Endodontics
Course Review
Enoch Ng, DDS 2014
Retreatment
Retreatment Outcomes
Nonsurgical – 73%
Surgical – 57%
2
nd
nonsurgical – 47%
Replantation – 41%
Overall – 65%
Nonsurgical retreatment – 75%
Surgical retreatment – 59%
Surgery after NSRCT retreatment – 80%
Phases I and II
-
81% healed
-
93% functional
Phases III and IV
-
82% healed
-
86% improved
-
94% functional
Etiology of Non-Healing
o
89% of NSRCT teeth by endo specialists retained after 5 years
-
Inadequate seal
o
Coronally – leaky crown/filling
o
Apically – poor obturation/condensation, short fill, overextended fill
o
Perforation – untreated/leaky mechanical perforation in chamber floor/canal
o
Resorption
-
Untreated/contaminated canal space
o
Non-negotiable canal – dilacerations, ledge, calcification
o
Inadequate instrumentation
o
Lateral canal
o
Missed canal
-
Separate instruments/fragments
o
May block cleaning and sealing of canal system
-
Vertical root fracture
-
Trauma – resorption, fracture, avulsion
Indications of Non-Healing
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Sporadic, vague symptoms
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Widened PDL space
-
Static radiolucency/slight repair
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Voids in obturation in apical 1/3
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Overfill beyond anatomic apex
Causes of Non-Healing
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Periodontal involvement
-
Host factors
o
Non-odontogenic pathology
o
Systemic conditions (diabetes)
-
Misdiagnosis – another tooth is the etiology
Surgical Considerations
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Inability to reach/seal apex through canal
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Unable to remove old canal filling
-
Unable to remove post or other canal obstructions
-
Severe apical perforation/zip
