Dentaltown May 2017 - 123
continuing
education
Fig. 9. Pre-curved
Typhoon NiTi files
Fig. 8. Difficult file access into mandibular molar
because of limited mouth opening, and opposing
arch that's in the way of the handpiece.
SCENARIO: Difficult access to teeth
REASON FOR RISKS:
* Limited mouth opening.
* Posterior location of teeth.
* Long posterior teeth requiring long
files, which make accessibility difficult.
MANAGEMENT OF RISKS:
* Use short files (i.e. 21 millimeters)
* Pre-curve stainless steel hand files to facilitate
entry into endo access and canals.
* Use NiTi files with short shafts.
* Use NiTi files that can be pre-curved before
accessing canals, such as WaveOne Gold by
Dentsply Sirona or Typhoon by Clinician's
Choice.
Fig. 11. 25mm
#30 in a patient
with limited
opening.
Fig. 10
Fig. 12.
Precurvable
WaveOne Gold
NiTi files with
short shaft.
Fig. 13.
Long (left)
vs. short (right)
NiTi file shafts.
and require many appointments. To them,
this could translate into loss of confidence
in you and your skills.
From a patient retention perspective, you
must ask the following: What's the cost to
your patients and your practice when you
spend too long on a root canal or when it
fails? The patient doesn't benefit and neither
does your practice, because you may lose
that patient, along with any referrals. As
many of us (including myself) have found
the hard way, good news is often taken for
granted by patients, while bad news can
spread like wildfire. The cost to your practice
of a failed root canal could be significant.
This certainly is not a good thing when you
want to keep your patients in your practice.
We can't discuss endodontic risks without
touching upon the reality of legal hazards.
Unfortunately, we live in a society that can
easily be litigious. In fact, thanks in large
part to the internet, it's become easy for
patients to file complaints or take legal actions
against dentists. Futhermore, if you didn't
perform the root canal properly, your legal
and monetary risks could be even greater.
Part 2: Clinical
There are clinical scenarios and teeth
which present higher risks for clinical
complications. Some of the more common
scenarios with potential pitfalls are outlined
in Table 2 (p. 122) and Table 3 (p. 125).
Clinical scenarios that may complicate
endodontic procedures include: management
of calcified and curved canals; presence of
pulp stones; teeth and canals that are difficult
to access because of their posterior location;
a patient's limited opening; or the difficulty
in visualizing canals in an endo access.1 For
dentaltown.com \\ MAY 2017
123
http://www.dentaltown.com
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