PLANNING AND DIAGNOSTIC STEPS
Several planning and diagnostic steps prior to treatment are axiomatic in avoiding iatrogenic outcomes and to make treatment flow smoothly.
Risk Assessment
A risk assessment of every case should be made for possible iatrogenic events as well as to decide how the treatment should be carried out in light of the challenges that the tooth presents. While a comprehensive discussion of the various instrumentation strategies is beyond the scope of this paper, decisions about the likely final taper and master apical diameter can often be made from the initial films. For example, complex root forms will generally have less final taper than simpler root forms. Complex root forms will also usually require more initial hand negotiation prior to the use of RNT files.
Informed Consent
The patient must be well informed and give consent. Such informed consent is essential to build rapport and gain the patient’s trust. This informed consent is part of a larger examination that encompasses the patient’s medical and dental history and recording and duplicating the chief complaint. It also includes recording the objective and subjective findings amongst the other needed examination components. This consent stands in distinction to a procedure which is started and in which the patient does not know a root canal is being done or has been started until after the fact. The rubber dam should be used for all cases.
Optimal Visualization
Optimal visualization and magnification should be employed; for example, by using the surgical operating microscope (SOM [Global Surgical]). Profound anesthesia should be achieved and tested before access.
Treatment Planning
A plan for treatment should be made for the entire procedure before starting. While not entirely rigid, this plan should be followed unless there is a significant finding in the middle of treatment that necessitates a change in approach. (For example, moving to a step back instrumentation technique from a crown down approach.)
.
