General overview
The treatment sequence may be planned into a
number of stages including: (1) initial cause-related
therapy, e.g., emergency pulp extirpation;
(2) re-examination, e.g., response to initial endodontic
treatment; (3) corrective treatments, e.g., complete root
canal treatment and restorative treatment; and
(4) maintenance, e.g., measures to prevent the disease
recurrence.
Treatment plans can conveniently be divided into
“simple” and “complex”. The treatment plan may be
simple if only one tooth is involved and the overall
status of the dentition is acceptable,
especially for
regularly attending patients with a well-maintained
dentition (Fig 7). A more complex treatment plan is
often required for patients who have not attended for
some time or where there is a need for a major
reassessment of a declining state of dental health
(Fig 8). If the patient requires an extensive treatment
plan, it is important to manage the acute pain and
swelling associated with a tooth that requires root
canal treatment before offering a definitive treatment
plan.
Prior to endodontic treatment, the existing
restoration should be removed completely because
visual clinical examination is an unreliable indicator of
the presence of marginal breakdown, caries, cracks and
fractures in teeth with pulp and/or periapical disease.
It may be necessary to defer the final decision to under-
take root canal treatment until after the restoration has
been removed and the remaining tooth structure can be
assessed more thoroughly.