Case Selection And Treatment Planning In Endodontics Notes

Case Selection And Treatment Planning In Endodontics Notes

Every single tooth starting from the central incisor to the third molar can be a potential candidate for root canal therapy. According to the treatment point of view, four factors determine the decision to do or not to do a root canal treatment.

These factors are accessibility, restorability, the strategic value of a tooth, and general resistance of the patient which ensures success. In this chapter, we will discuss indications, contraindications, and treatment planning regarding endodontic therapy.

Read And Learn More: Endodontics Notes

Indications Of Endodontic Treatment

Actual Reason for Endodontic Therapy:

If the pulp is involved due to caries, trauma, fracture, etc., the tooth should be saved by endodontic treatment

Elective Endodontics:

In teeth with cracks or large restoration, elective endodontics is done to prevent premature loss of cusp during their restoration because in these cases elective endodontics allows more predictable and successful results.

Inadequate Restorations:

Sometimes when an attempt is made to repair the teeth with cracks or inadequate crown margins, a high degree of restorative failure is seen. In such cases, endodontic treatment followed by post endodontic restoration provides a high success rate.

Desensitization of Tooth:

Sometimes teeth with attrition, abrasion, or erosion defects need endodontic treatment to get rid of the sensitivity of the patient.

Endodontic Emergency:

If a patient presents acute dental pain/swelling, endodontic treatment is indicated before the complete examination and treatment plan.

Contraindications Of Endodontic Therapy

The following four factors influence the decision of endodontic treatment:

• Accessibility of apical foramen
• Restorability of the involved tooth
• The strategic importance of the involved tooth
• General resistance of the patient

Though there are only a few absolute contraindications of endodontic therapy, the following cases are considered Poor candidates for endodontic treatment:

• • Teeth with extensive root caries, furcation caries, poor crown/root ratio, and fractured root are contraindicated for endodontic treatment
  • Teeth in which instrumentation is not possible like roots with dilacerations, calcifications, dentinal sclerosis, etc.
  • Trismus or scarring from surgical procedures or trauma, etc. may limit the accessibility due to limited mouth opening
  • Teeth with large, multiple external root resorptive lesions
  • Teeth with vertical root fractures
  • Teeth with no strategic value:

Two main factors which determine the status of a tooth are restorability and periodontal support. A tooth which cannot be restored or that has inadequate, amenable periodontal support has a hopeless prognosis.

Evaluation of the oral cavity can decide whether the tooth is strategic or not, for example, if a person has multiple missing teeth, a root canal of a third molar may be needed. But in the case of well-maintained oral hygiene with full dentition, an exposed third molar can be considered for extraction

• • Evaluation of the clinician:

The clinician should be honest to evaluate his/her efficiency to do the patient

• • Systemic conditions:

Most of medical conditions do not contraindicate the endodontic treatment, but the patient should be thoroughly evaluated in order to manage the case optimally

Treatment Planning

Treatment planning signifies the planning of management of the patient’s dental problems in a systematic and ordered way which assures complete knowledge of the patient’s needs, the nature of the problem, and the prognosis of the treatment.

Thus this stage of assessment of a complete picture overlaps with the stages of decision-making, treatment planning, and treatment phase.

Factors Affecting Treatment Planning

• Chief complaint regarding pain and swelling requires urgent treatment and planning for a definitive solution
• Previous history of dental treatment (solve the residual problems of previous dental treatment)
• Medical history (identify factors that affect the prognosis of the treatment)
• Intraoral examination (to know the general oral condition first before focusing on the site of complaint so as not to miss the cause)
• Extraoral examination (to differentially diagnose the chief complaint)
• Oral hygiene
• Periodontal status (to see the periodontal foundation for the long-term prognosis of the involved tooth)
• Teeth and restorative status (to identify replacement of missing teeth, the status of the remaining dentition)
• Occlusion (to check the functional relationship between opposing teeth, parafunctional habits, etc.)
• Special tests (to explore the unseen tissues)
• Diagnosis (repeat the series of conclusions)
• Treatment options (evaluate various options to decide the best choice for the long-term benefit of the patient)

Medical Conditions Influencing Endodontic Treatment Planning

Efficient and successful endodontics begin with proper case selection. The clinician must know his/her limitations and select cases accordingly. Since the success of endodontic treatment depends upon many factors which can be modified to get better before initiating the treatment.

Therefore accurate and thorough preparation of both patient, as well as a tooth to be treated, should be carried out to achieve successful treatment results.