This document discusses common errors that can occur during endodontic treatment and ways to prevent or manage them. It covers errors related to accessing the pulp space like treating the wrong tooth, incomplete caries removal, or perforating through a full coverage restoration. It also discusses errors during canal cleaning and shaping such as ledge formation, canal deviations, or instrument separation. Finally, it addresses procedural errors during obturation like underfilling or overfilling the canal with gutta percha. Throughout, it provides tips for preventing errors like using small instruments sequentially, maintaining canal patency, and taking pre-operative radiographs to understand anatomy.

1. BDS 4
Makerere University

2.  Related to access opening of the pulp space
 Related to canal shaping and cleaning
 Related to obturation

3. RELATED TO ACCESS OPENING OF
THE PULP
 A. Treating the wrong tooth
Prevention –
-Make a suitable mark on the
radiograph and also on the tooth in
question before application of rubber dam
-Alternatively, the initial access
cavity into the enamel or dentino-enamel
junction can be completed before the rubber
dam
B. Incomplete removal of caries
Secondary caries under restoration;-one
must study the preoperative radiograph under
magnification and good lighting, if any doubt
exists, the entire filling should be removed and
the cavity redesigned accordingly.
old occlusoproximal cavities should be
removed
distal caries; clinician might concentrate
on access opening in the mesial part of the
tooth and cause incomplete removal of caries
****such teeth will get re-infected in the future
and ultimately fail, coronal leakage

4. Secondary caries

5.  C .Access opening through full-
coverage restoration
If a soft carious lesion is suspected
under the crown from a radiograph, one
should remove the crown even at the
cost of the remaining tooth structure
 Burs are available for cutting through
ceramic crown without chipping the crown
 They are also available for cutting through
the metal crowns for easy access

6. D. inability to locate extra canals/missed canals
Causes
failure to externalize internal
anatomy
lack of knowledge pertaining to
root canal anatomy, confirguration and its
variations
improper access and not observing
the basic cavity design features
incomplete deroofing of the pulp
chamber
incomplete removal and shaping
of the lateral walls of the pulp chamber
Prevention and action
Good periapical radiographs
preoperatively and during cleaning and
shaping
observe radiographs under
magnification
multiple radiographs in varying
angulations to better understand the
morphology of the tooth
Use DG16 or size 06/08/10 ISO k-
file instruments to locate the orifices
C+ file and profinder

8. E. iatrogenic perforations (cervical perforations)
Management of nonfurcal cervical
perforations
hemorrhage control with 1:50,000
epinephrine followed by perforation repair
with MTA
Prevention;
one must study the crown root
angulations esp. of the max. lat. Incisors and
the mad. first premolar
when removing caries, one must be
careful not remove healthy dentine which
might undermine the tooth structure and
result in a perforation
Management of cervical perforations in
the furcation area
Once there’s blood flooding, one
must suspect a perforation which can be
confirmed with a radiograph or apex
locator
MTA is the material of choice for
sealing perforations
The patient should be informed
that a patient has occurred and the
prognosis discussed

9. Prevention of cervical perforations in the
furcation area
study the preoperatively
radiograph and evaluate the pulp
chamber morphology
access bur penetration for depth
and angulation should be confirmed
before proceeding
straight line access is cardinal
“stay lingual rule” for max. lat.
Incisor and mad. First premolar
remove existing crowns and old
restorations
For calcified chambers and pulp
spaces, the endodontists must externalize
the internal tooth anatomy

11. ERRORS RELATED TO
CLEANING AND SHAPINGa. Canal blockage and ledge formation.
Prevention of canal blockage;-
-Always use the smaller instrument first
-Use instruments in sequential order
-Pre-curve the stainless steel instruments
-Use copious amount of irrigants
-Recapitulate frequently
-Dispose off instruments suitably

12.  Causes
 Not extending the access cavity sufficiently
to allow adequate access to the apical third
 Incorrect assessment of canal curvature
 Erroneous root canal length determination
 Forcing and driving the instruments into the
canal
 Using non-curved stainless steel instrument
 Failing to use instruments in sequential
order
 Overuse of reaming motion
 Inadequate irrigation
 Over relying on chelating agents
 Attempting to retrieve broken instruments
 Attempting to prepare calcified root canals
 Creating apical blockages
 Attempting instruments into proximal
cavities or restorations
 Prevention
 Preoperative radiograph to assess unusual
root canal curvature
 Patency should be maintain throughout
cleaning and shaping
 Recapitulation
 Work passively without forcing the
instruments into the canal
 Never force an instrument apically
 Work sequentially by increasing the sizes of
the instruments without jumping to large
numbers

14. deviation from normal canal anatomy
 Zipping; an apical transportation of a
curved canal caused due to improper
shaping technique
 Transportation
 Elbow; is the narrowest portion of a
zipped canal
Management prevention is the best form
of management
-adhering to principles of root canal
instrumentation and appreciation of canal
anatomy and instrument dynamics
-in cases of a zip or transportation, any
type of obturation can be used but
thermoplasticized technique is the best

