INTRODUCTION

Man desires success. Mishaps can be considered to be natures curse.,

but a pathway for future success.
Success and failure are part of the game. Failures are necessary if we
want to relish success. Failures are milestones to success. Similarly endodontic
mishaps are a milestone in the journey of an endodontist.
DEFINITION (INGLE):
Endodontic mishaps or procedural accidents are those unfortunate
occurrences that happen during treatment, some owing to inattention to detail,
others totally unpredictable.
STEPS FOR MANAGEMENT OF MISHAPS
Recognition
 First and foremost is recognition of size, site and type of lesion
 May be by radiograph
 Clinical observation (objective symptoms)
 Patients complaint (subjective symptoms)
e.g. taste of sodium hypochlorite due to a perforation of the crown of tooth
pain during treatment i.e. missed canal
Correction: depends on
 Type
 Extent
 Site
Sometimes a mishap causes such damage that it may need extraction.
Revaluation of prognosis
 Reevaluation may effect the entire treatment plan
 Effects the entire treatment plan
 May involve dentolegal consequences. What will be future of lesion after
restoration.
Prevention
 Key to prevent mishap – experience that is we learn from our own and other’s
mistakes.
Treatment and evolution:
Examine the various steps that lead to the mishap and determine how it
could have been avoided. Treatment evaluation can help prevent future
occurrence.
Endodontic mishaps sometimes have dento legal consequences. These
can be avoided by providing patient with adequate information prior to
endodontic procedure
It procedural accident occurs inform the patient of the nature of mishaps
what can we done to correct it.
 Prevention is better than cure
DIFFERENCE BETWEEN MISHAP AND RETREATMENT
‘Mishap’ is a broader term which includes retreatment. Retreatment is one
of the steps in management of mishaps.

CLASSIFICATION OF ENDODONTIC MISHAPS

Access Related:
 Treating the wrong tooth
 Missed canal
 Damage to existing restoration
 Access cavity perforation
 Crown fracture
Instrumentation Related:
 Ledge formation
 Cervical canal perforation
 Midroot perforation
 Apical perforation
 Separated instruments and foreign object
 Canal blockages
Obturation related:
 Over or under obturation
 Nerve paresthesia
 Vertical root fracture
Miscellaneous:
 Post space perforation
 Irrigant related
 Tissue emphysema
 Instrument aspiration and ingestion
ACCESS RELATED MISHAPS
 Misdiagnosis: if tooth number 23 has been diagnosed with a necrotic pulp
and rubber dam is placed on tooth fracture 24 and tooth opened that is
mishap.
 Recognition:
- Symptoms after treatment
- Error may be detected after removal of the rubber dam have been
removed
 Correction:
- Appropriate treatment of both teeth
a) One which is opened
b) One with the original problem
Explain to the patient what has happened and how it can be solved.
 Prevention:
- Detailed history / symptoms
- Before making a definitive diagnosis obtain at least three good pieces of
evidence supporting the diagnosis
a) Radiograph with apical lesion
b) Electric bulb testing
c) Draining sinus tract
- Mark tooth with pen before rubber dam application
Missed Canals:
Some root canals are not easily accessible or readily apparent from the
chamber .e.g.: Mesial roots of maxillary molar and distal roots of mandibular
molar. Lack of knowledge about root canal anatomy can lead to missed canals.

