A 33-year-old construction worker self-referred himself for a second opinion. Six months previously he fell over forty feet resulting in severe injuries that kept him hospitalised for several weeks. Near the end of his stay, a fascial space infection developed in the right cheek. Since then, he endured a cacophony of IV and oral antibiotics to no avail. With a no discernable diagnosis and a recalcitrant, but constrained, infection a rebukable extra-oral incision was performed. An unaesthetic indentation will serve as a permanent reminder of this contemptuous misadventure…
Endodontic instrument fracture during root canal treatment occurs in 2% to 5% of cases. Removal of instrument fragments in infected root canals or the coronal third of canals should be attempted if they cannot be successfully bypassed, because resultant persistent periapi-cal infection and additional surgi-cal treatment can increase patient morbidity and raise treatment costs. The American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology recommend cone beam computed tomography use to assess separated endodontic instruments.
Patients with diseased dental pulp have traditionally received nonsurgical root canal treatment. However, the development of modern osseointegrated dental implants has changed the calculus for many of these patients, and current trends appear to favor implants as the standard procedure in cases that would have previously undergone endodontic treatment. Although many studies have been conducted comparing outcomes from the 2 treatment options, establishing which procedure is more predictable remains problematic due to significant differences in study design and definitions, especially the differing measures of outcomes between treatment options.
It has been demonstrated repeatedly that the quality of a coronal restoration after endodontic therapy is crucial to the long-term success and retention of the tooth. Crowning an endodontically treated tooth with a full coverage crown has also been shown to increase the tooth’s retention. In addition, there is some indication that the timing of placement of the full coverage restoration has also an impact on success rate.
Over the years, there has been a great deal of discussion about how best to restore endodontically treated teeth, especially with regard to the need for a post. Some clinicians maintain that the role of a ferrule is more important than that of the post, while others feel strongly that posts enhance the survival of endodontically treated teeth.
Studies of patients ≤20 to ≥40 years of age have shown that both pulp chamber size and root canal diameter decrease as people age. Such changes may also result from carious lesions, deep restorations and periodontal disease.
The proper treatment of cracked teeth requires a determination of tooth restorability and pulpal status.
Pivotal for successful treatment, profound anesthesia prior to endodontic therapy is not always easy to achieve, especially in the lower molar area.
It has been well established that nickel-titanium (NiTi) alloy files are able to maintain the original canal shape during the instrumentation procedure. However, they do come with one important disadvantage: a higher risk of file separation or breakage compared with stainless steel hand files.