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Ledge by Mind Map: Ledge
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Ledge

Ledge is an iatrogenically created root canal wall irregularity that may impede placement of an intracanal instrument to the apex.

ENDODONTIC MISHAPS

Access related

Treating the wrong tooth

Missed canal

Damage to existing restoration

Crown fractures

Access cavity perforations

Instrument related

Ledge formation

Cervical canal perforations

Midroot perforations

Apical perforations

Separated instruments and foreign objects

Canal blockage

Obturation related

Over- or underextended root canal fillings

Nerve paresthesia

Vertical root fracture

Miscellaneous

Post space perforations

Irrigant related mishaps

Tissue emphysema

Instrument aspiration and ingestion

CAUSES

Lack of straight line access

Improper access prepartion

Compromise the negotiation of the apical third of a canal through improper coronal flaring

Anatomy of the canal

Length, Longer canals have a greater potential for ledge, Recapitulate to confirm patency

Canal Diameter, Smaller diameter canals have greater potential for ledge

Degree of curvature, Degree of curvature increases, the potential for ledge increases

Inadequate irrigation or lubrication

NaOCl is a good irrigant, but an additional lubricant is neccessary

Lubricants allow for ease of file insertion, decrease of stress on instruments, and ease of of debris removal

Excessive enlargement of the curved canals with large files

Instruments have the tendency to cut straight ahead and straighten out., Files cut dentin toward the outside of the curvature at the apical portion of the root, a process called transportation.

Transported tip of the file may gouge into the dentin and create a ledge or perforation outside the original curvature of the canal

Don't jump a file size.

Obstruction or the packing of debris in the apical portion of the canal

Correction

Recognition of a ledge is the first step in its management; this might be by

clinical

radiographic observation with the instrument placed at the point of the suspected ledge

Canal first must be relocated and renegotiated

One technique is to use a precurved (1 to 2 mm apically) small file to re-establish correct working length

Use plenty of lubrication

Use a picking motion, If the true canal is located, use a reaming motion and occasionally an up-and-down movement to maintain the space and débride the canal

Flaring the access may help improve access to the apical third of the canal

Despite all effort, correction of a ledge is difficult because instruments and obturation materials tend to be directed into the ledge.

If unable to bypass ledge, clean and shape at the "new" working length.

Prognosis

Successful treatment after ledge creation depends on the extent of debris remaining in the region past the ledge.

The amount of debris depends on when the ledge formation occurred in the cleaning and shaping process.

Short and cleaned apical ledge have better prognoses

Inform the patient of the prognosis, and instill the importance of recall and the signs that would indicate failure.

Tips

The best approach to managing ledges is prevention

If the radiograph shows that the instrument point is directed away from the lumen of the canal, then it is highly likely that there is a ledge

the shortest file to reach working length should be chosen. Shorter instruments provide more stiffness and move the clinician’s fingers closer to the tip of the instrument

A nickel–titanium instrument should not be used to bypass ledges

Do not use (EDTA) for chelation because it tends to intensify the ledge.

Ref.

JOE — Volume 33, Number 10, October 2007

InglePDQ: Ch. 08 - Endodontic Mishaps

Ingle’s ENDODONTICS 6th Edition

Mindmap Author

Mahmoud Al-Johani

Twitter: @dr_aljohani

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