Assistant Professor

Dr. Fawad Ali Shah

BDS, FCPS
Operative Department,KCD,Peshawar
Causes of root canal failure
(post treatment disease)
 Contents
• Etiological factors
• Diagnosis
• Treatment Plan
 Learning objectives
1. Etiological factor of root canal failure
2. How to diagnose the cause of root canal failure
3. What should be your treatment plan
 Etiological Factors

• iatrogenic procedural errors such as poor access cavity design

• untreated canals (both major and accessory)
• canals that are poorly cleaned and obturated
• complications of instrumentation (ledges, perforations, or separated instruments), and
• overextensions of root-filling materials.
• Coronal leakage
• Persistent or reintroduced intraradicular microorganisms
• Extraradicular infection
• Foreign body reaction
• True cysts
• radicular cysts
The causes of posttreatment disease. (1) Intraradicular
microorganisms.
(2) Extraradicular infection. (3) Foreign body reaction. (4) True
cysts.
 Persistent or Reintroduced Intraradicular Microorganisms

• root canal space and dentinal tubules are contaminated with microorganisms or their by-products
• if pathogens are allowed to contact the periradicular tissues, apical periodontitis ensues.
• Causes are Inadequate cleaning, shaping, obturation, and final restoration of an endodontically diseased tooth
• major cause of posttreatment disease
• iatrogenic treatment complications, such as creation of a ledge or separation of an instrument, result in
persistence of bacteria in the canal system
 Extraradicular Infection

• Occasionally bacterial cells can invade the periradicular tissues either by direct spread of infection from the root
canal space via contaminated periodontal pockets that communicate with the apical area, extrusion of infected
dentin chips, or by contamination with overextended, infected endodontic instruments.
• two species of microorganisms, Actinomyces israelii and Propionibacterium propionicum, can exist in the
periapical tissues and may prevent healing after root canal therapy.
 Foreign Body Reaction

• Occasionally, persistent endodontic disease occurs in the absence of discernible microorganisms and has been
attributed to the presence of foreign material in the periradicular area.
• Several materials have been associated with inflammatory responses, cellulose fibers from paper points.
• filling material extrusion
 True Cysts

• Cysts form in the periradicular tissues when nests of epithelial cells, retained from tooth development, begin to
proliferate due to the chronic presence of inflammatory mediators.
• These epithelial cell rests of Malassez are the source of the epithelium that lines cystic walls, and cyst formation
may be an attempt to help separate the inflammatory stimulus from the surrounding bone.
• two types of periapical cysts:
– the periapical true cyst
– periapical pocket cyst
• True cysts have a contained cavity or lumen within a continuous epithelial lining.
• Pocket cysts the lumen is open to the root canal of the affected tooth.
 DIAGNOSIS OF POSTTREATMENT DISEASE

• Rule out nonodontogenic etiology

• All of the appropriate tests
• subjective information
• Use of rubber dam
• patient’s health history
• objective information
• clinical and radiographic examination.
• visual extraoral and intraoral examination
• periodontal evaluation
• Cone beam computed tomography (CBCT)
• Bitewing radiographs
 TREATMENT PLANNING

• what is “best” for the patient

1. Do nothing
2. Extract the tooth
3. Nonsurgical retreatment
4. Surgical retreatment
 References
• Pathways of pulp
.