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Endodontics II > Lecture 5: Case Selection & Recall Responsibilities > Flashcards

Lecture 5: Case Selection & Recall Responsibilities Flashcards

1
Q

The single most important factor affecting RCT success:

A

Case selection

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2
Q

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

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

For case selection, you should consider: (2)

A
  1. the great variety of personality types
  2. your current patient management skills
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4
Q

List the primary considerations for RCT: (2)

A
  1. Does the patient WANT endo treatment?
  2. Does the patient UNDERSTAND the commitments required of the treatment
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5
Q

List the subsequent considerations for RCT: (4)

A
  1. Is the tooth strategic & functional?
  2. Is the tooth restorable?
  3. Is it periodontally sound?
  4. Is the investment justified by the benefits
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6
Q

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

A

True

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7
Q

NEVER start RCT on any tooth for which:

A

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

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8
Q

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

A

EXACTLY the same

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9
Q

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

A

AAE

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10
Q

Once you determine the _____, you have a reasonable basis to divide if you should ____ the case or _____

A

Difficulty level; Accept; Refer

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11
Q

The AAE Endodontic Case Difficulty Assessment Form Column Categories include:

A
  1. minimal risk
  2. moderate risk
  3. high risk
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12
Q

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

A

Column with the most checks

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13
Q

The following positions in the arch fall into what category in the endodontic case difficulty assessment form?

-Anterior/premolar
-Slight inclination (<10 degrees)
-Slight rotation (<10 degrees)

A
  1. minimal risk/difficulty
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14
Q

The following positions in the arch fall into what category in the endodontic case difficulty assessment form?

-1st molar
-moderate inclination (10-30 degrees)
-moderate rotation (10-30 degrees)

A
  1. moderate risk/difficulty
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15
Q

The following positions in the arch fall into what category in the endodontic case difficulty assessment form?

-2nd or 3rd molar
-extreme inclination (>30 degrees)
-extreme rotation (>30 degrees)

A
  1. high risk/difficulty
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16
Q

Additional considerations included on the AAE Endodontic case difficult assessment form inlcude: (3)

A
  1. trauma history
  2. endodontic treatment history
  3. periodontal-endodontic condition
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17
Q

List the parameters for AAE Case Difficult @ UMKC: (UNDERGRAD)

A
  • Category 1 cases only
  • No second or third molars
  • No molars until 2-3 successful anteriors done
  • Nothing through a crown
  • Approved by endo faulty for all undergrad
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18
Q

Re-treatment & Procedural incidents are all:

A

Hight risk cases

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19
Q

Where do category 2 cases get treated at UMKC?

A

Endo honors or advanced endo

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20
Q

Where do category 3 cases get treated at UMKC?

A

Advanced endo only

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21
Q

In order to perform a molar RCT at UMKC by an undergrad, ____ successful anteriors have to be done first

A

2-3

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22
Q

What teeth are absolutely excluded for undergrad endo at UMKC?

A

2nd & 3rd molars

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23
Q

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

A

False- approved by endo faculty for all undergrad

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24
Q

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

A

False- Never do anything through a crown

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25
Q

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

A

2x

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26
Q

Teeth with roots over ______mm are considered long

A

23mm

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27
Q

4th canal mandibular molar or C-shaped canals=

A

radix (potential problem)

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28
Q

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

A

High cervical break

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29
Q

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

A
  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 23mm)
30
Q

List some cases that we would routinely refer:

A
  1. All procedural incidents
  2. surgery cases
  3. re-treatment cases
  4. insoluble paste RCT
31
Q

List some procedural incidents that would automatically result in us referring the RCT:

A
  1. instrument separation
  2. most/all perforations
  3. can’t find canals
32
Q

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

A

true

33
Q

The best time to refer is: (3)

A
  1. BEFORE a problem occurs
  2. BEFORE your liability is incurred
  3. BEFORE your credibility is compromised
34
Q

