Orthograde endodontic retreatment
Whether an endodontic treatment has an acceptable or not radiographic appearance, many times the aims of Endodontics have not been fulfilled. Prevention and treatment of apical periodontitis is the cornerstone of our treatments and when a revision of a previous treatment is needed many factors are to be taken into consideration in order to achieve the desirable results.
Armamentarium and level of training are important, still nowadays technology has made our lives easier in many aspects and in all stages of the treatment. From diagnosis to restoration microscopes and different instruments help us to be thorough and effective in most cases and have reproducible results. Enhanced magnification is essential in all stages of the treatment, especially in locating missed canals, which is the main reason for treatment failure. Modern rotary files and ultrasonic tips also help us deal with the problems the previous operator might has faced with even greater ease and reduced risk. In addition to these, high resolution CBCT has revolutionized the way we interpret our x-rays and correlate them to clinical reality, thus changing the way we think and act, thus becoming more and more essential.
The retreatment process does not only involve the renewal of the root canal filling materials. It has to do with the treatment of an infection, with a different microbial spectrum from the primary treatment, in an environment where most of the times mishaps and mistakes also exist. Separated instruments, ledges, perforations and previous materials and posts complicate the situation. The correction and removal of these is sometimes a difficult task and careful planning is needed in order not to create more problems than the ones we have to solve.
Moreover, in the treatment plan, the dentist has to be able to have in his mind the goals of the procedure and whether or not he can offer an alternative treatment. Careful case selection under the prism of medical and dental history, the cost-benefit equation, and a sound diagnosis allows us to choose between orthograde endodontic retreatment and surgical options.
In general aim of the lecture is to improve the understanding and to increase awareness regarding the different factors that affect dealing with treatment failures.
After the lecture the attendant will know:
- How to make a sound diagnosis in a retreatment case
- How to take into consideration all those factors that affect treatment planning
- When to partially retreat a tooth or when not to retreat at all
- When to ask for CBCT imaging and how to get the most out of it in terms of interpretation
- How to give realistic prognosis to his cases and when to propose extraction
- When surgery is a better option
- The techniques for instrument removal and when bypassing or not dealing at all is indicated
- How and when it is advisable to treat with perforations in all thirds of the root canal system
- How to bypass ledges and how to avoid forming new ones
- How and when to deal with previous post and core restorations
- How to deal with all kind of different filling materials, including silver points and red Russian cement
- Which instruments and techniques to use during mechanical preparation
- How to improve disinfection and how to deal with heavily infected cases
- How to treat flare-ups
- When to retreat in one or more sessions and why
Carlos Aznar Portoles is in 2004 afgestudeerd als tandarts aan de Universitat Internacional de Cataluña, in Spanje. In 2009 heeft hij hier ook een MSc in endodontologie afgerond. Sindsdien bestaan zijn werkzaamheden uitsluitend uit endodontologie.
Carlos heeft zich in 2011 in Nederland gevestigd, waarna hij het ‘Postgraduate programme in Endodontology’ van ACTA (Amsterdam) heeft afgerond. Carlos is erkend als Tandarts-Endodontoloog door de NVvE (Nederlanse Vereniging voor Endodontologie).
Carlos heeft diverse artikelen gepubliceerd in vakbladen en geeft regelmatig nationale en internationale lezingen. Hij is gastdocent aan de Universitat Internacional de Cataluña en is betrokken bij de organisatie van de cursus ‘Endodontic Microsurgery and Retreatment’ in Caracas (Venezuela).
"The new Endodontic Microsurgery: the attention to the small details"
Endodontic microsurgery has proven to be a very predictable alternative for the treatment of teeth with Apical Periodontitis. Outcome studies show very high success rates when modern techniques are employed. But, is there any room for improvement? During this conference we will review the different steps of the microsurgical endodontic treatment and evaluate different approaches and techniques. We will discuss in depth ergonomy of the whole team, 3-D treatment planning and new materials available.
- List the different indications for modern endodontic microsurgery
- List the different steps of endodontic microsurgery
- Learn new materials and microsurgical techniques