Endodontic case selection

Question 1

how can pregnancy affect endodontic treatment?

Answer 1

• treat in 2nd trimester
• but if in 1st trimester can carry out emergency intervention
• consult with obstetrician/physician

Question 2

how can cardiovascular disease/MI affect endodontic treatment?

Answer 2

• MI within 6 months is contraindication
• emergency treatment should be provided in consultation with patient’s cardiologist
• requires stress reduction protocol - short appointments, sedation, pain and anxiety control

Question 3

how can cancer affect endodontic treatment?

Answer 3

• thorough history essential
• chemo/radiotherapy to head/neck region can impair healing
• consult with oncologist

Question 3

how can bisphosphonate therapy affect endodontic treatment?

Answer 3

• MRONJ - IV bisphosphonates have higher risk (as well as dose and duration)
• preventative care and caution during nonsurgical endodontic treatment
• carry out non-surgical endodontic treatment of teeth that may otherwise be extracted

Question 4

how can diabetes affect endodontic treatment?

Answer 4

• acute endodontic infection can compromise a diabetic
• schedule appointments to not interfere with normal insulin schedule (eat before appt - don’t want hypoglycaemic attack as appointments can be long)
• minimise stress - short appointments, sedation, pain and anxiety control

Question 5

how does calcification affect endodontic treatment?

Answer 5

• can be isolated or continuous - makes treatment very difficult
• harder to locate, clean and shape canals
• if orthograde treatment unavailable, surgery may be considered
• travels coronal to apical as requires vital pulp tissue

Question 5

what restorative considerations should you have when evaluation for endodontic treatment?

Answer 5

• sub-osseous caries (very deep caries, may have worse prognosis, harder to restore)
• poor crown/root ratio (should be 1:1 or higher, increased risk of fracture with increased crown load)
• misalignment of teeth (complicates procedure, may fracture with excessive uneven forces, may lead to perio issues (perio-endo lesion))
• healthy tooth tissue remaining (all decay must be removed to evaluate tooth)

Question 6

what periodontal considerations should be carried out during evaluation?

Answer 6

• BPE of tooth is essential
• poor perio prognosis may necessitate loss of tooth
• perio-endo or endo-perio lesion may be present (is it a primary endo problem or secondary from perio?)

Question 7

how does resporption affect endodontic treatment?

Answer 7

radiograph or CBCT scan required to differentiate
* external resorption appears to be superimposed on the canal
* internal resporption appears to be continuous with the canal
* tooth may not be salvageable

Question 8

what can you use to help determine if you treat or refer a patient?

Answer 8

• AAE case difficulty assessment form - minimal (treat), moderate (treat if competent and experienced) and high (refer to specialist) degrees of difficulty
• Restorative Dentistry Index of Treatment Need - complexity assessment 1-3