In the introduction of the program, the author reveals an alarming 24%-60% global prevalence of Apical lesions in teeth with inadequate root canal treatment. The literature’s histopathologic term used in describing these lesions is Apical Periodontitis. (AP). The statistics are alarming because the “Standard Normal” prevalence of Apical lesions in endodontically untreated teeth is 1½% - 7%.
This program stands for the management of teeth with substandard endodontic treatment failures because of the evidence-based relationship between abusive endodontic treatment, and root structure cracks initiation and propagation. Abusive endodontic treatment is one form and a principal cause of substandard endodontic treatment. More on this relationship discussed in part III of the master class series.
The program is composed of seven chapters planned to include the most clinically relevant facets of the inadequate or sub-standard endodontic treatment.
Chapter One
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Tells the story of misdiagnosing of a failing substandard endodontic treatment as periodontitis. Analyzes the complications and shows the importance of proper diagnostic investigation.
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Chapter Two
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Review of the current definitions and terminology used in describing endodontic apical translucencies.
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Chapter Three
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Discuss the most important studies on the factors influencing endodontic treatment success or failure.
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Chapter Four
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Identify the factors, materials, methods and clinical practices that promote quality treatment, prevent, and heal Apical Periodontitis.
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Chapter Five
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Examine the factors, materials, methods and clinical practices that result in substandard endodontic treatment and development of Apical Periodontitis.
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Chapter Six
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How to use the 4ROD protocol to investigate substandard endodontic procedures, identify the cause of the failure and rule-out cracks.
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Chapter Seven
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Introduces nonsurgical and surgical interim endodontic therapy to eliminate large Apical Periodontitis Infections, regenerate native bone and prepare the sites of hopelessly fractured teeth for implant placement.
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Pulpal necrosis and substandard endodontic treatment are the principal causes of Apical Periodontitis. Mechanical root canal preparation is an integral part of modern endodontic practice. The improper use of mechanical or manual endodontic instruments causes root canal ledging, stripping, perforating and instrument breakage. These errors cause incomplete root filling which is the leading cause of substandard endodontic treatment outcomes. Collectively about 80% of endodontic treatment failures are contributed to root canal preparation errors.
To correct canal preparation errors, the clinician uses manual, mechanical tools and gadgets to bypass a root canal ledge or broken instrument. The generated forces associated with these attempts may initiate within the root canal surfaces micro cracks or propagate existing ones. The clinical complications of these cracks usually manifest months or years following endodontic treatment and post placement completion.
Therefore, regardless of the patient signs and symptoms, the radiographic diagnosis of a tooth with substandard endodontic treatment, should be considered a dental treatment risk factor. The clinician should investigate the tooth when considering endodontic retreatment or plan to use the previous root canal filling as a foundation for a post placement or new restoration.
Chapter 6 outlines the procedural protocol to follow when treating patients with substandard endodontically treated teeth. The clinician’s objectives are:
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Establish a doctor–patient relationship based on considerate interaction especially when the patient is unaware of having an iatrogenic dental problem.
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Identify and correct the cause of the substandard treatment.
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Rule out the presence of line cracks in the pulp chamber or the clinical crown before endodontic or restorative retreatment.
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Prevent tooth crack propagation thru changing the treatment protocol to atraumatic endodontic and restorative retreatment.
The program contains advanced specialty knowledge that enhances the clinician diagnostic and treatment skills. The general practitioners need such knowledge because they perform 72%- 88% of endodontic treatments services provided in the USA and Canada.
Chapter five discusses the role of the dental school as an important influencing factor in resolving the problem of substandard endodontic treatment. Endodontic curricula must have additional instructional hours’ time. Need to focus on more relevant content presented by full-time endodontic faculty committed only to the undergraduate curriculum and advanced continuing education courses to the general practitioners.
This program offers concepts, methods and guiding principles based on evidence, and tested clinical practices. The goal is to enhance the clinicians understanding of endodontic treatment diagnostics and the relationship between endodontic treatment and tooth structure cracks.