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

A

Dr. Ronald R. Riley

35
Q

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

A

“endodontic recall procedures”

36
Q

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

A
  1. outcome discovery
  2. validation of your treatment
  3. professional responsibility
  4. ethical & moral obligation
  5. legal mandate
37
Q

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

A

Recall immediately

38
Q

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

A
  1. infection
  2. pain or continued sensitivity
  3. draining sinus tract
39
Q

Minimum recall interval for the “greatest improvement”

A

6 months - 1 year (Klevant 1983)

40
Q

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

A

2

41
Q

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

A

true

42
Q

The purposed of endodontic recall is to: (4)

A
  1. assess the status of the treated tooth
  2. determine need for additional treatment
  3. document recall procedures
  4. document 3 unsuccessful attempts???
43
Q

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

A
  1. healed/healing
  2. functional
  3. diseased
44
Q

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

A

1) 2 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

45
Q

What radiographs will you take for a recall patient?

A

Two diagnostic PAs; potentially a CBCT

46
Q

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

A
  1. Negative percussion
  2. Negative palpation
  3. No DST
47
Q

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

A
  1. Persistent subjective symptoms
  2. RECURRENT SINUS TRACT SWELLING
  3. Discomfort to persuasion and/or palpation
  4. Evidence of fractured tooth
  5. Excessive mobility or progressive periodontal breakdown
  6. INABILITY TO FUNCTION ON THE TOOTH
48
Q

What degree of success should be expected/communicated?

A

Reasonable to say well over 90% ASSUMING INTELLIGENT CASE SELECTION

49
Q

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

A
  1. minimal risk
  2. moderate risk
  3. high risk
50
Q

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

A

Column with the most checks

51
Q

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

A

Re-treatment RCTs and procedural instruments

52
Q

AAE Case difficulty @ UMKC:

What cases can undergrads do?

A

Category 1

53
Q

Category 1 endo cases do not include:

A

2nd & 3rd molars

(no second or third molars for undergrad)

54
Q

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

A

2-3 successful anteriors are done

55
Q

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

A

False- never!

56
Q

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

A

True

57
Q

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

A

Category 2

58
Q

Category 3 cases must be performed by:

A

Advanced endo only!

59
Q
  • teeth with abnormal anatomy
  • tipped teeth
  • malposed teeth
  • malformed teeth
  • teeth with long roots (over 23mm)
  • 4 canal mandibular molars
  • C-shaped canals
  • high cervical breaks

These are all reasons to:

A

refer endo treatment

60
Q

Routinely refer procedural incidents including:

A
  1. instrument separation
  2. most or all perforations
  3. trouble finding all canals
61
Q

Routinely refer what types of cases:

A
  1. procedural incidents
  2. surgery cases
  3. re-treatment cases
  4. insoluble paste RCT
62
Q

When can we refer?

A

Anytime before or during the diagnosis or treatment

63
Q

The best time to refer is:

____ a problen occurs
____ your liability is incurred
____ your credibility is compromised

A

BEFORE!!!

64
Q

List the three reasons for a recall procedure:

A
  1. if a patient reports adverse signs or symptoms
  2. infection, pain or continued sensitivity
  3. DST
65
Q

Minimum recall intervals:

A

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

66
Q

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

A

2

67
Q

What is the purpose of endodontic recall? (3)

A
  1. assess STATUS of treated tooth
  2. determine the need for ADDITIONAL TREATMENT
  3. DOCUMENT recall procedures
68
Q

The status of an endodontically treated tooth may be:

A
  1. healed/healing
  2. functional
  3. diseased
69
Q

For a recall appointment radiographically we should take:

A

2 diagnostic P/A films

70
Q

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

A
  1. Normal PDL width
  2. PARL eliminated
  3. Normal lamina dura
  4. Normal to fine-meshed osseous trabeculae
  5. No resorption
  6. Assess need for CBCT
71
Q

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

A

negative percussion; negative palpation; no draining sinus tract

Endodontics II (10 decks)

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