is any deviation from the accepted standard

of care.

These unfortunate iatrogenic errors occur

due to inattention and/or some occur

totally unpredictable.

Each step in Endodontic treatment has a

possibility of technical errors that may

affect the prognosis of the treated tooth.

Access related

Instrumentation related

Obturation related

Miscellaneous

1. •Causes

2. •Recognition

3. •Correction

4. •Prevention

1) Treating the wrong tooth

2) Under extended cavity

3) Over extended cavity

4) Missed canals

5) Failure to remove all caries and unsupported structures

6) Damage to existing restoration

7) Access cavity perforations

8) Crown fractures

Treating the Wrong Tooth

•misdiagnosis

•a tooth adjacent to the one scheduled for treatment was inadvertently opened.

Causes

•Re-evaluation of the patient who continues to have symptoms after treatment

•When the rubber dam has been removed

Recognition

•appropriate treatment of both teeth: the one incorrectly opened and the one with the original pulpal problem

Correction

•arrive at the correct diagnosis

•marking the tooth to be treated

Prevention

Under extended cavity

•Poor access cavity prep

•Lack of information of anatomy

•Mistaking pulp horns for orifices

Causes

•Shallow depth

•Whitish dentin color

•Absence of developmental grooves

Recognition

•Proper lateral and vertical wall extension.

•Correcting any resulted error Correction

•Proper knowledge of the pulp morphology. Prevention

Over extended cavity

•Inexperienced dentist.

•Lack of knowledge of the root canal.

•Searching for the orifices of the main canals at a shallow depth.

Causes

•overextension preparation in buccolingual or in mesiodistal direction will eventually lead to weakening of the tooth structure.

Recognition

•Reaching good depth and locating the canals.

•Reinforcing tooth structure.

•Post core and crown

Correction

•Proper knowledge of the pulp morphology. Prevention

1. Gouge in the pulp chamber: A gouge is

unnecessary removal of tooth structure

in the pulp chamber area.

2. Long bevel created during access

opening preparation of anterior teeth:

Missed canal

•Lack of knowledge

•Lack of tools to search for canals

•Under extended access

Causes

•R.G., when inst. isn’t centered in the root.

•Persistence of signs

Recognition

•Detection of all canals, cleaning and obturate. Correction

•Proper knowledge of the pulp morphology. Prevention

Knowledge of root canal morphology.

Adequate coronal access .

Additional radiographs with mesial and

distal angulations.

Failure to remove all caries

and unsupported structures

Leads to contamination and

re infection of the prepared root

canal with saliva and bacteria

conducting to endodontic failure.

Correction: According to the case,

sometimes retreatment may be needed.

Prevention: Careful remove of all caries and

unsupported tooth structure.

Damage to existing restoration

In preparing an access cavity through a porcelain or porcelain-bounded crown, will sometimes chip.

Correction: Minor porcelain chip can at time be repaired by bounded composite resin to the crown, however, the longevity of such repairs is unpredictable.

Prevention: Placing a rubber dam clamp directly on the margin of porcelain crown is preventing

damage to the crown margin and/or fracture of porcelain.

The solution to prevent damage to an existing

permanently cemented crown is to remove it before treatment with little or no damage to the crown.

• Failure to recognize proper axial inclination of the tooth

• Tilted crowns

• Failure to recognize proper depth of floor

Causes

•Profuse bleeding from the canal

•Immediate sever pain

•Radiograph will confirm the periodontal communication.

Recognition

• Above the PDL, fill with no need of surgery

• Below PDL, IF SMALL filled intra coronaly, IF LARGE, for good seal fill it surgically

Correction

•Multiple preoperative R.G. Prevention

• Preexisting infraction Causes

• By direct observation Recognition

• Tooth Extraction Correction

• Reduce the occlusion before working length is established

Prevention

Thank you

• Excessive removal of tooth structure

• Need to accommodate large plugger or post Causes

•Radiographically

•Vertical root fracture Recognition

• Using bonded sealers in an attempt to strengthen the root canal Correction

•Carful treatment planning and knowledge. Prevention

• Incorrect determination of the working length causing perforation of apical foramen.

Causes

• Paper point will show bleeding.

• Radiograph will assure over preparation.

• Tactile sensation of the apical foramen will be lost.

• Extrusion of irrigation sol. Or obturation material

Recognition

•Re-establishment of working length.

•Enlarging the canal with larger instruments short than W.L.

