Thermal injury through intraradicular heat transfer using ultrasonic devices: precautions and practical preventive strategies.

BACKGROUND: The use of ultrasonic energy is a highly efficient method of removing obstructions and cements within the root canal space when re-treatment or rehabilitation of that ultrasonic energy dislodges and removes cemented objects from the bonded interface of the canal wall. When using this method, there is less potential for structural loss or root damage and significantly less operator stress than when using other methods. CASE DESCRIPTIONS: There is little evidence in published research of the considerable heat transfer that occurs during use of ultrasonic devices to remove posts, pastes and separated instruments in teeth. The authors present three cases of patients who experienced serious burn injuries during application of ultrasonic energy for restorative dentistry. The authors also offer techniques and strategies for safe and effective use of ultrasonic devices. CLINICAL IMPLICATIONS: On the basis of the best available evidence, the authors recommend strategies to provide safe and effective therapy while using ultrasonic devices in intraradicular obstruction removal. The intent of the suggested protocols is to provide advanced and sophisticated therapies in a safe and regulated manner with patient safety as an overriding priority.

Nonsurgical retreatment.

With all the potential for endodontic success, the fact remains clinicians are confronted with posttreatment endodontic disease. When the elected treatment plan is endodontic nonsurgical retreatment, then the goal is to access the pulp chamber and remove materials from the root canal space and if present, address deficiencies or repair defects that are pathologic or iatrogenic in origin. This article provides a literature review with clinical recommendations for one important group of retreatment issues: the removal of posts and broken instruments.

Nonsurgical endodontic retreatment.

The purpose of this clinical article is to emphasize that although there is enormous potential for endodontic success, clinicians are, at times, confronted with post-treatment disease. A rationale for endodontic treatment is followed by the goals of nonsurgical retreatment. The focus of this article is to identify the various nonsurgical retreatment categories and provide an overview of the concepts, armamentarium and techniques available to disassemble roots, address deficiencies or repair defects that are pathological or iatrogenic in origin.