Recognition:
 During or after treatment
Instrument or filling material is not exactly enter in the root

Fast break
 Computerized digital radiography
 Magnifying lobes
 Microscope
 Endoscope
Correction:
Retreatment before an attempt for surgical correction.
Prognosis:
 Decreased prognosis results in treatment failure
 In case of Type-II apical foramen may be sealed
Prevention:
 Adequate coronal access
- Follow principles of access cavity .
- Radiograph to be taken with mesial or distal angle
 Eccentrically located canals
 Proper knowledge of root canal morphology
Armamentarium and Technique:
 Anatomical familiarity
 Radiographic analysis i.e. cone directed straight on mesio oblique and disto
oblique
 Computerized digital radiography (CDR)
 Magnifying loupes, head lamps translumination device, microscope
 Surgical length bur enhance direct vision by moving the head of hand piece
further away
 Access cavity – occlusally broad, firmly probe the floor for catch
 Piezoelectric ultrasonic new CPR ultrasonic instruments CPR – 1-5
ziroconium
 Micro-opener (Dentsply Malleifer -flexible, stainless steel of set handle)
 Taper – 0.04-0.06
 Enhance strength, easier to locate penetrate and perform initial enlargement.
 Dye like methylene blue – rinse and dry- it will road map the anatomy
 Sodium hypochlorite (NaOCl) (champagne test) – after closing and shaping,
access cavity flooded with NaOCl.
Solution is observed to see if bubbles are present.
Bubbles represent that either sodium hypochlorite is reacting with residual
tissue within canal or reacting with a missed canal.

DAMAGE TO EXISTING RESTORATION

Preparing an access cavity through PFM crown will chip off porcelain
Correction:
Minor chip – composite resin
Prevention:
 Placement of rubber dam
 Jaws of clamp to be placed coronal to margin of restoration
 Release rubber dam from wings and position with rubber between the jaws of
the retainer and restoration to provide a better grip.
 Remove crown with special device called Metalift crown and bridge system
 Vibration

GRASPING INSTRUMENT
 Trident crown placer(CK dental specialties)
 K.Y. pliers
 Wynman crown gripper
Percussive instrument
 Force delivered either directly or indirectly to restorative
 Ultrasonic energy
 Peerless crown
 Corono flex
Active instrumentation
 Devices cut small occlusal window to facilitate mechanical action of the
instrument.
 Metalift (Classic practice)
 Kline crown remover (Brasseler)
 High bridge remover (Higo, Manufacturer, Canada)

ACCESS CAVITY PERFORATION

In the process of searching for canal orifices, perforations of the crown
can occur. Either peripherally through the side of crown or through the floor at the
chamber into the furcation.
Recognition:
 Above the periodontal attachment
- Presence of leakage either saliva into the cavity or NaOCl out in to the
mouth
 Perforation into periodontal ligament
- Bleeding
- To confirm place a small file and take a radiograph.
Correction:
 Perforation of coronal walls above the alveolar crest can be repaired
intracoronally without the need for surgical intervention.
- Perforation, in to the periodontal ligament
Laterally
Furcation
 Good seal as soon as possible
 Materials – Cavit, amalgam, calcium hydroxide, GIC or haemostatic agent
such as Gelform.
Barrier technique:
 Artificial barrier (floor) using either calcium sulphate and hydroxyapatite is
used as a barrier, significantly improving the sealing ability of Vitrebond and
providing successful barrier against its over extension.
 Concept of artificial barrier against which to condense and help combine the
repair material has led to the use of absorbable i.e. haemostatic collagen
product such as collostat OBP,collacote.
Calcium hydroxide:
 Control bleeding
 Calcium hydroxide placed in the area of perforation and left for at least few
days will leave the area dry and allow for inspection of perforation.
Prognosis:
 Prognosis for tooth perforation depends on the location, length of time the
perforation is open to contamination, the ability to seal the perforation and
accessibility to main canal.
 Sooner the repair undertaken better will be success
Prevention:
 Examination of preoperative IOPA
 Check the long axis of tooth aligning the long axis of the access bur with tooth
 See for calcified chamber (no drop felt)
 Improper access opening – close attention should be paid to principles of
access cavity preparation
 Proper knowledge of tooth anatomy pulpal anatomy.

