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 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. Zdroj: Manuál firmy Maillefer 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 !!!!!! Irrigation of the root canal ❑ Removal of corpuscular material ❑ Desinfection Výplachové roztoky ✓ Natrium hypochlorite – 0,5% – 5,25% (1% - 2%) ✓Chlorhexidin (0,12 – 0,2%) ✓EDTA 17% solution or lubrication gel ✓ Hydrogen peroxide 3% ✓ Peracetic acid – 1% ◼ Cannula Activation of irrigation ➢Hand ➢Ultrasound ➢Hydrodynamic ➢Laser Desinfection ➢ 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 Mode of action ➢ Realease of hydroxyl ions ➢ Long term alkalinization ➢ Stimulation of hard tissues formation Koçkapan, C.:Curriculum Endodontie, p. 377-385, Quintessenz, Berlin 2003 Dressing Calcium hydroxide ◼ Short term action 1 – 2 weeks Desinfection, haemostasis Calcium hydroxide ◼ Midle term action 2 – 3 months Apexification Chronic form of apical periodontitis Calcium hydroxide ◼ Long term action 3 months and more Prevention of resprption Magistraliter The powder is mixed with destilled water Lentule 2 mm less than WL !!!!! Apexit® Plus ApexCal® Root canal filling Root canal filling Good coronal, Middle Apical seal. 1 2 3 Quality guidelines for endodontic treatment, European Society of of Endodontology (ESE), 1994 Root canal fillings Sealers Cones Pasts Guttapercha Resilon Silver/titanium Zinkoxid eugenol Polyketons Epoxy resins Glasionomers Calcium hydroxide Silicons Composits/ adhesives Ideal root canal filling (Grossman 1988) 1. Easy mixing 2. Sufficient working time 3. Good seal 4. X- ray contrast 5. Easy removal 6. No shrinkage 7. Long term volume stability 8. No bacterial growing 9. No permeability for fluids 10. Biocompatibility 11. No staining Classification of root canal fillings ➢ Solid ➢ Semisolid ➢ Pastes Guttapercha Dried juice of the Taban tree (Isonandra percha) (gutta) 1,4 - polyisoprene Crystallin structure (60%) Brittle Guttapercha ◼ Beta phase ◼ Alpha phase 42 – 49 °C - plastic - Gamma phase 56 – 62° (amorfní) Cooling process very slowly (less than 0,5°C) – alpha phase normal cooling– beta phase Composition of guttapercha materials in endodontic Guttapercha 19% – 22% Zinc oxide 59 - 79% Heavy metal salts 1% - 7% Wax or resin 1% - 4% Resilon (Pentron) ➢ Thermoplastic synthetic polymer ➢ Points or material for injection Composition: Polyester polymers Bioactive glass Radioopaque fillers (bismuthum oxichlorid a and baryum sulphate) Silver or titanium cones ➢ No good seal ➢ Silver cones - corrosion Sealery Chemically curing plastic materiáls Good adhesion to root canal walls as well as solid cones X- ray contrast Biocompatibility Sealers Zinc Oxide-Eugenol Chloropercha Calciumhydroxide Resins Glasionomer Silicone Sealers Importance Filling of the spaces between the solid cones Seal of the root canal filling Zinc - Oxid Eugenol Powder: Zinc oxide Liquid: Eugenol Acidic resins Good adhesivity, antimikrobial effect, cytotoxic. resorbable) Zink Oxid Eugenol sealers Pulp Canal Sealer (Kerr, USA)) Tubuli- Seal (Kerr, USA) Caryosan (Spofa Dental, ČR) Chloropercha Powder Canadian balsam Resins Guttapercha Zinc oxide Liquid: Chloroform Resins Chloroperča Vlastnosti: Good adhesivity Shrinkage Toxicity Calciumhydroxide sealers Base ( powder) Calcium hydroxide Zinc oxide Other components and vehicula Kalciumhydroxidové sealery Catalystr (paste) Zinc stearat Titanium dioxide Baryum sulphate or Eugenol,. Eukalypt others Kalciumhydroxide sealers ➢ Increase of the healig potential of periapical tissues ➢ Antibacterial effect ➢ Easy manipulation But! Resorbable if not homogeneus Not suitable for the single cone technique Resins ➢Rezorcin formaldehyd ➢Epoxide ➢Polyketone ➢Metacrylate Rezorcin formaldehydové pryskyřice Toxicity N2, Endomethason, Riebler´s paste, Foredent