3. Case Selection & Treatment Planning Flashcards
What factors should you consider when assessing a potential endo case?
Medical Psychological Dental factors Social factors Endodontic complexity
Would you treat a pregnant woman for endodontics?
Might choose to delay either beyond 1st trimester or after pregnancy so there is less chance of infection
Would you treat a patient with diabetes for endodontics?
They are more prone to infection so there is a poorer outcome
If case is difficult/severe extraction may be a better option
Would you treat a patient on bisphosphonate therapy with endodontics?
May choose to do endodontics when a tooth could be extracted as bone healing is a problem in these patients (MRONJ).
What other medical conditions have contraindications to endodontics?
Cardiovascular disease
End-stage renal disease
Immunosuppression
Behavioural & psychiatric disorders - compliance
Would you treat a patient with cancer for endodontics?
They will be immunosuppressed so increased infection risk.
Extraction may be better option.
Would you treat a patient on anticoagulants with endodontics?
Must first check patient’s INR, especially if IDB is to be undertaken.
Also do not use aspirin as an analgesic.
Why should you consider the periodontal health of patients requiring endodontics?
Poor perio prognosis may necessitate loss
What restorative aspects should you consider in a patient requiring endo?
Presence of sub osseous caries?
Poor crown/root ratio?
Misalignment of teeth?
Presence of pre-existing full coverage restorations?
What other dental factors (than medical, perio & restorative) should you considering before treating a patient for endodontics?
Calcifications, dilacerations and resorption Inability to isolate tooth Unusual anatomy Ledges and perforations Posts Separated instruments
What are the other treatment options if endodontics is not suitable?
Extraction
Follow-up
Orthograde RCT
Surgical endodontics
What are the different complexity gratings of endodontic treatment and who can treat each grade?
Grade 1 - GDP
Grade 2 - GDP with special interest in endo
Grade 3 - Specialist in endodontics
What is the outcome for orthograde root canal treatment?
Up to 90% over 10 years in teeth with irreversible pulpitis
Up to 80% over 10 years in neurotic teeth
What are the outcomes if endodontically treating a tooth that has not had RCT previously?
Without periradicular periodontitis 83-100%
With periradicular periodontitis 46-93%
What are the outcomes when retreating a tooth that has had previous RCT?
Without periradicular periodontitis 89-100%
With apical periodontitis 56-84%
