Case Selection and Recall Responsibilities Flashcards
Can you treat #19 in the Predoctoral Endo clinic?
NO!
- two fast breaks present
The single most important factor affecting RCT success is…
case selection
Should you do this case?
No! The bull’s eye is very tricky
Should you do this case?
Prolly not
it gonna be hard
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 and
- if you have the appropriate training, instrumentation & equipment
Why do you study radiographs before the RCT?
recognize problems
canal sclerosis
What are the primary considerations for a RCT?
- Does the patient WANT endodontic treatment?
- Does the patient UNDERSTAND the commitments required of the treatment?
- Is the tooth strategic & functional?
- Is the tooth restorable?
- Is it periodontally sound?
- Is the investment justified by the benefits?
Untreated canals were associated with periapical pathology in ___% of the cases
82.6%
Never start RCT on any tooth for which an excellent result cannot be reasonably expected . . .
in your hands at that time with that patient
The Standard of Care expected of the General Dentist is the same exactly as that expected of the…
Endodontic Specialist
The AAE has developed a form (Case Difficulty Assessment Form) which will help you determine the ____________ level of each case in question
difficulty/risk
What are the requirements for cateogory 1 cases (for undergraduates)?
- No 2nd or 3rd Molars
- No Molars until 2-3 successful anteriors done
- Nothing through a crown
- Approved by endo faculty for all undergrad
What are the requirements for cateogory 2 cases?
endo honors/advanced endo
What are the requirements for cateogory 3 cases?
advanced endo only
What are the problems you should avoid using case selection?
- invasive resorptoin or perforating internal resorption
- teeth with aberrant anatomy
- tipped, malposed, or malformed teeth
- teeth with long roots
- 4 canal mand molars or c-shaped canals
- high cervical break
When is the best time to refer?
Before a problem occurs
Before your Liability is incurred
Before your Credibility is Compromised
When do you need to refer immediately?
- if patient reports adverse S/S
- Infection, pain or continued sensitivity
- Draining Sinus Tract
What are the minimum recall invertals?
- 6 months to 1 year “Greatest Improvement”
- 2 years
- 4 years
What is the purpose of an endodontic recall?
- access status of treated tooth
- determine need for additional treatment
- document recall procedures
What do you need to evaluate during the recall appointment?
- 2 Diagnostic P/A films
- Normal PDL width
- PARL eliminated
- Normal lamina dura
- Normal to fine-meshed osseous trabeculae
- No resorption
- CBCT ?
CLINICALLY = percussion, palpation, and no draining sinus tract
What clinical symptoms are concerning during a recall?
- 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
What degree of Success should be expected/communicated?
- Reasonable to say well over 90%
–Assuming intelligent CASE SELECTION
–Assuming competent & careful technique
What is the AGD guideline 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 !
