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INTRA RADICULAR

PREPARATION ERRORS
(CANAL BLOCKAGE
AND LEDGE)
GROUP 2 A
1) SAABIRAH KHADEEJAH MOHD SIDEK
2) SALWATUL IZZRA BINTI MAHADI
3) SITI RAZAN BINTI RAMLI
4) SITI FATIMAH BINTI MOHD KAMAL

CANAL BLOCKAGE






This condition occurs when the operators feel
that working length and canal patency is loss and is
due to apical pushing lead to packing of tissue or
dentinal debris which has been removed during
cleaning and shaping.
CANAL BLOCKAGE
CLINICAL APPEARANCE

Full working length cannot be reached
because the instruments are working against
the packed mass at the apex. A radiograph
will confirm this suspicion.
At area of blockage canal feels sticky due to
aggregation of debris.

CANAL BLOCKAGE
ETIOLOGY

- Failure to maintain full working length during
preparation.
- insufficient irrigation .
- Lack of recaputilation during preparation.
CANAL BLOCKAGE
PREVENTION

- Always use smaller sized instruments first.
- Use instruments in sequential order.
- Always pre-curve stainless steel hand
instruments.
- Use copious amount of irrigants and always work
in wet canal.
- Use reproducible reference points and stable
silicon stoppers on instruments while cleaning
and shaping.

CANAL BLOCKAGE
TREATMENT AND MANAGEMENT

- Operator should irrigate the canal and start negotiating
the canal at full working length using the initial file
(smallest file reaching the working length).

- Ultrasonic irrigation maybe very beneficial in steering-
back the accumulated debris and facilitate its removal
by irrigants. Also the alternate use of
hypochlorite/peroxide solutions with the resulting
bubbling effect may help removal of blocking debris.

- Correction is made by recapitulationstarting with
finer instruments used in a quarter-turn motion.
Adding a chelating agent such as EDTA is helpful.

LEDGE










Among the complications most commonly observed during
root canal instrumentation is a deviation from the original canal
curvature without communication with the periodontal ligament,
resulting in a procedural error termed ledge formation or ledging.
LEDGE










CLINICAL APPEARANCE

- Instrument can no longer be inserted into the canal to the full
working length.
- Loss of normal tactile sensation, a feeling that the instrument is no
longer engaging the walls.
Stop! Take a radiograph with the instrument in place.
LEDGE
ETIOLOGY
1) Insertion of uncurved instruments.
2) Large instrument out of sequence.
3) Inflexible instrument in curved
canals.
4) Not extending the access cavity
sufficiently to allow adequate access
to the apical part of the root canal.
5) Over enlargement of the curved
canals.
6) Complete loss of control of the
instrument
7) Incorrect assessment of the root
canal direction
8) Erroneous root canal length
determination
9) Forcing and driving the instrument
into the canal

10) Failing to use the instruments in
sequential
11)Rotating the file at the working length
(that is, overuse of a reaming action)
12) Inadequate irrigation and/or
lubrication during instrumentation
13) Over-relying on chelating agents
14) Attempting to retrieve broken
instruments
15) Removing root filling materials during
endodontic retreatment
16) Attempting to prepare calcified root
canal.
17) Inadvertently packing debris in the
apical portion of the canal during
instrumentation (that is creating an
apical blockage)
LEDGE
Prevention :

- Be careful and attentive during the instrumentation
process.
- Use of accurate preoperative and working radiographs
to determine the root canal length, copious irrigation,
precurved files, and incremental instrumentation .
- Awareness of canal morphology.
- Use of flexible file.
- Pre curved instruments should be used.
- Working length should be followed.
- Newer instruments with non-cutting tips have materially
reduced this problem. The rounded tip does not cut into
the wall but slips by it.

LEDGE
Treatments & Managements :

1- Location the ledge by a radiograph and verification the depth
2- Irrigate the canal copiously
3- Explore the ledge area with a small file No 6, 8, 10, 15 in which a
precurvature has been
made form the tip extending about 3 mm up the blade.
4- The curved tip should be pointed toward the wall opposite the ledge.
5- Once the ledge is bypassed start circumferential filling till be ledge is
removed
6- Use a lubricant irrigate frequently to remove the dentine chips
*Do not use ethylenediaminetetraacetic acid (EDTA) for chelation
because it tends to intensify
the ledge.
7- If the ledge cannot be bypassed then clean, shape and obturate the
canal at that level
8- If endodontic treatment fails then alternative treatment such as roof
end filling hemisection may be considered.

THANK YOU

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