Sunday, August 30, 2009

Iatrogenic Dentistry

(This blog is mostly for dental nerds)
The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice.  Examples are a wrong dose medicine, surgical instrument left inside the body cavity, or wrong leg amputation.  Thankfully in dentistry iatrogenic events are far less spectacular but still cause plenty of headaches and unplanned outcomes.
The specialty of endodontics presents many opportunities for "misadventures" as a professor once told me.    Indeed this occurred to me as I was completing RCT on a staff member at Kijabe Hospital.  For no apparent reason on a non-curved canal, with straight-line access, a Tulsa Rotary 40X.08 separated.  
The radiograph shows the file trapped and short 4 mm of the apex (and with obvious periapical pathosis).  Leaving the file is not a preferred option as it is short, does not provide seal, and there is a RL at the apex.  Apicoectomy (surgically removing the last 5 mm of the root tip) is a possibility, but unfortunate and somewhat invasive  Extraction is another option yet terrible.  The last option was to attempt to retrieve the file--something I had never been successful in accomplishing.

The Tulsa Dental Piezo Ultrasonic came in handy again (thanks for the donation)!  After 30 minutes of using multiple non-surgical tips and different ultrasonic levels (5-15), water and no water, stil the file failed to come loose.  All I knew about operating this instrument was to circle the file (which was not visible) in a counter-clockwise fashion.  It didn't seem to be working.  All that seemed to be happening was the removal of intracanal cementum and possibility of perforation.  
Persistence proved successful and the separated file in a swift movement was loosened and removed.  The canal was shaped (somewhat overshaped in the coronal third).  The canal was irrigated with NaOCL, dried, sealed with therma-seal, and obturated with thermafil GP.  Decent fill with a "puff" of sealer extruded past the apex confirming patentcy.

I'm grateful for an understanding patient and the chance to correct an iatrogenic event.

No comments: