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

Lecture 5: Case Selection & Recall Responsibilities Flashcards

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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
A long tooth may be ____ the work & time of a normal length tooth
2x
26
Teeth with roots over ______mm are considered long
23mm
27
4th canal mandibular molar or C-shaped canals=
radix (potential problem)
28
When we see a 45 degree bend from access to root canal:
High cervical break
29
List some potential anatomical problems that would complicate RCT: (7)
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
List some cases that we would routinely refer:
1. All procedural incidents 2. surgery cases 3. re-treatment cases 4. insoluble paste RCT
31
List some procedural incidents that would automatically result in us referring the RCT:
1. instrument separation 2. most/all perforations 3. can't find canals
32
T/F: You may refer a patient AT ANY TIME; before or during the dx or treatment
true
33
The best time to refer is: (3)
1. BEFORE a problem occurs 2. BEFORE your liability is incurred 3. BEFORE your credibility is compromised
34
Who did Dr. Weisleder discuss that was a great mentor in endodontics to her?
Dr. Ronald R. Riley
35
What did Dr. Ronald Riley contribute to in the oral surgery journal volume 37?
"endodontic recall procedures"
36
List some of the key discussion points from Dr. Ronald Riley: (5)
1. outcome discovery 2. validation of your treatment 3. professional responsibility 4. ethical & moral obligation 5. legal mandate
37
When should you recall if your patient reports adverse signs & symptoms?
Recall immediately
38
What are some signs and symptoms that require you to recall the patient IMMEDIATELY?
1. infection 2. pain or continued sensitivity 3. draining sinus tract
39
Minimum recall interval for the "greatest improvement"
6 months - 1 year (Klevant 1983)
40
At UMKC, as a student dentist you have required recall of a minimum of ____ RCT patient recalls
2
41
T/F: at UMKC you may be asked to recall RCT patients of graduates
true
42
The purposed of endodontic recall is to: (4)
1. assess the status of the treated tooth 2. determine need for additional treatment 3. document recall procedures 4. document 3 unsuccessful attempts???
43
When assessing the status of the treated tooth (purpose of endodontic recall) you should examine the tooth to see if it is:
1. healed/healing 2. functional 3. diseased
44
For a recall endo patient, what are we looking for radiographically?
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
What radiographs will you take for a recall patient?
Two diagnostic PAs; potentially a CBCT
46
For a recall endo patient, what are we looking for clinically?
1. Negative percussion 2. Negative palpation 3. No DST
47
What are some signs/symptoms that may be observed at a recall visit that hint towards an unsuccessful RCT: (6)
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
What degree of success should be expected/communicated?
Reasonable to say well over 90% ASSUMING INTELLIGENT CASE SELECTION
49
What are the column categories for the AAE endodontic case difficulty assessment form?
1. minimal risk 2. moderate risk 3. high risk
50
With the AAE endodontic case difficulty assessment form, what determines the difficult level?
Column with the most checks
51
According to the AAE endodontic case difficulty assessment form, what cases are automatically high risk?
Re-treatment RCTs and procedural instruments
52
AAE Case difficulty @ UMKC: What cases can undergrads do?
Category 1
53
Category 1 endo cases do not include:
2nd & 3rd molars (no second or third molars for undergrad)
54
At UMKC, an undergrad cannot do a first molar RCT until:
2-3 successful anteriors are done
55
T/F: Rarely can a UMKC undergrad perform a root canal through a crown
False- never!
56
T/F: RCT cases must be approved endo faculty for all undergrad
True
57
What category of cases can be done by endo honors as well as advanced endo?
Category 2
58
Category 3 cases must be performed by:
Advanced endo only!
59
- 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:
refer endo treatment
60
Routinely refer procedural incidents including:
1. instrument separation 2. most or all perforations 3. trouble finding all canals
61
Routinely refer what types of cases:
1. procedural incidents 2. surgery cases 3. re-treatment cases 4. insoluble paste RCT
62
When can we refer?
Anytime before or during the diagnosis or treatment
63
The best time to refer is: ____ a problen occurs ____ your liability is incurred ____ your credibility is compromised
BEFORE!!!
64
List the three reasons for a recall procedure:
1. if a patient reports adverse signs or symptoms 2. infection, pain or continued sensitivity 3. DST
65
Minimum recall intervals:
6 moths to 1 year (greatest improvement) 2 years 4 years
66
At UMKC we must see a minimum of ____ RCT patient recalls
2
67
What is the purpose of endodontic recall? (3)
1. assess STATUS of treated tooth 2. determine the need for ADDITIONAL TREATMENT 3. DOCUMENT recall procedures
68
The status of an endodontically treated tooth may be:
1. healed/healing 2. functional 3. diseased
69
For a recall appointment radiographically we should take:
2 diagnostic P/A films
70
At a recall appointment we should radiographically take 2 diagnostic P/A films to determine:
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
At a recall appointment, in addition to the radiographs, clinically we should detect:
negative percussion; negative palpation; no draining sinus tract

Endodontics II (10 decks)

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