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BDS4 Endodontics > 3. Case Selection and Tx Planning > Flashcards

3. Case Selection and Tx Planning Flashcards

1
Q

Are there any contraindications to endo tx?

A

No absolute contraindications but if in doubt speak to doctor

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2
Q

Can endo tx be done in pregnancy?

A

Not contraindication but avoid elective procures during first trimester due to risk of infection

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3
Q

Why do we avoid endo tx in first trimester?

A

to avoid risk of infection - we only provide emergency intervention in semester 1

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4
Q

What is a contraindication to endo in relation to the CVS?

A

MI within the last 6 months - usually we will delay and wait until 6 months has passed but if emergency tx needed then consult with cardiologist

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5
Q

What is the stress reduction protocol?

A

This is where we have short appointments

consider sedation

pain and anxiety control

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6
Q

What can an endo infection do to a diabetic pt?

A

can compromise a well controlled diabetic so all diabetic pts must be monitored carefully to ensure pts dont have any unidentified or untreated endo diseases

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7
Q

What must we ensure with diabetics?

A

we must ensure that appointments are scheduled to not interfere with meal and insulin schedule

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8
Q

What are bisphosphonates?

A

Group of drugs designed to slow down bone loss

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9
Q

What do we want to avoid in pts on bisphosphonates?

A

Extractions - we would rather do Endodontic tx as extraction can lead to bone necrosis and bone showing through the gum

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10
Q

When deciding whether to do RCT what must we consider? 3

A

pt assessment

tooth assessment

clinical self assessment - am I capable

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11
Q

Before deciding a pt needs endo what must we do?

A

Periodontal exam - BPE of all pts is carried out at every exam then we do a closer exam of tooth of interest

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12
Q

If the cause is Endodontic and tooth is vital what treatment do we do?

A

Periodontal tx

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13
Q

If cause is endo and tooth is non vital what tx do we do?

A

Endo tx

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14
Q

If tooth is caused by a perio and endo problem what tx do we do?

A

endo tx first then perio therapy

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15
Q

When we are considering restoring the the dentition? 4

A

Crown root ratio

misalignment of teeth

existing full coverage restorations

sub-osseous caries

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16
Q

What should we consider before RCT?

A

If the tooth can be restored

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17
Q

What is the coaxial illumination?

A

This is when the light source and our visual path are not coincident and as a result we get shadow casting - can improve this by brining light and visual paths closer together to reduce shadows

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18
Q

What are most dental mirrors?

A

rear facing which causes increased distortion as angle of mirror is increased

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19
Q

What dental mirrors do we use in endo?

A

Front facing mirror - we get a very clear single image

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20
Q

What adds complexity to endo tx?

A
  • Calcifications, dilacerations and resorption
  • Inability to isolate a tooth
  • Unusual anatomy
  • Ledges and perfs
  • Posts
  • Separated instruments
21
Q

What are the types or resorption?

A

Internal and external

22
Q

What is internal resorption?

A

This is when resorption is continuous with the canal

23
Q

What is external resorption?

A

When resorption is superimposed on the canal

24
Q

What is the issue with teeth with internal or external resorption?

A

The issue is with control of irrigation and ease of obturation

25
Q

What are the types of canals?

A

type 1

type 2

type 3

type 4

26
Q

What is a type 1 canal?

A

Single canal from pulp chamber to apex

27
Q

What is a type 2 canal?

A

Two separate canals leave pulp chamber then join to form one at apex

28
Q

What is a type 3 Canal?

A

One canal leaves the pulp chamber divides into 2 and joins to form one canal at the apex

29
Q

What is a type 4 canal?

A

Two separate and distinct canals present from pulp chamber to apex

30
Q

What is a type 4 canal?

A

One canal leaves pulp chamber and goes into 2 operate canals with two apical foramina

31
Q

What is the gold standard for endo assessment?

A

Two views radiographically to allow us to discern canal divisions, multiple roots

we must do two radiographs with CONE SHIFT - SLOB

32
Q

What are options for treatment of an endo pt?

A

NO active tx with review and monitor

XLa

Orthograde RCT

Surgical RCT

33
Q

How can we assess complexity of RCT?

A

There are several assessments:

AAE case difficult assessment form

Restorative dentistry index of tx need

34
Q

What is standard 3 of GDC?

A

Consent - must obtain valid consent before starting any tx and must explain all relevant tx options, risks and benefits of each and the costs

35
Q

What does obtaining consent require?

A

Tx options

Prognosis

Risks and benefits

cost

36
Q

What is prognosis of orthograde Endodontics tx?

A

there is no guarantee but orthograde endo is predictable and often successful with outcome rates up to 90% for 10 years for teeth with irreversible pulpitis and no PA radiolucency

37
Q

Outcome for orthograde endo when pt has irreversible pulpitis and no PA pathology

A

90%

38
Q

Outcome rates for pt with necrotic teeth needing orthograde endo?

A

80%

39
Q

What affects outcome rates?

A

Complex anatomy, perforations, separated instruments

40
Q

What are the risks of RCT?

A

Perforation

Instrument seperation

Pain

41
Q

What is the risk of perforation in endo?

A

In endo tx there is a risk the instruments perforate the tooth which would affect the outcome for the tooth - if pt has very curved canals then higher risk

42
Q

When is risk of instrument separation higher?

A

If pt has curved canals

narrow canals

43
Q

What must we tell pt about pain in regards to endo pt?

A

Following endo tx they will feel pain - you should expect a few days of discomfort related to tooth tx - its like surgery you would expect some post op pain!

analgesic advice - prophylactic pain advice - take soon after leaving surgery (IBUPROFEN!!)

44
Q

How can we explain what root canal treatment is to a pt?

A

RCT is a procedure that retains a tooth that would otherwise be lost or need extracted

45
Q

How do we describe success rates and risks of endo tx to pt?

A

Endo tx usually has very high degree of success the results can’t be guaranteed - occasional the tooth may need re root treated, surgery or extraction

46
Q

What are risks after tooth has been RCT?

A

Tooth fracture

47
Q

How do we restore a tooth after endo?

A

Restoration, crown and or post and core to restore the tooth

48
Q

What are the risks during endo tx that we tell a pt?

A

There is risk of instrument separation, perforations, damage to any bridges, fillings, crowns or veneers, missed canals, loss of tooth structure in gaining access and fractured teeth and the risk that tooth may not be suitable for RCT

49
Q

What are risks involved in no tx and monitoring?

A

Pain, swelling, infection, loss of tooth

BDS4 Endodontics (7 decks)

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