Common Complications in Endodontics: Prevention and Management

294 Pages·2018·8.51 MB·English

by  Priyanka Jain (eds.)

Common
Complications in
Endodontics
Prevention and
Management
Priyanka Jain
Editor
123
Common Complications in Endodontics
Priyanka Jain
Editor
Common Complications
in Endodontics
Prevention and Management
Editor
Priyanka Jain
Department of Endodontics
Apex Medical Clinics
Dubai
United Arab Emirates
ISBN 978-3-319-60996-6 ISBN 978-3-319-60997-3 (eBook)
https://doi.org/10.1007/978-3-319-60997-3
Library of Congress Control Number: 2017960806
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Foreword
It is a pleasure for me to write the Foreword to the first edition of Complications in
Endodontics: Prevention and Management.
This is a fine collaboration of internationally renowned authors that summarizes
every clinical aspect of how to avoid procedural errors that might occur and how to
correct these errors if they should occur.
The twenty-first-century style of this textbook reflects the most current ways of
imparting information and acquiring knowledge in this digital era.
The multitude of well-documented case presentations, including outstanding
photographs, illustrations, and radiographs, helps to reinforce, in a step-by-step
approach, the concepts discussed in each chapter.
The flawless continuity between the following chapters and the coordination of
topics is a real tribute to the authors and editors to inform and educate the
clinician.
The clinically based “how to” style in which each of these chapters is written will
be a great help for the clinician. The superb organization and comprehensive nature
of Complications in Endodontics: Prevention and Management makes it a valuable
addition for all clinician’s libraries.
Stephen Cohen, M.A., D.D.S., F.I.C.D., F.A.C.D.
Diplomate, American Board of Endodontics
San Francisco
CA, USA
v
Preface
The common problems clinicians encounter during practice continue to stem from
the areas of diagnosis and cleaning and shaping techniques. Successful endodontics
requires a thorough diagnosis, a complete knowledge of the anatomy of the canal
systems being treated along with their complete debridement, and careful shaping
techniques, thus providing for complete obturation and a coronal seal provided by a
final permanent restoration. Assessment of the risks associated with any treatment
procedure is aimed to prevent, identify, and manage any potential complication. A
clinician should always be prepared to manage any undesirable results.
Complications can occur during many dental procedures. The clinician responds
by either correcting the problem during treatment or, ideally, preventing the prob-
lem from occurring in the first place.
A decision on how or whether to treat or not cannot be made without a proper
diagnosis. Endodontic treatment is not a diagnosis but is a treatment plan arrived at
after a thorough and careful assessment. A radiolucency on a radiograph alone can-
not provide a diagnosis. Separate pulpal and periapical diagnoses must be reached.
Careful examination along with a detailed history is of prime importance. It must be
kept in mind that the findings can change between appointments.
The importance of correct radiographic interpretation cannot be emphasized
enough. It is a common understanding that both large and small lesions and ana-
tomical entities can be routinely missed in radiographic interpretation both by the
operator and the limitations of the technology when encountering differences in
anatomic variation. Digital imaging of dental structures has become a common
diagnostic modality in the last decade in dental offices around the world. New radio-
graphic imaging systems have recently become available for use in the dental field
and have completely transformed the way we diagnose and treat problems. Among
these are cone beam computed tomography (CBCT), which allows for precise and
accurate visualization and evaluation of teeth and their surrounding structures.
CBCT has become an essential diagnostic tool in the modern endodontic practice.
But we need to carefully evaluate the potential risk and maximize the benefit to the
patient.
Although an emphasis is placed in the literature on instrumentation and obtura-
tion techniques, we cannot forget that a basic aspect of providing care is doing the
treatment painlessly. True anesthesia failures (i.e., primary, secondary, and adjunct
forms of anesthesia delivered skillfully that fail to anesthetize the pulp) are rare
vii
viii Preface
occurrences. Adequate anesthesia can be achieved despite initial failure through
patience, skillful delivery of the anesthetic, and understanding of the original cause
of failure. Factors that contribute to anesthesia failure are discussed, and recom-
mendations to overcome them are proposed and discussed in Chap. 3.
Paresthesia due to over-obturation as well as other neural complications must be
considered as a serious problem. These injuries require a thoughtful strategy for
prevention during endodontic procedures as well as a careful systematic approach
toward its management, should the endodontic procedure result in such injury.
