenová výplň. stullerovazip MTA nUmožňuje hojení – dobrý okrajový uzávěr ! nZabraňuje přístupu mikroorganismům, numožňuje hojení dřeně a periodoncia tvrdou n tkání. mta7 okacvych1 n Bez názvu 1 kopie capovova1 Regional complications n frankova3 frankova1 frankova2 frankova4 frankovazhoj IMG_1378 Píštěl Systemic complications Systemic complications ØPeriostitis Ø ØInflammation of soft tissues (face, neck) Ø ØGulp of the instrument (X ray, remnant diet, information)- cough n ØAspiration of the instrument -emesis Ø Ø n ciziteleso1 ciziteleso2 Caution! n n n nAlways find the loss instrument !!!!!! n n n n n n Medicaments in endodontics nIrrigants and lubricants nCalcium hydroxide nMTA nAntibiotics and corticoids nDisinfectants nAgents for devitalization of dental pulp n n Irrigation of the root canal q Removal of corpuscular material q Desinfection Irrigants nSodium hypochlorite (2% - 5.5%) n nChlorhexidine 0,12 – 0.2% n nEDTA (17%) Lubricants nGel EDTA, carbamide peroxide n nSodiumhypochlorite n n nCannula kanyly kanyly2 Activation of irrigation ØHand ØUltrasound ØHydrodynamic ØLaser Disinfection Ø Calcium hydroxide n n Ø ØAntibiotics and corticosteroids Calcium hydroxide Ø ØAlcaline ØAntibacterial ØStimulation of hard tissue formation ØHaemostatic and antiphlogictic Calcium hydroxide Temporary root canal filling Subbase Component of sealers Mode of action n Ø Realease of hydroxyl ions Ø Long term alkalinization Ø Stimulation of hard tissues formation n Koçkapan, C.:Curriculum Endodontie, p. 377-385, Quintessenz, Berlin 2003 Dichter Verschluss Dressing Calcium hydroxide n Short term action n1 – 2 weeks nDesinfection, haemostasis n Calcium hydroxide nMiddle term action n2 – 3 months n nApexification nChronic form of apical periodontitis Calcium hydroxide nLong term action n3 months and more n nPrevention of resorption n Bakterienreduktion 4 Magistraliter The powder is mixed with destilled water Lentule 2 mm less than WL !!!!! [USEMAP] Apexit® Plus ApexCal® Apexit_Broschüre_06021 P1010002 P1010002 mtabahno MTA composition n Dicalcium silicate nTrikalcium silicate nTrikalcium aluminate nTetrakalcium aluminate nCuprum sulphate nBismuthum trioxide n= Portland cement n vachaor vachaorupr MTA nUmožňuje hojení – dobrý okrajový uzávěr ! nZabraňuje přístupu mikroorganismům, numožňuje hojení dřeně a periodoncia tvrdou n tkání. mta7 Weitere_Produkte 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 nLedermix n nSeptomyxin n n nAntibiotics, corticoids, Zinoxid eugenol, Paraformaldehyd nExceptionally 1 -3 days. Agents for devitalization n They causes necrosis of dental pulp n nAs2O3 nCobalt paste nParafphormaldehyd paste (Depulpin, Caustinerf) n n