This document discusses factors to consider for case selection in endodontic treatment. It outlines 21 local "tooth" considerations related to factors like periodontal support, condition of remaining dentition, root canal anatomy, periapical condition, and complex root morphologies. Key considerations include adequate periodontal support, access and negotiation of canals, and ability to properly clean, shape and fill canals. Complex anatomies may require surgical intervention or extraction. Proper case selection is important for successful root canal treatment.

2. Leads
to
 Proper case selection successful RCT.
 The two factors important for case selection
are:
PATIENT ENDODONTIST

3. PATIENT
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.

4. 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

5. ENDODONTIST
1. Continuing education  to
improve his skills and understanding.
2. Facilities and equipment  most
recent instruments and materials are needed

6. Considerations
in case selection
Local “ tooth “
considerations
Systemic
considerations
21 factor

7. Local “ tooth “ considerations
1. Inadequate periodontal support:
Periodontal therapy is done first , if it failed 
RCT is contraindicated

8. 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.

9. 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

10. 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.

11. 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

12. 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.

13. 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

14. Local “ tooth “ considerations
14. Dens invaginatus (Dens in dent):
if the root canal system is accesible 
conventional treatment is done
if the root canal system is not accessible
surgical treatment is done

15. Local “ tooth “ considerations
15. Taurodontism:
- Inherited trait
- large crown, large pulp chamber, short roots.
unfavorable for RCT.

16. 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.

17. 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

18. 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.

19. Local “ tooth “ considerations
20. Root perforation:
- Size and site of perforation are very important.
- Conventional or surgical therapy could be applied.
- Irrepairable perforations extraction.

20. 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-buccal
orifice.

21. Local “ tooth “ considerations
21. Complex morphology:
 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.

22. Local “ tooth “ considerations
21. Complex morphology:
 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.

23. THANK YOU
GOOD LUCK