Endodontic mishaps and their disposal

Endodocija je složena disciplina dentalne medicine i kliničar se može susresti s mnogim nepredvidljivim okolnostima koje mu mogu otežati liječenje. Takve okolnosti se nazivaju pogreškama tijekom endodontskog postupka. Pogreške u endodontskoj terapiji možemo podijeliti na pogreške nastale tijekom izrade pristupnog kaviteta, te pogreške tijekom instrumentacije i punjenja korijenskog kanala. Mogu se dogoditi i druge nezgode, kao što su proboj stijenke uslijed preparacije za intrakanalnu nadogradnju, protisnuće sredstva za ispiranje, emfizem i udisanje ili gutanje instrumenta. Nastalu pogrešku treba prepoznati i procijeniti mogućnost uspješnosti retretmana endodonskog liječenja određenog zuba ili endodontsko-kirurškog zbrinjavanja. Nekirurški retretman je prva metoda izbora u liječenju pogrešaka endodontskog liječenja. U slučaju neuspjeha nekirurške terapije ili prisutnosti perzistentne periapikalne lezije potrebna je periapikalna kirurgija, odnosno amputacija ili hemisekcija korijena. U ovom su radu osim pregleda literature, prikazana i tri slučaja endodontskih pogrešaka te njihovo zbrinavanje. U prvom slučaju prikazan je proboj bukalne stijenke u središnjoj trećini i zbrinjavanje proboja punjenjem pravog i jatrogenog korijenskog kanala. U drugom slučaju prikazan je zalomljen instrument u cervikalnoj trećini i njegovu uklanjanje iz korijenskog kanala. U trećem slučaju prikazana je vertikalna fraktura mezijalnog korijena madibularnog molara i zbrinjavanje frakture hemisekcijom. Poznavajući dobro morfologiju endodontskog prostora, pravila i tehnike instrumentacije i punjenja korijenskih kanala možemo smanjiti mogućnost pogrešaka, te povećati uspjeh endodontske terapije.Endodontics is a complex branch of dentistry and clinician may encounter many unforeseen circumstances that may complicate his treatment. Such circumstances are called mishaps during endodontic procedures. These mishaps in endodontic therapy can be divided into mishaps occurring during the preparation of the access cavity, mishaps during root canal instrumentation and obturation. But others accidents can also happen, such as post space perforation during preparation for intracanal upgrade, irrigant related mishaps, tissue emphysema and instrument aspiration or ingestion. Regardless of the possibility that such mishaps can happen, clinicians should not be discouraged to approach endodontic therapy. If a clinician is well educated and diagnosis is properly set, most of the problems can be avoided. In case the mishap still occurs despite the experience and intuition of the therapist, his task is to recognize the mishap and to assess the ability of successful endodontic retreatment of a particular tooth. Therapy options for endodontic mishaps are non-surgical retreatment or endodontic surgery. Non-surgical retreatment is the first treatment of choice for the endodontic mishaps. In case of failure of non-surgical therapy or the presence of persistent periapical lesion, apical surgery or amputation or hemisection of the root is required. In this graduate thesis, except from the literature review, there are described three cases of endodontic mishaps and their treatment. First case shows midroot perforation of the buccal wall and it's treatment by filling real and iatrogenic root canal. Second case shows separated instrument in the cervical third of the tooth and it's removal from the root canal. Third case shows vertical fracture of the mesial root of mandibular molar and it's managment by doing hemisection of the mesial root. By knowing well the morphology of the pulp space, rules and techniques of the instrumentation and filling of the root canals, we can reduce the possibility of endodontic mishaps and increase success of endodontic treatment