2020 Volume 8 Issue 3

Evaluation of Endodontic Errors Causes and Management Approach: Literature Review

Rawan Waleed Alhussain1, Yaqean Khaleal A Alhajimohammed1, Rola Eid Almohammadi1, Razan Waleed Alhussain1, Asma’a Ayed Alruwili1, Entesar Jaber Almalki2, Asma Mohammed Shagagi3, Hanin Mohammed Basheer3, Salih Mohammed Aljasem4, Abdullah Khaled Abdullah Albaz5

1 Faculty of Dentistry Medicine, Alfarabi Medical College, Riyadh, KSA.

2 Department of Dentistry, Evian Dental Center, Aseer, KSA.

3 Faculty of Dentistry Medicine, King Abdulaziz University, Jeddah, KSA.

4 Faculty of Dentistry Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA.

5 Dentistry Department, Prince Sultan Military Medical City, Riyadh, KSA.


ABSTRACT

Background: Endodontic treatment (ET) is an operative dental procedure that aims at managing an infected tooth pulp. The tooth pulp contains the neurovascular bundle that is encapsulated within a hollow structure of the tooth termed root canal. One of the essential predictors of effective bacterial eradication and future dental protection is sedulous operative techniques.

Objectives: The occurrence of any of the aforementioned errors can result in devastating consequences, and thus, ET errors are of extreme importance and clinical relevance for practicing clinicians. Therefore, in this paper, we will review the proper literature discussing the causes and the available treatments of ET errors.

Methodology: We conducted the literature search within the PubMed database using the keywords: “Endodontic” and “Errors” and “Treatment” and “Failure” and “Root” and “Canal” and with dates from 1990 to 2020.

Review: A dentist might run into many unforeseen complications that might directly affect the o of the outcome of the disease. Appropriate knowledge and expertise of performing procedures in a standardized fashion is vital to prevent and/or overcome such complications should they arise

Conclusion: In conclusion, the current review has summarized the current state of the literature regarding the causes and treatments of endodontic errors. It has explained the various processes common endodontic errors occur during the multiple phases of endodontic management.

Key words: Endodontic; Errors; Treatment; Failure.


Introduction

 

Endodontic treatment (ET) is an operative dental procedure that aims at managing an infected tooth pulp. The tooth pulp contains the neurovascular bundle that is encapsulated within a hollow structure of the tooth termed root canal. The main objectives of ET are (1) infection eradication and (2) tooth protection. Despite the importance of all procedural steps in endodontic management, complete elimination of bacterial infection from the root canal system is the key step 1.

One of the essential predictors of effective bacterial eradication and future dental protection is sedulous operative techniques. For example, it is estimated that success rates approaching 100% could be achieved if such meticulous practice is followed 2, 3. In contrast, a significant increase in failure rates is observed in a situation where poor effort is made to eliminate affected tissues 4.

ET errors can be classified into three main categories: (1) length errors, (2) cleaning errors, and (3) obturation quality errors. For example, length-related ET errors can manifest in over-filling or under-filling of the managed tooth. While cleaning-related ET errors can present in multiple ways, including: (1) ledge formation, (2) apical transportation, (3) perforations, and (4) instrument fracture. Lastly, voids, lack of uniformity, and lack of homogeneity can all result from poor quality of obturation.  Having poor health care or any defect on the external surface of the teeth enamel makes the teeth prone to discoloration 5-8. The criteria considered for assessing the radiographic quality of root filling (Table 1).

Parameter

Criteria

Definition

Length of the root canal filling

Adequate

Root canal filling is 0-2 mm from the radiographic apex

Under -filled

When it is more than 2 mm from the radiographic apex

Overfilled

Any extrusion beyond the radiographic apex.

Density

Adequate

Homogeneous with the absence of voids

Inadequate

Not uniform homogeneity with the presence of voids.

Taper

Adequate

Consistent and uniform taper from the coronal to an apical area with a reflection of the original shape of the canal.

Inadequate

Inconsistent taper

Procedural errors

Ledge

A root filling is at least 1 mm shorter than the working length and deviated from the original canal shape in teeth where root canal curvature occurred.

Transportation

The filling material is located on the outside curve of the canal at the apical third

Perforation

The obturation material is detected outside the canal walls

Source: Evaluation of the Quality of Root Canal Treatments Performed by Dental Undergraduates: Is There a Need to Review Preclinical Endodontic Courses?.

Table 1. Criteria used to assess the radiographic quality of root filling.

The occurrence of any of the aforementioned errors can result in devastating consequences, and thus, ET errors are of extreme importance and clinical relevance for practicing clinicians. Therefore, in this paper, we will review the proper literature discussing the causes and the available treatments of ET errors.

Methodology:

We conducted the literature search within the PubMed database using the keywords: “Endodontic” and “Errors” and “Treatment” and “Failure” and “Root” and “Canal” and with dates from 1990 to 2020. We also used the Google Scholar database for additional literature search. After reading the abstracts, we manually selected the relevant papers for this review. In regards to the inclusion criteria, the articles were selected based on the inclusion of one of the following topics; endodontic treatment failure and management of endodontic treatment failure. Exclusion criteria were all other articles that did not have one of these topics as their primary endpoint.

