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Post Endodontic Treatment Disease
Michael Gossack 11/10/2018 ECDS Meeting May 2002
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Post Endodontic Treatment Disease
vs Endodontic Failure 11/10/2018 ECDS Meeting May 2002
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Topics of Discussion Diagnosis Etiology Treatment Options
Clinical cases 11/10/2018 ECDS Meeting May 2002
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Diagnosis Patient Complaint ( if any) Clinical Examination
Radiographic Examination Elimination of Other Possible Etiologies 11/10/2018 ECDS Meeting May 2002
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Patient Complaint Can patient localize symptoms to a particular tooth
Temperature sensitivity Previous swelling or drainage Sensitivity to pressure chewing 11/10/2018 ECDS Meeting May 2002
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Clinical Examination Percussion sensitivity Palpation sensitivity
Swelling Sinus tract Periodontal pocketing Fracture lines 11/10/2018 ECDS Meeting May 2002
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Radiographic Examination
Evaluation of previous endodontic treatment Periapical radiolucent lesion Bone loss on lateral aspect of root Tracing of sinus tract 11/10/2018 ECDS Meeting May 2002
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Eliminate Other Etiologies
Pulpitis from another tooth Healing in progress Sinusitis Perio TMJ Neuralgias 11/10/2018 ECDS Meeting May 2002
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Etiology Inadequate prior root canal therapy Fractures Coronal leakage
Complex root canal anatomy 11/10/2018 ECDS Meeting May 2002
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Inadequate Prior Treatment
Canal treated short of apex Poorly cleaned and shaped canal Poorly obturated canal Missed canal-MB root Max Molars most common - D roots Mand Molars, Mand Incisors, Max Premolars Iatrogenic Errors- perforations, separated instruments, ledged canals, post perforations, transported canals 11/10/2018 ECDS Meeting May 2002
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Treatment Options Retreatment with possible disassembly
Periapical Surgical Treatment Extraction (Intentional Replantation) 11/10/2018 ECDS Meeting May 2002
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Treatment Considerations
Patient’s motivation to save tooth or pursue best long term outcome Periodontal Status of Tooth Restorability of Tooth Strategic Value of Tooth Costs Involved Time Constraints Previous Treatments Performed Clinician’s Experience, Skill, and Armamentarium 11/10/2018 ECDS Meeting May 2002
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