Dentaltown February 2018 - 36
message board
Would You Refund an RCT
in a Case Like This?
Persistent PARL and endo referral make the Townie wonder how others would proceed
MetalDoc
Member Since: 05/20/13
Post: 1 of 98
I'll keep it short and sweet: Patient with fistula around
10. PA reveals large radiolucency and decay. RCT recommended. I'm a GP but seemed straightforward enough.
RCT completed in one step in early January. Patient comes
in in September, saying tissues have not healed, slight pain
in area. PA reveals radiolucency still present. My buddy says
it's gotten smaller but to me, honestly looks about the same.
Advised endo consultation. Patient now wants a refund
because endodontist will be redoing treatment. I told patient
I'm fine with a refund as long as I can get notes or chat with
the endodontist. Recent PA included. ■
10/23/2017
winnfd
Member Since: 02/12/15
Post: 2 of 98
Your RCT looks good. The radiolucency looks somewhat J-shaped. Did you probe around
the tooth to look for a crack? ■
10/23/2017
eeznogood
Member Since: 02/23/06
Post: 4 of 98
It is not cracked. The endo does look good, but this on its own is not a good indication of
clinical success. This case should have ideally been two-stepped, in order to assess healing of
the fistula before sealing the tooth. Laterals are notorious for not healing well. Possibly because
they are too fast to treat.
Technically, there is no need for a refund, but in reality, it will be kind of tough to get out of
this one. In my office I would refund (and have done it before, unfortunately). You do enough
endo, some stuff will fall back on you, and whether you find it fair or not, it's there and you need
to make it go away.
For the future:
1. Cases like this one, I two-step or multistep until resolution of symptoms before sealing.
2. Beforehand, I tell the patient that when I see a PARL, there is a possible need for an
apico if the area does not heal after endo. I always tell them that. And I always give
them the quote for the apico and tell them that 5 percent will need it. So that they know
ahead of time and it is not a surprise if it happens.
These two things have now almost eliminated the need to refund and made my endo journey more pleasant. ■
10/23/2017
docdino
Member Since: 11/25/02
Post: 5 of 98
Why would you refund the money? RCT looks like it is done to the standard of care. What
is the endodontist's dx of why RCT is failing? Sometimes RCTs don't solve the problem; tooth
could be cracked. If the endo RCT doesn't solve problem, does patient get another refund?
Could be more significant path. ■
10/23/2017
36
FEBRUARY 2018 // dentaltown.com
http://www.dentaltown.com
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