Endodontic assessment: pulps, pain and prognosis. Author Clifford J Ruddle 1 Affiliation 1 Loma Linda University, USA. The altered physical properties of tooth tissues following endodontic treatment, Amount of dentin that will remain following caries and/or restoration removal and access cavity preparation, Existence of a fracture/crack, and the extent of the fracture/crack, Functional demands that will be placed on the restored tooth, Clinical feasibility of ensuring that biologic width can be respected when the new restoration is placed with an adequate ferrule, Likelihood of restoring or maintaining the ideal embrasure space and emergence profile, The patient’s understanding that endodontic treatment is not complete until the permanent restoration is placed, Weakening of the tooth due to loss of tooth structure, especially loss of marginal ridges, Alteration in the physical properties of the tooth due to the effects of chemical irrigants, such as hypochlorite and ethylenediaminetetraacetic acid, Microbial factors, including the effects of bacteria/dentin interactions, Restorative factors (for example, the effect of post-core restorations), Age factors, and the effect of age changes on dentin, Describe prognosis and outcome assessment, based on the best-available current evidence, Recognize restorability of a tooth and possible need for crown lengthening, Evaluate the patient’s periodontal status, Assess the quality of previous endodontic treatment, Identify past traumatic dentoalveolar injuries, Recognize the presence of incomplete crown/root fractures, Assess the presence of internal or external root resorption, Explain the benefits, risks, alternatives and prognosis of treatment options in terms that are appropriate to patient’s background and knowledge of dentistry, Compare prognoses and the cost effectiveness of initial root canal treatment, retreatment, surgical treatment and tooth replacement options, Explain the difference between success and survival as outcome measures, Determine patient preference regarding treatment options, Evaluate immediate posttreatment outcomes, and explain the influence of procedural errors, missed canals, quality of obturation, and significance of coronal restoration to long-term outcomes, Assess posttreatment healing and recognize situations in which referral for possible treatment revision and/or surgery is indicated, Describe potential causes of persistent pain following root canal treatment, and explain diagnostic tests and methods to distinguish between pain of odontogenic and nonodontogenic origin. Upgrade one’s skills to meet the standard of practice, as determined by the endodontic specialty. Email: info@aae.org. An accurate diagnosis provides the foundation for effective endodontic treatment planning and therapy — and demonstrating competence in all three areas is key to ensuring optimal outcomes. This includes the ability to recognize clinical signs and symptoms of pulpal and periapical pathoses, and normal/abnormal test results and clinical findings. and periapical diagnosis is to determine what clinical treatment is needed (3, 4). Are dental implants a panacea of should we better strive to save teeth? In the diagnosis and appropriate treatment of root resorption as a sequelae of trauma, clinicians should be capable of making a differential diagnosis of the types of root resorption, and be knowledgeable of the proper management for resorptive lesions, including referral to a dental specialist (as necessary) after appropriate imaging — including three-dimensional (3D) imaging technologies. Pulp necrosis, root resorption and ankylosis are the most common sequelae presenting major clinical challenges; this is due to the high risk of infraposition and underdevelopment of the alveolar bone. This checklist is a guide to assist potential applicants in evaluating their suitability for admission and must be submitted with the application form. Before considering endodontic treatment, clinicians should understand that general dentists are bound to the same standard of care as endodontic specialists. This could include performing endodontic treatment when it is not needed or providing no treatment or some other therapy when root canal treatment is truly indicated. Such therapy should only be rendered by those who are able to meet today’s standard of care, as established by the AAE. In addition, practitioners must be proficient in identifying the clinical signs and symptoms of pulpal and periapical pathoses from nonendodontic pathoses, and interpreting normal/abnormal test results and clinical findings. There are a number of factors — including biologic, intrinsic and psychological — that may preclude a successful result. After an endodontic diagnosis is made, the benefits, risks, treatment plan, and alternatives to endodontic treatment — including any patient refusal of recommended treatment and the consequences of refused treatment — should be presented to the patient or the patient’s guardian. The CDAF specifically states that “technology, instruments and materials are not a replacement for clinical skill and experience, but, rather, adjuncts that a practitioner can employ to reach a desired goal.” The CDAF is intended to assist practitioners with endodontic treatment planning, but can also be used to help with referral decisions and record keeping. Online retailer of specialist medical books, we also stock books focusing on veterinary medicine. Endodontic diagnosis Dent Today. