![Lack of
[Devices & Technology] and Time
Dentist Related
Contended
Contraindications](https://image.slidesharecdn.com/caseselection-141013025558-conversion-gate02/85/Case-selection-49-320.jpg)
Uploaded byAl-Azhar University, Cairo, Egypt
Case selection
This document discusses factors for a dentist to consider when determining if a case is appropriate for endodontic treatment or if it should be referred. It identifies patient-related factors like age and medical conditions, tooth-related factors like abnormal canal configurations and cracks, and dentist-related factors like lack of experience or equipment. Contraindications are discussed for conditions that could make endodontic treatment difficult or risky. The document provides an extensive list of medical conditions and how they may impact anesthesia or healing from endodontic treatment.
More Related Content
![ONFH[AVN HIP] -TRIPLE REGIME -A NOVAL SURGICAL CONCEPT .pptx](https://cdn.slidesharecdn.com/ss_thumbnails/onfhavnhip2026koaconcalicutdrgokuldevdrmashraf-260210064517-213ec005-thumbnail.jpg?width=640&height=640&fit=bounds)
Case selection
- 1. AshrafRefai Samir BDSMSc 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 AskHimself 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 theFirst Question Then you need to determine whether the case in indicated or contraindicated for endodontic treatment
- 5. Indications ❖ Pulpalaffection due to pulpal or periodical pathosis ❖ Pulpal affection due to traumatic injury ❖ Facilitation of restoration (intentional endodontic treatment)
- 6. Contra-Indications 1. InsufficientPeriodontal Support
- 8.
- 11. Contra-Indications 3. VerticalFracture
- 14. Contra-Indications 4. Conditionof remaining dentition
- 16.
- 18. Operator Should AskHimself 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 theSecond 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 Phobiafrom 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 StatusPatient Related Contended Contraindications
- 26. Patient Motivation PatientRelated Contended Contraindications
- 27. Patient Availability PatientRelated 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 ToothRelated Contended Contraindications
- 34. Root Resorption ToothRelated Contended Contraindications
- 35. Hyper Calcification ToothRelated Contended Contraindications
- 36. Crown Root RatioTooth Related Contended Contraindications Referral might be required Extraction might be required
- 37. Periapical Condition ToothRelated 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 & IatrogenicErrors Tooth Related Contended Contraindications Referral is usually required Needs experience
- 40. Traumatic Injuries ToothRelated Contended Contraindications Avulsion Extrusion Intrusion
- 41. Cracked Tooth ToothRelated 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 VitalStructures 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 MedicallyRelated 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 MedicallyRelated 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 MedicallyRelated 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 MedicallyRelated 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 MedicallyRelated 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 MedicallyRelated 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 MedicallyRelated Contended Contraindications Patients may require post-operative antibiotics because of risk of infection
- 59. Tuberculosis & LungDisease 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 MedicallyRelated 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 BDSMSc DD HMD Lecturer of Endodontics Al-Azhar University ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +201001434323