Case Selection and Treatment Planning Flashcards
What are the reasons for claims? (from most to least
- ‘Unsatisfactory’ treatment (including other procedures)
- Failed/inadequate endodontic treatment
- Post-treatment complications: infection, persistent pain and fractured teeth
- Fractured and/or retained instrument
- Adverse incidents during treatment, e.g. burn to lip, swallowed instrument
- Poor management, including failure to take radiographs or refer appropriately
- Perforation
- Valid consent not obtained
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