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Additionally, the clinician must have an understanding of clinical and radiographic criteria for determining success or nonhealing following endodontic treatment. Category Education; Song Luky Serenade (Original Version) Artist Luciano Milanese Quartet 1. Second in a two-part series: The material in this multipart series was adapted from a white paper published in 2017 by the American Association of Endodontists. Because endodontists set the standard of practice for conventional endodontics, if this standard cannot be met — such as the need for microscopy, performing regenerative procedures, treating complex traumatic injuries, 3D imaging for complex anatomy, or the need for apical surgery — the generalist should refer the patient to an endodontist. Malmgren B, Andreasen JO, Flores MT, et al. Evaluation of endodontic outcomes follows the same diagnostic pathway as for initial treatment (see Chapter 5 ). Describing prognosis and outcome assessment based on ⦠Following nonsurgical treatment, the clinician must have an understanding of the criteria for successful therapy; this includes clinical monitoring of the patient’s signs and symptoms, identifying iatrogenic incidents during treatment (such as missed canals, loss of length, ledges, apical transportation, apical, lateral and furcal perforations, or fractured instruments), and evaluating the quality of obturation, including adequate length, density, taper and coronal seal. Gilbert GH, et al. The AAE designed the Endodontic Case Difficulty Assessment Form for use in endodontic curricula as well as by dentists to help with referral decision making and recordkeeping. For example, implants should never become an insurance policy for inadequate endodontic treatment. Possible reasons for this include: Managing dental trauma remains a significant clinical challenge that affects all dental professionals. Ready for a brand-new way to assess endodontic cases? Strindberg (1956) established strict criteria for clinical and radiographic evaluation of the endodontically-treated tooth at follow-up examinations. In determining prognosis for endodontic treatment, the dentist should be able to forecast the outcome of initial nonsurgical root canal treatment, based on the pulp and periapical diagnosis, tooth anatomy and morphology, remaining tooth structure, and periodontal support. From Decisions in Dentistry. © 2020 - Decisions in Dentistry • All Rights Reserved. Endodontic Prognosis DOI 10100797833194241251 Introduction: Endodontic Prognosis and Outcome Nadia Chugal, Louis M. Lin, and Bill Kahler Abstract Prognosis and outcome are two terms routinely used in medicine and dentistry to predict and assess the treatment of disease. Cone-beam computerized tomography (CBCT) technology has further advanced the ability of a dentist to better interpret root fractures and endodontic pathosis when making an endodontic diagnosis and prognosis assessment. Full Text Links. Minimal tooth structure should be removed while achieving all of the goals of debridement, disinfection and obturation. Annals of the Royal Australasian College of Dental Surgeons 2012, 21: 101-2. Del Fabbro M, Taschieri S, Testori T, Francetti L, Weinstein RL. They have additional training and use specialized techniques and technologies to perform root canal treatment and diagnosis and treat tooth pain. A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables. Clinicians are encouraged to provide endodontic treatment consistent with their education, clinical experience and contemporary standards. The general dentist should be knowledgeable about the prevention, diagnosis and treatment of traumatized teeth, including the need for advanced 3D technology for diagnosis and treatment planning. Ng YL, Mann V, Gulabivala K. Outcome of secondary root canal treatment: a systematic review of the literature. Outcomes of root canal treatment in Dental PBRN practices. All dental professionals are expected to accurately diagnose, provide appropriate emergency care, and develop a treatment plan for traumatically injured teeth and their supporting structures. Endodontic treatment on a hopeless tooth is just as unethical as extracting a restorable tooth and replacing it with an implant. nchugal@ucla.edu For example, if an incorrect assessment is made, then improper management may result. Following an accurate diagnosis, careful treatment planning will enhance the delivery of appropriate endodontic care and lead to optimal outcomes. All departures from expected outcomes should be noted in the patient’s record at the time of service, and the patient should be advised of compromised results as soon as the dentist is aware of the facts. The American Association of Endodontists is a global resource for knowledge, research and education for the profession, members and the public. Lazarski MP, Walker WA 3rd, Flores CM, Schindler WG, Hargreaves KM. Avulsion of permanent teeth. Morris MF, Kirkpatrick TC, Rutledge RE, Schindler WG. The AAE designed the Endodontic Case Difficulty Assessment Form for use in endodontic curricula as well as by dentists to help with referral decision making and recordkeeping.
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