Lecture 5: Case Selection & Recall Responsibilities

Question 1

The single most important factor affecting RCT success:

Answer 1

Case selection

Question 2

To avoid great risk or serious error, you must examine & fully understand: (4)

Answer 2

1. the patient
2. the complexities of the root canal system
3. the specialized techniques requried
4. have the appropriate training, instrumentation & equipment

Question 3

For case selection, you should consider (2):

Answer 3

1. the great variety of personality types
2. your current patient management skills

Question 4

List the primary considerations for RCT: (2)

Answer 4

1. Does the patient WANT endo treatment?
2. Does the patient UNDERSTAND the commitments required of the treatment?

Question 5

List the subsequent considerations for RCT: (4)

Answer 5

1. Is the tooth strategic & functional?
2. Is the tooth restorable?
3. Is it periodontally sound?
4. Is the investment justified by the benefits?

Question 6

T/F: Missed canals have a significant impact on treatment prognosis

Answer 6

True

Question 7

NEVER start RCT on any tooth for which:

Answer 7

an excellent result cannot be reasonably expected.. in your hands at that time with that patient

Question 8

The standard of care expected of the general dentist is _____ as that expected of the endodontic specialist

Answer 8

EXACTLY the same

Question 9

The ____ has developed a form which will help you determine the difficulty/risk level of each case in question.

Answer 9

AAE

Question 10

Once you determine the ___, you have a reasonable basis to decide if you should ____ the case or ____.

Answer 10

Difficulty level; Accept; Refer

Question 11

The AAE Endodontic Case Difficulty Assessment Form Column Categories include: (3)

Answer 11

1. minimal risk
2. moderate risk
3. high risk

Question 12

Re-treatment & procedural incidents are all:

Answer 12

High risk cases

Question 13

Undergrads at UMKC can only do:

Answer 13

category 1 cases

Question 14

What teeth are absolutely excluded for undergrads at UMKC?

Answer 14

2nd and 3rd molars

Question 15

In order to do a molar RCT at UMKC by an undergrad, _____ successful anteriors have to be done first.

Answer 15

2-3

Question 16

T/F: RTC cases can be approved by generalists in your team.

Answer 16

False- RCT must be approved by endo faculty for all undergrad

Question 17

Category 2 cases can be performed by:

Answer 17

Endo Honors/ Advanced Endo

Question 18

Category 1 cases can be performed by:

Answer 18

Undergrads

Question 19

Category 3 cases can be performed by:

Answer 19

Advanced Endo ONLY

Question 20

T/F: It is rarely acceptable to do endo through a crown as an undergrad student

Answer 20

False- Never do anything through a crown in undergrad

Question 21

A long tooth may be ____ the work & time of a normal length tooth

Answer 21

2x

Question 22

Teeth with roots over ____mm are considered long

Answer 22

23mm

Question 23

4th canal Mandibular molar or C-shaped canals=

Answer 23

radix (potential problem)

Question 24

List some potential anatomical problems that would complicate RCT: (7)

Answer 24

1. high cervical break
2. 4th mandibular molar canal
3. c- shaped canals
4. invasive resorption or perforating internal resorption
5. teeth with aberrant anatomy
6. tipped, malposed, or malformed teeth
7. long roots (over 23 mm)

Question 25

When we see a 45 degree bend from access to root canal:

Answer 25

High cervical break

Question 26

List some procedural incidents: (3)

Answer 26

1. instrument separation 2. most/ all perforations 3. can't find canals

Question 27

List some cases that we would routinely refer: (4)

Answer 27

1. Procedural incident cases 2. Surgery cases 3. Re-treatment cases 4. Insoluble paste RCT

Question 28

T/F: You may refer a patient AT ANY TIME; before or during the dx or treatment

Answer 28

true

Question 29

The best time to refer is: (3)

Answer 29

1. BEFORE a problem occurs 2. BEFORE your liability is incurred 3. BEFORE your credibility is compromised

Question 30

Who did Dr. Weisleder discuss that was a great mentor in endodontics to her?

Answer 30

Dr. Ronald R. Riley

Question 31

What did Dr. Ronald Riley contribute to in the oral surgery journal volume 37?

Answer 31

"endodontic recall procedures"

Question 32

List some of the key discussion points from Dr. Ronald Riley: (5)

Answer 32

1. Outcome discovery 2. Validation of your treatment 3. Professional responsibility 4. Ethical & moral obligation 5. Legal mandate

Question 33

When should you recall if the patient reports adverse signs & symptoms?

Answer 33

Recall immediately

Question 34

What are some signs and symptoms that require you to recall the patient IMMEDIATELY? (3)

Answer 34

1. infection 2. pain/continued sensitivity 3. draining sinus tract

Question 35

Minimum recall interval for the "greatest improvement"

Answer 35

6 months - 1 year. (Klevant 1983)

Question 36

At UMKC, as a student dentist you have required recall of minimum of ____ RCT patient recalls

Answer 36

2

Question 37

T/F: At UMKC you may be asked to recall RCT patients of graduates

Answer 37

true

Question 38

The purpose of endodontic recall is to:

Answer 38

1. assess the status of the treated tooth 2. determine need for additional treatment 3. document recall procedures 4. document 3 unsuccessful attempts???

