ENDODONTIC FAILURES

• Incorrect diagnosis and primary treatment

• Infection
• Cysts
• Root fracture
• Foreign body reactions
 INFECTION
Intraradicular Infection
• Not have been effectively disinfected
• Could have become reinfected
• Bacterial infection is the major cause of
persistent periapical inflammation following
root canal treatment.
• Poor aseptic technique
• Incorrect irrigant
• Inability to prepare the canal to length
• Missed canals
• Procedural errors
• Poor obturation
• Poor restoration and coronal microleakage
• Resistant bacteria.
 Poor aseptic technique

• The use of a rubber dam is considered

mandatory for root canal treatment
 Incorrect Irrigants
• Bacteria are removed mechanically with
instruments but also killed using irrigants
which penetrate the complex internal
anatomy of the root canal system
Inability to Prepare to Length
 Missed Canals
• A missed canal could harbour persistent
bacteria.
• Maxillary first molars contain two canals in the
mesiobuccal root in approximately 92% of
teeth. Mandibular incisors have two canals in
over 40% of cases.
 PROCEDURAL ERRORS
• Ledges are effectively an internal
transportation of the canal and can be caused
by a file working against compacted dentine
chips.
• Apical transportation
 Instrument Separation
• The real problem is that the separated
instrument prevents thorough cleaning,
shaping, disinfection, and canal obturation
 POOR OBTURATION
• The aim of obturation and restoration of the
endodontically treated tooth is to achieve a
complete seal from the apex to the oral cavity.
 Poor Coronal Restoration
• Having thoroughly cleaned the root canal
system, the coronal restoration helps to
prevent ingress of bacteria into the internal
environment and assists in providing a total
seal.
• Good root canal treatment with good coronal
restoration achieves the best outcome.
 RESISTANT BACTERIA
• The microbiological flora in failing root-treated
teeth has been considered to be different
from that of an untreated canal
 EXTRARADICULAR INFECTION
• Bacterial colonies on the external root surface
may be associated with failure. Typically,
failure occurs in these cases despite a high
standard of primary endodontic treatment.
Bacteria such as Actinomyces israelii and
Propionibacterium propionicum have been
isolated from such infections
 CYSTS
• Apical pocket cysts, in
which the epithelial
lined sac is in
communication with
the root canal system of
the tooth
• Apical true cysts, in
which the lesion is
completely enclosed by
the epithelial lining and
has no communication
with the root canal
system of the tooth
CRACKED TEETH AND FRACTURES
INCORRECT DIAGNOSIS AND
TREATMENT
 FOREIGN BODY REACTIONS
• Foreign body reactions against cholesterol
crystals derived from disintegrating host cells
have been implicated in failure
• The cellulose component of paper points, cotton
wool etc.
• Leaving a tooth in open drainage is also ill-
advised as the root canal can become packed
with food debris, small particles of which can
eventually be forced into the periapical tissues.
• If there is no radiographic evidence of
periradicular pathosis prior to root canal
treatment, no radiographic signs of pathosis
should ever appear following treatment
• If there is radiographic evidence of
periradicular pathosis at the time of
treatment, periodic postoperative
reexamination radiographs should indicate
that the pathosis is healed or is healing
• If there are no preoperative symptoms, none
should arise postoperatively. Conversely, any
preoperative symptoms should resolve
completely with treatment.