وصف
Endodontic mishaps are unfortunate mistakes that occur during the treatment or diagnosis of RCT. Mishaps are instrument separation and lodging in the canal, lack of adaptation of filling material to the canal walls, loss of coronal seal leading to reinfection, Iatrogenic damages to adjacent structures, such as the inferior alveolar nerve or the sinus. Proper irrigation, cleaning and shaping is crucial in avoiding endodontic mishaps. If a perforation occurs, sealing the perforation with appropriate material can prevent further complications. Radiographic and clinical examinations should be performed to determine the extent of the mishap.
ملخص
- Misabs in endodontics are procedural accidents deviating from accepted standards of care, potentially leading to liability. They can arise from practitioner negligence, critical errors, or be untreatable. Prevention through accurate diagnosis, proper case selection, and adherence to basic principles is crucial.
- Root canal therapy involves scientifically-based technical procedures. Lack of knowledge, poor application, or breaks in the proper sequence can cause "endo-in-a-day Misabs." Palpal anatomy's variations impact the ability to completely clean and fill the canal system.
- The causes of misabs are multifactorial: Access-related, instrument-related, ligation-related, observation-related, and post-based preparations. Occurring during diagnosis, access opening, cleaning and shaping, and observation.
- Statistics show a significant percentage of dental negligence cases stem from endodontic negligence, often due to lack of informed consent and proper referral protocols. Fractured instruments, nerve damage, perforations, and infections requiring hospitalization are some consequences.
- When misabs occur, patients must be informed about the incident, necessary corrective procedures, alternative treatments, and the tooth's prognosis. Sometimes, extraction becomes necessary due to extensive damage.
- Diagnostic misabs can involve misinterpreting sinus tracts, where confirmatory tests like GP tracing are essential to avoid treating the wrong tooth. Improper case selection includes non-restorable teeth with extensive caries or vertical root fractures.
- Anesthesia-related misabs include needle breakage, persistent anesthesia, and hematoma formation. Precautions involve using long needles, avoiding full insertion, and managing hematomas with ice.
- Irrigating solutions can cause incidents if injected instead of local anesthesia. Sodium hypochlorite extrusion leads to pain, swelling, and tissue necrosis. Immediate management includes aspiration, ice packs, antibiotics, and analgesics.
- Instrument aspiration or ingestion, often due to lack of rubber dam use, requires immediate medical attention and radiographic examination. Rubber dam isolation misabs can occur if the clamp is swallowed, hence tying the dental floss is a necessity for safety.
- Access opening misabs include isolating the wrong tooth, missing canals, and perforations. Magnification, ultrasonics, and dyes can help locate hidden canals. Access cavity perforations necessitate prompt repair with materials like MTA.
- Ledge formation, an internal transportation of the canal, arises from inadequate straight-line access, using files without pre-curving, and over-enlargement. Separated instruments require bypass techniques, grading, endo extractors, or micro tube and glue methods for removal.
- Instrument retrieval systems like IRA and Masserann kits, along with ultrasonic instruments, are employed to remove separated instruments. Surgical treatment may be necessary when instruments are behind curves or deeply embedded.
- Perforations can be caused by over-instrumentation. Vertical root fractures occur during instrumentation, obturation, or post placement. Post-pest perforations, resulting from misdirection, require careful management with materials like calcium hydroxide or MTA.
- Case reports highlight the successful retrieval of fractured instruments, hemisections for preserving tooth structure, instrument bypass techniques, and repair of perforations using MTA.
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