The next section talks about the various mishaps encountered during the proce-
dural phase of endodontic therapy. Procedural errors may be defined as improper
action or inaction of the practitioner either before or after the procedure. These may
not have any effect or may, in some cases, result in a complication.
The cause of perforations during access is mainly due to lack of axial inclination
and failure to hold the bur parallel to the tooth. Inadequate access can also lead to
misdirection and unnecessary gouging. Prevention is the key to success and includes
a thorough understanding of the tooth morphology, having multiple radiographs to
reference, and patience.
In endodontic treatment separated rotary Ni-Ti files are a common procedural
problem. Through understanding that the main causes of file breakage are cyclic
fatigue and torsional stress, a dentist can best prevent this occurrence by using hand
files before rotary files, creating a straight-line access into a canal, and pre-flaring
the coronal portion before using rotary files in the apical third of the canal. A case
does not necessarily fail if the separated file cannot be removed. The prognosis in
these cases can still be favorable, if care is taken to reduce the concentration of canal
debris with hand instrumentation and chemical irrigation prior to rotary file
insertion.
Wouldn’t it be nice and simple if all canals were straight? Since they aren’t, we
must understand how curved canal cleaning and shaping can be achieved without
creating ledges. The most common canals that are “prone to ledging are small,
curved, and long.” Prevention of ledging can be minimized with accurate preopera-
tive and working radiographs, copious irrigation, pre-curved files, and incremental
instrumentation. The prognosis of teeth that have ledges in them varies and surgical
endodontics may be needed.
The next chapter discusses the obturation complications. These are best pre-
vented by giving proper attention to the working length and attaining a smooth and
even taper and flare during the cleaning and shaping process.
In the dental literature, several mishaps during root canal irrigation have been
described, from damage to the patient’s clothing, splashing of the irrigant into the
patient’s or operator’s eye, to injection through the apical foramen or air emphy-
sema and allergic reactions to the irrigant. Forcibly injecting sodium hypochlorite
(or other types of irrigants) into the radicular tissues can cause tissue damage, par-
esthesia, muscle weakness, and extreme discomfort. The author discusses various
management measures should such a complication occur in Chap. 7. Measures that
can prevent and/or minimize such accidents, which can occur during the course of
endodontic therapy, are also discussed.
Preface ix
Chapter 8 describes the way to maximize disinfection and avoid reinfection via
case preselection, antimicrobial strategy, and reinfection prevention. Occasionally,
a nonsurgical root canal procedure alone cannot save the tooth and a surgical
approach may be needed. Surgical endodontics and the common risks/complica-
tions such as wound healing impairment, infection, and bleeding are discussed
under this chapter.
An endo-perio lesion can have a varied pathogenesis ranging from simple to a
relatively complex one. Having proper knowledge of these disease processes is
essential in coming to the correct diagnosis. It is important to remember that the
recognition of pulp vitality is essential for a differential diagnosis and for the selec-
tion of primary measures for treatment of inflammatory lesions in the marginal and
apical periodontium.
Endodontic needs of today’s and tomorrow’s growing older adult population
present increasing challenges for clinicians. Biologic and anatomic differences in
the dental pulpal tissues between older and younger patients must be carefully
understood and considered in treatment planning and performance for appropriate
endodontic procedures. These differences generally do not contraindicate treatment,
which, when performed correctly, will be successful in the elderly patient.
When the endodontic procedure is carried out in patients with systemic illness or
who are under medical management, it is important to avoid the potential medical
emergencies. Hence, clinicians must be aware of common diseases and drugs that
have an impact in endodontic treatment and the management options in such cases.
The last chapter aims to highlight the most commonly occurring clinical conditions
that require special endodontic attention.
This book presents up-to-date recommendations for the prevention, diagnosis,
and management of complications in endodontic procedures, based on the best
available scientific evidence. It is ideal for both endodontists and general dentists, as
the text combines the precision of quality endodontic care with achievable and pain-
free outcomes for the patient. Each chapter has been carefully written from a clini-
cal viewpoint to help the clinician and accompanied by an extensive bibliography,
allowing the reader to explore the topic further, should they desire.
