ACCIDENTS AND INCIDENTS DURING CONSERVATIVE DENTISTRY AND ENDODONTICS TREATMENTS

ACCIDENTS AND INCIDENTS DURING CONSERVATIVE DENTISTRY AND ENDODONTICS TREATMENTS

Any conservative or endodontic treatment, like any other treatment, can cause complications. These are relatively rare when the principles of conservative or endodontic therapy are followed.

1. Accident incidents during restorative treatment (during curettage):
   1. Accidental exposure of the pulp:

A poor assessment of the depth of the cavity and its proximity to the pulp can lead to damage to the pulp horn during dentin curettage.

2. Accident incidents during endodontic treatment:
   1. Accidents in the use of arsenic dioxide

• The arsenic rocket.
  • Causes:
    • Technical foul.
    • Leakage of the dressing.
    • Necrosis may affect: Gum, periodontal ligament and bone.
• Action to take:
  • Redo the dressing.
  • Removal of the eschar or sequestrum.
  • Do a good curettage until you see bleeding.
  • Application of antidote drugs such as: ferric hydrate porridge.

2. Perforation of a coronary wall during the creation of the access cavity

• Causes
  • Lack of knowledge of anatomy.
  • wrong orientation of the cutter axis relative to the root axis.
  • Bad technicality.
• Action to take:
  • Restoration of the perforation as if it were a cavity.

3. Accidents during the search for canal entrances
4. Floor perforation

* Causes

• Lack of knowledge of endodontic anatomy.
• Bad technicality.
• Bad reading of the preliminary radio.
• Reduction in the volume of the pulp chamber or presence of calcification making the orifices invisible.

* Signs:

Heavy hemorrhage in sheets, intense pain, and a stinging sensation in the event of necrosis.

* Action to take:

-Hemostasis.

🡪 If the exposure is recent and small:

• dressing the wound with sodium hypochlorite then rinsing with physiological serum.
• careful drying using sterile paper tips.
• Deposit of calcium hydroxide (it must be renewed 21 days later) or MTA in contact with the perforation.
• permanent obturation of the canal system.
• Place a temporary watertight coronal filling.

🡪 If the perforation is large or old: Surgical intervention is required either:

— by separating the roots if they are sufficiently divergent.

— by amputating a root.

The endodontic phase must precede the surgical phase.

— if endodontic treatment proves impossible, extraction is necessary.

2. Accidents occurring during preparation:
3. Instrumental overtaking
   • Causes:

-Incorrect determination of the length of the work.

-forced instrumental introduction.

-unnoticed movement of stops

-presence of anatomical and pathological conditions favoring displacement.

*clinical signs:

• If the tooth is not anesthetized, there will be a stinging sensation.

-Hemorrhage.

• conduct to adopt:
• Stop the bleeding with a hemostatic solution (NaCl bath for 4 to 5 minutes).
  • Rectification of the LT.
  • Prescription of NSAIDs and painkillers.

2. Creating a fake channel
   • Definition: It is an artificial route starting from the pulp chamber or canal and ending in the periodontal ligament.
   • Causes
     • surgical error during canal unblocking.
     • Presence of an obstacle to overcome.
     • Improper use of instruments.
   • clinical signs:
     • ligament sensitivity if the tooth is not anesthetized.
     • heavy bleeding.

Confirmation is made by X-ray.

* Action to take:

– False cervical canal of the third cervical vertebra

.Hemostasis.

.Ca(OH)2 or MTA filling to close the opening leading to the periodontal ligament.

.Permanent sealing.

– False canal of the middle or apical 1/3

. Hemostasis.

. Consider the false channel as a channel.

. Root canal filling with hardening paste.

3. Dentin plug

The dentin plug is made up of organic debris pushed out by the instruments and dentin chips detached by the instruments.

• Causes

• Absence or insufficiency of irrigation.
• Failure to follow the instrumental sequence.
• Neglect of the recapitulation.
• Action to take
  • Abundant irrigation with sodium hypochlorite.
  • Introduction of a pre-bent 0.8 MMC and rotation.
  • If this fails, dry the canal and fill it with RC Prep for 2 to 3 minutes and repeat the operation.
  • taking an x-ray to ensure that the plug has been crossed and the instrument has reached the apical limit.

4. Shoulder or step
   • Causes
     • Uncontrolled action of the files at the middle or apical 1/3.
     • Presence of curvatures.
     • use of rotating files.

• Action to take:
  • Pre-sew an MMC file (0.8).
  • Coat the canal with RC Prep.
  • Go up to the shoulder contact, turn the file a few degrees until the shoulder is clear.
  • Once the apical limit is reached, use a file or MME(15) under abundant irrigation to erase the shoulder.

5. Hemorrhage
   • Causes

• Laceration of pulp tissue.
• Repeated crossing of apical limits by instruments.
• Punctures and false passages.
• Action to take:

If bleeding occurs at the beginning of the preparation :

• Continue the preparation under abundant irrigation with sodium hypochlorite while respecting the Length of Work (LT).

Bleeding during TRT :

• Check the LT, ensure that there is no false channel and stop the bleeding with a sodium hypochlorite bath for 4 to 5 minutes before resuming preparation.

Bleeding at the end of preparation :

• Stop the bleeding with a NaCl bath.
• Dry using absorbent tips.
• make a stop cone and carefully seal it.

