Quality guidelines for endodontic treatmentIevietots 21.01.2012
Quality guidelines for endodontic treatment: The assurance of the quality of a service rendered by a member of the dental profession is an essential feature of any system of peer review in dentistry. This document addresses two essential elements: (i) appropriateness of treatment modality and (ii) quality or level of treatment rendered. In revising these guidelines the European Society of Endodontology is responding to a public and professional need. In receiving care of a specialized nature such as endodontic treatment, patients need and deserve treatment that meets the standard of care generally given by competent practitioners. The European Society of Endodontology has the expertise and professional responsibility necessary to assist the dental profession by instituting guidelines on the standard of care in the special area of Endodontics. In accepting this responsibility the European Society of Endodontology formulated treatment guidelines that are intended to represent current good practice. This document is the revised version of an earlier consensus report [International Endodontic Journal (1994) 27, 115-24]. As there is not one single way of performing treatment, these guidelines have been formulated in broad terms. 2 Elective devitalization, e.g. to provide post space, prior to construction of an overdenture, doubtful pulp health prior to restorative procedures, likelihood of pulpal exposure when restoring a (misaligned) tooth and prior to root resection or hemisection. 2 Teeth with insufficient periodontal support. 3 Teeth with poor prognosis, uncooperative patients or patients where dental treatment procedures cannot be undertaken. 4 Teeth of patients with poor oral condition that cannot be improved within a reasonable period. 2 Teeth with inadequate root canal filling when the coronal restoration requires replacement or the coronal dental tissue is to be bleached. 2 Extruded material with clinical or radiological findings of apical periodontitis and/or symptoms continuing over a prolonged period. 3 Persisting or emerging disease following root canal treatment when root canal retreatment is inappropriate. 4 Perforation of the root or the floor of the pulp chamber and where it is impossible to treat from within the pulp cavity. 2 Tooth with inadequate periodontal support. 3 Uncooperative patient. 4 Patient with a compromised medical history (as mentioned in ’Contra-indications for root canal treatment’). 2 Direct pulp capping: defined as a procedure in which the pulp is covered with a protective dressing or base placed directly over the pulp at the site of exposure. This procedure may be performed when the pulp is exposed through noninfected dentine and the tooth has no recent history of spontaneous pain and a bacteria-tight seal can be applied. The tooth should be isolated to prevent contamination. The cavity should be washed with a sterile, nonirritating solution and gently dried. The exposure site and surrounding dentine should be covered with material(s) that protect(s) the pulp from additional injury and permit(s) healing and repair. An overlying restoration with a bacteria-tight seal is required to prevent infection. An observation period of at least 1 year is necessary to evaluate the pulp condition of such a tooth confirmed by radiological examination and sensitivity tests. Indirectly fabricated gold alloy and ceramic restorations are not advised before pulp health has been determined. 2 Pulpectomy: defined as a procedure in which the total pulp is removed and which is followed by root canal treatment (see ’Root canal treatment’). This procedure may be performed when the pulp is considered to be irreversibly inflamed or when (part of) the pulp cavity is needed for retention of a restoration. Devitalization or chemically modifying the pulp should not be undertaken with materials containing toxic components as there are no indications for this approach. 2 A radiologically visible lesion has appeared subsequent to treatment or a pre-existing lesion has increased in size. 3 A lesion has remained the same size or has only diminished in size during the 4-year assessment period. 4 Signs of continuing root resorption are present.
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