Subject

Non-Surgical Re-Treatment.

  • code 11458
  • course 1
  • term Anual
  • type OB
  • credits 1

Main language of instruction: English

Other languages of instruction: Spanish

Teaching staff

Introduction

Despite recent advances in endodontics, the goal of treatment is not always achieved, and apical periodontitis  may persist or after treatment. The first option to endodontic fail is the orthograde retreat.

Pre-course requirements

No prerequisites

Objectives

At the end of the formation the student must  achieve the following objectives:

 

1. Knowing which is the purpose and justification of endodontic retreatment and making a good diagnosis, decisions-making process and a proper perform in the treatment planning.

 

Knowing which is the purpose and justification of endodontic retreatment and making the right diagnosis, decisions-making process and the proper performance according to  the treatment planning.

 

2. Acquiring knowledge to remove coronal restoration, removal of pastes, gutta percha and cements, hard and silver tips and separate instruments.

 

3. Ability to treat a drilling and renegotiate the duct system.

 

4. Getting knowledge about irrigation and medication during orthograde nonsurgical retreatment.

 

5. The learning  of endodontic surgery procedures.

Competences / Learning outcomes of the degree programme

The student must be able by himself to diagnose the octopus-persistent periapical pathologies after endodontic treatment, whether by perpetuating the same or new appearance. This is achieved by studying the literature on the orthograde retreat.

 

Self-learning ability in developing new techniques for solving problems in/ through the acquisition of new scientific concepts, and in the search for new scientific information. Therefore, the basis of the course will be to analyze the problems, to acknowledge the action methods and the skill training carried out. Being able to make public presentations on own clinical cases justified based on the scientific literature, using correct scientific terminology related to pulpo periapical resorptions  pathology and dental traumatology.

 

Syllabus

Item 1. Justification of endodontic retreatment.

 

Identifying  possible causes of treatment failure:

 

• Biological Failures

• Cysts:

• Teeth cracked and fractures.

• Incorrect diagnosis and treatment.

• foreign body reactions.

• Healing scars.

• Neuropathic problems.

• Economic constraints.

 

 

Item 2. Decision making and treatment planning.

 

 

• Success Retreatment: clinical view point of the patient, histology.

 

• Clinical guidelines of the European Association of Endodontics: Recognize the characteristics of success and treatment failure.

 

• Decision-making: Portraying or not portray, endodontic retreatment, apical surgery, extraction, refer to other specialists.

 

• Decision-making and treatment planning: Where, how and when treatment was performed. Thermal  testing and radiographic examination.

 

• Factors influencing treatment outcome: Periapical periodontitis (PAI index) Limit instrumentation and sealing material, size of the periapical radiolucency, technical factors, broken instruments and silver points, types of sealing material, drilling , coronal restoration, periodontal assessment, patient expectations, cost, risk.

 

• Treatment Planning

• Teeth cracked and fractures.

• Incorrect diagnosis and treatment.

• Foreign body reactions.

• Healing scar.

• Europathic problems.

• Economic constraints.

 

Item 3. Removal of Coronal restorations.

 

• Crowns removal.

• Crown removal methods: Chisel, forceps, lift crowns, ultrasound, chisel and mallet, WAMkey, section crowns, bridges.

 

• Removal of poles: Poles threaded bolt stump cast, devices for removing poles, removal kit Ruddle, post fracture without supracoronal remaining material, kit Masserann, trephine, pullers, fiber posts.

 

• Removal of amalga.

 

Item 4. Removal of pasta, gutta percha and cements hard.

 

 

• Pasta: Types, radiographic appearance, appearance, consistency.

• Removal of pasta: Mechanical, solvent preparation (types). Removal drugs calcium hydroxide and calcium hydroxide / iodoform.

 

• Removal of gutta percha.

 

1. Types shutter, single cone, Hedstroem Files, endosonic file, nickel- titanium rotary instruments, overextended gutta-percha, gutta-percha consensual, strawberries Gates-Glidden, heat, solvents.

 

2. Removal of Thermafil, Hedstroem file, rotary nickel-titanium instruments, QuickFill.

 

3. Other systems: Gutta flow, Resilon,

 

• Removal of hard cements: Types, radiographic appearance, appearance, consistency.

 

Item 5. Removal of silver points and separate instruments.

 

 

• Removal silver points:

 

- Silver points with poor cement:

 

1. Types, appearance.

2. Techniques: Meitrac kit kit Cancellier, and File-tube method (IRS)

 

- Well cemented silver points, silver points broken, twisted Hedstroem limes.

 

• Removal of separated instruments.

 

1. Favorable factors: Straight pipes, front teeth, before bending location, larger fragments 5 mm, hand files.

 

2. Removal stainless steel instruments: Gates-Glidden bur modified.

 

3. IRS (Removal System Tools).

 

• Removal of nickel- titanium Instruments.

