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We are now open in our brand new office on the corner

of Chaparral Boulevard and 194th avenue S.E.

SOUTH CALGARY ENDODONTICS

ISSUE 1 FALL 2014

Please join us for our hands on rotary instrumentation course on November 20, 2015. This course will give the general practitioner some helpful hints in navigating endodontic treatment utilizing Nickel titanium

rotary instrumentation.

This course is eligible for 7 CE credits and approved by the ADA and C.

Please contact South Calgary Endodontics at (403) 474-1893 or via email at kelly.southcalgaryendo@shaw.ca for more information to register as space is limited.

www.southcalgaryendo.ca

Aliquam: Ultricies Sed justo.

Dr. Dean Staniloff & Dr. Kamil Kolosowski welcome all new referrals and offer same day appointments.

403-474-1893 Fall 2015

Office Hours

Monday – Thursday 8:30 AM-4:00 PM

Friday 8:30 AM– 2 PM

Same day emergency appointments

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Issue #: [Date] Dolor Sit Amet

Treatment of Endodontic Misadventures. Although majority of endodontic treatments are performed without complications, occasionally unfortunate iatrogenic accidents and mishaps occur. Broken instruments, perforations and canal ledging are just some of the incidents that can occur during endodontic treatment. The ability to prevent or manage those mishaps at an early stage tends to reduce the consequences of long term healing associated directly with these mishaps. Although it is possible to repair and correct most endodontic mishaps, the long term success or failure of any endodontic treatment will ultimately be affected by the ability to clean and treat all canals.

One of the most important tools in treating and managing endodontic mishaps is light and magnification. Endodontic operating microscopes provide an invaluable aid in visualizing perforations, separated instruments, and helps to maintain proper orientation of treatment instrumentation and placement of repair materials. If we can’t see it, we can’t treat it. Perforations: During Endodontic Therapy and Post-preparation A perforation can occur during any part of the endodontic treatment process, access opening, instrumentation, or during post preparation. The long-term prognosis of perforation repair depends on many factors:

1) Its size: small perforations tend to heal better than larger ones, as they will be easier to seal.

2) Contamination: decay or saliva in the perforation site will affect its long term healing.

3) Location of perforation: the more apical the perforation the better the ability to be properly

repaired.

4) Timeliness of repair: probably the most important factor, the sooner the perforation is repaired

the more likely that he perforation is free of bacteria and breakdown of periodontal tissue has not

occurred.

Although coronal perforations may appear to be relatively easy to repair, one must take great care to make sure the perforation is clean, disinfected and properly sealed. Mineral Trioxide Aggregate (MTA or its various derivatives) is a material of choice to repair all perforations. Dovgan carrier, MAP system, or other MTA carriers are helpful in delivering minute quantities of MTA into the operating area.

FIGURE 1:

Tooth 36 presents with a separated instrument in a mesial root, a perforation in a distal canal (sinus tract) and an obstruction in the distal canal.

FIGURE 2. MAP System is a handy tool for MTA delivery into the pulp chamber and root canals.

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Issue #: [Date] Dolor Sit Amet In coronal perforations MTA is packed using amalgam condenser, or gutta percha condensers, which are often employed if perforation is deeper. Ultrasonic files are also able to be utilized in mid-root and apical perforations. Being very biocompatible the furcal bone will heal well against the MTA.

Ledges and blockages. A canal ledge can occur when non flexible or large diameter files are used aggressively in a curved canal. The file creates the ledge, and can make the cleansing of the entire canal space challenging. A blocked canal can occur when organic or inorganic debris becomes lodged in the canal. If a ledge or blocked canal is created during instrumentation, the ability to get around the ledge or regain a working length will greatly affect the long term prognosis of endodontic treatment. Regaining apical patency is important to maintain a highly successful outcome of the endodontic treatment. To bypass a blockage a pre-curved (2mm at 45o) small K-file (#6 or #8) should be introduced into the canal with a gentle pecking motion attempt to find a sticky spot.

When found, this pecking should advance slowly into the canal until apex is found. This process must be slow utilizing miminum force, otherwise a blockage may turn to a ledge further complicating the matter. EDTA gel or liquid may be used as an aid with caution. EDTA decalcifies dentin which can result in eventual perforation. One the apex is reached, normal enlargement may follow. Bypassing a ledge is trickier, as files tend to follow the path to the ledge. If the ledge is bypassed with precurved K-file. It may be enlarged with additional sizes of stainless steel instruments in an attempt to file away the ledge. Ni-Ti rotary instrumentation are generally resistant to precurving and make the ledge more severe. Endodontic files are generally resistant to the modifications, and while precurving may achieved one must bear in mind the file will be more susceptible to fracture.

Apical surgery might be necessary if bypassing the blockage and ledge proves impossible and post treatment disease is present.

Figure 3. A coronal perforation repaired with gray MTA

FIGURE 4.

Endo-Bender pliers used to provide gentle curve to stainless steel files.

FIGURE 5. When a ledge is present, a pre-curved instrument must be used to instrument the apical portion of the canal

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Issue #: [Date] Dolor Sit Amet Overinstrumentation Inadvertent instrumentation past the apex creates a problem for obturation, as no apical stop is present. Apical extrusion of gutta-percha material may occur. In maxillary tooth the overfilling of gutta-percha into maxillary sinus can occur. In mandibular molars teeth extrusion into mandibular canal can also occur, potentially causing long term problems. To create the apical stop a series of larger size stainless steel files must be utilized just short of the apex with the largest size being at least 3 file sizes bigger than the apex. Alternatively, a preparation taper/size-matched gutta-percha cones can be used for obturation without further instrumentation. If the larger file instrumentation is impractical or risky and matching cones are not available, then the apical stop can be created with the use of MTA with or without a collagen plug beyond the apex. MTA is placed at the apex, allowed to set, and gutta percha can be safely packed in the canal

The best way of managing endodontic mishaps and accidents is prevention. Join us for a rotary instrumentation hand-on course to polish your endodontic skills. The winter newsletter will is focus on the management and treatment of teeth when an instrument separation occurs.

FIGURE 6. Endodontic obturation material is placed beyond the apex and into the mandibular canal causing permanent inferior alveolar nerve damage.

FIGURE 7. Size 130 at the apex of #46. MTA apical stop and MTA backfill (with MAP System) was utilized to minimize extrusion in the distal canal.

Issue #: [Date] Dolor Sit Amet