ENDODONTIC CONSIDERATIONS

Patient Related Factors

● Age, gender, tooth location, lesion size and pulp status, and symptoms do not affect outcomes of RCT

● Pre-operative presence of periapical lesions does not have a negative effect on the outcome of RCT

● Diabetes may have effect on the healing of the periapical lesions

SYSTEMIC AND LOCAL HEALTH FACTORS

○ Irreversible pulpitis / Necrotic pulps

○ Restorable crowns ○ Salvageable periodontal conditions ○ Salvageable resorptive defects

○ Favorable crown to root ratio

INDICATIONS PULP AND PERIODONTAL CONDITIONS

○ Without pulpal pathosis (except those required to prosthodontic reasons)

○ With unrestorable crowns

○ Unsalvageable periodontal conditions

○ With unsalvageable resorption or fracture

○ defects and ○ With crown to root ratio

○ Inadequate ferrule

CONTRAINDICATIONS PULP AND PERIODONTAL CONDITIONS

remaining 1.5-2mm length, 1 mm in width of remaining tooth structure that acts as a collar = if there is inadequate ferrule, RCT is not indicated

Ferrule

● Depend on the susceptibility to dental caries

● Limited abilities or interest in performing routine oral hygiene procedures and poor candidates for RCT or periodontal treatment

BIOLOGICAL AND ENVIRONMENTAL CONDITIONS

● The interdental papilla sometimes does not fill the cervical embrasure space around crowns

● Preservation of a tooth through root canal treatment may provide better soft tissue esthetics than extracting the tooth and placing an implant.

SOFT TISSUE ANATOMY

● Higher chance of bone grafting if patient will choose dental implant

● Retaining RCT teeth with long term poor prognosis may affect the quality and quantity of bone

QUANTITY AND QUALITY OF BONE

● Retaining tooth through RCT is more esthetically advantageous than replacing with FPD or implants with dental crown

● Color matching might be difficult

TEETH WITH UNIQUE COLOR CHARACTERISTICS

● Patient centred treatment plan

● Provide the longest lasting, most cost-effective treatment that addresses the chief complaint of the patient and meets or exceeds expectations

ETHICAL CONSIDERATIONS

● Higher level anxiety to RCT than extraction - perhaps delay the treatment or recommend other treatment

PATIENT COMFORT AND PERCEPTION

Due to root canal irritants or root canal filling materials – if you do not know how to fix the problem you can refer the patients or consider additional procedures

PROCEDURAL COMPLICATIONS

● May require crown lengthening, posts, orthodontic extrusions, dental crown etc.

● Retreatment

ADDITIONAL PROCEDURES

● Retention of a periodontally sound tooth through root canal treatment clearly has tremendous cost benefit and cost-effectiveness in comparison with any alternative.

● Referral to specialist

COST OF TREATMENT

● Prognosis

● Survival rate

● Success rate

TREATMENT OUTCOME