Case Selection and Treatment Planning Flashcards
What are the 3 aspects of patient evaluation duing case assessment?
- medical
- psychological
- social factors
Is there a contraindication to endodontic treatment?
no absolute however some medical conditions can be affected
What are the medical conditions that may be affected by endodontic treatment?
- Pregnancy
- Cardiovascular disease
- Cancer
- Diabetes mellitus
- Bisphosphonate therapy
- Allergies
Why may pregnancy be an issue?
- Not a contraindication to endodontic therapy
- First trimester emergency intervention only
- Pain and infection managed in collaboration with obstetrician/physician
How should CVD be assessed?
time scale
- Myocardial infarction within the past 6 months is a contraindication
- Emergency treatment, should be provided in consultation with the patient’s cardiologist
- Stress Reduction Protocol
▪ Short appointments
▪ Sedation
▪ Pain and anxiety control
Why might cancer be an issue?
- Chemotherapy and radiotherapy to the head and neck region can compromise healing
Why may diabetes be an issue?
- An acute endodontic infection can compromise even a well controlled diabetic; so all diabetes patients must be carefully monitored
- Patients with uncontrolled diabetes should be monitored
- Appointments should be scheduled so as not to interfere with the patient’s normal insulin and meal schedule
- Minimise stress
Why may oral bisphosphonates be an issue?
- BRONJ Bisphosphonate-Related Osteonecrosis of the Jaw.
- IV bisphosphonates greater risk than oral administration – all patients should be considered at some risk (AAE)
- Preventive care
- Non-surgical endodontic treatment of teeth that might otherwise be extracted
- Use the entire health care team, when developing treatment plans for these patients
When are allergies an issue?
- If the patient is allergic to latex rubber, a dam should be made of vinyl
- Gutta Percha not a risk as non-cross- reactive
What are the periodontal considerations?
- Periodontal probing essential – BPE and tooth of interest
- Poor perio prognosis may necessitate loss (extraction)
What are the restorative considerations of endo?
– Sub-osseous caries
– Poor crown/root ratio
– Misalignment of teeth
– Presence of pre-existing full coverage restorations
How should restorability be evaluated?
All decay should be removed so that the extent of healthy tooth structure can be determined
Using magnification and co-axial illumination with front surface mirrors
– Calcifications, dilacerations and resorption
– Inability to isolate a tooth
– Unusual anatomy
– Ledges and perforations
– Posts
– Separated instruments
Why may calcifications be an issue?
- Isolated or continuous - can make treatment very difficult even for the most skilled clinician
- Iforthograde management not possible surgery may be considered
How can internal resorption be differentiated from external resorption?
radiographic appearance/CBCT
External resorption appears to be superimposed on the canal, whereas internal resorption appears to be continuous with the canal
Why might the disapperance of the canal at the end on a radiograph indicate?
canal spilts into 2 smaller, less visible canals
What are the options for treatment?
- No active treatment with review
- Extraction
- Orthograde root canal
treatment - Surgical endodontics
What do options depend on?
– Patient assessment
– Dental assessment
– Patient motivation
– Patient time
– Financial implications
What are the 3 complexies of root canal treatment set out by the NHS?
1 - ● Single/Multiple root canals with curvature < 15o to root axis that are considered negotiable from radiographic or clinical evidence through their entire length. No root canal obstruction or damaged access
● Incision and drainage
2 - ● Single/multiple root canals with curvature > 15o but < 40° to root axis that are considered negotiable from radiographic or clinical evidence through their entire length.
● Teeth with incomplete root development
3 - ● Single/multiple root canals with curvature > 40°
● Single/multiple root canals that are NOT considered negotiable
from radiographic or clinical evidence through their entire length
● Periradicular surgery
● Teeth with iatrogenic damage or pathological resorption
● Teeth with difficult root morphology
Who are the 3 complexies carried out by?
1 - general practicioner
2 - gp with training/courses
3 - specialist
What are the 3 things you should obtain consent for?
- Options for Treatment
- Prognosis
- Risks
What is the prognosis of orthograde root treatment?
- Predictable and usually successful
- Outcome rates up to 90% over 10 years for teeth
with irreversible pulpitis - Outcome rates up to 80% over 10 years for necrotic teeth
What are the risks you should outline when gaining consent?
perforation
instrument separation
hypochlorite accident
pain
fracture
swelling
infection
