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CLINICAL ASPECTS

ENDODONTIC TREATMENT FAILURES

1C. BOITOR, 2ANCA FRIL, 3MONA IONAS, 4O. BOITOR

1,2,3Lucian Blaga University of Sibiu, 4Student Lucian Blaga University of Sibiu, Sibiu

Abstract: The causes of endodontic treatent failures

de!end on technical, biological or iatrogenic factors,"hich contribute to the acco!lishent of the treatent#

$no"ing and understanding the relation bet"een thesefactors ay hel! in increasing the chances of !reventing

the !ossible endodontic treatent failures#Keywords:endodontic treatents failures

Rezumat:%au&ele unor e'ecuri (n endodon)ie de!ind defactori tehnici, biologici sau iatrogeni care contribuie la

reali&area trataentelor endodontice# %unoa'terea 'i(n)elegerea cau&alit*)ii dintre ace'ti factori contribuie la

s!orirea 'anselor de !revenire a unor !osibile e'ecuri aletrataentelor endodontice

Cuvinte cheie:trataente endodontice, e'ecuri !osibile

The chances of curing the pulp affections requireendodontic treatment, which involves the removal of thepulp and root canal obturation. This might also be the

source of possible failures.A. Failure !ue "# "e$%&i$al rea#&.

In most cases, these are related to root canalanatomy and may be due to the following causes:

- Root variation in terms of shape and length are due tothe non topical dental morphology, or due to certain

root resorptions, short roots with large canals. Rootvariations inconveniencies may be overcome by

retroalveolar X-rays with needles in canals or by theelectronic measurement of the root length locator

ape!".- #dditional root, most of the times revealed only by

oblique radiography. $ouble canals, apicallybifurcated canals or even pulp diverticulum may be

detected on this occasion, as well.%"- &avity access with insufficient opening. The cavity

access should allow the surgeon to remove the

affected tissue, as well as to handle the instruments inthe best conditions. 'hen carrying out the access, we

should consider the location of canal holes, which

most of the times are mas(ed by hyper calcificationsand secondary dentine root filling. In order to

emphasi)e the opening of the root canal, we are

sometimes forced to use the colouring agents theyare more strongly retained by the soft tissues" orsodium hypochlorite*hydrogen pero!ide which

produce bubbles when they are in contact with

organic pulp substances".Root canal irrigation plays a (ey role in the

success of the endodontic treatment. This is obtainedthrough irrigation and mechanical removal of the root

canal contents and of the smear lear. In addition, there is achemical dissolving of the organic tissue, which depends

on the chemical composition of the irrigation substance.# good irrigation depends on the quantity of the solutions

used, on the antiseptic efficiency freshly preparedsolutions are more efficient" and also on the degree of

penetration of the antiseptic used. +owever, there is noideal irrigation solution, so the association of certain

complementary solutions is the most effective method.

The most recommended antiseptic solutions forendodontic lavages are: hydrogen pero!ide % vol.",

hypochlorite sodium %- vol.", clorhe!idine gluconatsolutions %-", /T#$ 0io 1ure 2olutions do!icylinhyclat , citric acid 3.45, .5 detergent Tween 6"

solutions containing chelating substances 7$T#, citricacid", which have the advantage of an easier penetration

of the canal, removing the remaining debris.4" &helatingsubstance can sometimes be at the origin of therapeutic

failures by creating false routes, using wrong methods. 0ythe use of the antiseptic substances, the efficiency of the

antibacterial treatment is increased8 it is suggested to usesodium hypochlorite, as the last substance used, because it

has a great power of neutrali)ing the traces of thechelating substances and of promoting a more al(aline

p+, which prevents bacterial multiplication."B. Failure !ue "# 'i#l#(i$al rea#&.

These failures are due to wrong mechanicaltraining or to a pure filling material.

