Having taken the case history and carried out the relevant diagnostic tests, the patient’s treatment is then planned. The type of endodontic treatment chosen must take into account the patient’s medical condition and general dental state. The indications and contra-indications for root canal treatment are given below and the problems of reroot treatment discussed. The treatment of fractured instruments, perforations and perio-endo lesions are discussed in subsequent chapters.
It should be emphasised here that there is a considerable difference between a treatment plan and planning treatment. Figure 8 shows a radiograph of a patient with a severe endodontic problem. A diagnosis of failed root canal treatments, periapical periodontitis (both apically and also associated with a perforation of one root), and failed post crowns could be made. A treatment plan for this patient may be orthograde re-root canal treatment, with repair of the perforation, followed by the provision of new posts and cores, and crowns.
However, success in this case may depend upon the correct planning of treatment. For example, what provisional restorations will be used during the root canal treatment, and during the following re-evaluation period. Temporary post-crowns have been shown to be very poor at resisting microleakage.
The provision of a temporary over denture, enabling the total sealing of the access cavities, would seem an appropriate alternative, but if this has not been properly planned for, problems may arise and successful treatment may be compromised.