Assessment of Difficulty

Question 1

Describe 3 components of the restorability assessment

Answer 1

1. Periodontal
2. Prosthodontic
3. Endodontic

Question 2

What is the prosthodontic status of a tooth?

Answer 2

• Remaining coronal dentine
• Rubber dam on tooth
• Integrity of dentine - Fractures / Defects

Question 3

What is the endodontic status of a tooth?

Answer 3

• Pulpal and periapical status of the tooth
• Sensibility testing
• Absence of sinus tract

Question 4

What is the periodontal status of a tooth?

Answer 4

• Inflammatory sinus
• Deep localized pocketing
• Failure of root structure

Question 5

Describe 3 further investigations when assessing a tooth with regards to whether you have the skill level to carry it out

Answer 5

1. Parallax
2. CBCT
3. Complexity indices

Question 6

Name 4 considerations when deciding the complexity of a treatment

Answer 6

1. Patient consideration
2. PMH and PDH
3. Tooth restorability
4. Root morphology

Question 7

Describe the 3 levels of difficulty with regards to AAE Endodontic Case Difficulty Assessment

Answer 7

Minimal - 1 point
Moderate - 2 points
High - 5 points

< 20 points - Dental student could treat
20 - 40 points - Graduate dentist could treat
> 40 points - Should be referred to specialist

Question 8

Describe minimal, moderate and high risks of PMH with regards to AAE Endodontic Case Difficulty Assessment

Answer 8

Minimal - No medical issues
Moderate - 1 or more medical conditions
High - Complex PMH / Serious Illness / Disability

Question 9

Describe minimal, moderate and high risks of mouth opening and physical limitations with regards to AAE Endodontic Case Difficulty Assessment

Answer 9

Minimal - Normal opening (>35 mm)
Moderate - Reduced opening (25-35 mm)
High - Significantly reduced opening (<25 mm)

Question 10

Describe minimal, moderate and high risks of radiography difficulty with regards to AAE Endodontic Case Difficulty Assessment

Answer 10

Minimal - Normal condition
Moderate - High FOM, low palate, strong gag reflex
High - Superimposed anatomy, severe gag reflex

Question 11

Describe minimal, moderate and high risks of diagnosis with regards to AAE Endodontic Case Difficulty Assessment

Answer 11

Minimal - Straightforward and clear
Moderate - Several diagnoses
High - Confusing and complex signs and symptoms

Question 12

Describe 6 tooth factors to consider when assessing difficulty

Answer 12

1. Position of tooth in arch
2. Tooth inclination and rotation
3. Root curvature and resorption
4. Crown and canal morphology
5. Apical morphology
6. Iatrogenic damage

Question 13

Describe minimal, moderate and high risks of tooth position in the arch with regards to AAE Endodontic Case Difficulty Assessment

Answer 13

Minimal - Anterior tooth / premolar
Moderate - First or second molar
High - Third molar

Question 14

Describe minimal, moderate and high risks of tooth inclination with regards to AAE Endodontic Case Difficulty Assessment

Answer 14

Minimal - Under 10 degree inclination
Moderate - 10-30 degree inclination
High - Over 30 degree inclination

Question 15

Describe minimal, moderate and high risks of tooth rotation with regards to AAE Endodontic Case Difficulty Assessment

Answer 15

Minimal - Under 10 degree inclination
Moderate - 10-30 degree inclination
High - Over 30 degree inclination

Question 16

Describe minimal, moderate and high risks of crown morphology with regards to AAE Endodontic Case Difficulty Assessment

Answer 16

Minimal - Normal condition
Moderate - Full coverage restoration, BA, microdontism, taurodontism
High - Dens in Dente

Question 17

What is taurodontism?

Answer 17

Congenital condition where coronal aspect of the tooth is enlarged vertically at the expense of the root, making instrumentation and obturation of the roots difficult

Question 18

Describe minimal, moderate and high risks of canal morphology with regards to AAE Endodontic Case Difficulty Assessment

Answer 18

Minimal - “I” shaped canal
Moderate - “J” shaped canal
High - “C” or “S” shaped canal

Question 19

Describe minimal, moderate and high risks of root curvature with regards to AAE Endodontic Case Difficulty Assessment

Answer 19

Minimal - Under 10 degree curvature
Moderate - 10-30 degree curvature
High - Over 30 degree curvature

Question 20

Describe minimal, moderate and high risks of apical morphology with regards to AAE Endodontic Case Difficulty Assessment

Answer 20

Minimal - Close apex
Moderate - N/A
High - Open apex ( > size 60 K file)

Question 21

Describe minimal, moderate and high risks of canal calcification with regards to AAE Endodontic Case Difficulty Assessment

Answer 21

Minimal - Canals clearly visible
Moderate - Pulp chamber canals are reduced or pulp stones
High - Invisible canals in any part of tooth

Question 22

Describe minimal, moderate and high risks of root resorption with regards to AAE Endodontic Case Difficulty Assessment

Answer 22

Minimal - N/A
Moderate - Internal resorption without perforation
High - External resorption or large internal root resorption with perforation

Question 23

Describe minimal, moderate and high risks of iatrogenic damage with regards to AAE Endodontic Case Difficulty Assessment

Answer 23

Minimal - N/A
Moderate - Supra-osseous perforation
High - Separated instrument, ledging, apical transportation and sub-osseous perforation

Question 24

Describe minimal, moderate and high risks of history of endodontic treatment with regards to AAE Endodontic Case Difficulty Assessment

Answer 24

Minimal - N/A
Moderate - Endodontic treatment started but not obturated
High - Previous endodontic treatment obturated / silver cone