Complications in Endodontics 1st Edition by Priyanka Jain ISBN 9783319609973 3319609971

Part I: Diagnosis

1: Clinical Diagnosis and Treatment Planning

1.1 Introduction

1.2 Examination

1.2.1 History of Chief Complaint

1.2.2 Pulpal Diagnosis [7–12]

1.2.2.1 Normal Pulp

1.2.2.2 Reversible Pulpitis

1.2.2.3 Symptomatic Irreversible Pulpitis (SIP)

1.2.2.4 Asymptomatic Irreversible Pulpitis

1.2.2.5 Pulp Necrosis

1.2.3 Apical Diagnoses [7–12]

1.2.3.1 Normal Apical Tissues

1.2.3.2 Symptomatic Apical Periodontitis (SAP)

1.2.3.3 Asymptomatic Apical Periodontitis

1.2.3.4 Chronic Apical Abscess

1.2.3.5 Acute Apical Abscess (AAA)

1.2.4 Condensing Osteitis

1.3 Clinical Evaluation

1.3.1 Palpation, Percussion, and Periodontal Probing

1.3.2 Sensitivity Testing

1.3.2.1 Thermal Tests

Cold Test

Heat Test

Electrical Sensitivity Test

1.3.3 Biting and Release

1.4 Radiographic Evaluation and Diagnosis

1.5 Treatment Planning and Considerations

1.5.1 Strategic Value of the Tooth

1.5.2 Periodontal Factors

1.5.3 Patient Factors

1.5.4 Restorability of the Tooth in the Arch

1.5.5 Other Considerations

1.5.5.1 When to Refer and When to Perform Endodontic Retreatment

1.5.5.2 Post-endodontic Restoration

1.6 Pulp Canal Obliteration

1.6.1 Clinical Picture

1.6.2 Radiographic Appearance

1.6.3 Management

References

2: Importance of Radiographic Interpretation

2.1 Introduction

2.2 Digital Radiography

2.3 Digital Image Acquisition and Receptors

2.4 Limitations of Bidimensional Radiography

2.5 Cone Beam Computed Tomography in Endodontics

2.5.1 Canal Morphology

2.5.2 Periapical Pathosis

2.5.3 Root Resorption

2.5.4 Vertical Root Fractures

2.6 Artifacts in CBCT

2.6.1 Hypodense Halo

2.6.2 Streak Artifacts

2.6.3 Cupping Effect Artifact

2.7 Root Fracture Detection in Endodontically Treated Teeth

References

3: Complications of Local Anaesthesia in Endodontics

3.1 Introduction

3.2 Failure to Deliver Pain-Free Local Anaesthesia

3.3 Failure to Obtain Adequate Pulpal Anaesthesia in Mandibular Teeth

3.3.1 Achieving Anaesthesia in Maxillary Teeth

3.4 Complications of Local Anaesthesia and Endodontic Treatment

3.4.1 Possible Mechanism of LA Nerve Injury

3.4.2 Damage to the IANB

3.4.2.1 Neuropathy

3.4.2.2 Neurological Injuries Resulting from Untreated Periapical Infections

3.4.2.3 Motor Nerve Palsy Due to Endodontic Treatment

3.4.2.4 Paraesthesia and Pain Associated with Endodontically Related Nerve Injuries

3.4.2.5 Local Anaesthesia-Related Neuropathy During Endo Procedures

3.4.3 Assessment of Trigeminal Nerve Injuries

3.4.4 Management of Neuropathy Related to Endodontics

3.4.4.1 Management

Acute Management

Delayed Management

3.4.5 Recommendations Based on the Current Evidence

3.4.6 Incidence of LA Nerve Injuries

3.4.6.1 Significance of IANB Nerve Injuries

3.5 Needle Breakage and Equipment Failures

References

Part II: Endodontic Complications During Procedure

4: Access-Related Complications

4.1 Introduction

4.2 Case Selection and Risk Assessment for Endodontic Access

4.3 Goals of Endodontic Access

4.3.1 Traditional Access Preparation Compared to Minimally Invasive Access

4.3.2 General Rules for Establishing the Outline and Depth of an Endodontic Access Cavity

4.3.3 When Not to Use a Rubber Dam

4.4 Selection of Burs and Instruments for Initial Access

4.5 Locating Calcified Canals

4.5.1 Value of Magnification and Illumination

4.5.1.1 Loupes and Microscopes

4.5.1.2 Fiber Optics

4.5.2 Intra-treatment Supplemental Radiographs and Cone Beam Computed Tomography

4.5.3 Ultrasonics and Special Burs

4.6 Managing Teeth that Are Rotated, Crowded, Tilted, or Heavily Restored

4.7 Management of Complications During Access

References

5: Instrumentation-Related Complications

5.1 Introduction

5.2 Reversible Errors

5.2.1 Blockage

5.2.2 Separated Instruments

5.3 Irreversible Errors

5.3.1 Transportation

5.3.2 Ledge

5.3.3 Zipping

5.3.4 Gouging/Elbow

5.3.5 Damage to the Periapical Tissues/Flare-ups

References

6: Complications due to Root Canal Filling Procedures

6.1 Introduction

6.2 Root Canal Filling Materials

6.2.1 Characteristics of Ideal Root Canal Filling Materials

6.2.2 Characteristics of an Ideal Root Canal Filling

6.2.3 Contemporary Filling Materials

6.2.3.1 Endodontic Sealers

Zinc Oxide-Eugenol Sealers

Polymer Resin Sealers

Silicon-Based Sealers

Calcium Hydroxide-Based Sealers

Glass-Ionomer Sealers

Bioglass-Based Sealers

Calcium Silicate-Based Sealers

6.2.3.2 Core Materials

Gutta-Percha

Resilon

6.2.3.3 Coated Gutta-Percha Points

Injectable Materials

Mineral Trioxide Aggregate (MTA)