Correction

• Correct determination of working length Prevention

Schielder’s mechanical principles of root

canal preparation states

that the canal should be prepared and

mechanically cleaned three sizes beyond

the Initial binding file

(remove three dentine layers)

• Inadequate removal of dentin Necrotic tissue and microorganism left in the unprepared part result in case failure

Causes

•Discolored dentin shavings. Recognition

• re-enlarge the RC with successive files Correction

• Correct planning of the case . Prevention

• Incorrect determination of the working length causing Bacteria or necrotic material left beyond this point might result in case failure, Short RC filling with subsequent micro leakage, which may lead to case failure

Causes

•Radiograph will assure under instrumentation.

• short RC filling

Recognition

•Re-establishment of working length.

•Perform correct RC ttt . Correction

• Correct determination of working length Prevention

• Lack of coronal pre flare.

• Using large straight files in curved canals

• Lack of irrigation during the procedure of shaping and cleaning.

• Skipping file sizes

Causes

• Loss of working length in the canal.

• Tactile sensation : feel of hitting hard solid wall.

• Radiographic examination revealing the direction of the file away from the canal curve.

Recognition

• Pre-curving of the file and inserting the file in the same direction of the curve.

• Use the file in Watch winding cutting motion for negotiation.

• Once the canal has been reestablished an anticurvature filing motion is used to soften off the ledge

Correction

• Always respect canal curvature during preperation. Prevention

• Improper access cavity

• Skipping file sizes

• Excessive rotation of the file in the canal

• Manufacturer defects

Causes

•Confirmed by Radiograph

•Sudden loss of working length.

•Instrument inspection. Recognition

•Retrieval

•Bypass and sealing the fragment within the root canal space,

•True blockage.

Correction

• Knowledge

• Proper access cavity preparation

• Proper instrumentation

• Routine Inspection of instruments

Prevention

Level of separation:

Apical

Coronal

Middle

Vital V.S. necrotic: when canal is vital before treatment leaves less opportunity for bacterial infection after file separation.

Amount of cleaning: if proper cleaning has been done prior to file separation this will eventually lead to better prognosis.

Usually occur due to

inattentive access opening.

the bur is not properly angulated in

relation to the long axis of the tooth

searching for a canal orifice

prepare a root canal with pulp stone.

correct a ledge.

bypass a separated instrument.

preparing a root canal a mis-oriented instrument.

Misuse of rotary instruments while preparing room for a post, or removing gutta-percha during endodontic retreatment.

roots which have a figure-eight shape

cross section, such as the mesio-buccal

root of maxillary molars.

It may occur in the furcal aspect of

coronal third of mesial roots of lower

molars “danger zone” due to excessive

enlargement.

It may occur due to instrumentation of

the root canal beyond its anatomical

apical foramen.

a) Direct observation

b) Paper points

c) Radiographs

d) Electronic apex locators

e) Symptomatic findings

Perforations coronal to gingival

attachment may be conventionally

repaired with a restorative material or a

crown.

Sub gingival perforations slightly apical

to the crestal bone can be restored using

an endodontic-orthodontic technique.

Large perforations in the Furcation area

can be treated by bicuspidization,

hemisection, or root amputation.

Surgical repair

Surgically inaccessible perforations of

the midroot can be treated by intentional

replantation.

Apicoectomy performed (provided a

satisfactory crown-root ratio remains

after surgery).

Apicoectomy and retrograde filling

Thank you

Causes:

false working lengths

apical perforations during the process of shaping and cleaning the canal

obstruction that will cause loss of working length (e.g.: ledge, canal blockage and separated instrument)

Detection:

by radiograph

corrected :

re-establishing the actual working length of the canal and properly obturating it.

Causes:

Increased pressure during lateral condensation

Increased apical pressure during post cementation

Detection:

Sharp sound

Pain

Bleeding

Loss of resistance against lateral condensation

Radiolucency along side of the fracture line

Treatment:

Single root will have to be Extraction

Multi rooted according to certain conditions can undergo root resection.

Causes:

Gross over extended fillings.

Formaldehyde containing sealers

Surgical procedures

Apical Perforation with files.

Detected: by patients complaint

Treatment:

Observation for a certain period of time for

nerve regeneration.

Surgical decompression for the edematous

portion of the nerve

Cortisone treatment.

escape to periapical region, sinus, or

periodontal tissue

Irrigant may cause damage to the tissue

it escapes to.

Irrigant may cause allergy.

Irrigant may start abscess formation.

Thank you