Case selection
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A lecture on case selection in endodontics
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Case selection
- 1. AshrafRefai Samir BDS MSc DD HMD Lecturer of Endodontics Al-Azhar University ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +201001434323
- 2. www.arefai.edublogs.org Case Selection Dr. Ashraf Refai BDS MSc DD HMD Lecturer of Endodontics Al-Azhar University ashraf_refai@hotmail.com
- 3. Operator Should Ask Himself 2 Questions 1. Are the patient best needs served by endodontic treatment or is another approach preferable? 2. Are you capable of handling the case or would a referral be better?
- 4. Two Answer the First Question Then you need to determine whether the case in indicated or contraindicated for endodontic treatment
- 5. Indications ❖ Pulpal affection due to pulpal or periodical pathosis ❖ Pulpal affection due to traumatic injury ❖ Facilitation of restoration (intentional endodontic treatment)
- 6. Contra-Indications 1. Insufficient Periodontal Support
- 8. Contra-Indications 2. Non-Restorable tooth
- 11. Contra-Indications 3. Vertical Fracture
- 14. Contra-Indications 4. Condition of remaining dentition
- 16. Contra-Indications 5. Non-strategic tooth
- 18. Operator Should Ask Himself 2 Questions 1. Are the patient best needs served by endodontic treatment or is another approach preferable? 2. Are you capable of handling the case or would a referral be better?
- 19. Two Answer the Second Question Then you need to decide whether to treat the case yourself or to refer
- 20. Contended Contraindications ❖ Patient related ❖ Tooth related ❖ Dentist related ❖ Medically related
- 21. Patient Related Contended Contraindications
- 22. Age Deciduous teeth Open apex Cooperation Patient Related Contended Contraindications Calcified canals Medical conditions Cooperation
- 23. Local Anesthesia Phobia from local anesthesia Patient Related Contended Contraindications Allergies & difficulty in obtaining anesthesia
- 24. Physical LimitationsPatient Related Contended Contraindications ❖ Limited mouth opening ❖ Inability to recline the patient
- 25. Patient Financial Status Patient Related Contended Contraindications
- 26. Patient Motivation Patient Related Contended Contraindications
- 27. Patient Availability Patient Related Contended Contraindications
- 28. Patient Related Contended Contraindications ❖ Age ❖ Local anaesthesia ❖ Physical limitations ❖ Patient financial situation ❖ Patient motivation ❖ Patient availability
- 29. Tooth Related Contended Contraindications
- 30. Abnormal Canal Configurations Tooth Related Contended Contraindications Taurodontism Dens invaginatus
- 31. Abnormal Canal Configurations Tooth Related Contended Contraindications ❖ Severely curved canals ❖ C-shaped canals
- 32. Abnormal Canal Configurations Tooth Related Contended Contraindications ❖ Aberrant extra canals ❖ Lingual developmental grooves
- 33. Immature Apex Tooth Related Contended Contraindications
- 34. Root Resorption Tooth Related Contended Contraindications
- 35. Hyper Calcification Tooth Related Contended Contraindications
- 36. Crown Root Ratio Tooth Related Contended Contraindications Referral might be required Extraction might be required
- 37. Periapical Condition Tooth Related Contended Contraindications Referral might be required Not an absolute contra-indiction
- 38. Tooth Location & Malpositioning Tooth Related Contended Contraindications Difficulty in isolation & access cavity preparation May even required extraction
- 39. Retreatment & Iatrogenic Errors Tooth Related Contended Contraindications Referral is usually required Needs experience
- 40. Traumatic Injuries Tooth Related Contended Contraindications Avulsion Extrusion Intrusion
- 41. Cracked Tooth Tooth Related Contended Contraindications Difficult to diagnose May require extraction May required referral
- 42. Endodontic Periododntic Condiserations Tooth Related Contended Contraindications May require multi-specialty treatment
- 43. Persistent Signs & Symptoms Tooth Related Contended Contraindications You tried your best but still…
- 44. Approximation to Vital Structures Tooth Related Contended Contraindications Skill & experience for endodontic surgery
- 45. Existing RestorationsTooth Related Contended Contraindications Crowned tilted or rotated teeth Little margin for error
