As the landscape of dentistry continues to change, many clinicians are reflecting on their current workflows. Digital technology will impact many clinicians’ professional lives now and in the future. As such, it is important to consider the fundamentals of endodontic diagnosis, case assessment, and treatment planning. Digital tools may assist clinicians in these areas in the coming years.
Diagnosis and case assessment
When establishing a diagnosis, it is important to use the correct clinical language. By using the right diagnostic terminology, it is clear to anyone reflecting on the case that you understood the condition that’s present. This is especially important in clinical notes. A patient’s notes must be a true and accurate reflection of the situation. They should then inform any subsequent treatment. In the increasingly medicolegal world in which we operate, we should always record our notes using the correct terms.
Clinicians should consider both the pulpal and periapical diagnosis. Some teeth will have both, whereas others may have mixed vitality – some might have apical infection without pulp necrosis. It is important to establish this during the consent process as, generally, pulpal disease has a slightly better prognosis.[i]
Case assessment and planning treatment in detail
Having arrived at a diagnosis, it’s time to move on to planning treatment in detail. Amongst other things, planning treatment involves deciding:
It is encouraged to write a detailed plan, including timings to guide the entire journey. Breaking the appointment down into segments helps to use the time efficiently, and a sequential approach is useful for the dental nurse too.
Case assessment is an essential aspect of planning treatment. Clinicians should consider the specifics of the case, including:
There are a number of case assessment tools[ii] available to help clinicians understand the difficulty of the situation by answering a series of questions. Medicolegally, a complexity assessment can help to support clinicians’ decisions to treat or refer.
Clinicians should not be afraid to refer cases which are outside of their expertise, or upskill to enable them to tackle more challenging cases. Complex cases would not be expected to be undertaken in a general dental practice. Case assessments can help practitioners avoid wasting time in the practice, and depleting patients trust when preventable complications occur.
The use of digital tools in endodontics
The most impactful technological development in recent years has been CBCT imaging. Whilst it should not be used routinely, it should be employed when its findings will impact the treatment.
CBCT imaging is particularly useful for:
This means less time wasted searching for canals which aren’t there, and reduced risk of complications as you’re able to plan with more accuracy.
Predictive AI is also a growing area of dentistry – this includes CBCT. This should be used with caution as programmes such as ‘metal artifact reduction’ technically alter the image, filling in the gaps. As such, it may not accurately represent what is really there.
Whilst it may be impossible to avoid dental AI going forward, the technology is not flawless yet. As such, clinicians can do better by using their skills, knowledge, and experience. However, for those who carry out very few root canal treatments, assistive technology can offer helpful guidance.
Author: Alyn Morgan (Immediate Past-president of the British Endodontic Society and CEO of Mimetrik)
[i] Yong, D., and P. Cathro. “Conservative pulp therapy in the management of reversible and irreversible pulpitis.” Australian dental journal 66 (2021): S4-S14.
[ii] https://britishendodonticsociety.org.uk/professionals/bes_case_assessment_tool.aspx