Procedural complications

Procedural complications

1. Ledge Formation

   • Why?
     • Not a proper straight-line access
       • Not a proper glyde path
   • What is it?
     • Artificial irregularity createdon surface of root canal wall
   • Usually happens in....
     • Smaller canals
     • Curved canals
     • Longer canals
     • Inadequate irrigation or lubrication
   • Solutions
     • Flexible NiTi files
     • Use smaller instrument to bypass ledge
     • A little bend in the file

2. Instrument separation or fracture within the confines of a canal

   • Why?
     • Excessive force
     • Jumping up a file size
     • Inadequate irrigation or lubrication
     • Not replacing files often enough
       • Too many times sterilized
   • Flexible NiTi more likely to fracture

3. Perforation

   • Coronal
     • Through the crown
       • Avoid by burring following the axis of the tooth
   • Furcal
     • Through pulpal floor
   • Strip
     • Excessive coronal flaring
       • Shaves off too much dentin
   • Root
     • For example through a ledge foration (lateral perforation)
       • Immediate hemorrhage or sudden pain
         • Due to the PDL: lots of vessels 
     • More apical, better prognosis
     • Internal repair with MTA