CROWN FRACTURE
Infraction may be present earlier. Parts of crown may be mobile when
patient chews on tooth and it may become true fracture weakened additionally by
an access preparation.
Recognition:
 Direct observation
 When infraction become true fracture, part of crown may be mobile
 Usually extraction unless fracture is of “chisel type”
Treatment – loose segment is removed. If it is an extensive fracture, then it may
need to be extracted.
Prognosis:
 Crown infraction may spread to the roots leading to vertical root fracture.
Prevention:
 Reduce the occlusion before working length.
 Infraction cases – bands or temporary crowns can be used.

INSTRUMENT RELATED MISHAPS

Ledge:
 Internal transportation of canal creates ledge.
Complication:
 56% buccal curvature of palatal root of maxillary first molar.
 Labial or lingual curvature of maxillary central incision and canine.
Recognition:
 Instrument not inserting to full working length.
 Loss of normal tactile sensation i.e. instrument hitting against solid wall, loose
feeling with no tactile sensation of tensioned binding.
 Instrument point appears to be directed away from the lumen of the canal.
Correction:
 Small file No. 10 or 15 with curvature of the tip.
 Tip of instrument directed to apposite wall to that of the ledge. (tear shaped
silicone stop)
 Watch – winding motion
 Whenever resistance felt or met the file is slightly retracted, rotated and
advanced again until it by pass ledge.
 It exploring instrument can be introduced full working length take radiograph.
 Use lubricant, irrigate frequently to remove dentin chip and maintain curvature
and use short strokes where ledge is located.
Greater Taper files :
GT files are not introduced into the canal until the ledge has been
bypassing canal negotiated the canal and patency established.
By barring the ledge and negotiating the canal up to a No. 15 , if
necessary No. 20 file creates a pilot hole so that GT file can passively follow this
glide paths.
 Pre curve the instrument with Endo Bender plier. Securely grasp between
jaws of the file border and handle is pulled through radius of between 180 to
2700. Use in a crown down position.
In the instance when the ledge can’t be removed, fitting master gutta-
percha cone can be challenging. In such cases, master cone is trimmed so the
terminal diameter equals the so diameter of the file that was snug at length.
Cone is then pre curved to stimulate curvature of canal and radicular
portion is placed in a dappen dish of 70% isopropyl alcohol. Place orientation
notch on cone to recognize placement of cone.

PERFORATION
Radicular perforation:
1. Cervical
2. Mid root
3. Apical root
 Perforation of all these locations may be caused by two errors
1. Creating ledge in canal wall during initial instrument and perforating
through the side of the root of the point of canal obstruction and root
curvature.
2. Using too large or too long an instrument and either perforation directly
through apical foramen or wearing hole in lateral surface (canal stripping)

Cervical canal perforations:

During widening or location of canal orifice or inappropriate use of gates
glidden drills.
Recognition:
 Sudden appearance of blood which comes from periodontal ligament space.
 Magnification with loupes, endoscopy or a microscope very useful in this
situation.
 Use radiograph after placing small file.
Correction:
 Both internal and external repair
 Small area – sealed from inside the tooth
 Large area – seal first from inside then surgical exposure external aspect of
tooth and repair damaged tooth.
 Material used – Geristore (Amalgam, Cavit, GIC and MTA)
Prognosis:
 Surgical correction may be necessary if a lesion or symptoms develop.
Prevention:
 Achieved by reviewing each tooth’s morphology.
 Radiographically verifying one’s position in the tooth.

MID ROOT PERFORATION

 Lateral perforation at mid root level lend to occur mostly in curved canals
 Along inside curvature of root as canal straightened out.
Recognition:
 Stripping is a lateral perforation caused by over instrumentation through this
wall in the root that is distal wall (inside of canal or concave) at mesial root
 Bleeding in dry canal
 Paper point placed in canal can confirm presence and location of perforation.
Correction:
Both
- Non surgical
- Surgical
i.e. root canal is first obturated and then the defect is repaired surgically. Remove
extra gutta percha using a hot spatula and cold burnishing at the perforation site.
 Material – Amalgam, GP, Ca(OH)2, GIC
 impressive results using MTA
Prognosis:
 Reduced prognosis
 Loss of tooth structure and integrity of the root wall can lead to root segment
fracture or microleakage.
Prevention:
 Mesiobuccal canal is in most danger of being stripped.
 Berutti and Fedou have shown how delicate the tooth structure is in this area.
In lower 1st molar at 1.5mm below furcation they found dentin of root to be 1.2
to 1.3mm thick
 Anticurvature filing i.e. maintaining the pressure of mesial wall to avoid
delicate ‘danger zone’.

