Case Selection and Treatment Planning in Endodontics Flashcards
what do problems that arise during treatment usually highlight
problems with the pre-treatment assessment
○ Evaluation of patient
○ Evaluation of tooth
○ Self-evaluation of clinician
following examination and diagnosis of an endodontic problem, what questions should you ask when beginning case selection?
○ Is treatment indicated?
○ Is patient’s oral health needs best met by maintaining the tooth?
○ Complete patient evaluation necessary
○ Who should treat?
what 3 things about the patient need to be evaluated
- Medical
- Psychological
- Social factors
what medical findings about the patient need to be considered with regards to case selection
(this is a looooong one sorry xxx)
- No absolute contraindication to endodontic treatment - If in doubt speak with patient’s physician
- pregnancy
- not a contraindication
- only emergency intervention in the first trimester
- pain / infection should be treated with obstetrician / physician
• cardiovascular disease
- MI within past 6 months = contraindication
- emergency treatment should be done in consultation with cardiologist
- have stress reduction protocol which includes short appointments, sedation and pain / anxiety control
• cancer
- chemo / radiotherapy to H&N region can compromise healing
- work with oncologist
- need to manage infection risk
• diabetes mellitus
- must be carefully monitored
- endodontic infection can compromise even a well controlled patient
- appointments should not interfere with insulin / meal scheldule
- minimise stress
- may have poorer healing
• bisphosphate therapy
- not a contraindication, may actually move us towards endodontics
- BRONJ
- IV phosphates greater risk than oral
- preventive care
- non-surgical endo treatment of teeth that might otherwise get extracted (endo is safer alternative)
- be cautious
• allergies
- allergy to latex rubber = use dental dam made of vinyl
- GP not a risk as non-cross-reactive
what restorative considerations should be included in a dental evaluation
○ Sub-osseous caries ~ tooth will be grossly carious
○ Poor crown / root ratio
§ May not be appropriate for endo treatment
○ Misalignment of teeth
§ Is it sensible to treat?
§ Is it better to extract?
§ Does this affect our ability to gain access to the tooth appropriately?
○ Presence of pre-existing full coverage restorations
§ Is the tooth already seriously compromised?
what restorability considerations should be included in a dental evaluation?
• The restorability of the tooth must be thoughtfully considered first, deconstruct if necessary if you are unsure
○ Remove the restoration
○ Remove the decay
All decay should be removed so that the extent of healthy tooth structure can be determined
fractures running along the floor of the cavity can be missed if deconstruction does not occur
explain coaxial illumination
Because the light source at the dental chair and your line of vision / visual path are not the same you get shadow casting - this is if your eye line and the line of light are further apart
But if you bring the light source and your visual path closer together you are less likely to see shadows
However a light source attached to your loupes is the best way to improve your visualisation
what happens in rear surface reflecting mirrors
End up with a distance between the front of the glass and the mirror
This causes increasing distortion as the angle of the mirror is increased
Eg when looking down canals
what sort of mirrors do we want to be using?
front surface mirrors
gives a clear single image
list other factors that should be included in a dental evaluation
○ Calcifications, dilacerations and resorption ○ Inability to isolate a tooth ○ Unusual anatomy ○ Ledges and perforations ○ Posts ○ Separated instruments
these things are often found from looking at the pre-operative radiograph
how can you tell the difference between internal and external resorption
External resorption appears to be superimposed on the canal, whereas internal resorption appears to be continuous with the canal
what are the different type of complex arrangements of the lower incisor root canal structure
- type 1
a single canal present from the pulp chamber to the apex - type 2
2 separate canals leave the pulp chamber and join to form once canal at the apex - type 3
once canal leave the pulp chamber and divides into 2 and join to form one canal at the apex - type 4
2 separate canals are present from the pulp chamber to the apex - type 5
one canal leaves the pulp chamber, divides into 2 separate canals with 2 apical foramina
explain the fast break rule
Can see a single canal reaching the apical portion (first premolar) and people will often think the loss of the canal will be due to calcification but actually calcification will not generally occur in that direction (it goes from coronal to apical because it requires vital pulp tissue and as the tissue recedes you get lying down of the dentine)
actually showing the division of a canal
So there is a single canal that divides into two or maybe 3 canals and it gets more difficult to discern the individual canal structure
not sure any of this makes sense hahahah
when are CBCT radiographs used
“CBCT should be considered on a case by case basis where lower dose conventional radiography does not provide adequate diagnostic value”
These are generally reserved for more complex cases
what determines if a perforated canal can still have a successful outcome
The position and size of the perforation and
how readily it can be repaired and
whether there is periodontal breakdown
