HEROIC ENDODONTICS (WHEN TO SAY NO!!)

Editor's Notes

• #4: but it is not easy in all the times,there are issues where they threaten the credibility of endodontic therapy as the first choice . There are actually a fair number of them, some very obvious and some a bit more obscure.
• #5: It was really Dr. Herbert Schilder—defining the objective of RCT as consistency of long-term outcomes or “predictability”—who began the next chapter of endodontic therapy when he stated and taught that our success was wholly dependent on our ability treat root canal systems to their full apical and lateral extents.
• #11: first priority as it is in control of us, and which were are definitely accountable for. A negative which haunts us stil today is over enlargement of canals.in past there are k files without magnification or highly flexible files ,where it became necessary to enlarge the canals to have a larger view . despite advances that allowed us to be more conservative in our preparations and still achieve consistent outcomes, many endodontists and general dentists are still working for that full-bodied “look” at the end of the case because it became associated with better treatment results. H
• #12: After coronal leakage the problem of primary concern is in increased vertical fracture .
• #14: If the canals are predictably sterilized that is the internal spaces with perfect coronal seal to the cej lEvel and be done with it.-buchanan. There are dentists who stil fel nervous or guilty about treating canals. When there is no skil rather doing a rot canal treatment and having the toth extracted anyway,a nice toth can be replaced with a wel done implant. As the general dentists with the inadequate skil wil not quit from doing rot canals it wil just convince them to cut out the endodontist as an option when the case fails.
• #16: Perforations are procedural accidents that can adversely affect the outcome of endodontic therapy. Sinai found the prognosis for a tooth with a perforation depends on The location of the perforation. How long the perforation is exposed to contamination. The feasibility of sealing perforation. Fractures also create areas of persistent inflammation that may necessitate extraction. Fractures are often difficult to see on radiographs. Sometimes their presence is indicated when radiographs show: • A vertical black line between the obturation material and the root • A ‘halo’ shaped radiolucency surrounding a root (not the typical circumscribed radiolucency associated with a chronic apical abscess) Changing the vertical angulation of the central ray may allow detection of horizontal fractures (usually caused by trauma). A radiograph should be taken at a right angle to the long axis of the root, along with two additional views, one at 45 degrees toward the apex and one at 45 degrees toward the crown. When all the information required to diagnose the etiology of the endodontic failure is analyzed a prognosis for retreatment can be offered. A poor prognosis is given for: • Vertical root fractures with probing depths that are markedly greater than immediately adjacent sites. This indicates that the fracture, in addition to being subgingival extends infraosseously. This bone is expected to eventually be lost due to bacterial infection of the Fracture • Furcation perforations with a sulcular communication • Apical third perforations in roots with abrupt apical curvature. It can be very difficult to re-enter the natural canal to complete the endodontics in this situation. Surgery is usually a more predictable approach here
• #19: meticulous serial sections of human periapical lesions showed that overall 52% of the lesions (n 256) were epithelialized, but only 15% were actually periapical cysts . Periapical cysts can be differentiated into true cysts, which have a completely enclosed lumina, and pocket cysts that are open to the root canal It is the prevailing opinion that pocket cysts heal after endodontic therapy , but true periapical cysts may not heal after nonsurgical endodontic therapy . Only a subsequent surgical intervention will result in healing of such a lesion. Thus, from a purely pathological point of view, approximately 10% of all periapical lesions require surgery in addition to endodontic treatment. In addition, failed re-treatment cases because of apical transportation or procedural errors, often the result of using NiTi rotary files, are in many cases, best treated by surgical endodontics, especially if they have post restorations