Case selection and treatment planning in endo Flashcards
What factors would you evaluate in a patient for a case assessment for endodontic treatment? (3)
- Medical
- Psychological
- Social factors
What are some medical findings that might influence our decision to do endodontic treatment or not? (6)
- Pregnancy
- CVD
- Cancer
- Diabetes Mellitus
- Bisphosphonate therapy
- Allergies
Is pregnancy a contraindication to endodontic therapy?
- No
- However, the first trimester is emergency intervention only
- Pain and infection is managed in collaboration with obstetrician/physician
Is CVD a contraindication to endodontic treatment?
- If patient has had an MI within the past 6 months it is a contraindication
- Emergency treatment should be provided in consultation with the patient’s cardiologist
Stress reduction protocol for a patient with CVD in relation to endo treatment? (3)
- Short appointments
- Sedation
- Pain and anxiety control
What is essential to have with a cancer patient for endodontic treatment?
- A thorough history is essential
- Consult with the oncologist
What could be compromised in a patient who is undergoing chemotherapy or radiotherapy to the head and neck region in endo treatment?
- Healing can be compromised
- Consult with the oncologist
Why might diabetes be a complication for endo treatment?
- 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
How might you accommodate a diabetic who is getting endodontic treatment? (2)
- Appointments should be scheduled so as not to interfere with the patient’s normal insulin and meal schedule
- Minimise stress
What does BRONJ stand for?
- Bisphosphonate-related osteonecrosis of the jaw
Bisphosphonates slide - can’t think of questions
- BRONJ
- IV B’s greater risk than oral administra tion - all patients should be considered at some risk
- 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
If a patient is allergic to latex rubber, what should the dam be made of?
- Vinyl
Is GP a risk of an allergic reaction?
- No as non-cross reactive
What perio considerations do you need to make when doing a dental evaluation? (3)
- Periodontal probing essential - BPE and tooth of interest
- Poor perio prognosis may necessitate loss
- Perio-endo or endo-perio lesion
What restorative considerations do you need to make when doing a dental evaluation? (4)
- Sub-osseous caries
- Poor crown/root ratio
- Misalignment of pre-existing
- Presence of pre-existing full coverage restorations (is the tooth already seriously compromised?)
What restorability considerations do you need to make when doing a dental evaluation?
- The restorability of the tooth must be thoughtfully considered first, deconstruct if necessary
- Remove restoration and decay and have a good look and evaluate the tooth
- If tooth is unrestorable then RCT should not be happening unless exceptional circumstances
What is coaxial illumination?
- Problem with light source that is available on the chair is that because the light and your visual path are not co-incident we get shadow casting
- If bring light and visual path closer together you are less likely to see shadows
Why do we use front surface mirrors for endodontics?
- Most mirrors are rear surface reflecting
- This causes increasing distortion as the angle of the mirror is increased e.g. when looking down canals
What are other factors that should be included in your dental evaluation before endodontic treatment? (6)
- Calcifications, dilacerations and resorption
- Inability to isolate a tooth
- Unusual anatomy
- Unusual anatomy
- Ledges and perforations
- Posts
- Separated instruments
What calcification considerations do you need to make when doing a dental evaluation? (2)
- Isolated or continuous - can make treatment very difficult even for the most skilled clinician
- IF orthograde management not possible surgery may be considered
What resorption considerations do you need to make when doing a dental evaluation? (2)
- Internal resorption can be differentiated form external resorption by its radiographic appearance
- External resorption appears to be superimposed on the canal, whereas internal resorption appears to be continuous with the canal
What anatomical considerations do you need to make when doing a dental evaluation? (3)
- Does the anatomy look different?
- Are there extra canals/root structures
- Is there bifurcations?
- Even teeth that we think are simple can be a lot more complex than we may think
Where does calcification go from and to?
- Goes from coronal and towards apical because it requires vital pulp tissue
What is the fast break rule for where we can’t see the canal reaching the apical portion?
- This indicates the division of the canal - divides into 2/3 canals and it becomes harder to discern the individual canal structure
It is really important that 2 views of intra-oral radiography are used in an endo assessment. Why is this?
- Allows us to discern canal divisions, multiple roots with a cone shift radiograph
Why might we use cone beam CT in an endo assessment?
- CBCT should be considered on a case-by-case basis where lower dose conventional radiography does not provide adequate diagnostic information
What are out options for treatment in endodontics? (4)
- No active treatment with review
- Extraction
- Orthograde RCT
- Surgical endodontics
What is the decision of type of endo treatment carried out dependent on? (5)
- PAtient assessment
- Dental assessment
- Patient motivation
- Patient time
- Financial implications
When obtaining consent what do you need to include in your discussion? (3)
- Options fo rtreatment
- Prognosis
- Risks
When talking about options for treatment in the consent process what should you include? (5)
- Follow-up
- Extraction
- Orthograde RCT
- Surgical extractions
- What do the procedures involve in brief
When might perforations be at greater risk?
- If roots are very curved
You should assume that pain will be a feature in the post-op of endodontics. To try to minimise this what should you advise the patient?
- Advise patient to take some ibuprofen for a few days before the treatment
What should be discussed with the patient to obtain consent for the treatment? (6)
- Procedure
- Prognosis
- Alternatives
- Risks
- Opportunity to ask questions
- Agree on a plan - remember endodontics is not all that will be required - restoration and review
What risks should you include when obtaining consent form the patient? (4)
- Possibility of failure
individual risks related to the case:
- Perforations
- damage to existing restorations
- Fractures
- Hypochlorite accidents