Question 39

When assessing the status of the treated tooth (purpose of endodontic recall) you should examine the tooth to see if it is:

Answer 39

1. healed/healing 2. functional 3. diseased

Question 40

For a recall endo patient, what are we looking for radiographically?

Answer 40

1. Two diagnostic P/A films 2. Potential CBCT 3. Normal PDL width 4. PARL eliminated 5. Normal lamina dura 6. Normal to fine-meshed osseous trabeculae 7. No resorption

Question 41

What radiographs will you take for a recall patient?

Answer 41

two diagnostic PAs; potentially a CBCT

Question 42

For a recall endo patient, what are we looking for clinically?

Answer 42

1. Negative percussion 2. Negative palpation 3. No DST

Question 43

What are some signs/symptoms that may be observed at a recall visit that hint towards an unsuccessful RCT: (6)

Answer 43

1. Persistant subjective symptoms 2. RECURRENT SINUS TRACT OR SWELLING 3. Discomfort to percussion and/or palpation 4. Evidence of a fractured tooth 5. Excessive mobility or progressive periodontal breakdown 6. INABILITY TO FUNCTION ON THE TOOTH

Question 44

What degree of success should be expected & communicated?

Answer 44

Reasonable to say well over 90% ASSUMING INTELLIGENT CASE SELECTION

Question 45

What is the first rule for referral?

Answer 45

Refers when in the BEST INTERESTS of the patients

Question 46

What are the column categories for the AAE endodontic case difficulty assessment form?

Answer 46

1. Minimal risk 2. Moderate risk 3. High risk

Question 47

With the AAE endodontic case difficulty assessment form, what determines the difficult level?

Answer 47

Column with the most checks

Question 48

According to the AAE endodontic case difficulty assessment form, what cases are automatically high risk?

Answer 48

Re-treatment RCTs and procedural instruments

Question 49

AAE Case Difficulty @ UMKC: What cases can undergrads do?

Answer 49

Category 1 cases

Question 50

Category 1 endo cases do not include:

Answer 50

2nd & 3rd molars (No second or third molars for undergrad)

Question 51

At UMKC, an undergrad cannot do a first molar RCT until:

Answer 51

2-3 successful anteriors are done

Question 52

T/F: Rarely can a UMKC undergrad perform a root canal through a crown

Answer 52

False- never!

Question 53

T/F: RCT cases must be approved by endo faculty for all undergrad

Answer 53

True

Question 54

What category of cases can be done by endo honors as well as advanced endo?

Answer 54

Category 2

Question 55

Category 3 cases must be performed by:

Answer 55

advanced endo only!

Question 56

- Teeth with abnormal anatomy - tipped teeth - malposed teeth - malformed teeth - teeth with long roots (over 23 mm) - 4 canal mandibular molars - C-shaped canals - high cervical breaks These are all reasons to:

Answer 56

refer endo treatment

Question 57

Routinely refer procedural incidents including:

Answer 57

1. instrument separation 2. most or all perforations 3. trouble finding all canals

Question 58

Routinely refer what types of cases:

Answer 58

1. procedural incidents 2. surgery cases 3. re-treatment cases 4. insoluble paste RCT

Question 59

Wen can we refer?

Answer 59

anytime before or during the diagnosis or treatment

Question 60

The best time to refer is: _____ a problem occurs ______ your liability is incurred _____ your credibility is compromised

Answer 60

BEFORE!!

Question 61

List the three reasons for a recall procedure:

Answer 61

1. if a patient reports adverse signs or symptoms 2. infection, pain, or continued sensitivity 3. DST

Question 62

Minimal recall intervals:

Answer 62

6 months to 1 year (greatest improvement) 2 years 4 years

Question 63

At UMKC we must see a minimum of ____ RCT patient recalls

Answer 63

2

Question 64

What is the purpose of endodontic recall? (3)

Answer 64

1. assess the STATUS of the treated tooth 2. determine the need for ADDITIONAL TREATMENT 3. DOCUMENT recall procedures

Question 65

The status of an endodontically treated tooth may be:

Answer 65

1. healed/healing 2. functional 3. diseased

Question 66

For a recall appointment radiographically we should take:

Answer 66

2 diagnostic P/A Films

Question 67

At a recall appointment we should radiographically take 2 diagnostic P/A films to determine:

Answer 67

1. normal PDL width 2. PARL eliminated 3. Normal lamina dura 4. Normal to fine-meshed osseous traveculae 5. No resorption 6. Assess need for CBCT

Question 68

At a recall appointment, in addition to the radiographs, clinically we should detect:

Answer 68

negative percussion & negative palpation, & NO DST