15. c. instrument separation in the canal
 Causes
-Cyclic fatigue
-Torsional fatigue
-Carelessness in the instrumentation
technique
Treatment plan
-instrument retrieval, coronal a third
-by passing the instrument and making it
part of the obturation, beyond a
curvature, apical a third, narrow canals
-surgical intervention in the form of hemi
section of the root or root resection in
roots with apical third instrument
separation

17. d. obstruction from previous obtrutrating materials
 Gutta-percha
 Can be removed by application of;
-Mechanical force in the form of
instrumentation; canal orifice are
reopened mechanically by forcing No, 20
or 25 H-file through the orifice or Gates
Glidden drill
-Heat to sear and soften the gutta percha ;
with an excavator
-Solvents; to assist sequence
instrumentation, used be used carefully,
not recommended for apical thirds
-Ultrasonics
-Combination of the above
 Silver Cone
 Not removed as easily as GP unless the
butt end of the silver cone extends into the
pulp chamber which is vibrated with an
ultrasonic scaler to break the cementing
media
 Cone is then seized with a pair of narrow-
beaked pliers(stieglitz)
 If the cone extends slightly into the pulp
chamber, it can often be made loose by
vibrating with an ultrasonic scaler

19. PROCEDURAL ERRORS
FROM OBTURATINGa. Under filling of GP
Instability to seat the master cone to the
estimated full working length-
Occurs usually due to loss of working
length as a result of packing dentinal mud
into the pulp space
Hints ;-
Recapitulation and irrigation
Obtain a radiograph after this procedure
and reposition the master cone
 Over filling of GP
Instrumentation beyond the constriction
Should not occur if the basic biological and
mechanical principles are observed as
cardinal rules

20. ….OTHERS
 Aspiration or Ingestion of endodontic
instruments
Can be a clinical disaster ending up in the
need for major surgery
Preventable procedural error
Use rubber dam
High power suction

21. EVALUATION OF
ENDODONTIC TREATMENT
Clinical Evaluation
Presence of symptoms though indicates the presence of pathology, but absence of a pain
or any other symptoms does not confirm the absence of a disease. A little correlation
exists between the presence of symptoms and the periapical disease.
Clinical criteria for success
• No tenderness to percussion or palpation
• Normal tooth mobility
• No evidence of subjective discomfort
• Tooth having normal form, function and esthetics
• No sign of infection or swelling
• No sinus tract or integrated periodontal disease
• Minimal to no scarring or discoloration

22. Radiographic Evaluation
The radiographic criteria for failures are development of radiographic periapical areas
of rarefaction after the endodontic treatment, in cases where they were not present
before the treatment or persistence or increase in size of the radiolucency after the
treatment. To predict the success or failure, one should be able to accurately compare
the radiographs taken at different times.
Radiographic criteria for success of endodontic treatment
• Normal or slightly thickened periodontal ligament space
• Reduction or elimination of previous rarefaction.
• No evidence of resorption.
• Normal lamina dura.
• A dense three dimensional obturation of canal space.

23. Histological Evaluation
Histological criteria for success or failure of endodontic therapy may include absence of
inflammation and regeneration of periodontal ligament, bone and cementum following
endodontic therapy.
Histological criteria for success
• Absence of inflammation
• Regeneration of periodontal ligament fbers
• Presence of osseous repair
• Repair of cementum
• Absence of resorption
• Repair of previously resorbed areas

24. DEFINITIONS RELATED TO
ENDODONTIC TREATMENT
OUTCOME

Healed: Both clinical and
radiographic presentations are
normal

Healing: It is a dynamic process,
reduced radiolucency combined with
normal clinical presentation
 Disease: No change or increase in
radiolucency, clinical signs may or
may not be present or vice versa.

25. SUCCESS/FAILURE OF
ENDODONTIC TREATMENTThe percentage of successfully treated cases naturally varies with judgment in
selection of cases for treatment, with the method of therapy, with the skill of the
operator, with the technical difficulties,
and with other factors. Nevertheless, some idea of the probability of success can be
gained from published reports

26. CAUSES OF ENDODONTIC
FAILURELocal factors
• Infection
• Incomplete debridement of
the root canal system
• Excessive hemorrhage
• Over instrumentation
• Chemical irritants
• Iatrogenic errors
– Separated instruments
–Canal blockage and ledge
formation
– Perforations
– Incompletely filled teeth
– Overfilling of root canals
• Corrosion of root canal fillings
• Anatomic factors
• Root fractures
• Traumatic occlusion
• Periodontal considerations
Systemic factors
• Nutritional deficiencies
• Diabetes mellitus
• Renal failure
• Blood dyscrasias
• Hormonal imbalance
• Autoimmune disorders
• Opportunistic infections
• Aging
• Patients on long
term steroid therapy