Apical perforation
Perforation in an apical segment of the root canal may be the result of :
- File not negotiating curved canal
- Not establishing accurate working length.
- Perforation of a curved root is the result of “ledging” or apical zipping
Recognition:
 Sudden pain during treatment
 Canal becomes flooded with blood
 Tactile resistance is lost
Confirm:
 Radiograph
 Paper point
Correction:
 Effort to renegotiate
 Perforation site new foramen
 vertical compaction of heat softened gutta-percha
Treatment:
 Shorten the original length then enlarge canal with a larger instrument.
 Create an apical barrier
 Materials used:
- Dentin chip
 - Calcium hydroxide
- Proplast
- Hydroxyapatite
- MTA (recently)
Prognosis:
 With successful sealing or perforation , prognosis may be good.

TECHNIQUE FOR MANAGING APICAL TRANSPORTATION

Transportation:
Moving the position of a canals physiologic terminus to a new iatrogenic
location. Canal exhibits reversed apical architecture and fails to provide
resistance to gutta percha.
Type I:
 Minor movement of physiologic foramen
 Exhibit reverse architecture
Type II:
 Moderate movement of the physiologic foremen
Treatment:
 Barrier selected to control bleeding
 Choice – MTA (proroot)
 Remarkably cementum grows over this nonresorbable and radiopaque
material.
Type III:
 Severe movement of the physiologic foremen to a new iatrogenic location on
the external surface of the root.

Treatment: Obturation as best as possible with follow up corrective surgery or

extraction
SEPARATED INSTRUMENT AND FOREIGN OBJECTIVES
Separated objects in canal
 Glass beads from sterilizers, burs, GG, amalgam, lentulo spiral, file and
reamers and tips of dental instruments.
 Patient placed foreign objects such as nails, pencil lead, tooth pick, tomato
seeds, hot pins and needles.
Common errors leading to this mishap are:
- Exaggerated bends in instrument to negotiate a curved canal
- Forcing files down canals before the canal has been opened fully.
- Smaller files used in reaming motion.
Rotary instrument such as Gates Glidden drills, stresses will be created in
areas close to the shank, leaving a piece that can be grasped and easily
retrieved. Steiglitz forceps.

Correction:
 Ultrasonic fine instruments are effective in loosening and “flushing out” broken
fragments.
Procedure: with special fine diamond tips, a tunnel can be created around the
separated instrument and the sleeve is positioned in the canal and around the
separated instrument
 In one study cyanoacrylate is used to bind and remove the instrument.
 H-file is wedged in the sleeves until the instrument is locked between the
flutes of the file and the wall of the sleeve.

Conditions:
 When instrument fragment is stuck between the irregularities of canal, bypass
the instrument with lubricants. If possible canal preparation should be
completed and canal filled regardless of whether instrument segment is
removed during the process of canal preparation. Instrument then becomes
part of filing.
 It fragment can not be bypassed, prepare and fill canal to the level to which
instrument can be accomplished.
 If fragment extends past the apex –make an effort to remove it. If non-
surgical attempts are unsuccessful ,corrective treatment will include apical
surgery

Treatment:
Cleaning and shaping and filling the canal.
Apical surgery would include removal of part of the instrument fragment that
extends beyond the apex and retrograde filling if indicated.
Prognosis;
 Good – if instrument is bypassed
 Reduced – if surgical correction is needed
Prevention:
 Stressed instrument should be avoided.
 If small instrument are to be used, they should be checked properly before
use.
 No. 8 and 10 should be used only once.
 Smaller instruments should not be wedged, rather teased gently into place.
 Use canal lubricants
 Sequential instrumentation should be done.
 Using quarter-turn
 Increase the file size only after the current working file fits loosely into the
canal without binding.

