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Consensus Report of the European Society of Endodontology

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Consensus Report of the European Society of Endodontology doi:10.1111/j.1365-2591.2006.01180.x QUALITY GUIDELINES Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology European Society of Endodontology Abstract generally given by competent practitioners. The Euro- pean Society of Endodontology has the expertise and European Society of Endodontology. Quality guidelines professional responsibility necessary to assist the dental for endodontic treatment: consensus report of the European profession by instituting guidelines on the standard of Society of Endodontology. International Endodontic Journal, care in the special area of Endodontics. In accepting this 39, 921–930, 2006. responsibility the European Society of Endodontology The assurance of the quality of a service rendered by a formulated treatment guidelines that are intended to member of the dental profession is an essential feature of represent current good practice. This document is the any system of peer review in dentistry. This document revised version of an earlier consensus report [Interna- addresses two essential elements: (i) appropriateness of tional Endodontic Journal (1994) 27, 115–24]. As there is treatment modality and (ii) quality or level of treatment not one single way of performing treatment, these rendered. In revising these guidelines the European guidelines have been formulated in broad terms. Society of Endodontology is responding to a public and Keywords: periodontics, standards, root canal treat- professional need. In receiving care of a specialized ment, vital pulp therapy, dental trauma. nature such as endodontic treatment, patients need and deserve treatment that meets the standard of care Received 13 June 2006; accepted 13 June 2006 ontology (European Society of Endodontology 2001). Introduction Endodontic treatment encompasses procedures that are Endodontology is concerned with the study of the form, designed to maintain the health of all or part of the function and health of, injuries to and diseases of the dental pulp. When the dental pulp is diseased or dental pulp and periradicular region, their prevention injured, treatment is aimed at preserving normal and treatment; the principle disease being apical periradicular tissues. When apical periodontitis has periodontitis, caused by infection. The aetiology and occurred treatment is aimed at restoring the periradi- diagnosis of dental pain and diseases are integral parts cular tissues to health: this is usually carried out by of endodontic practice. The scope of the special area of root canal treatment, occasionally in combination with dental practice known as endodontics is defined by the surgical endodontics. educational requirements for the training of a dentist, The scope of endodontics includes, but is not limited as described by the European Society of Endodontology to, the differential diagnosis and treatment of oro-facial in the undergraduate curriculum guidelines for Endod- pain of pulpal and periradicular origin; prevention of pulp disease and vital pulp therapy; pulp extirpation and root canal treatment; root canal treatment in cases Correspondence: Prof. Dr. Claus Lo¨st, Zentrum fu¨r Zahn-, of apical periodontitis; (root canal) retreatment in case Mund- und Kieferheilkunde, Poliklinik fu¨r Zahnerhaltung, of post-treatment apical periodontitis; surgical endod- Osianderstr. 2-8, D-72076 Tu¨bingen, Germany. (Tel: 0049 7071 2982157; fax: 0049 7071 295656; e-mail: claus.loest@ ontics; bleaching of endodontically treated teeth; treat- med.uni-tuebingen.de). ment procedures related to coronal restoration by ª 2006 International Endodontic Journal International Endodontic Journal, 39, 921–930, 2006 921 Quality guidelines European Society of Endodontology means of a core and/or a post involving the root canal lymphadenopathy, presence of sinus tracts and pres- space and/or endodontically related measures in con- ence of temporomandibular joint dysfunction. nection with crown-lengthening and forced eruption procedures and treatment of traumatized teeth. As part Intra-oral examination of dentistry’s main goal to maintain a healthy, natural The practitioner should look for the standard of oral dentition for the public, the aim of endodontic treat- hygiene, condition of oral mucosa, presence of swell- ment is to preserve functional teeth without prejudice ings and sinus tracts, condition of teeth present, to the patient’s health. Every dental practitioner is periodontal condition, quantity and quality of restor- expected to be able to recognize and treat effectively ative work. pulpal and periapical injuries and diseases that are commonplace and within the skills acquired by gradu- Diagnosis ates of dental schools in Europe (European