Endodontic treatment can be extremely complicated at times due to various factors. These may include but are not limited to patient factors, diagnostic and treatment related factors, operator factors and more.
The two most common documents published to help clinicians evaluate the difficulty of endodontic cases are the American Association of Endodontists’ (AAE) Endodontic Case Difficulty Assessment Form and Guidelines and the Dutch Endodontic Treatment Index (DETI). (Links to these documents are available below)
Both forms list various variables such as canal curvature etc. in different difficulty columns which clinicians would fill in. The main difference between the two forms is that the DETI has a scoring system which gives an overall case difficulty and predictability statement, whilst the AAE leaves it quite subjectively to the clinician to decide.
The application developed here is an adaptation of both these forms in a digital way. The criteria are nearly identical to the AAE’s form, but a scoring system is also included. All variables in the “LOW DIFFICULTY” column score +1, “MEDIUM DIFFICULTY” scores +2 and “HIGH DIFFICULTY” scores +3. A total score is also given.
how to use application
It’s very simple to use the application. On launch, there is a form on the screen with various options to choose from in each category. Each row represents a different category. The form is divided into 3 parts – Patient factors, diagnostic/treatment factors and other factors. For each row, the user should chose the appropriate option from either the LOW, MEDIUM or HIGH DIFFICULTY column.
Although not made mandatory, users should try to fill in every row before clicking “calculate score”. The “check boxes” are optional.
For more information on scoring and uses, click on the “HELP AND ABOUT BUTTON”.
Uses for the application
- Clinicians can more objectively explain patient’s the details of their endodontic treatment with regards to its difficulty
- The application allows clinicians to systematically assess the endodontic case through all the variables on the application
- Clinicians themselves are better informed regarding the difficulty of the case which can help them treatment plan more effectively
- Can help clinicians decide when to undertake cases themselves or refer cases to a more experienced colleague
- The difficulty score may also be used to estimate chair time required
- The application can help in providing objective reasons for treatment planning the case in a particular manner – e.g. justifying removing a full coverage crown prior to commencing root treatment
- The application may be used by clinicians to estimate or categorise patient charges more justifiably
limitations of the application
With any scoring system, however objective it appears to be, the clinician should base their decisions on contemporary, relevant and high quality evidence.
Furthermore, sometimes only a single “HIGH DIFFICULTY” variable may be present, and the application will return an overall difficulty of “LOW”. However this one variable may make the case extremely difficult. For e.g. if all other variables are LOW DIFFICULTY except for “canals that are not visible on the radiograph”, the application will still given an overall LOW DIFFICULTY. An experienced clinician may struggle with with such a case.
These limitations are not exclusive to the application but inherently related to scoring based systems.
Downloading the application
The application can be downloaded by clicking the link below. It has been made to work on Windows 32 and x64 bit systems.
Ree, Marga & Timmerman, M.F. & Wesselink, paul. (2003). An evaluation of the usefulness of two endodontic case assessment forms by general dentists. International endodontic journal. 36. 545-55. 10.1046/j.1365-2591.2003.00688.x. (Available here)
(2006). AAE Endodontic Case Difficulty Assessment Form and Guidelines Guidelines for Using the AAE Endodontic. (Available here)