lecture 5: case selection and recall responsibilites

Question 1

can you treat it?

Answer 1

no - it has calcified canals

Question 2

what is the sigle most important factor affecting RCT success

Answer 2

case selection

Question 3

can we treat this

Answer 3

probs not has canal sclerosis.

so makes it hard to do.

Question 4

can we tx this

Answer 4

probs not, difficult to tx bc of canal sclerosis

Question 5

is the tooth strategic and functional?

is the tooth restorable?

is it periodontally sound?

is the investment justified by the benefits?

Answer 5

subsequent considerations

is the tooth restorable is an impt question.

Question 6

what do we see here?

Answer 6

there should be 4 canals, ther is a missing MB2

Question 7

what do we see here?

Answer 7

periapical lesion

probs from a missed 4th canal in the molar

Question 8

can we tx this?

Answer 8

if there is no antagonist then will not do pt justice to restore it.

Question 9

can we tx this?

Answer 9

the tooth itself is not restorable, too much decay

Question 10

can we tx this

Answer 10

no, it is missing at least 2mm of sound dentin that is needed to do a RCT.

Question 11

can we tx this?

Answer 11

no, it is not periodontally sound

Question 12

what is the case difficulty assessment form

Answer 12

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

Question 13

the AAE endodontic case difficulty assessment form includes what

Answer 13

Colum Categories are:

1. minimal 2. moderate 3. high risk.

Question 14

re-treatment and procedural indicidents are always what category of aae difficulty assessment form

Answer 14

high risk

Question 15

can we tx this?

Answer 15

yes, it meets the subsequent considerations.

Question 16

at umkc, AAE case difficulty is:

category 1

category 2

category 3

Answer 16

category 1: undergrad

category 2: endo honors/advanced endo

category 3: advanced endo

Question 17

at umkc undergrads can do what:

Answer 17

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

Question 18

can we tx this

Answer 18

no

if we cannot see the chamber then we will not be able to find canals

this happens after many years of trauma.

Question 19

can we tx this

Answer 19

no

its is invasive resportion or perforating internal resorption

need to take CBCT and othe tech to do so.

Question 20

can we tx this

Answer 20

no

its is invasive resportion or perforating internal resorption

need to take CBCT and othe tech to do so.

Question 21

can we tx this

Answer 21

no

its is invasive resportion or perforating internal resorption

need to take CBCT and othe tech to do so.

Question 22

can we tx this

Answer 22

probs not, you would predict potential problems and see that these teeth have aberrant anatomy

it is a “nightmare”

Question 23

can we tx this

Answer 23

us probs not, refer, you would predict potential problems and see that these teeth have aberrant anatomy

here it splits into different roots

Question 24

what is wrong here

Answer 24

they missed the second canal in this md PM

24% of pts have this second canal

Question 25

whats wrong here

Answer 25

they missed the second canal in this md PM 24% of pts have this second canal

Question 26

can we tx this

Answer 26

it is very difficult tipped, malposed or malformed teeth are all very difficult

Question 27

can we tx this

Answer 27

tipped, malposed or malformed teeth are all very difficult

Question 28

can we tx this

Answer 28

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

Question 29

can we tx this

Answer 29

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_**

Question 30

can we tx?

Answer 30

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.

Question 31

can we tx this?

Answer 31

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.

Question 32

what 4 things should we routinely refer:

Answer 32

1. procedural incidents (instrument separation, most or all perforations, if you cannot find a canal) 2. Surgery cases 3. Re-tx cases 4. Insoluble paste RCT (different than GP, hard to break through)

Question 33

can we tx this?

Answer 33

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.

Question 34

when should you refer?

Answer 34

ANYTIME before or during the dx or tx.

Question 35

how often should you recall endo procedures?

Answer 35

6, 12, and 24 months after tx. this is your professional responsibility, ethical and moral obligation and legal mandate.

Question 36

when should you recall procedures?

Answer 36

* **_immediately_** if the pt reports adverse S/S * minimum recalls intervals months to a year later (6, 12, 24)

Question 37

if pt has adverse s/s after RCT tx what should you do?

Answer 37

recall immediately S/S include: - infection, pain, or continued sensitivity. - DST.

Question 38

what is the purpose of endo recall?

Answer 38

- 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

Question 39

how much success do you have on endo:

Answer 39

well over 90% (assuming intelligent case selection) and assuming competent and careful technique.

Question 40

can we tx this

Answer 40

yes. as pre-doc too. has big pulp chamber, 2 root canals.

Question 41

can we tx this?

Answer 41

yes. even as predocs.

Question 42

can we tx this.

Answer 42

yes, as endo honors? why? see a fast break.

Question 43

can we tx this?

Answer 43

probs not, refer. there are pulp stones, the roots are really long and thin.

Question 44

what is the #1 rule for refferal:

Answer 44

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.

Question 45

is the case selection a form of infomed consent to the pt, and what things does it include?

Answer 45

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.

Question 46

guidelines for a reffer for AGD:

Answer 46

- 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.