Society of Endodontology 2001). The cases that are beyond an The cause of the patient’s complaint should be identi- individual dental practitioner’s means concerning fied. Some or all, of the following diagnostic tests may diagnostic and/or technical alternatives should be be applied: palpation, mobility test, percussion, perio- referred to a colleague who has completed specialty dontal examination, occlusal analysis, testing for training in Endodontology (European Society of Endod- possible cracked teeth, pulp sensitivity tests, transillu- ontology 1998) or to a colleague who has acquired the mination, selective local anaesthesia, radiography necessary expertise elsewhere. (normally by using the paralleling technique and a beam guiding device for good reproducibility), colour matching and sinus tract exploration. It may be History, diagnosis and treatment planning necessary to take radiographs from more than one Many features of evaluation in Endodontics are com- angle, sometimes supplemented with bitewing and mon to all aspects of dental practice. These elements occlusal plane radiographs. Some patients may have are herein abbreviated, yet included for the purposes of to be recalled at periodic intervals to compare some of completeness. the examination data from one time interval to another to make an accurate diagnosis of the onset, progression or arrest of a certain process. At times it is advisable to Medical and dental history obtain radiographs from previous practitioners to have Medical history should reveal any medical condition or a clearer understanding of the progress of a condition medication which might influence diagnosis, e.g. (as it presents to the clinician at a given time). This is sinusitis, neoplasia, or treatment which may be influ- the case especially where previous root canal treatment enced by dental procedures; this should include allergy. has been carried out. Dental history discovers factors that may be import- ant for diagnosis and treatment planning. History of Treatment planning present complaint is recorded briefly and preferably in the patient’s own words. Pain history is recorded to Treatment should be planned for those teeth that are give information on the pain, but phrased to avoid functionally or aesthetically important and have rea- leading questions. The questions may include: the sonable prognosis. Procedures to maintain pulp health nature, duration, site, periodicity, precipitating or are described in ‘Management of the vital pulp’. relieving factors and associated symptoms. Indications for root canal treatment Root canal treatment may be carried out on all patients Clinical examination where other dental procedures may be undertaken. The patient should be examined both extra- and intra- Specific indications are orally and may also need to be checked for pyrexia and 1 An irreversibly damaged or necrotic pulp with or blood pressure. without clinical and/or radiological findings of apical periodontitis. Extra-oral examination 2 Elective devitalization, e.g. to provide post space, The practitioner should look for asymmetry, presence prior to construction of an overdenture, doubtful pulp and extent of swelling in the head and neck region, health prior to restorative procedures, likelihood of 922 International Endodontic Journal, 39, 921–930, 2006 ª 2006 International Endodontic Journal European Society of Endodontology Quality guidelines pulpal exposure when restoring a (misaligned) tooth tial for medico-legal reasons. These guidelines are and prior to root resection or hemisection. limited specifically to record keeping in relation to endodontic treatment. Contra-indications for root canal treatment 1 Teeth that cannot be made functional nor restored. The following should be recorded 2 Teeth with insufficient periodontal support. 3 Teeth with poor prognosis, uncooperative patients or Presenting symptoms, history of the present complaint patients where dental treatment procedures cannot be with a dental history related to this, results of clinical undertaken. examination and sensitivity tests, report on radio- 4 Teeth of patients with poor oral condition that graphs taken, diagnosis and treatment plan. cannot be improved within a reasonable period. Informed consent Indications for root canal retreatment 1 Teeth with inadequate root canal filling with radio- Where there are alternative treatments or special logical findings of developing or persisting apical problems, these should be explained and discussed periodontitis and/or symptoms. with the patient along with the likely prognosis and 2 Teeth with inadequate root canal filling when the recorded. It is good practice to provide the patient with coronal restoration requires replacement or the coronal written information. It should be recorded that the dental tissue is to be bleached. patient
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