Dental Products Report - February 2009 - (Page 64)

CLINICAL 360° ENDODONTICS THE TAKE-AWAYS Consider multiple factors to evaluate follow-up for failed endo treatment. Use multiple radiographs when assessing obturation. Retreatment decisions Evaluating all the options is key to making informed clinical choices between retreatment and implants. by D R . RICHARD E. MOUNCE AT A GLANCE THE TEAM Bringing together a variety of voices for the best advice and big ideas. TEAM MEMBERS Dr. John West (Lead) Dr. Richard E. Mounce Dr. Fred Barnett Dr. Susan Wolcott THE SET-UP “It’s Monday morning and your patient had endodontic treatment from years ago that now appears to be unsuccessful. Do you endodontically retreat or remove and replace with a bridge or implant? How do you choose? In this article, Dr. Richard Mounce outlines the biologic and structural thought process needed to make the best decision for maximum predictability.” —DR. JOHN WEST, TEAM LEAD 1 ABOUT THE AUTHOR Richard E. Mounce, DDS, is in private practice in endodontics in Vancouver, Wash. He lectures globally and is widely published. Dr. Mounce offers intensive customized endodontic single-day training programs in his ofﬁce for groups of one to two doctors. He can be reached at RichardMounce@ MounceEndo.com. WHEN The products that appear in conjunction with this article are for illustrative or informational purposes only. Their inclusion does not denote endorsement by the author of this article. it comes to the management of a failed root canal treatment as well as cases where restorability and long-term tooth retention is in question, clinicians now have more options than ever. The primary options for these cases include: retreatment (and orthograde root canal treatment), endodontic surgery, or extraction and an implant or other suitable replacement. As a result of these options, it is vital for clinicians confronted with di ering subjective and objective ndings to have a sound criterion for restorability on which to base treatment planning decisions. Implants have become more predictable over time and, in this sense, implant service challenges endodontics to provide better or at least equal clinical success rates when direct and indirect costs are considered. It is noteworthy that endodontics meets this challenge and does so with fewer maintenance issues than the implant alternatives.1,2 This column will discuss the general indications and contraindications to endodontic retreatment with an indirect goal of illuminating those cases where, depending on the clinical ndings, extraction and implant may be a better option. 2 FIGS. 1 and 2 The apical third of this lower first molar was untouched. Once the gutta-percha was removed passively, patency was easily achieved and the tooth was able to be retreated. Care was taken in the mid-root curvature to ensure a proper glide path was present and that the rotary NiTi file was used passively and gently during canal shaping. Irrigation and recapitulation followed every rotary file insertion. EVALUATING RADIOGRAPHS Radiographic evidence is a key component when evaluating the success or failure of an endodontic treatment. While it should not be the only consideration, a review of radiographs taken from multiple angles, including mesial, distal and buccal, can be valuable when deciding between endodontic retreatment or extraction and replacement with an implant. Figs. 1 and 2 show a case where retreatment was the most viable option, while Figs. 3 and 4 illustrate situations calling for extraction. WEB EXCLUSIVE To access data from the most recent DPR survey on your peers and endo procedures, go to dentalproductsreport.com and search “Endodontics.” Retreatment indications The indications for retreatment involve assessing the technical quality of the existing treatment; whether that treatment can be revised, and if so, to what standard; and whether the existing treatment—even though it may not be ideal—represents a true clinical failure or an “esthetic” failure, such as a situation where the radiograph is unattractive but the clinical situation may be considered a success. While many cases of endodontic success and failure can be easily determined, there are shades of gray. Signs of a successful clinical root canal include ndings that the tooth is functional, asymptomatic, lacks radiographic pathology and has a normal periodontium, or the periodontal status has not worsened since DENTALPRODUCTSREPORT.COM | February http://www.dentalproductsreport.com/articles/show/dpr0508_tid_endodontics http://www.dentalproductsreport.com

Table of Contents Feed for the Digital Edition of Dental Products Report - February 2009

Dental Products Report - February 2009 Contents From the Editor 10 Questions Product Watch Clinical 360° Is This Your Nightmare? Place Predictable Posterior Restorations The New Standard in Caries Diagnosis Veraviewepocs 3De Retreatment Decisions Soft Tissue and Periodontal Diagnosis The Importance of Immunization Products in Practice How to Up Your Caries Detection Game A Team of Experts SurgiTel Oakley Loupes Snap-On Smile Word of Mouth

Dental Products Report - February 2009

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