Allen_ali_nasseh

Submitted by: Allen Ali Nasseh on 09/29/2017

Category: Endo » Pre-treatment topics

Tags: diagnosis prognosis treatment planning

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When to do the endo prior to the crown (Friday Questions) basic free

Some of the tx planning decisions for doing the endo prior to a crown are discussed

Description

A short discussion over some of the diagnostic and strategic points for doing or not doing the endo in a tooth with normal pulp or reversible pulpitis requiring a crown.

Comments (5)

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Allen_ali_nasseh

Rank: Faculty General

Comments: 137

Allen Ali Nasseh

Let me know what additional factors you consider prior to recommending prophylactic endo prior to a crown?
Image

Rank: Rookie

Comments: 1

Most importantly the dentist must ask him/herself; are you reliably able to perform the endo without iatrogenic damage & complications?
Lauzi

Rank: Rookie

Comments: 1

Laura Mikschofsky

I decided to place a crown on a upper molar immediately after doing the endo because I was not able to do a sufficient composite filling as the distal part was quite subgingival - so there would be microleakage and the root would probably get an infection with time. It was a pulpitic tooth, so there was no periapical lesion, and I could find and fill all 4 canals. But what if the tooth has already had a lesion (mesiobuccal) and what if the outcome of the endo had only been 3 canals..? I don't know! Try to re-do the filling...?
Allen_ali_nasseh

Rank: Faculty General

Comments: 137

Allen Ali Nasseh

@Johan Andreas Fuebotten: I agree 100% Johan. The ability to correctly estimate one's own ability is a critical factor and a big assumption in this whole thing. Unfortunately, this knowledge comes with time and experience but putting the patient's interest first is always a good philosophical approach. We rely on people's good conscience for most rules to work in the society and we should constantly remind people of this fact. Great point. @Laura Mikschofsky: This is where a CBCT would be helpful. If only three canals are found then a CBCT can hopefully detect the presence or absence of a 4th canal. With experience, you can know from the two angles pre-operative radiograph and microscopic analysis of the chamber floor; but a CBCT is helpful in earlier stage of one's career. If the CT shows an untreated 4th canal another attempt to find it would be worthwhile. So, here, the critical factor is the knowledge of an actual canal to help triage. Thank you for your comments!
Screenshot_20171020-220601-01

Rank: Rookie

Comments: 1

Stanley John

Piezo instead of NSK?