Endodontic complications

1. By
Dr.Mohamed Rahil Ali

2. Access related
Instrumentation related
Obturation related
Miscellaneous

3. Access related mistakes
• Treating the wrong tooth
• Missed canals
• Failure to remove all caries and unsupported
structures
• Damage to existing restoration
• Access cavity perforations
• Crown fractures

4. Treating the Wrong Tooth
• misdiagnosis
• a tooth adjacent to the one scheduled for
treatment was inadvertently opened.
Causes
• appropriate treatment of both teeth: the one
incorrectly opened and the one with the
original pulpal problem
Correction

5. Failure to remove all caries as well as
weak and unsupported tooth structure
 Leads to contamination and re infection of the prepared root
canal with saliva and bacteria conducting to endodontic failure.
Correction:
 According to the case, sometimes retreatment may be needed.

6. Damage to existing restoration
In preparing an access cavity through a porcelain
or porcelain-bounded crown, will sometimes chip.
Correction: Minor porcelain chip can at time
be repaired by bounded composite resin to the
crown.

7. • Peripherally through the side
of the crown
• or at the Floor of the chamber
Access cavity perforations

8. Access cavity perforations
 The first sign of an accidental
perforation will often be the
presence of leakage: either
saliva into the cavity or
irrigating solution into the
mouth.
 To confirm the perforation
place a small file through the
opening and take a radiograph

9. Correction
Perforations should repaired as
soon as possible to minimize the
injury to the tooth’s supporting
tissues.
materials used for the repair
amalgam, calcium hydroxide paste,
glass ionomer,gutta-percha,
hemostatic agents.

10. CROWN FRACTURE
Causes: Preexisting infraction
Recognition: By direct observation
Treatment:
 supported the infarcted tooth with
circumferential bands or temporary
crowns

11. Instrumentation related
mistakes

12. • Ledge formation
• Canal blockage
• Cervical canal perforations
• Midroot perforations
• Apical perforations
• fractured Instruments and Foreign
Objects

13. Ledge is an internal
transportation of the canal
which prevents positioning of
an instrument to the apex in an
otherwise patent canal.
LEDGE FORMATION

14. Causes 0f Ledge formation
1-Using straight instruments in curved canal.
2-Packing debris in the apical portion of the canal.
3-Rapid advancement in files sizes or skipping file size.

15.  Use of a small file, No. 10 or 15 with a small
bend at the tip of the instrument.
 penetrate the file carefully into the canal.
Correction of the Ledge

16. Fractured Instruments and Foreign Objects :
 Instrument breakage is a common problem in
endodontic treatment which occurs by improper or
overuse of instruments.

17.  Attempt to bypass it with a small file or reamer.
Bypassing is made easier with a lubricant. If successful,
the canal preparation can be completed and the canal
filled.
[thus the instrument segment becomes part of the filling
material.
If the fragment extends past the apex and
efforts to remove it non surgically are
unsuccessful, the corrective treatment will
probably include apical surgery by apicectomy
Treatment of fractured Instruments

19. Root perforation
• cervical
• midroot
• apical

20. causes of root perforation
• Creating a ledge and persisting
until a perforation develops
• Wearing a hole in the lateral
surface of the midroot by
overinstrumentation (canal
stripping)
• Using too long instrument and
perforating the apex.

21. Treatment of root perforation
• Recognition: Sudden appearance of
blood in the cavity
Correction:-
 The bleeding is stopped and Mineral
Trioxide Aggregate (MTA) is applied
to the perforation.
 Cotton should be placed in the
chamber and a good temporary
filling is placed to allow time for the
MTA to set (> 3 hr). Preparation is
continued at a subsequent
appointment.

22. Obturation – Related complications
 Overextended fillings
 If the overextended filling can not be
removed through the canal ,it will be
necessary to remove the excess
surgically
 Underextended root canal
fillings
 Treated by removal of the old filling
followed by proper preparation &
obturation of the canal.

23. MISCELLANEOUS COMPLICATIONS

24. • Irrigant-Related Mishaps
• Instrument Aspiration and Ingestion
MISCELLANEOUS COMPLICATIONS

25. • Forcibly injecting NaOCl or any other irrigating
solution into the apical tissue can be a
disastrous
• The patient may immediately complain of
severe pain.
• Swelling can be violent and alarming.
Irrigant-Related Mishaps

26. Management:
• Antihistamines, ice packs, intramuscular
steroids, even hospitalization and surgical
intervention may be needed.
Prevention:
• using passive placement of a modified needle.
• The needle must not be wedged in the canal.

27. Patient should reffered
to ENT specialist or
cardiovascular surgeon
Instrument Aspiration and Ingestion