- 46. Tooth Related Contended Contraindications ❖ Iatrogenic problems ❖ Traumatic injuries ❖ Cracked tooth ❖ Endodontic Periodontic lesions ❖ Persistant signs & symptoms ❖ Approximation to vital structures ❖ Existing restorations ❖ Abnormal canal configurations ❖ Immature apex ❖ Root resorption ❖ Hypercalcificaiton ❖ Crown/Root ration ❖ Periapical condition ❖ Tooth location & malpositioning ❖ Retreatment
- 47. Dentist Related Contended Contraindications
- 48. Lack of Knowledge & Skills Dentist Related Contended Contraindications
- 49. Lack of [Devices & Technology] and Time Dentist Related Contended Contraindications
- 50. Dentist Related Contended Contraindications ❖ Lack of knowledge & skill ❖ Lack of devices & technology ❖ Lack of time
- 51. Medically Related Contended Contraindications
- 52. Cardiac Disease Medically Related Contended Contraindications 1. Congenital heart disease 2. Heart murmur 3. Rheumatic fever 4. Valvular disease or previous valvular surgery 5. Patients with pacemakers May required premedication & older pacemakers maybe effected by certain equipment
- 53. Cardiovascular Disease Medically Related Contended Contraindications 1. Hypertension 2. Anticoagulant therapy Maybe contraindicated for surgery & may have some restrictions on type of local anesthesia being used
- 54. Blood Disorders Medically Related Contended Contraindications 1. Hemophillia 2. Leukemia 3. Thrombocytopenia 4. Aplastic anemia 5. Platlet disorders Severe bleeding tendency can even contraindicate placement of a clamp Referral Mandatory
- 55. Diabetes Mellitus Medically Related 1. Blood sugar must be controlled to avoid diabetic coma and hypoglycaemic coma 2. Non-epinephrine containing anesthesia ( Blood Sugar) 3. Non-asprin containing analgesics ( Blood Sugar) 4. Patients are prone to infection Contended Contraindications Referral maybe required
- 56. Liver Disease Medically Related Contended Contraindications Use drugs that are not detoxified in the liver 1. Aspirin 2. Acetaminophen (Paracetamol) 3. Penicillin's & Cephalosporins Diseased livers cannot detoxify medication and in late cases there maybe bleeding tendency
- 57. Kidney Disease Medically Related Contended Contraindications Avoid drugs that are detoxified in the Kidney 1. Aspirin 2. Acetaminophen (Paracetamol) 3. Penicillin's & Cephalosporins Diseased kidney’s cannot detoxify medication The antibiotic of choice is Erythromycin
- 58. Radiation Therapy Medically Related Contended Contraindications Patients may require post-operative antibiotics because of risk of infection
- 59. Tuberculosis & Lung Disease Medically Related Contended Contraindications 1. Poor oxygenation of the blood 2. Susceptible to infection 3. Prophylactic antibiotics maybe needed 4. Care should be taken because these disease are contagious Referral maybe required
- 60. Pregnancy Medically Related Contended Contraindications 1. Use of medication should be limited 2. 2nd trimester is the most appropriate time to operate Referral maybe required
- 61. Epilepsy Medically Related Contended Contraindications 1. Should be controlled with medication 2. Avoid injection into vein (May bring on attack) Referral maybe required
- 62. Diseases of the Adrenal Cortex Medically Related Contended Contraindications 1. Addison’s disease (low levels of corticosteroids) Patient unable to handle stressful 2. Cushing’s diseases (high levels of corticosteroids) Patients are more susceptible to infection & tissue healing is impaired Referral maybe required
- 63. Thyroid Disease Medically Related Contended Contraindications 1. Hypothyroidism Diminished resistance to infection (Prophylactic antibiotics) 2. Hyperthryoidism Unable to handle epinephrine it potentiates effect of thyroid resulting in thyroid crisis (Non-epinephrine containing anaesthesia) Referral maybe required
- 64. Chronic Corticosteroid Treatment Medically Related Contended Contraindications 1. Autoimmune diseases sometimes require steroid treatment 2. Patients are more prone to infection Referral maybe required
- 65. Medically Related Contended ❖ Radiation therapy ❖ Tuberculosis & lung disease ❖ Pregnancy Epilepsy ❖ Diseases of the adrenal cortex ❖ Thyroid disease ❖ Chronic corticosteroid treatment Contraindications ❖ Cardiac disease ❖ Cardiovascular disorders ❖ Blood disorders ❖ Diabetes mellitus ❖ Liver disease ❖ Kidney disease
- 67. AshrafRefai Samir BDS MSc DD HMD Lecturer of Endodontics Al-Azhar University ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +201001434323