The aim is to provide the readers with in-depth knowledge and tools to incorpo-
rate an evidence-based approach to prevent, identify, and manage complications
that occur during the endodontic procedure. Every attempt has been made to discuss
the common procedural complications in depth and detail. The text presents the
material in a reader-friendly manner with helpful flowcharts, tables, and figures.
Enjoy the book and we welcome your feedback at any time.
Dubai, UAE Priyanka Jain
Acknowledgments
This book is for all my teachers, colleagues, and friends in the field of endodontics.
It took close to 18 months in conceiving and executing this project. A book of this
caliber and scope cannot be accomplished by a single person. It is the result of a
great multiauthor dedication and effort. I have several people to thank, for without
their help, guidance, perseverance, and patience, this book would not have seen the
light of the day. They are the true heart and spirit of the book.
Therefore, my sincere gratitude to Carla Cabral dos Santos Accioly Lins, Flavia
Maria de Moraes Ramos Perez, Andrea dos Anjos Pontual de Andrade Lima, and Maria
Luiza dos Anjos Pontual, authors of the chapter on radiographic interpretation;
Alexander J Moule, Unni Krishnan, and Tara Renton, authors of the chapter on compli-
cations of local anesthesia; Ray Bradford Johnson for his expertise on access-related
complications; Sami Chogle, Obadah Attar, and Tun-Yi Hsu for the chapter on instru-
ment-related complications; Gianluca Plotino, Nicola Maria Grande, and Mauro Venturi
for their work on obturation-related complications; Zuhair Alkatib and Rashi el Abed,
authors for the chapter on complications due to medicaments; Federico for his expertise
on strategies to reduce the risk of reinfection in endodontics; Igor Tsesis, Eyal Rosen,
Tamar Blazer, and Shlomo Elbahary for their work on complications during surgical
endodontics; Prof. Omer for his chapters on endo-perio relationship and geriatric patient;
and finally Catherine Wynne for contributing to the chapter on endodontic consider-
ations in systemically compromised patients.
I would also like to thank Mr. Kumar Krishna Mohan, for his help with the
images and illustrations.
I would also like to extend my thanks to Dr. Reem, Dr. Dana, Dr. Aga and
Dr. Hessa for their help with cases.
Sincere thanks to Dr. Stephen Cohen for once again providing the Foreword. He has
always been my inspiration and I was very grateful when he agreed to write the Foreword.
I would also like to thank Dr. Sverre Klemp for his faith in me and giving me this
opportunity to write the book. My sincere thanks to Ms. Abha Krishnan, Springer,
and their team for their professional expertise in making this book a reality.
Most importantly, thanks to my husband Gaurav and my children, Navya and
Armaan, and all my family members who put up with all my apprehensions and late
working hours.
And finally and most important of all, I thank them who are responsible for what-
ever I am today—my parents.
xi
Contents
Part I Diagnosis
1 Clinical Diagnosis and Treatment Planning . . . . . . . . . . . . . . . . . . . . . 3
Priyanka Jain
2 Importance of Radiographic Interpretation . . . . . . . . . . . . . . . . . . . . . 27
Carla Cabral dos Santos Accioly Lins, Flavia Maria de
Moraes Ramos Perez, Andrea Dos Anjos Pontual de Andrade Lima,
and Maria Luiza dos Anjos Pontual
3 Complications of Local Anaesthesia in Endodontics . . . . . . . . . . . . . . 41
Unni Krishnan, Alex Moule, and Tara Renton
Part II Endodontic Complications During Procedure
4 Access-Related Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Bradford R. Johnson
5 Instrumentation-Related Complications . . . . . . . . . . . . . . . . . . . . . . . 87
Obadah H. Attar, Sami M. Chogle, and Tun-Yi Hsu
6 Complications due to Root Canal Filling Procedures . . . . . . . . . . . . . 101
Gianluca Plotino, Mauro Venturi, and Nicola Maria Grande
Part III Miscellaneous
7 Complications Due to Medicaments . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Zuhair Alkhatib and Rashid El Abed
8 Strategies to Reduce the Risk of Reinfection in Endodontics . . . . . . . 177
Federico Foshi
9 Complications of Endodontic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 203
Igor Tsesis, Tamar Blazer, Shlomo Elbahary, and Eyal Rosen
10 Endodontic-Periodontal Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Mehmet Omer Gorduysus
xiii