6.3 Filling the Root Canal System in Three Dimensions

6.3.1 Techniques for Filling the Root Canal System

6.3.1.1 Single Cone

6.3.1.2 Chemoplasticized Gutta-Percha

6.3.1.3 Cold Lateral Compaction

6.3.1.4 Warm Lateral Compaction

6.3.1.5 Warm Vertical Compaction

6.3.1.6 Continuous Wave of Condensation

6.3.1.7 Injection Technique

6.3.1.8 Thermomechanical Compaction

6.3.1.9 Carrier-Based

6.3.1.10 Apical Barrier

6.4 Complications Due to Obturation Procedures

6.4.1 Prevention of Extrusion of Filling Materials

6.4.2 Complications Due to Extrusion of Filling Materials

6.4.2.1 Anatomical Areas Involved

Maxillary Sinus Damage

Neurological Damage

6.4.3 The Management of the Extrusion of Filling Materials and Its Complications

6.4.4 Complications Due to Chemical Effects

6.4.4.1 Toxic Effects of Root Canal Filling Materials

6.4.4.2 Discoloration

6.4.5 Complications Due to Heat

6.4.6 Complications Due to Mechanical Damage

References

Part III: Miscellaneous

7: Complications Due to Medicaments

7.1 Introduction

7.2 Sodium Hypochlorite (NaOCl)

7.2.1 Complications

7.2.1.1 Due to Accidental Spillage

7.2.1.2 Arising from Hypochlorite Extrusion Beyond the Root Apex

7.2.2 Probable Aetiological Factors

7.2.3 Signs and Symptoms of NaOCl Complications

7.2.4 Management of NaOCl Extrusion

7.2.5 Treatment

7.3 Relative to the Time of Injury and Includes Immediate, Early and Late Treatment (Appendix

7.3.1 Prevention

7.4 Air Emphysema

7.4.1 Hydrogen Peroxide as Endodontic Irrigant Causing Air Emphysema

7.4.2 Signs and Symptoms

7.4.3 Management

7.4.4 Prevention

7.5 Sodium Hypochlorite Mix with Chlorohexidine

7.5.1 Concern with Sodium Hypochlorite (NaOCl)

7.5.2 Concern with Chlorhexidine Gluconate (CHX)

7.5.3 NaOCl and CHX Interaction

7.5.4 PCA Toxicity

7.6 Prevention

7.7 Calcium Hydroxide

7.7.1 Aetiological Factors

7.7.2 Signs and Symptoms

7.7.3 Prevention

7.7.4 Treatment

7.8 Gutta-Percha Solvents

7.8.1 Toxicity

7.8.2 Prevention

7.9 Iatrogenic Injury of Oral Mucosa Due to Formaldehyde-­Containing Medications

7.9.1 Formocresol Toxicity

7.9.2 Signs and Symptoms

7.9.3 Management

7.9.4 Prevention

Appendix 7.1

References

8: Strategies to Reduce the Risk of Reinfection in Endodontics

8.1 Endodontic Microbiology

8.1.1 Medically Compromised Patients and Relapse of Endodontic Infections

8.1.2 The Microbiota of Refractory Endodontic Infection

8.2 Diagnosis of the Refractory Endodontic Infection

8.3 Restorability and Coronal Seal

8.4 Operative Strategies to Eradicate Endodontic Infection

8.5 Access Cavity and Infection Prevention

8.6 Shaping with Stainless Steel and NiTi Instruments

8.7 Irrigation

8.8 Avoid Iatrogenic Infection: Primum Non Nocere

8.9 To Dress or Not to Dress

8.10 Advanced Disinfection Techniques

8.11 Ozone

8.12 Photodynamic Therapy

8.13 Future Development

References

9: Complications of Endodontic Surgery

9.1 Introduction

9.1.1 Soft Tissue Complications in Endodontic Surgery

9.1.2 Periapical Osteotomy and Curettage

9.1.3 Complications During Root-End Management

9.2 Bleeding in Endodontic Surgery

9.3 Nerve Injury During Endodontic Surgery

9.3.1 Maxillary Sinus Complications

9.3.2 Postoperative Pain, Swelling, and Infection

References

10: Endodontic-Periodontal Relationship

10.1 Introduction

10.2 Pathways of Communication

10.3 Anatomical/Physiological Pathways

10.3.1 Apical Foramen

10.3.2 Lateral Canals

10.3.3 Dentinal Tubules

