Case Selection and Recall Procedures Flashcards
The single most
important factor affecting
RCT success
Case Selection
To avoid great risk or serious error, you must examine
and fully understand:
(4)
the patient
the complexities of the root canal system
the specialized techniques required and
have the appropriate training, instrumentation &
equipment
Consider:
(2)
⦿The great variety of personality types
⦿Your current patient management skills
Never start RCT on any tooth for which
an excellent
result cannot be reasonably expected . . . in your hands
at that time with that patient.
If not, you must ethically & morally REFER
Standard of Care
In the eyes of the legal community:
*The Standard of Care expected of the General Dentist is exactly
the same as that expected of the Endodontic Specialist.
Case Difficulty Assessment Form
The AAE has developed a form which will help you determine the
difficulty/risk level of each case in question.
Once you determine the difficulty level, you have a reasonable
basis to decide if you should
ACCEPT the case or REFER.
COLUMN CATEGORIES:
(3)
- Minimal Risk
- Moderate Risk
- High Risk
Review each column and each related entry:
- If it is a concern, place –
- Column with most checks
determines
check
Difficulty Level
RETX & Procedural Incidents
are all – Risk Cases
High
AAE Case Difficulty @ UMKC
Category 1 Cases only: Undergraduates
(4)
No 2ndor 3rdMolars
No Molars until 2-3 successful anteriors done
Nothing through a crown
Approved by endo faculty for all undergrad
Category 2 Cases:
Endo Honors/Advanced Endo
Category 3 Cases:
Advanced Endo only
Procedural Incidents:
(3)
–Instrument Separation
–Most or All Perforations
–Can’t find all canals
Routinely Refer
(3)
*Surgery Cases
*Re-treatment Cases
*Insoluble Paste RCT
May refer at ANY TIME Before or during the DX or treatment
The BEST TIME to refer is:
(3)
BEFOREa problem occurs and
BEFOREyour Liability is incurred and
BEFOREyour Credibility is Compromised
Recall immediately if patient reports
adverse S/S
Infection, pain or continued sensitivity
Draining Sinus Tract
Minimum Recall Intervals
6 months to 1 year * “Greatest Improvement”
2 years
4 years
Required Recall of a minimum of — RCT patient Recalls:
May be asked to Recall RCT patients of graduates
2
Purpose of Endodontic Recall:
(4)
Assess status of treated tooth
Determine need for additional treatment
Document Recall Procedures
(or 3 Unsuccessful Documented Attempts)
Assess status of treated tooth
(3)
*Healed/Healing
*Functional
*Diseased
Skipped
Areas of evaluation:
Radiographic
–2 Diagnostic P/A films
(6)
Normal PDL width
PARL eliminated
Normal lamina dura
Normal to fine-meshed osseous trabeculae
No resorption
CBCT ?
Clinical:PERCUSSION (-), PALPATION (-),
NO DRAINING SINUS TRACT (DST)
Skipped
Clinical
(6)
Persistent subjective symptoms
Recurrent sinus tract or swelling
Discomfort to percussion and / or palpation
Evidence of fractured tooth
Excessive mobility or progressive periodontal
breakdown
Inability to function on the tooth *
Can reported symptoms be
demonstrated clinically?
(4)
Is issue non-odontogenic?
Inadequate endodontic treatment?
Leaking Coronal Restoration?
Trauma/Fracture
Unknown
What degree of Success should be
expected/communicated?
(2)
*Scores of studies over decades
*Reasonable to say well 0ver 90%
–Assuming intelligent CASE
SELECTION
–Assuming competent & careful
technic
Referral Guidelines
(3)
⦿“We have the professional, moral, ethical and legal responsibility
to recognize the extent of our patient’s treatment needs and to
refer when referral is in the best interests of the patient.” ADA
⦿“It is the role of the general dentist to manage the overall dental
health care of the patient. When appropriate, any care rendered
by a specialist should be coordinated with that of a general
dentist, with a clear understanding of the role of each in
providing care to the patient” AGD
⦿“It is the responsibility of the specialist to refer the patient back
to the generalist for restoration when RCT is completed.” AAE
1 Rule for Referral
Refer when in the BEST INTERESTS of patient
*Secondary Concerns (equipment - time?)
Skipped
Case Presentation must qualify as “Informed
Consent”
*Whether you do it In-house or Refer:
–Patient must UNDERSTAND (simple language)
*The current condition and all reasonable options
*The Sequelae of no treatment
*Risks v. Benefits of TX options (>90%)
*Possible procedural complications of RCT
–Separated Instrument & Perforation
–Fracture of root or tooth (need for Crown)
–Other unforeseen complications
–Approximate expectation of success (Prognosis)
*The approximate cost of RCT & all related services
Skipped
AGD: Guidelines for Referral
*Name & contact info for the patient
*Appointment time
*Reason for the referral
*General background which may affect the case
*Medical & dental information
–Medical consultations & specific problems
–Previous contributory dental history
–Radiographs !
2 Way Communication
Endodontist should call GD office at completion
of RCT to schedule Restoration
