Minimise mistakes, maximise success – Nik SisodiaFeatured Products Promotional Features
Posted by: The Probe 13th April 2019
It goes without saying that endodontic treatment does not come with a 100% success rate. There are a number of reasons for this – some of which are beyond a dentist’s control. In other instances, failure can occur due to human error, poor practice or lack of experience.
It is not uncommon, for example, to miss one or more canals, with one study showing that of 1100 endodontically failing teeth examined, 42% were as a result of missed canals.[i]It is for this reason that practitioners are always advised to take radiographs from a variety of angles, and why – when a canal anatomy is not clearly visible – it is advisable to utilise CBCT technology (with the patient’s consent, of course). It is thought that using the ‘same-lingual-opposite-buccal’ technique can also help to locate any extra canals, which is important to remember as it may come in use.[ii]
Another common error that can occur during root canal therapy is instrument breakage in the root canal or beyond the apex. This can be a result of factors such as unusual canal anatomy, severe curvature or calcifications, but if the working length is inaccurately calculated, or there’s forceful or overzealous instrumentation, then breakage can also take place. It is important to note, however, that while far from ideal (patients tend not to react too positively to being told they’ve got a fractured instrument in their mouth), evidence suggests that the instrument itself has little to do with endodontic failure. Rather, the prognosis is compromised when a concomitant infection is present.[iii]This usually occurs if disinfection and obturation of the part of the canal distal to the fractured instrument becomes difficult, which can lead to continuing infection.[iv]
Aside from that, there’s always the possibility that the crown or root may perforate if there’s improper access cavity preparation, post space preparation or canal instrumentation,ii or that the root canal may be either under or over filled.iDentists should also be aware that if the coronal area is not adequately and completely sealed during the restorative phase, there is a higher risk of reinfection and coronal leakage.i
With all this in mind, there’s a lot to be said for taking a cautious approach when it comes root canal treatment, whether that’s embarking on further education to gain additional skills or choosing to refer to an experienced specialist endodontist. Ten Dental Facial offers a dedicated endodontic referral service across several of its practices so that dentists with less experience and confidence are able to ensure that treatment is carried out to the highest possible standard.
Success is never guaranteed but with the right skills and experience, mistakes can be minimised, helping to ensure that the optimal results are achieved. If you have a case that you feel would benefit from being referred to someone more experienced, contact Ten Dental Facial today.
For more information visit www.tendental.comor call on 020 33932623
[i]Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Jan-Mar; 10(1):144-147. Accessed online 1 November 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784145/
[ii]Ramugade MM, Sagale AA. A Review of Medicolegal Considerations of Endodontic Practice for General Dental Practitioners. J Int Soc Prev Community Dent. 2018 Jul-Aug; 8(4): 283-288. Accessed online 1 November 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071360/
[iii]Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34 (1): 1 -10. Accessed online 1 November 2018 at https://www.ncbi.nlm.nih.gov/pubmed/11307374
[iv]Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979;5:83–90. Accessed online 1 November 2018 at https://www.sciencedirect.com/science/article/pii/S0099239979801545
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