TECHNIQUE FOR BROKEN INSTRUMENT REMOVAL

 Coronal access i.e. straight line access to all canal orifices.
 Radicular access.
 If radicular access is limited, hand files are used seriously to create sufficient
space for G.G. drills. Gates Glidden drills are then used like “brushes” to
create additional space.
 Buds of Gates Glidden are modified by cutting it perpendicular to its long axis.
 To maintain vision, use Stopiko three way adapter with appropriate luer-lock
tip to direct continue stream of air and blow out dentinal dust.
 Canal wall often causes the broken instrument to abruptly “jump out” of the
canal.

Irs option:
 Broken instrument deep in to root canal space
 IRS composed at variously sized microtubes and insert wedges that are
sealed to fit and work deep within root canal space.
 Microtube has a small handle to enhance vision and its distal end is
constructed with a 450 beveled end and cut out window.

Procedure:
 Coronal straight line access
 Use ultrasonic tips to slowly expose 2 to 3 mm of the seperated file.
 Microtube is then selected that can slide passively and drop over the
exposed, broken instrument.
 Long part of its bevel is oriented to the outer wall of canal to “scoop up” the
head of broken instrument and guide it into its lumen.
 Insert wedge is then placed through open end of microtube and passed down
its internal lumen until it contacts broken obstruction. The broken instrument
is engaged and secured by turning the handle.
 Insert wedge’s handle and screw in a clockwise rotation. Progressive
rotation tightens wedge and often displaces the head of the broken file
through the microtubes cutout window.
CANAL BLOCKAGE OR BLOCK OUT
 Buchanan pointed out that “blockage occurs when files compact apical debris
into a hardened mass. He further noted that “fibrous blockage occurs when
vital pulp tissue is compacted and solidified against the apical constriction.
Recognition:
 When confirmed working length is no longer obtained
 Radiographically the file is not near the apical terminus.
Correction:
 Recapitulation:
Smaller file is used-Quarter turn technique using chelating agent
 Pre curving the instrument to redirect is also effective and
 Radiographic confirmation
Prognosis:
Depends on the stage of instrumentation completed when block out occurs
 Decrease – Before BMP
 Increase – After BMP
 Increase – Teeth with vital pulp
 Decrease – Necrotic pulp
Prevention:
 Frequent irrigation during canal preparation
 Water soluble lubricant such as file eze or KY jelly
Technique for managing blocks:
 Flood the root canal with sodium hypochlorite
 Well angulated radiograph taken
 Use shortest file to reach working length(as they are more stiffer and have
greater tactile sensation)
 Precurve the file
 If not able to negotiate – slightly precurve the file -used in picking action
 Very short amplitude, light pecking strokes to negotiate the canal terminus
 Handle of file should never be are excessively rotation
 If No. 10 file moves apically, move to a smaller instrument -0.08 or 0.06mm
 If sodium hypochlorite does not give good results, shift to viscous chelator.
 If No. 10 file sticks and engages into debris then smaller instrument such as
0.08 file is used.
 Continued short amplitude is best – with push and pull strokes move the file
over range of 1 to 1mm.
 If the file moves freely increase the length of strokes over 3-04 mm
 If the canal can not be negotiated:
Asymptomatic-
 Obturate to this level and inform the patient about the possible need for
surgery..

OBTURATION – RELATED MISHAPS OVER OR UNDER EXTENDED ROOT

CANAL FILLING
OVER EXTENSION
Gross overextension can lead to symptoms and treatment failure. A
frequent cause of this mishap is apical perforation with loss of apical constriction.
 Treatment failure is less from irritation of filling material and more from
leakage around poorly compacted filling
 Solution – Roane balanced force technique.

