L14. Endodontic Case Selection Flashcards
Who/what should be evaluated during case selection?
- Patient;
- Tooth;
- Self-evaluation of clinician.
What patient factors need to be considered during case selection?
- Medical history;
- Psychological status;
- Social factors.
How can pregnancy contraindicate endodontic treatment?
Unless an emergency, avoid tx during first trimester but risk to pt/ baby should always be evaluated and discussed with physician if necessary
How can cardiovascular disease contraindicate endodontic treatment?
- Avoid tx within six months of a MI (higher risk);
- Tx should be provided in consultation with pt’s cardiologist;
- Stress Reduction Protocol.
What three things can be done to reduce stress under the Stress Reduction Protocol?
- Short appointments;
- Sedation;
- Pain and anxiety control.
How can cancer contraindicate endodontic treatment?
- If undergoing chemotherapy or radiotherapy in the head and neck region, healing can be compromised;
- Infection control;
- Should consult with oncologist.
How can diabetes contraindicate endodontic treatment?
- Poor infection control;
- Poor healing, can effect ultimate prognosis;
- Appointments should be scheduled not to interfere with pt’s meal schedules (avoid hypos);
- Minimise stress.
How can bisphosphonates contraindicate endodontic treatment?
- A hx of bisphosphonates does not;
- May indicate RCT to a tooth which would otherwise be extracted (issues with bone healing);
- Special care over dental dam placement and instrumentation to prevent damage to PDL/ bone.
How can allergies contraindicate endodontic treatment?
- Vinyl dental dam instead of latex rubber;
- GP is NOT cross-reactive.
What factors need to be considered in a dental evaluation under case selection?
- Periodontal (BPE and perio prognosis);
- Restorative;
- Restorability (is the tooth in question restorable and after removal of restorations etc.);
- Calcifications;
- Resorption;
- Anatomy;
- Previous ledges/ perforations/ separated instruments.
Why should a front-facing mirror be used in endodontics?
To reduce distortion and give a clearer, more accurate vision of the field being worked on
What is meant with regards to calcification in endodontics?
These can occur within pulp chambers/ roots as a response to inflammation or tissue death - calcifications can interfere with tx
What is meant with regards to calcification in endodontics?
These can occur within pulp chambers/ roots as a response to inflammation or tissue death - calcifications can interfere with tx and make it more complex
How can external resorption be differentiated from internal resorption?
- Radiographic appearance/CBCT;
- External appears to be superimposed whereas internal appears to be continuous with the canal.
Give examples of anatomical considerations when evaluating a radiograph:
- Canal splits;
- Extra roots;
- Extra canals;
- Extra furcations;
- Open apices (particularly when large);
- C-shaped roots.
What are the different treatment options, depending on diagnosis, in endodontics?
- No active tx with review;
- Extraction;
- Orthograde (via crown of tooth) root canal tx;
- Surgical endodontics.
How is complexity graded using the AAE case difficulty assessment form?
- Minimum;
- Moderate;
- High.
(degrees of difficulty)
What are the main features to increasing complexity of a case?
- Medical history;
- Patient cooperation;
- Tooth position in arch;
- Root anatomy;
- Root curvature;
- Radiographic difficulties;
- Resorption;
- Previous restorations;
- Periodontal condition;
- Trauma history.
What 3 factors must be discussed when obtaining consent?
- Options for tx;
- Prognosis;
- Risks.
What risks must be discussed and explained when obtaining consent for endodontic treatment?
- Perforation;
- Curved/ narrow canals;
- Separated instruments;
- Fractures (to crown or existing restorations);
- Failure;
- Pain;
- Hypochlorite accidents (rare).
