case selection part 1 ( local factors )

Proper case selection successful RCT.

The two factors important for case selection are:

Leads to

PATIENT ENDODONTIST

1. Motivation inform the patient the importance of keeping his natural dentition.

2. Economics still the cost of RCT is less than the cost of extraction and replacement.

3. Age RCT can be successful in any age.

However you may face some problems , like :

old age canals are narrow or calcified.

Young age canals are immature or wide.

PATIENT

4. Number of involved teeth any number of teeth could be endo. treated.

However, multiple involvement indicate bad oral hygiene and less care.

5. Occupation certain occupations require

preservation of the natural teeth as “ politicians , Lawyers , singers , musicians

PATIENT

1. Continuing education to improve his skills and understanding.

2. Facilities and equipment most recent instruments and materials are needed

ENDODONTIST

Considerations in case selection

Local “ tooth “ considerations

Systemic considerations

21 factor

1. Inadequate periodontal support:

Periodontal therapy is done first , if it failed RCT is contraindicated

Local “ tooth “ considerations

2. Condition of remaining dentition:

Poor oral hygiene or multiple cavities RCT is contraindicated.

3. Non restorable teeth:

Badly mutilated teeth or caries extension infrabony

extraction.

Local “ tooth “ considerations

4. Non strategic teeth:

if Non functioning teeth with no prosthetic value extraction

5. Crown/root ratio :

if Exceeding 1:1 ratios physiologically unfavorable.

6. Vertical fracture:

- if Vertical fracture poor prognosis.

- However, if bucco-lingual fracture hemisection or bicuspidization can be done

Local “ tooth “ considerations

7. Predictable failure ( lingual developmental groove )

lingual developmental groove extending all the length of root surface.

- It causes pulpal involvement

due to direct communication

between the apical foramen

and gingival sulcus.

Local “ tooth “ considerations

8. Limited accessibility:

TMJ limited movement unfavorable for RCT

9. Proximity to vital structures:

Close proximity to vital structures such as; mental foramen, mandibular canal, maxillary sinus etc.hinders surgical procedures

Local “ tooth “ considerations

10. Type of root canal:

Different techniques should be employed for different types of canals.

11. Hypercalcification:

Fine instruments and chelating agents may be used.

Local “ tooth “ considerations

12. Obstructed root canals:

if there are Foreign particles such as amalgam, cement, separated instruments which can not be bypassed or incorported into the obturation material

apical surgery is done

13. Severely curved canals:

if the Conventional techniques are unsuitable

surgical intervention is done

Local “ tooth “ considerations

14. Dens invaginatus (Dens in dent):

if the root canal system is accesibleconventional treatment is done

if the root canal system is not accessible surgical treatment is done

Local “ tooth “ considerations

15. Taurodontism:

- Inherited trait

- large crown, large pulp chamber, short roots. unfavorable for RCT.

Local “ tooth “ considerations

16. Bifurcated canal system:

- Commonly seen in lower premolars.

- if the bifurcation in the coronal 1/3

favorable for conventional RCT.

- if the bifurcation in the middle or the apical 1/3 conventionally employing the sectional or injection techniques or both.

Local “ tooth “ considerations

17. Immature apex:

- if the pulp is VITAL

pulp capping or pulpotomy is done

- if the pulp is NON VITAL

apexification.

apical surgery.

tailor made technique.

Are done

Local “ tooth “ considerations

18. Periapical condition:

Periapical lesion with sinus opening

conventional or surgical RCT.

19. Excessive crown or root damage:

Tooth could either be saved conventionally or surgically or not according to the size, site and extent of damage.

Local “ tooth “ considerations

20. Root perforation:

- Size and site of perforation are very important.

- Conventional or surgical therapy could be applied.

- Irrepairable perforations extraction.

Local “ tooth “ considerations

21. Complex morphology:

Trifurcated maxillary premolars:

Some maxillary premolars has 3 roots (two buccal and one palatal)

Mesiobuccal canal narrow and difficult to file and fill.

Three rooted mandibular molars:

The third root disto-lingual.

Orifice of the disto-lingual root : is mesial to the disto-buccalorifice.

Local “ tooth “ considerations

Root resorption:

- Internal resorption special cleaning and shaping and obturation techniques.

- Perforation may or may not be treatable

Multiple canals:

Negotiable conventional or surgical RCT

Un-negotiable extraction.

21. Complex morphology:Local “ tooth “ considerations

C-shaped canals:

Often occurs in mandibular second molars.

Complex case both longitudinally and transversely.

Instruments should be precurved to negotiate canal curvatures

Surgical intervention may be needed.

21. Complex morphology:Local “ tooth “ considerations

THANK YOU

GOOD LUCK