UNDER EXTENSION
 Caused by failure to fit master-cone gutta –percha accurately OR
 Poorly prepared canal
Over extension is incomplete without extrusion of sealer along with gutta-percha.
(i.e. AH 26, Diakett, zinc oxide eugenol etc.)
Rowe stated, “in the teeth whose apices are near the inferior alveolar
nerve the most frequent cause of damage is excess filling material which has
passed through the orifice”.
Cause: Pressure or neurotoxic effect on nerve.
Recognition
 Post treatment radiograph – examination
Correction:
 Under extended – retreatment
 Over extended – attempt to take out filling. Gutta-percha will “break off”.
 Root canal filling material i.e. gutta-percha and many sealers are well
tolerated by surrounding tissues.
 Asymptomatic – No surgical treatment
 Symptomatic – Surgical removal
 It excess of GP (root canal should be cleaned and filled retrogradeably} .
Prognosis:
 Over extended – Better as it provides a good seal
 Under extended – prognosis depends on presence or absence of
periradicular lesion
Prevention:
 Accurate working length
 Modify the obturation technique
 Young patient (with wider apex) or teeth with apical resorption
Create an apical barrier with-
- Ca (OH)2
- Dentin chip
- MTA
Two steps
 Maintain working length throughout procedure
 Radiograph during initial phase of obturation.

TECHNIQUES TO REMOVE GUTTA-PERCHA

Dividing the root into three parts, GP is initially removed from the canal in
coronal one third, the middle one and finally eliminated from apical 1/3rd
Techniques:
 Rotary files
 Ultrasonic instrument
 Heat
 Hand files with heat or chemical
 Paper point with chemical
Mostly combination of methods are required.

Rotary removal
 NiTi 0.04 and 0.06 taper file
 Mentally divide canal into three halfs and then select 2 to 3 opposite size
rotary instruments that will fit passively within these progressively smaller
regions.

Ultrasonic removal:
Energized instrument produces heat that thermo softens GP. Specially
designed ultrasonic instrument are carried into the canal that have sufficient
shape to receive them.

Heat removal:
Larger canal – touch –N-heat System – B
Heat till red hot .plunge it into coronal aspect of GP. Deactivate the heat
carrier and cool it . this will freeze bite GP.
instrument withdrawal generally results in removal of attached bite of GP

Heat and instrument removal

A hot and H-file
Procedure:
Heat soften GP with heated instrument
 Withdraw the instrument and immediately insert No. 35, 40, or 45 H file
 Screw into soften GP.
 Technique good for apically overextended GP
 If residual GP and sealer is left -use chemical removal
File and chemical removal:
 Small and curved canal
 Fill pulp chamber with chloroform, select appropriate K-file and then gently
probe into the chemically softened GP
 Initially size 10 and 15 Stainless steel file is used to “prick”
 Only soften GP is removed from coronal 1/3 .
 clinician should repeat in middle 1/3rd and finally apical 1/3rd
 This prevents extrusion of GP periapically

Paper point and chemical removal :

Wicking: Drying solvent filled canal with paper point is known as “wicking”.
Wicking action is essential in removal of residual GP and sealer out of canals.

Procedures:
Canal is first flushed with chloroform -80% and then absorbed with paper
point
After choloroform wicking procedure, canal is liberally flushed with 70%
isopropyl alcohol.

NERVE PARESTHESIA
Factors:
 Local
 Systemic

LOCAL
Not limited to iatral root canal therapy
 Adjacent tooth with necrotic pulp
 Over extension
 Over instrumentation
 Orthograde canal therapy
Nerve damage can be permanent or transient.
Correction:
 Systemic prednisone
 Surgical decompression

Prevention:
 Appropriate case selection
 Patient should be informed of this problem before surgery.

