lecture 5: case selection and recall responsibilites Flashcards
can you treat it?
no - it has calcified canals
what is the sigle most important factor affecting RCT success
case selection
can we treat this
probs not has canal sclerosis.
so makes it hard to do.
can we tx this
probs not, difficult to tx bc of canal sclerosis
is the tooth strategic and functional?
is the tooth restorable?
is it periodontally sound?
is the investment justified by the benefits?
subsequent considerations
is the tooth restorable is an impt question.
what do we see here?
there should be 4 canals, ther is a missing MB2
what do we see here?
periapical lesion
probs from a missed 4th canal in the molar
can we tx this?
if there is no antagonist then will not do pt justice to restore it.
can we tx this?
the tooth itself is not restorable, too much decay
can we tx this
no, it is missing at least 2mm of sound dentin that is needed to do a RCT.
can we tx this?
no, it is not periodontally sound
what is the case difficulty assessment form
it helps you determine the difficulty level, so you have a reasonable basis to decide if you should accept or refer the case
made by the AAE
the AAE endodontic case difficulty assessment form includes what
Colum Categories are:
- minimal 2. moderate 3. high risk.
re-treatment and procedural indicidents are always what category of aae difficulty assessment form
high risk
can we tx this?
yes, it meets the subsequent considerations.
at umkc, AAE case difficulty is:
category 1
category 2
category 3
category 1: undergrad
category 2: endo honors/advanced endo
category 3: advanced endo
at umkc undergrads can do what:
category 1 cases include:
- no 2M or 3M
- no M until 2-3 successful ant done
- nothing through a crown
- approved by endo faculty for all undergrad
can we tx this
no
if we cannot see the chamber then we will not be able to find canals
this happens after many years of trauma.
can we tx this
no
its is invasive resportion or perforating internal resorption
need to take CBCT and othe tech to do so.
can we tx this
no
its is invasive resportion or perforating internal resorption
need to take CBCT and othe tech to do so.
can we tx this
no
its is invasive resportion or perforating internal resorption
need to take CBCT and othe tech to do so.
can we tx this
probs not, you would predict potential problems and see that these teeth have aberrant anatomy
it is a “nightmare”
can we tx this
us probs not, refer, you would predict potential problems and see that these teeth have aberrant anatomy
here it splits into different roots
what is wrong here
they missed the second canal in this md PM
24% of pts have this second canal
whats wrong here
they missed the second canal in this md PM
24% of pts have this second canal
can we tx this
it is very difficult
tipped, malposed or malformed teeth are all very difficult
can we tx this
tipped, malposed or malformed teeth are all very difficult
can we tx this
GD, probs not, refer out
why? because this tooth is LONG, a long tooth may be 2x the work AND time of a normal length tooth.
teeth with long roots are anything over 23mm
need special instruments
can we tx this
difficult because it is a 4th canal mand molar
C-shaped canals are also very difficult (seen in 2nd MX M)
and radix = an additional root
can we tx?
probs not, this is a high cervical break, which means there is a 45 degree bend, even if the root isnt that curved, it still makes it difficult to tx.
can we tx this?
probs not, refer, becaues there is LOTS of curvature happening here.
Seen in the apical 1/3, middle 1/3 AND the roots are really long.
what 4 things should we routinely refer:
- procedural incidents (instrument separation, most or all perforations, if you cannot find a canal)
- Surgery cases
- Re-tx cases
- Insoluble paste RCT (different than GP, hard to break through)
can we tx this?
there is an OPEN APEX so, no.
why? bc you cannot seat GP with an open apex. You would have to do a different technique and would need microscopes.
Refer.
when should you refer?
ANYTIME before or during the dx or tx.
how often should you recall endo procedures?
6, 12, and 24 months after tx.
this is your professional responsibility, ethical and moral obligation and legal mandate.
when should you recall procedures?
- immediately if the pt reports adverse S/S
- minimum recalls intervals months to a year later (6, 12, 24)
if pt has adverse s/s after RCT tx what should you do?
recall immediately
S/S include:
- infection, pain, or continued sensitivity.
- DST.
what is the purpose of endo recall?
- assess the status of tx tooth
- healed/healing (will see if it is function or diseased) want to pay attention that the lesion is getting smaller.
- determine the need for additional tx
- document recall procedures
how much success do you have on endo:
well over 90% (assuming intelligent case selection)
and assuming competent and careful technique.
can we tx this
yes. as pre-doc too.
has big pulp chamber, 2 root canals.
can we tx this?
yes. even as predocs.
can we tx this.
yes, as endo honors?
why? see a fast break.
can we tx this?
probs not, refer.
there are pulp stones, the roots are really long and thin.
what is the #1 rule for refferal:
refer when it is in the BEST interest of your pt.
but also, do the math, sometimes can loose money and incurliabiltiy, so better off just to refer.
is the case selection a form of infomed consent to the pt, and what things does it include?
yes.
the patient has to understand all the complexities of what happens after the RCT, the cost of RCT and all the related services too like a crown.
The pt has to know everything that can go well or wrong during RCT too.
guidelines for a reffer for AGD:
- name and contact info for the pt
- appointment time
- reason for the referral
- general background which may affect the case
- med and dental info
- med consultations and specific probs
- prev. dental history
- and XRAYS
it is a 2 way communcation between endodontist and GD.
