Case Selection and Recall Procedures

Question 1

what is 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:

Answer 2

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

Question 3

to avoid risk or error you must consider:

Answer 3

• the great variety of personality types
• your current patient management skills

Question 4

what are the primary considerations

Answer 4

does the patient want endo tx
- does the pt understand the commitments required of the tx

Question 5

what are the subsequent considerations

Answer 5

• is the tooth strategic and functional
• is the tooth restorable
• is it periodontally sound
• is the investment justified by the benefits

Question 6

retreatment and procedural incidents are all ____ risk cases

Answer 6

high

Question 7

what difficulty level are undergrads at UMKC allowed to do

Answer 7

category 1 cases

Question 8

what are category 1 cases

Answer 8

• no 2nd or 3rd molars
• no molars until 2-3 successful anterior done
• nothing through a crown
• approved by endo faculty for all undergad

Question 9

who does category 2 cases

Answer 9

endo honors or advanced endo

Question 10

who does category 3 cases

Answer 10

advanced endo only

Question 11

what cases should you routinely refer

Answer 11

• procedural incidents: instrument separation, most or all perforations, cant find all canals
• surgery canses
  -retreatment cases
• insoluble paste RCT

Question 12

when can you refer

Answer 12

at any time before or during the dx or treatment

Question 13

the best time to refer is:

Answer 13

• before a problem occurs
• before your liability is incurred
• before your credibility is compromised

Question 14

when should you recall a patient that is symptomatic and what would be the symptoms

Answer 14

immediately
- infection, pain, continued sensitivity, DST

Question 15

what are the minimum recall intervals

Answer 15

6 months to 1 year

Question 16

what are the recall requirements for graduation

Answer 16

• minimum of 2 RCT patient recalls
• may be asked to recall RCT patients of graduates

Question 17

what is the purpose of endo recall

Answer 17

• assess status of treated tooth
• healed/healing
• functional
• diseased
• determine need for additional tx
• document recall proceudres
• or 3 unsuccessful documented attempts

Question 18

what are the areas of evaluation for recall

Answer 18

• radiographic: need 2 diagnostic PA films
• normal PDL width
• PARL eliminated
• normal lamina dura
• normal to fine meshed osseous trabeculae
• no resorption
• possible CBCT
• clinical: negative to percussion, palpation and no DST

Question 19

what are the clinical symptoms of a failed RCT on recall

Answer 19

• persistent subjective symptoms
• recurrent sinus tract or swelling
• discomfort to precussion and/or palpation
• evidence of fractureed tooth
• excessive mobility or progressive periodontal breakdown
• inability to function on the tooth

Question 20

what needs to be considered with a diseased outcome

Answer 20

• can reported symptoms be demonstrated clinically
• is issue non-odontogenic
• inadequate endo tx
• leaking coronal restoration
• trauma/fracture
• unknown

Question 21

what is the success rate of RCT assumng intelligent case selection and competent and careful technique

Answer 21

well over 90%

Question 22

we have the ___________ responsibility to recognize the extent of our patients treatment needs and to refer when referral is in the best interest of the patient” -ADA

Answer 22

professional, moral, ethical and legal

Question 23

it is the role of a general dentist to manage the overall dental health care of the patient, when appropriate any care rendered by a _________________ with a clear understanding of the role of each in providing care to the patient” -AGD

Answer 23

specialist should be coordinated with that of a general dentist

Question 24

“it is the responsibility of the specialist to ________ for restoration when the RCT is complete” - AAE

Answer 24

refer the patient back to the generalist

Question 25

what is the #1 rule for referral

Answer 25

refer when in the best interests of patient

Question 26

what is the informed consent the patient must understand

Answer 26

• the current condition and all reasonable options
• the sequelae of no tx
• risks and benefits of tx options
• possible procedural complications
• separated instrument and perforation
• fracture of root or tooth
• other unforeseen complications
• approximate expectation of success
• the approximate cost of RCT and all related services such as a crown

Question 27

what are the ADA guidelines for referral

Answer 27

• name and contact info for the patient
• apppointment time
• reason for the referral
• general background which may affect the case
• medical and dental information
• medical consultations and specific problems
• previous contributory dental history
• radiographs

Question 28

what is the “2 way communication”

Answer 28

endodontist should call GD office at completion of RCT to schedule restoration