Dental Products Report - February 2009 - (Page 66)

CLINICAL 360° ENDODONTICS AT A GLANCE 3 4 FIG. 3 The furcation has been perforated, the distal root fractured, and there is evidence of coronal microleakage. This tooth needs immediate extraction. FIG. 4 Overzealous use of orifice openers created a strip perforation in the mesial root of this lower molar. The patient was 12 years old; when presented with all the options, the mother opted to extract the tooth. treatment. Alternatively, signs of clinical failure include teeth that: Are painful to chewing or will not allow function. (An endodontically treated tooth that is becoming more painful to chewing—and is duplicated with percussion sensitivity, one measure of the degree of apical in ammation—shows symptoms that all point to a clinical failure.) Are spontaneously painful— usually a dull pain. Have developed radiographic signs of pathology where none existed before or have unresolved radiographic pathology. Show signs of periodontal breakdown (bone loss) as, for example, a result of vertical root fracture. In general, failed root canals are without thermal sensitivity, especially to cold. The above not withstanding, some failed cases may present with a chief complaint of pain to hot. They are uncommon, and such cases require consultation with a specialist. Patient symptoms are but one measure of the need for retreatment and a possible determination of failure. In the mind of the endodontist who retreats a wide variety of failed cases, there may be little di erence in urgency between cases requiring retreatment with and without symptoms. Asymptomatic teeth with obvious pathology and previous defective treatment are often highly unpredictable. The tooth may remain asymptomatic for long periods of time or are up without warning. It is unknown when such teeth will are up, but it is almost a certainty that they will. It is far simpler to manage these cases while they are asymptomatic rather than to watch and wait. Waiting can lead to more complex management with incision and drainage as a necessary f irst step before retreatment. The same is true of first-time orthograde cases where an obvious radiographic pathology is observed and is veri ed by the required objective tests, including cold, percussion, palpation, mobility, probings and radiographic evaluation. Simply put, it is better to treat the “quiet” non-vital tooth rst rather than manage such a case after it has ared up. 61% of general practitioners refer endodontic retreatment cases to specialists. Source: May 2008 DPR Endodontics Survey Determining restorability The rst consideration when assessing the relative merits of endodontic retreatment versus implants is a restora bi lity assessment. Clinical opinions of what is restorable and what is not vary widely. Factors such as the number of patient visits required, patient discomfort, longterm predictably of the treatment, risk of vertical fracture, treatment cost, required interventions and maintenance required to make an implant successful must be considered when weighing the future viability of the tooth against the option of extraction and implant. The functional service to the patient that both implant and retreatment will provide must be taken into account as well. In determining restorability, the clinician should consider the amount of bone remaining, tipping, rotations, access limitations, feasibility of retreatment, risk of vertical fracture, remaining tooth structure, furcal involvement, tissue contours, erosion attrition, abrasion, parafunctional habits, the periodontal probing, the amount and health of attached gingiva, root morphology, function of the tooth, direct and indirect costs, patient desires, medical history, dental history, and the patient’s esthetic and functional needs. In addition to the list above, a consideration of restorability should take into account an assessment of whether a tooth that is not restorable now can be made restorable in the future, usually through periodontal intervention. Endodontic success and failure Deciding whether the treatment has healed or failed may not be entirely DENTALPRODUCTSREPORT.COM | February http://www.jsdental.com http://www.jsdental.com http://www.dentalproductsreport.com

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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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