Heavy and stubborn bleeding :

• Use lime milk for washing or fill the canal with Ca(OH)2 for a few days or place a wick soaked in haemostatic solution (trichloroacetic acid).

6. Instrumental fracture

🡪 Manual instruments for root canal preparation

• Causes
  • Fatigue from repeated sterilization cycle.
  • Exerting excessive force on the instrument.
  • Inadequate access cavity.
  • Poor technique of the practitioner.
  • Preparation without irrigation.
  • Patient fatigue and uncooperation.
  • Complicated canal morphology.

* Action to take:

. Immediate R(x) (location, length of the fractured part).

. Use of eviction means: 1 – Mechanical:

-> The principle of Marmasse friction which consists of passing alongside the broken instrument and reaming the canal beyond it.

-> Gripping (Masserann’s method) which consists of using the Masserann extractor. Masserann’s idea is to take the fragment of the instrument by introducing a tube around it which encases it and allows it to be removed.

-> the Bypass technique which consists of:

-redevelopment of the access cavity to eliminate overhangs.

-fill the access cavity with chelator.

-a file no. 08 or 10 will be introduced along the fractured instrument with a creeping movement from near to near.

– radiological control for each mm of progression.

-when the fragment is completely bypassed, the operation must be repeated with different files of increasing size until a 15 file can pass freely.

-introduction of a No. 15 ultrasonic file while stationary.

-activation under abundant irrigation.

-reassemble the fractured fragment.

2. – Surgical (resection of the apex if the fragment is at the apical level);
3. – Acoustics and laser.

. Failed: extraction.

🡪 Rotary instruments for root canal preparation

• Causes
  • Cyclic fatigue of the instrument.
  • Very high rotation speed.
  • Instruments forced into the canal.
  • Technical fault of the operator .
• Action to take
  • R(x) immediate.
  • Use of eviction measures.
  • Failed: extraction.

7. Subcutaneous emphysema
   • Definition

– Infiltration of water or gas into subcutaneous or submucosal tissues.

• Causes
  • Use of compressed air for canal drying.
  • Favored by:

The existence of a periapical lesion.

. Large periodontal pocket.

• Action to take:
  • Reassure the patient (emphysema resolves spontaneously or after a few days 4-5 days).
  • ATB coverage is mandatory if the tooth to be treated is infected.

8. Swallowing and inhalation of a root canal instrument (foreign body)
   • Causes
     • Position of the tooth.
     • Long duration of certain treatments.
     • Small instruments.
     • gloved hands and wet oral cavity.
     • Lack of isolation by an adequate operating field.

* We can have either:

• Fall in the digestive tract => swallowing.
• Fall into the airways => inhalation.

Symptomatology : allows the instrument to be located

-Supra laryngeal => breathing and swallowing disorders.

• Laryngeal => breathing disorder and characteristic noises.
• Tracheal => trouble breathing, noises and coughing.
• Bronchial => Dyspnea, cough or no signs.

Action to take

• Reassure the patient.
• Careful inspection to see if the instrument is secured in an area accessible with a clamp.
• Swallowing instrument:

. At the stomach level => Clinical monitoring and regular examination of the stools will confirm the evacuation of the instrument.

. At the level of the esophagus => Emergency endoscopic examination which allows the disinsertion and extraction of the instrument.

• Inhaled instrument:

The patient will be given oxygen while waiting for the emergency services to arrive.

. If complete asphyxia with cyanosis: HEMLICH maneuver.

3. Accidents related to root canal filling
4. Fracture of a root canal obturation instrument

• Rotary instrument (lentulo)
  • Causes
    • Lentulo not tested before use.
    • Lentulo placed in a channel that is too narrow / its Ø.
    • Lentulo returned to the canal.
    • Passage of the lentulo into the apical narrowing.
    • Too fast rotation causing dangerous twisting.
    • Reverse rotation.
    • Worn instrument.

Action to take:

Fracture during root canal filling

=> Lentulo visible: removed using a tweezer.

=> Invisible lens: take another one and turn it counterclockwise.

=> Lentulo sealed with the filling paste and the canal is filled: leave in place.

=> Fractured lentulo before apical obturation:

try to fill the apical part using the paste pushed by a pin.

• Old fracture

=> if the lentulo is not sealed: extraction of the debris if not we try to pass next to it and block the canal.

• Old fracture

=> If the lentulo is not sealed:

• Extraction of the debris, otherwise we try to go around it and block the canal.

=> If the lentulo is sealed:

• We try to soften the dough and extract the debris.
• Manual obturation instrument

– The fracture of the rammers is exceptional.

2. Excess of the root canal filling material
   • Causes
     • Failure to respect the working length.
     • Destruction of the cemento-dental junction.
     • Very fluid consistency.
     • Lentulo used at very high speeds.
   • Action to take:

=> Exceeding at the periapical level.

• In case of slight excess: abstention.
• In case of significant excess: surgical TRT.

Conclusion

Endodontic practice is a mix of successes and failures.

The constant improvement of our technology based on respect for fundamental biological principles should make it possible to limit failures and complications and push back the limits of endodontics .

ACCIDENTS AND INCIDENTS DURING CONSERVATIVE DENTISTRY AND ENDODONTICS TREATMENTS

  Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.

ACCIDENTS AND INCIDENTS DURING CONSERVATIVE DENTISTRY AND ENDODONTICS TREATMENTS