Prof. Dr. Paula Perlea

Common iatrogenic errors through endodontic treatment- can they be avoided?

Prof. Dr. Paula Perlea, DDS, PhD, Assist. Prof. Dr. Cristina Coralia Nistor, DDS, PhD

Errors in access cavity preparation, errors in measuring or accurately maintaining the working length, errors in cleaning and shaping of the root canal system (missed canals, perforations, ledge formation, uncentered preparations, not continuous or progressive taper, apical transportation, instrument separation), lack of disinfection, errors in root canal filling (overfill, underfill, voids, not homogenous obturation, gaps, microleakage), errors in the post endodontic treatment planning are the main reasons for poor outcome of the endodontic treatment.

An over- or underextended access cavity, not complying with the current principle of being as small as practically possible, in relation with a inadequate chemo-mechanical root canal preparation can have negative consequences such as the creation of ledges, false paths, perforations, missed canals or fractured instruments or undermining the strength of the tooth with the risk of vertical root fractures.

Studies show that 20-60% of endodontically treated teeth show periapical modifications at the follow-up, requiring endodontic retreatment to result in a functional, asymptomatic tooth with no apical pathology. The resumption of endodontic treatment is also indicated in the absence of apical pathology when a new prosthodontic restoration is required.

The technological advance of endodontic equipment and materials, such as the dental operating microscope, the new rotary Ni-Ti instruments made of heat-treated alloys, CBCT, ultrasound, but also bioceramic materials, allow conservative treatments even in difficult cases. Endodontic treatment outcome becomes more predictable.

Our presentation aims to show the most frequent errors during endodontic treatment, the management and follow-up of such iatrogenies, with examples of original, carefully documented clinical cases.

Key words: errors, endodontics, prevention

Professor Department of Endodontics, Faculty of Dentistry, Carol Davila University Bucharest, Dean Emeritus (2016-2020), President of the Romanian Society of Stomatology (founded 1923), President of the Romanian Association of Endodontology, President of the Romanian Medical Association (founded 1857), Chair of the Membership Liaison and Support Committee of the FDI, board member of ERO (European Regional Organization) of the FDI, member of the BASS Council
Prof Dr Paula Perlea graduated in 1993 as a valedictorian at the Carol Davila University of Medicine and Pharmacy, Faculty of Dentistry, Bucharest, Romania, received her PhD 1993-1997 (magna cum laude) at the Ruprecht Karl University, completed her postgraduate studies in endodontics at Case Western Reserve University Cleveland, Ohio, her specialization in Maxillo-Facial Radio diagnosis and Specialization in Endodontics and General Dentistry in Bucharest and obtained her habilitation at Carol Davila University. She published at the time 158 research articles as main or co-author, 2 books as coauthor, 3 books as main author and held over 150 presentations and conferences in National and International Congresses, also organizing more than 25 congresses. Professor Paula Perlea is on 5 editorial Board positions in national and international journals of dental medicine, being also the Executive Editor of the Romanian Journal of Stomatology. She is also FDI National Liaison Officer, member of the General Assembly of the European Society of Endodontology (ESE) and member of the Alumni International Association of Student Clinicians-ADA.