The requirements of an ideal filling material arethe following:

- The antiseptic power should be longer8

- The material should not be irritating8- To provide three-dimensional tight closing8

- To be stable overtime8

- 7asy to handle and remove.0iological healing cement closure of the ape!"

can be prevented by a mechanical processing with a

diameter of more than .45 mm of the apical area. #shorter preparation over .5-% mm of the radiologicalape! can be a source of endodontic failure, because it may

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CLINICAL ASPECTS

leave in apical area, microorganisms, en)ymes or to!ins,

which lead in time to inflammatory lesions. 7!ceeding thelength of the root canal is another source of treatment

failure, because it prevents the canal drying, removing thepossibilities of biological healing. /oreover, it is a source

of irritation for the neighbouring tissues apicalperiodontium, sinuses and dental nerves".

In case of in9ures, which lead to thedisappearance of the apical constrictions, a limit in the

canal preparation is required, according to the clinical andradiological evaluation with the needle in the canal. In

practical terms, this is done manually or with rotary toolsand has as results, the creation of a bloc(ing cone.3,5"

The classical electronic method for measuringthe length of the root canal, based on the tactile sense of

the apical constriction, is considered today an empirical

and non efficient method. Radiography with needles incanal is considered more accurate, but it still has certain

shortcomings related to the phenomenon of paralla! andto the repeated e!posures to radiation, regarding thepatients.

The current electronic method for measuring thelength of the root canal based on the electrical potential

difference between the crown and dental ape!" is the mostprecise and has the most reduced side effects. This

method requires certain conditions for the accuracy ofresults, such as: filling removal or metallic micro

prosthesis from the e!amined tooth, choosing the rightdiameter channel instruments. This is not indicated to

peace-ma(ers bearers. There are clinical situations, suchas the presence of suppurate apical e!udates, calcium

hydro!ide on the root walls, or an impenetrable apicalforamen, which may bring about wrong results of the

canal length.

C. )eali&( *ailure #* $er"ai& +eria+i$al i&urie i&+i"e #* a& e&!#!#&"i$ $#rre$" "rea"-e&".

$esiderata of a right endodontic treatment

consist in the prevention of bacterial coloni)ation, the use

of a biocompatible material, tight and stable filling

overtime. $epending on the clinical situation, it issuggested that the endodontic treatment follow these

steps:- In absence of apical periodontitis canal obturation

should be done in one time phase8- In presence of apical parodontitis canal obturation

should be done in two times first time temporaryfilling with calcium hydro!ide and second time - the

final canal filling"$espite a proper endodontic treatment, the

occurrence and*or the persistence of periapical lesionsmay be due to certain diagnosis mista(es ;":

- 1eriapical infections in apical parodontitis case withsignificant osseous resorptions8

- Root fissures of fractures with hidden symptoms8- 0acterial flora persistence in undetected canals8

- 'ell-built ape! infections, under the form of a cystor abscess, which require surgical treatment8

- 1ersistence of foreign bodies in the apical area8

- &oronary deficit tightness, which may be the starting

point of certain bacterial infiltrations of the oralcavity towards the periapical space.

D. Failure !ue "# ia"r#(e&i$ rea#&.

The most common causes are the fractures of thesteel and nic(el-titanium endodontic instruments. In these

cases, retro alveolar X-rays in different incidences areindicated. #fterwards, it is suggested to intervene

surgically in order to remove the bro(en instruments. Theremoval protocol is to create an access way near the

fractured fragment, its lavage with sodium hypochloriteand chelating substances. +andy needles or needles

attached to an ultrasound tartar removal instruments 1ronowing the possible sources of endodontic

treatments failures must determine the dentist to adopt aproper treatment according to the technical equipment, so

that the patient should be safe from endodontic treatmentfailures.

'hatever the clinical situation would be, thepatient should be informed clearly about the treatment

possibilities and their prognostic.

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instrumentation and irrigation with %, 4.5 and5.45 sodium hypochlorite. E 7ndodont

484;;":%-3.3. 2iquera EE. 7ndodontic infections: concepts,

paradigms and perspectives. =ral 2urg =ral /ed=ral 1athol =ral Radiol 7ndod 448A3":35%-35D.

5. /artin $. Retrait des instruments endocanalairesfractures. Real &lin 4;8%D3":65-3.

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