Master the Simple and Complicated Endodontic Treatment of Maxillary and Mandibular Anterior Teeth.
(Fig-1) Lack of follow-up, early diagnosis and proper endodontic treatment, led to formation of critical size apical periodontitis lesions on the maxillary and mandibular anterior teeth with a history of previous dental trauma.
1- The Prevalence of Large Lesions on Endodontically Treated MAX-MAD-ANTs. The global prevalence of Apical Periodontitis lesions (APL) associated with “Bad” endodontic treatment is an alarming 24% - 64% whereas the estimated and ordinary prevalence of APL associated with “Untreated” necrotic pulp and periapical diseases or “Good” endodontic treatment is 1.5%- 8%. The lack of timely and accurate diagnosis and proper treatment of APL leads to dentoalveolar bone loss and development of large lesions, and permanent defects. The analysis of endodontic treatment outcomes, complications, and long-term sequela raises questions about the quality of healthcare services provided to patients with endodontic, periodontic, restorative, and esthetic problems of their maxillary and mandibular anterior teeth.
(Fig-2) Improper management of nonsurgical and surgical endodontic procedures on maxillary anterior teeth lead to:1- the loss of most important physiologically and aesthetically functioning teeth, 2- destruction of the alveolus and maxilla bone, 3- and the start of most challenging surgical, prosthetic, and esthetically demanding implant dentistry procedure.
2- The Challenges of Dental Implant Placement in The Esthetic Zone Implant dentistry’s master clinicians and key- opinions leaders agree that implant placement in the esthetic zone, especially the two Maxillary Central Incisors is the most challenging implant dentistry procedure. In addition to the patient’s expectations factors, the challenges multiply with the lack of available quantity and quality bone and the need for GBR and GTR procedures. Tracing the causes of situation at hand always reveals poor quality of care in the management of the endodontic and restorative problems of the patient’s maxillary or mandibular anterior teeth.
(Fig-3) In the past, surgical endodontics was performed only on anterior teeth to correct procedural errors and manage treatment failures. Currently apical surgery is used when endodontic retreatment is not feasible or the procedural errors are the cause of treatment failure or risk tooth survival.
3- The increased Use of Surgical Endodontics to Manage Errors Associated with The Endodontic Treatment of MAX-MAD-Ants Most surgical endodontics procedures are performed on the maxillary lateral incisors Keith when standard endodontic retreatment is not possible. Surgical endodontics manages or corrects the procedure errors such as; Gross over-fills, short fills, instrument breakage, canal Ledging, root perforations, and Post-placement errors. Procedural endodontic treatment errors on maxillary or mandibular anterior teeth occur because:
- Insufficient knowledge of oral and dental anatomy of anterior teeth
- Aggressive use of automation in root canal preparation and obturation
- Use of anatomically unstandardized post space drills
- Misinterpretation of diagnostic imaging
- Predisposing erring factors caused by previous endodontic treatment
- Predisposing erring factors caused by existing crown restorations
Learning Objectives
The course focuses on enhancing the knowledge and clinical skills of General dentistry practitioners in the diagnosis, treatment, retreatment of Maxillary, and Mandibular Anterior Teeth.
NOTE; In prosthetics and cosmetic dentistry, the maxillary central incisor position will dictate your treatment plan. Armed with information about the maxillary central incisor position from the orthodontist (or prosthodontist, oral surgeon, periodontist, etc.), we can then determine the positions of the lower incisors to create a normalized overjet and overbite for our restorations. Most traditional orthodontics is treatment-planned with the lower incisor in mind, because the lower incisor position has the most limitations.
Once the initial position of the maxillary central incisor is determined, this will serve as our starting point. Now we have to consider all of the various treatments that we can render for the patient to place those teeth into the final position so that we can develop a treatment plan or road map. This blueprint will determine what treatments are possible. We can also decide if there are several different treatment plans that will work.
