Case Selection and Recall Procedures Flashcards
what is the single most important factor affecting RCT success
case selection
to avoid great risk or serious error you must examine and fully understand:
- the patient
- the complexities of the root canal system
- the specialized techniques required
- have the appropriate training, instrumentation and equipment
to avoid risk or error you must consider:
- the great variety of personality types
- your current patient management skills
what are the primary considerations
does the patient want endo tx
- does the pt understand the commitments required of the tx
what are the subsequent considerations
- is the tooth strategic and functional
- is the tooth restorable
- is it periodontally sound
- is the investment justified by the benefits
retreatment and procedural incidents are all ____ risk cases
high
what difficulty level are undergrads at UMKC allowed to do
category 1 cases
what are category 1 cases
- no 2nd or 3rd molars
- no molars until 2-3 successful anterior done
- nothing through a crown
- approved by endo faculty for all undergad
who does category 2 cases
endo honors or advanced endo
who does category 3 cases
advanced endo only
what cases should you routinely refer
- procedural incidents: instrument separation, most or all perforations, cant find all canals
- surgery canses
-retreatment cases - insoluble paste RCT
when can you refer
at any time before or during the dx or treatment
the best time to refer is:
- before a problem occurs
- before your liability is incurred
- before your credibility is compromised
when should you recall a patient that is symptomatic and what would be the symptoms
immediately
- infection, pain, continued sensitivity, DST
what are the minimum recall intervals
6 months to 1 year
what are the recall requirements for graduation
- minimum of 2 RCT patient recalls
- may be asked to recall RCT patients of graduates
what is the purpose of endo recall
- assess status of treated tooth
- healed/healing
- functional
- diseased
- determine need for additional tx
- document recall proceudres
- or 3 unsuccessful documented attempts
what are the areas of evaluation for recall
- 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
what are the clinical symptoms of a failed RCT on recall
- 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
what needs to be considered with a diseased outcome
- can reported symptoms be demonstrated clinically
- is issue non-odontogenic
- inadequate endo tx
- leaking coronal restoration
- trauma/fracture
- unknown
what is the success rate of RCT assumng intelligent case selection and competent and careful technique
well over 90%
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
professional, moral, ethical and legal
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
specialist should be coordinated with that of a general dentist
“it is the responsibility of the specialist to ________ for restoration when the RCT is complete” - AAE
refer the patient back to the generalist
what is the #1 rule for referral
refer when in the best interests of patient
what is the informed consent the patient must understand
- 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
what are the ADA guidelines for referral
- 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
what is the “2 way communication”
endodontist should call GD office at completion of RCT to schedule restoration
