Case Selection and Recall Procedures

Question 1

The single most
important factor affecting
RCT success

Answer 1

Case Selection

Question 2

To avoid great risk or serious error, you must examine
and fully understand:
(4)

Answer 2

the patient
the complexities of the root canal system
the specialized techniques required and
have the appropriate training, instrumentation &
equipment

Question 3

Consider:
(2)

Answer 3

⦿The great variety of personality types
⦿Your current patient management skills

Question 4

Never start RCT on any tooth for which

Answer 4

an excellent
result cannot be reasonably expected . . . in your hands
at that time with that patient.

If not, you must ethically & morally REFER

Question 5

Standard of Care
In the eyes of the legal community:

Answer 5

*The Standard of Care expected of the General Dentist is exactly
the same as that expected of the Endodontic Specialist.

Question 6

Case Difficulty Assessment Form

Answer 6

The AAE has developed a form which will help you determine the
difficulty/risk level of each case in question.

Question 7

Once you determine the difficulty level, you have a reasonable
basis to decide if you should

Answer 7

ACCEPT the case or REFER.

Question 8

COLUMN CATEGORIES:
(3)

Answer 8

1. Minimal Risk
2. Moderate Risk
3. High Risk

Question 9

Review each column and each related entry:
- If it is a concern, place –
- Column with most checks
determines

Answer 9

check
Difficulty Level

Question 10

RETX & Procedural Incidents
are all – Risk Cases

Answer 10

High

Question 11

AAE Case Difficulty @ UMKC
Category 1 Cases only: Undergraduates
(4)

Answer 11

No 2ndor 3rdMolars
No Molars until 2-3 successful anteriors done
Nothing through a crown
Approved by endo faculty for all undergrad

Question 12

Category 2 Cases:

Answer 12

Endo Honors/Advanced Endo

Question 13

Category 3 Cases:

Answer 13

Advanced Endo only

Question 14

Procedural Incidents:
(3)

Answer 14

–Instrument Separation
–Most or All Perforations
–Can’t find all canals

Question 15

Routinely Refer
(3)

Answer 15

*Surgery Cases
*Re-treatment Cases
*Insoluble Paste RCT

Question 16

May refer at ANY TIME Before or during the DX or treatment
The BEST TIME to refer is:
(3)

Answer 16

BEFOREa problem occurs and
BEFOREyour Liability is incurred and
BEFOREyour Credibility is Compromised

Question 17

Recall immediately if patient reports

Answer 17

adverse S/S
Infection, pain or continued sensitivity
Draining Sinus Tract

Question 18

Minimum Recall Intervals

Answer 18

6 months to 1 year * “Greatest Improvement”
2 years
4 years

Question 19

Required Recall of a minimum of — RCT patient Recalls:
May be asked to Recall RCT patients of graduates

Answer 19

2

Question 20

Purpose of Endodontic Recall:
(4)

Answer 20

Assess status of treated tooth
Determine need for additional treatment
Document Recall Procedures
(or 3 Unsuccessful Documented Attempts)

Question 21

Assess status of treated tooth
(3)

Answer 21

*Healed/Healing
*Functional
*Diseased

Question 22

Skipped
Areas of evaluation:
Radiographic
–2 Diagnostic P/A films
(6)

Answer 22

Normal PDL width
PARL eliminated
Normal lamina dura
Normal to fine-meshed osseous trabeculae
No resorption
CBCT ?

Question 23

Clinical:PERCUSSION (-), PALPATION (-),

Answer 23

NO DRAINING SINUS TRACT (DST)

Question 24

Skipped
Clinical
(6)

Answer 24

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 *

Question 25

Can reported symptoms be
demonstrated clinically?
(4)

Answer 25

Is issue non-odontogenic?
Inadequate endodontic treatment?
Leaking Coronal Restoration?
Trauma/Fracture
Unknown

Question 26

What degree of Success should be
expected/communicated?
(2)

Answer 26

*Scores of studies over decades
*Reasonable to say well 0ver 90%
–Assuming intelligent CASE
SELECTION
–Assuming competent & careful
technic

Question 27

Referral Guidelines
(3)

Answer 27

⦿“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

Question 28

1 Rule for Referral

Answer 28

Refer when in the BEST INTERESTS of patient
*Secondary Concerns (equipment - time?)

Question 29

Skipped
Case Presentation must qualify as “Informed
Consent”

Answer 29

*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

Question 30

Skipped
AGD: Guidelines for Referral

Answer 30

*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 !

Question 31

2 Way Communication

Answer 31

Endodontist should call GD office at completion
of RCT to schedule Restoration