Assessment of Difficulty Flashcards
Describe 3 components of the restorability assessment
- Periodontal
- Prosthodontic
- Endodontic
What is the prosthodontic status of a tooth?
- Remaining coronal dentine
- Rubber dam on tooth
- Integrity of dentine - Fractures / Defects
What is the endodontic status of a tooth?
- Pulpal and periapical status of the tooth
- Sensibility testing
- Absence of sinus tract
What is the periodontal status of a tooth?
- Inflammatory sinus
- Deep localized pocketing
- Failure of root structure
Describe 3 further investigations when assessing a tooth with regards to whether you have the skill level to carry it out
- Parallax
- CBCT
- Complexity indices
Name 4 considerations when deciding the complexity of a treatment
- Patient consideration
- PMH and PDH
- Tooth restorability
- Root morphology
Describe the 3 levels of difficulty with regards to AAE Endodontic Case Difficulty Assessment
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
Describe minimal, moderate and high risks of PMH with regards to AAE Endodontic Case Difficulty Assessment
Minimal - No medical issues
Moderate - 1 or more medical conditions
High - Complex PMH / Serious Illness / Disability
Describe minimal, moderate and high risks of mouth opening and physical limitations with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Normal opening (>35 mm)
Moderate - Reduced opening (25-35 mm)
High - Significantly reduced opening (<25 mm)
Describe minimal, moderate and high risks of radiography difficulty with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Normal condition
Moderate - High FOM, low palate, strong gag reflex
High - Superimposed anatomy, severe gag reflex
Describe minimal, moderate and high risks of diagnosis with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Straightforward and clear
Moderate - Several diagnoses
High - Confusing and complex signs and symptoms
Describe 6 tooth factors to consider when assessing difficulty
- Position of tooth in arch
- Tooth inclination and rotation
- Root curvature and resorption
- Crown and canal morphology
- Apical morphology
- Iatrogenic damage
Describe minimal, moderate and high risks of tooth position in the arch with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Anterior tooth / premolar
Moderate - First or second molar
High - Third molar
Describe minimal, moderate and high risks of tooth inclination with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Under 10 degree inclination
Moderate - 10-30 degree inclination
High - Over 30 degree inclination
Describe minimal, moderate and high risks of tooth rotation with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Under 10 degree inclination
Moderate - 10-30 degree inclination
High - Over 30 degree inclination
Describe minimal, moderate and high risks of crown morphology with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Normal condition
Moderate - Full coverage restoration, BA, microdontism, taurodontism
High - Dens in Dente
What is taurodontism?
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
Describe minimal, moderate and high risks of canal morphology with regards to AAE Endodontic Case Difficulty Assessment
Minimal - “I” shaped canal
Moderate - “J” shaped canal
High - “C” or “S” shaped canal
Describe minimal, moderate and high risks of root curvature with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Under 10 degree curvature
Moderate - 10-30 degree curvature
High - Over 30 degree curvature
Describe minimal, moderate and high risks of apical morphology with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Close apex
Moderate - N/A
High - Open apex ( > size 60 K file)
Describe minimal, moderate and high risks of canal calcification with regards to AAE Endodontic Case Difficulty Assessment
Minimal - Canals clearly visible
Moderate - Pulp chamber canals are reduced or pulp stones
High - Invisible canals in any part of tooth
Describe minimal, moderate and high risks of root resorption with regards to AAE Endodontic Case Difficulty Assessment
Minimal - N/A
Moderate - Internal resorption without perforation
High - External resorption or large internal root resorption with perforation
Describe minimal, moderate and high risks of iatrogenic damage with regards to AAE Endodontic Case Difficulty Assessment
Minimal - N/A
Moderate - Supra-osseous perforation
High - Separated instrument, ledging, apical transportation and sub-osseous perforation
Describe minimal, moderate and high risks of history of endodontic treatment with regards to AAE Endodontic Case Difficulty Assessment
Minimal - N/A
Moderate - Endodontic treatment started but not obturated
High - Previous endodontic treatment obturated / silver cone