10.4 Nonphysiological/Pathologic Pathways

10.5 Etiopathogenesis

10.5.1 Effect of Periodontal Lesions on the Pulp

10.5.1.1 Effects of Periodontal Treatment Procedures on the Dental Pulp

10.6 Pulpal Diseases and the Periodontium

10.6.1 Effects of Endodontic Infection on the Periodontium

10.7 Classification

10.8 Primary Endodontic Lesions

10.9 Primary Periodontal Lesions

10.9.1 Combined Lesions

10.9.1.1 Primary Endodontic Lesions with Secondary Periodontal Involvement

10.9.1.2 Periodontal Lesions with Secondary Endodontic İnvolvement

10.9.1.3 True Combined Lesions

10.9.2 Concomitant Pulpal and Periodontal Lesions

10.9.3 Iatrogenic Lesion

10.10 Diagnosis

10.10.1 Visual Examination

10.10.2 Radiographs

10.10.3 Palpation and Percussion

10.10.4 Mobility

10.10.5 Pulp Testing

10.10.6 Periodontal Pocket Probing

10.10.7 Acute or “Blowout” Lesions

10.11 Treatment Protocol

10.11.1 Clinical Considerations

10.11.2 Sequencing Treatment for Endo-Perio Lesions

Appendix 10.1: Treatment Protocol Recommendations

References

11: Endodontics in Geriatric Patient

11.1 Introduction

11.2 Categorizing

11.3 The Challenge

11.4 Medical Problems and Considerations for Geriatric Patients

11.5 Psychological

11.6 Age-Related Changes

11.6.1 Structural Changes

11.6.2 Tissue Responses

11.7 Medical History

11.8 Chief Complaint

11.9 Dental History

11.10 Subjective Symptoms

11.11 Objective Signs

11.12 Pulp Testing

11.13 Radiographs

11.14 Treatment Considerations

11.14.1 General

11.15 Patient Comfort

11.16 Anesthesia

11.17 Orthostatic Hypotension

11.18 Endodontic Considerations in the Elderly

11.18.1 During Access and Orientation

11.18.2 During Preparation

11.18.3 During Obturation

11.19 Success/Failure of Endodontic Therapy

11.20 Futuristic Recommendations

References

12: Endodontics in Systemically Compromised Patients

12.1 Introduction

12.2 Importance of History Taking

12.3 Cardiac Disorders

12.3.1 Hypertension

12.3.1.1 White Coat Hypertension

12.3.2 Ischemic Heart Disease

12.3.3 General Considerations in Patients with Cardiovascular Disorders

12.3.3.1 Physician Consent

12.3.3.2 Stress Reduction

12.3.3.3 The Use of Vasoconstrictors

12.3.4 Endodontic Consideration in Hypertensive Patients

12.3.5 Endodontic Considerations in Patients with Congestive Cardiac Failure

12.3.6 Endodontic Considerations in Patients with Ischemic Heart Disease (IHD)

12.3.7 Endodontic Considerations in Patients with Valvular Disease

12.3.8 Endodontic Considerations in Patients with Cardiac Arrhythmias

12.4 Diabetes

12.4.1 Endodontic Considerations

12.5 Endodontic Considerations in Patients with Bleeding Disorders

12.5.1 Hemophilia

12.6 Infectious Diseases

12.6.1 HIV and Endodontics

12.6.2 Hepatitis B and C and Endodontics

12.6.3 Endodontic Treatment in a Pregnant Patient

12.6.3.1 Local Anesthesia

12.6.3.2 Antibiotics

12.6.3.3 Analgesics

12.6.3.4 Anxiolytics

12.6.4 Endodontic Management

12.7 Endodontic Considerations for Patients Undergoing Chemo/Radiation Therapy and on Bisphospho

12.7.1 Patients Taking Antiresorptive and Anti-angiogenic Medication

12.8 Patients with Chronic Kidney Disease

12.8.1 For Patients on Hemodialysis

12.8.2 For Patients with Renal Transplant

12.9 Patients on Corticosteroid Therapy

12.10 Respiratory Disorders

12.10.1 Asthma

12.10.2 COPD

Appendix 12.1: Infection Prevention Recommendations (Modified and Adapted from CDC, US Department

References