Prof. Dr. Theodoros Lambrianidis - Özet

Prof. Dr. Theodoros Lambrianidis | Özet

Prof. Dr. Theodoros Lambrianidis

Prof. Dr. Theodoros  Lambrianidis
Prof. Dr. Theodoros Lambrianidis

Ledge Formation, Perforations and Separated Instruments in Root Canal Treatment
The sequence of interdependent steps characteristic of an endodontic treatment may be interrupted or even fail at any time or stage of the process due to iatrogenic errors. These procedural errors, in mild cases, may merely complicate conservative root canal treatment or simply affect its prognosis, imposing the necessity of periodic clinical and radiographic follow-up examinations. In more severe cases, however, such damage may eventually lead to surgical endodontics or even to tooth extraction. 
A ledge in the root canal is an irregularity in its walls that does not allow the access of instruments to the apex resulting thus in insufficient instrumentation and incomplete obturation. Ledge formation is easily recognised as the endodontic instrument can no longer be inserted in the canal to the full working length. At the same time, the characteristic tactile sensation that the instrument reaches the narrowest end of the root canal is replaced by that of an instrument hitting against a solid wall. 
Perforation is defined as a mechanical or pathological communication between the root canal system and the external tooth surface with subsequent  injury to the periodontium that results in the development of inflammation, destruction of periodontal fibers, bone resorption, formation of granulomatous tissue, proliferation of epithelium, and ultimately in the development of a periodontal pocket. 
A separated instrument is an undesirable troublesome incident during root canal treatment that frustrates both practitioners and patients and can occur even in experienced clinicians that follow the most appropriate preventive measures. Instrument fracture may occur in both anterior and posterior teeth, but it is most frequently reported in molars with similar instrument fracture rates for the maxilla  and mandible. Among molars, they are particularly reported occurring in the mesial roots of the mandibular ones.
Iatrogenic errors complicate the treatment and deteriorates the prognosis if not properly managed. The aim of this presentation is to highlight the most common causes of these errors, their recognition, management, prognosis, and most of all their prevention.