 

1. Modification cavity access, direct access, release the instrument from the walls, exceed the instrument, unable to remove.

 

Item 6. Complications during endodontic treatment

 

 

• Prevent punctures: Radiography, the pulp chamber floor, sclerotic ducts.

 

• Importance in healing perforations factors: level, location, size, time.

 

• Drilling furca: Microperforation (<0.5 mm) and large holes (> 0.5 mm)

 

• Materials meet various materials for sealing perforations.

 

1. MTA, Super EBA, IRM.

 

• Techniques repair of perforations: 1 step, 2 steps.

• Stripping.

• Drilling by posts.

• Apical Perforations.

• Negotiation ductwork: Locating conduits, conduit MV upper molars, presence of four conduits in lower molars, two ducts presence in lower incisors, two canals in presence of lower premolars. Exceeding steps, getting permeability.

• Effects of the use of ultrasound during endodontic retreatment.

 

Item 7. Introduction to endodontic retreatment surgery orthograde vs periapical surgery.

 

• Forecast endodontic surgery: complete healing, incomplete healing, uncertain healing failure.

 

• Current indications for endodontic surgery.

 

• Contraindications endodontic surgery.

 

• Preoperative Planning: Patient factors, systemic diseases, heart disease, respiratory diseases, hematological disorders, endocrine disorders, musculoskeletal, medication (non-steroidal antiinflamatorious, warfarin, liver and kidney disease), gastrointestinal disease, pregnancy, anatomical factors diseases (soft tissue: alveolar mucosa, attached gingiva, access and oral cavity size, bridles, palate), periodontal status, restorability of the tooth, neurovascular anatomy.

 

• Clinical evaluation: extraoral examination, intraoral radiographic evaluation.

Teaching and learning activities

In person

Weekly seminars will be held.

Evaluation systems and criteria

In person

The study will be evaluated weekly through presentations and discussion of articles.

End of the course exam consisting of 10 questions.

Bibliography and resources

Advanced Endodontics. Clinical retreatment and Surgery. John S Rhodes.

Ed., 2006.

 

Problems in Endodontics: Etiology, Diagnosis and Treatment. Michael Hülsmann, Clemens Bargholz, Claudia Barthel. Quintessence, 2009.

 

Pathways of the Pulp. Stephen Cohen, Kenneth M. Hargreaves. Elsevier Mosby, 2011.

 

Articles

 

De Chevigny, C., Dao, T.T., Basrani, B. R. et al, Treatment outcome in endodontics: the Toronto study-phase 4: initial treatment. J Endod. 2008; 34: 258-263

 

Sjogren, U., Hagglund, B., Sundqvist, G., Wing, K. Factors Affecting the long-term results of endodontic treatment. J Endod. 1990; 16: 498-504.

 

Salehrabi, R., Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod. 2004; 30: 846-850.

 

Ng, Y.L., Mann, V., Rahbaran, S., Lewsey, J., Gulabivala, K. Outcome of primary root canal treatment: systematic review of the literature-part 2: influence of clinical factors. Int Endod J. 2007; 41: 6-31

 

Nair, P. N. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39: 249-281.

 

Peters, A.O., Barbakow, F., Peters, C.I. An analysis of endodontic treatment With three nickel-titanium rotary root canal preparation techniques. Int Endod J. 2004; 37: 849-859.

 

Nair, P. N., Sjogren, U., Krey, G., Sundqvist, G. Therapy-resistant giant cell granuloma foreign body at the periapex of a root-filled human tooth. J Endod. 1990; 16: 589-595.

 

Aryanpour, S., Van Nieuwenhuysen, J.P., D'Hoore, Endodontic retreatment W. decisions: no consensus. Int Endod J. 2000; 33: 208-218.

 

Madison, S., Wilcox, L.R. An evaluation of coronal microleakage in endodontically Treated teeth: part III-vivo study. J Endod. 1988; 14: 455-458.

 

Ray, H. A., Trope, M. periapical status of endodontically Treated teeth in relationship to the technical quality of the root filling and the coronal restoration. Int Endod J. 1995; 28: 12-18.

Ruddle, C. Nonsurgical retreatment. J Endod. 2004; 30: 827-845.

 

Hülsmann, M. Stotz, S. Efficacy, cleaning Ability and safety of different gutta-percha devices for removal in root canal retreatment. Int Endod J. 1997; 30: 227-233.

 

Tasdemir, T., Yildirim, T., Celik, D. Comparative study of removal of current endodontic fillings. J Endod. 2008; 34: 326-329.

Friedman, S., Stabholz, A., Tamse, A. Endodontic retreatment: case selection and technique-part 3: retreatment techniques. J Endod. 1990; 16: 543-549.

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