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Endodontic Mishaps

Endodontic flare-ups are instances of pain or swelling during root canal treatment that lead to unscheduled patient visits, with higher incidence in women and those with pre-existing tooth pain. Causes include mechanical, chemical, and microbial factors, with management strategies focusing on patient reassurance, complete debridement, and appropriate medication. Precautions involve accurate diagnosis, correct working length, and thorough pulp removal to minimize risk.

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Ruth Samson
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109 views14 pages

Endodontic Mishaps

Endodontic flare-ups are instances of pain or swelling during root canal treatment that lead to unscheduled patient visits, with higher incidence in women and those with pre-existing tooth pain. Causes include mechanical, chemical, and microbial factors, with management strategies focusing on patient reassurance, complete debridement, and appropriate medication. Precautions involve accurate diagnosis, correct working length, and thorough pulp removal to minimize risk.

Uploaded by

Ruth Samson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Endodontic Flare-Ups And

Mishaps
Dr. Frehiwot.A (BDS,DDS)
May 23,2019
Endodontic flare up
 Flare up- occurrence of pain, swelling or the
combination of these during the course of RCT,
which results in unscheduled visits by patients.
 Rarely occur in older pt
 More common among women
 Low in patients using systemic steroids
 80% of pt who feel tooth pain before the
beginning of the tx will have post operative pain
2
Inter-appointment flare up causes
Pain

Swelling

Occurs within hours/days following


procedures
Requires unscheduled visit for an
emergency tx
Incidence – 1.4-16%
3
Thought related to etiology of flare-ups
Alteration of local adaptation syndrome
Changes in periapical tissue pressure
Microbial factors
Effect of chemical mediators (histamine, PG, LEU,
PAF)
Change in cyclic nucleotide
Immunological phenomena (IgG in periradicular
lesion)
Various psychological factors
4
5
Causes of flare up

Chemical microbial Mechanical

6
Mechanical cause
Over instrumentation of root canal
Extrusion of filling material
Incorrect WL
Inadequate removal of pulpal tissue
Chemical cause
Irrigant

ICM

Overextended root canal filling 7


8
Microbial
Necrotic tissues in root canal
Porphyromonas- symptomatic
periradicular lesion
Gram negative anaerobes (more virulent
ones)
Percusion pain- peptostreptococcus,
prevotela species, porphyromonas
endodontalis 9
Clinical conditions of flare-up

Apical periodontitis 2ry to treatment


Incomplete removal of pulp tissue
Recrudescence of chronic apical
periodontitis
Recurrent periapical abscess

10
Inter appointment emergencies are divided
into-
Previously vital pulps with complete
debridement
Previously vital pulp with pulps with
incomplete debridement
Previously necrotic pulp without swelling
Previously necrotic pulp with swelling
11
General management of flare-up
Reassurance to the patient
Complete debridement of root canal
system
Establishment of drainage
Relief of occlusion
ICM
Medications (analgesics, AB, steroids)
Placebo (enhance endorphin production)

12
Precautions
Proper Dx of case
Correct WL
Complete extripation of pulp
Avoid filling close to apex
Relief occlusion
Placement of ICM
Prescription of analgesics and ABs whenever
necessary
13
14

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