Mishaps

Inattention to details Unpredictable

Management of a mishap:

Causes and Prevention.

Detection.

Correction.

Prognosis.
I- Access-related Mishaps:

1. Treating the wrong tooth

During
Misdiagnosis
isolation
2. Under extended cavity: 3. Missed canals:
Improper access.
Lack of knowledge about root canal anatomy.
Abnormal canal position.
Magnification

Champagne test
Red line test
4. Compromised integrity of existing restoration:
Causes of Chipping of porcelain crowns:
➢ Access preparation through crown
➢ Rubber dam placement directly on the crown
➢ Crown removal procedures

Correction:
• Inform patient that crown may damage before
starting
• Minor chipping repair with composite
• Restoration replacement
5. Pulp chamber perforation:
Direct bleeding.

Radiographs.

➢ Glass
“sealing of the perforation” ionomer
➢ MTA
Furcal perforation
 Never
search for orifices
with bur
plz
use a probe
6. Crown Root Fracture

Reduce occlusion.
Avoid overextended access cavity.
➢If chisel fracture that is restorable…… Restore
➢If vertical root fracture………………….. Extract
II- Instrumentation-related Mishaps:

1. Over-preparation 2.Over-instrumentation

Overflaring using Gates glidden → weakening and

“Follow
strip mechanical
perforation and biological
long WL → design objectives”
apical perforation.
3. Ledge formation

Improper access.

Too large or straight instruments.

Anatomical complexities.
4.Canal Blockage
Compacted apical debris due to :
Insufficient irrigation.
Failure to maintain working length
Failure to recapitulate

Correction

Irrigants and Chelating agents.

Patency and Precurving.

Recapitulation.
 5. Root perforation
Cervical Root perforation
During canal orifice location.
Improper coronal preflaring in root (strip
Perforation).
Strip perforation
Mid Root Perforation
Paper point
detection
Apical perforation

Overextended WL of file.

Improper negotiation of Ledge and apical

transportation.
6. Separated Instruments

Locked instrument.

Stressed instrument.

Exaggerated bend on the instrument.

Forcing files down the canal.

Remove ……. Bypass…….Surgical removal
 Metal sleeve

Ultrasonic tip
 III- Obturation Related Mishaps:

1. Under/ overextended filling

• Errors in length of filling.

• Errors in quality of filling.
Underextended root canal filling
Overextended root canal filling :
2. Vertical root fracture

Too much obturation force.

Post placement.
 3. Nerve parathesia

Extrusion of formaldehyde containing sealers.

Over instrumentation.

Over extension of root canal fillings.

Surgical procedures.
IV- Miscellanous Mishaps:
1. Post space perforation

Misdirected post space preparation.

Use of end cutting drills.

2. Hypochlorite accident
3. Tissue Emphysema.
4. Instrument aspiration or ingestion

Use rubber dam.