Case Selection and Recall Procedures Flashcards
The single most
important factor affecting
RCT success
Case Selection
To avoid great risk or serious error, you must examine
and fully understand:
(4)
the patient
the complexities of the root canal system
the specialized techniques required and
have the appropriate training, instrumentation &
equipment
Consider:
(2)
⦿The great variety of personality types
⦿Your current patient management skills
Never start RCT on any tooth for which
an excellent
result cannot be reasonably expected . . . in your hands
at that time with that patient.
If not, you must ethically & morally REFER
Standard of Care
In the eyes of the legal community:
*The Standard of Care expected of the General Dentist is exactly
the same as that expected of the Endodontic Specialist.
Case Difficulty Assessment Form
The AAE has developed a form which will help you determine the
difficulty/risk level of each case in question.
Once you determine the difficulty level, you have a reasonable
basis to decide if you should
ACCEPT the case or REFER.
COLUMN CATEGORIES:
(3)
- Minimal Risk
- Moderate Risk
- High Risk
Review each column and each related entry:
- If it is a concern, place –
- Column with most checks
determines
check
Difficulty Level
RETX & Procedural Incidents
are all – Risk Cases
High
AAE Case Difficulty @ UMKC
Category 1 Cases only: Undergraduates
(4)
No 2ndor 3rdMolars
No Molars until 2-3 successful anteriors done
Nothing through a crown
Approved by endo faculty for all undergrad
Category 2 Cases:
Endo Honors/Advanced Endo
Category 3 Cases:
Advanced Endo only
Procedural Incidents:
(3)
–Instrument Separation
–Most or All Perforations
–Can’t find all canals
Routinely Refer
(3)
*Surgery Cases
*Re-treatment Cases
*Insoluble Paste RCT
May refer at ANY TIME Before or during the DX or treatment
The BEST TIME to refer is:
(3)
BEFOREa problem occurs and
BEFOREyour Liability is incurred and
BEFOREyour Credibility is Compromised
Recall immediately if patient reports
adverse S/S
Infection, pain or continued sensitivity
Draining Sinus Tract
Minimum Recall Intervals
6 months to 1 year * “Greatest Improvement”
2 years
4 years
Required Recall of a minimum of — RCT patient Recalls:
May be asked to Recall RCT patients of graduates
2
Purpose of Endodontic Recall:
(4)
Assess status of treated tooth
Determine need for additional treatment
Document Recall Procedures
(or 3 Unsuccessful Documented Attempts)
Assess status of treated tooth
(3)
*Healed/Healing
*Functional
*Diseased
Skipped
Areas of evaluation:
Radiographic
–2 Diagnostic P/A films
(6)
Normal PDL width
PARL eliminated
Normal lamina dura
Normal to fine-meshed osseous trabeculae
No resorption
CBCT ?
Clinical:PERCUSSION (-), PALPATION (-),
NO DRAINING SINUS TRACT (DST)
Skipped
Clinical
(6)
Persistent subjective symptoms
Recurrent sinus tract or swelling
Discomfort to percussion and / or palpation
Evidence of fractured tooth
Excessive mobility or progressive periodontal
breakdown
Inability to function on the tooth *