Review:

A dentist might run into many unforeseen complications that might directly affect the o of the outcome of the disease. Appropriate knowledge and expertise of performing procedures in a standardized fashion is vital to prevent and/or overcome such complications should they arise 9.

  • Length Errors:

Among all types of ET errors encountered during root canal treatment, some errors pose the most significant adverse effects on the outcome. For example, over- and under-fill have been shown to significantly decrease success rates 2, 10. Table 2 shows the characteristics of clinical and imaging outcomes in RCT.

Outcomes

Clinical features

Imaging aspects

Success

Absence of pain

Absence of periapical radiolucency

Tooth with definitive restoration

Tooth in masticatory function

 

 

 

Failure

Presence of pain

Presence or regression of periapical radiolucency

Tooth with definitive restoration

Tooth with a temporary restoration

Presence of swelling, sinus tract

 

 

 

Doubt

Absence/presence of pain

Presence of periapical radiolucency/ Absence of periapical radiolucency

Presence of sporadic pain

Presence of discomfort

Presence of swelling

Presence of sinus tract

RCT: Root Canal Treatment. Source: Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment.

Table 2. Characteristics of clinical and imaging outcomes in RCT.

It has been shown that during the management of root canal disease, filling material should no extend into periapical tissues. Despite careful attention in avoiding any extension, erroneous over-extension of such materials may take place. Tissue demise or post-operative pain are among the most commonly reported complications associated with overfilling errors 11, 12.

Management of length related errors can be accomplished with surgical removal of dental material from the affected canal. This has been shown to significantly improves symptoms of paraesthesia and anesthesia resulting from over-filling 12, 13.

  • Cleaning and Preparation Errors:

A deviation from the original canal curvature without coming in contact with the periodontal ligament is known Ledge formation is defined. This error can be caused by using small files that do not reach the full length of the canal 14.

Ideally, ledges should not occur in the first place, and thus, the best approach to manage them is by preventing their occurrence. The dentist’s experience plays an important role and thus learning from the previous misencounter is essential as it has been shown that treatment evaluation and critical analysis of one’s work can help prevent future occurrences 15.  Additionally, the usage of appropriate pre-operative and imaging during the procedure to determine the length of the root canal will significantly improve outcomes and prevent ledge formation 16.

Root perforation (RP) is a serious ET error that can occur during root canal treatment 10. If encountered, RP can seriously affect the treatment outcome and can persist as a significant postoperative complication if not managed. They mainly occur during the preparation phase of root canal treatment 17.

Concerning the management of RP, numerous materials can be used, such as (1) Indium foil, (2) Amalgam, (3) Plaster of Paris, (4) Zinc Oxide Eugenol, and (5) Gutta Percha. Table 3 shows the ideal requirements of root repair material. Table 4 shows various materials used for perforation repair.

Requirements of root repair material

It should provide an adequate seal.

It should be biocompatible.

It should have the ability to produce osteogenesis and cemento-genesis.

It should be bacteriostatic, and radiopaque.

It should also be beneficial to use a resorbable matrix in which a sealing material can be condensed.

It should be relatively inexpensive.

It should be non-toxic, non-cariogenic, and easy to place.

Source: Hartwell GR, England MC. Healing of furcation perforation in primate teeth after repair with decalcified freeze-dried bone: a longitudinal study. J Endod. 1993;19:357–61.

Table 3. Ideal requirements of root repair material.

Material

 

Indium foil

Cavit

Amalgam

Glass Ionomer Cement

Plaster of Paris

Metal-Modified Glass Ionomer Cement

Zinc Oxide Eugenol

Composite

Super EBA

Dentin chips

IRM (Intermediate Restorative Material)

Decalcified Freezed Dried Bone

Gutta Percha

Calcium Phosphate Cement

Table 4. Various materials are used for perforation repair.

  • Cavity Access Errors:

Furcal perforation is one of many feared complications that might occur during ET 18. Burs and inadequate direction while performing pulp chamber ceiling removal can result in this type of accident 17, 19. The prognosis of such errors is unfavorable 20. The management of furcal perforation is similar to that of apical perforation; however, favorable outcomes were obtained using calcium hydroxide 17, 21.

Conclusion:

In conclusion, the current review has summarized the current state of the literature regarding the causes and treatments of endodontic errors. It has explained the various processes common endodontic errors occur during the multiple phases of endodontic management. It is evident by those errors the vital role of clinicians to maintain the accuracy of the working throughout the procedure, especially the length as it is by far the most common error. Additional care must be directed towards community awareness programs that explain the importance of preventing caries, as caries can progress to endodontic treatment.

References

 

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  21. Holland R, Bisco Ferreira L, de Souza V, Otoboni Filho JA, Murata SS, Dezan E, Jr. Reaction of the lateral periodontium of dogs' teeth to contaminated and non-contaminated perforations filled with mineral trioxide aggregate. Journal of endodontics. 2007;33(10):1192-7.

 

Corresponding Author

 

Entesar Jaber Almalki

Department of Dentistry, Evian Dental Center, Aseer, KSA.

Email: entealmalki @ hotmail.com

Issue 4 Volume 8 - 2020
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