VERTICAL ROOT FRACTURE

CAUSE
 Instrumentation
 Post placement
 Obturation
Recognition:
 Sudden crunching sound (crepitus)
 Teardrop radiolucency (long standing fracture)
Correction:
 In most cases extraction is the only treatment of choice.
 Bonding ability of G.I.C had led to its use to repair vertical root fractures.
Prevention:
 Avoid taper
 Less forceful obturation
 Post placement

POST SPACE PERFORATION

 End cutting drill
 Round bur
 G.G. drill
Can cause perforation if not directed properly.
Recognition:
 Similar to lateral perforation
 Presence of blood in canals
 Radiographic evidence
Correction:
 Sealing the perforation
 Use of resin composite bonded to adjacent root dentin with a bonding agent
has been reported for both retro root filing material.
Prognosis:
 Least effective it perforation within bone
 Close to gingival sulcus – risk of periodontal pocket
Prevention:
 Knowledge
 Post space preparation on radiographic basis
 Prepare space at the time root canal is obturated with round bur or end-
cutting bur
 GG and pesos drill excessive dentin and can cause strip perforation.

IRRIGANT RELATED MISHAPS

VARIOUS IRRIGANTS
 Saline, hydrogen peroxide, alcohol and sodium hypochlorite
 Any irrigant, regardless of its toxicity has potential to cause problem if
extruded into periradicular tissues.
 Becker et al described damaging effect of on accidental injection of sodium
hypochlorite beyond the apex
 Infection of hydrogen peroxide causes tissue emphysema
 With sodium hypochlorite, an immediate inflammatory response followed by
tissue destruction ensues.
Recognition:
 Sever pain and swelling
 Initial swelling, pain, interstitial hemorrhage and ecchymosis
Treatment:
 Antibiotic analgesic
 Antihistamines
 Ice pack applied initially ,followed by warm saline soaks the following day
 Use of Intramuscular steroid
 In a severe case surgical intervention with wound debridement
Prognosis:
 Favourable – if immediate treatment
 Long term effect – paresthesia and muscle weakness
Prevention:
 Using passive placement of modified needle
 Needle must not be wedged into canal
 Use endodontic needles such as “Monojet endodontic needle” (modified tip
and side orifice or “pro rinse” (Dentsply)
 In case of maxillary sinus immediate lavage at sinus through root canal path
way with at least 30ml of sterile water or saline. Prevents damage to sinus
lining.

CONCLUSION
Mishaps cannot be avoided, but they can be prevented if we undertake
proper treatment regime. Proper knowledge of subject, experience and patience
are tools in the hands of clinicians to fight against mishaps.
“Mishaps are part of learning when they are considered for better
tomorrow”.
REFERENCES
1. Pathways of pulp, 8th edition, Cohen
2. Problems solving endodontis, Pittford & Rhodes
3. Problems solving endodontics, James L Guttman
4. Endodontics, 5th edition, John Ingle
5. Endodontic Therapy, 5th edition, Wiene
 CONTENTS

 INTRODUCTION
 DEFINITION
 STEPS FOR MANAGEMENT OF MISHAPS
 DIFFERENCE IN MISHAP AND RETREATMENT
 CLASSIFICATION
 ACCESS RELATED
- TREATING WRONG TOOTH
- MISSED CANAL
- DAMAGE TO EXISTING RESTORATION
- ACCESS CAVITY PERFORATION
- CROWN FRACTURE
 INSTRUMENT RELATED
- LEDGE FORMATION
- CERVICAL CANAL PERFORATION
- MID ROOT PERFORATION
- APICAL PERFORATION
- SEPARATED INSTRUMENT AND FOREIGN OBJECT
- CANAL BLOCKAGE
 OBTURATION RELATED
- OVER OR UNDER OBTURATION
- NERVE PARESTHESIA
- VERTICAL ROOT FACTURES