Dental Practicality Index Flashcards
What are the categories within DPI of restorability?
Structural integrity of remaining tooth tissue
Periodontal state
Endodontic state
Complexity of treatment
Context of tx
- state / absence of nearby teeth
- health related issues
What is level 0 structural integrity
Intact and healthy unrestored coronal tooth structure
Or well restored tooth with well adapted restoration
- no tx required
What is level 1 structural integrity?
Requiring simple indirect restoration which may be replacement or first cycle.
Adequate volume of sound coronal tissue
Level 2 structural integrity DPI?
Minimal sound tooth structure which may require post retained foundation or have subgingival margins
Or tooth to be restored has significant role in occlusion
Level 6 structural integrity DPI?
Insufficient tooth structure to allow for well adapted restoration
- insufficient ferrule
- deep subgingival margins
- vertical root fractures
What may constitute a level 6 in periodontal condition of DPI?
Untreatable or refractory periodontal disease. Advanced bone loss and mobility
What may indicate a level 6 on DPI for endodontic treatment need?
Canals not amendable to predictable disinfection or obturation
- irretrievable fractured instruments
- extreme limited access to tooth
- proximity of vital adjacent structures e.g. sinus / mandibular nerve
- chronic/acute AA, SAP, AAP
What is local context in DPI?
Oral environment and patients’ ability to maintain their own dentition
What is general context in DPI?
Overall view of the patient as a whole
- cost of tx
- impact of tx in wider social, dental, medical history
E.g.
- need of aesthetics for job
- MH contraindicated XLA - ORN / MRONJ risk
Give a typical tooth that would be a DPI 1 - simple tx required
SI - Simple indirect restoration
PTN - BPE max 3, RSD indicated
ETN - simple root canal system with/without endodontic disease
Local context
- tooth to be used as abutment
- pros tx surrounding tooth
General context
- radiotherapy of head and neck
- Immunocompromised pt
Give an example of typical DPI 2 tooth - complex tx required
SI - minimal tooth structure remaining - ferrule
PTN - BPE 4, grade 2 mobile, furcation, ? Crown lengthening surgery
ETN - complex canals e.g. curved canal or sclerotic
- complex re root canal tx
Local context
- complex pros tx of multiple adjacent teeth
General context
- high caries
- poor OH
- bruxism / lots of NCTSL
- active periodontal disease
Give an example of typical 6 DPI tooth
SI - not enough coronal tissue to provide restoration
PTN - active periodontal disease, through and through furcations, grade three mobility
ETN - untreatable root canal system with extreme perforations / irretrievable instrument fractures
Local context
- tooth would interfere with complex pros treatment / provision of denture
General context
- potentially life threatening medical conditions that should be managed in tertiary care
- aim of dental tx is tx of pain only
