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ENDO CASE

AAE EndoCase is an app developed by the American Association of Endodontists (AAE) to help assess the difficulty of endodontic cases.

Criteria and Subcriteria	Low Difficulty	Moderate Difficulty	High Difficulty
PATIENT CONSIDERATIONS
Medical History	No medical problem (ASA Class 1 or 2*)	One or more medical problem (ASA Clss 3*)	Complex medical history/serious illness/disability (ASA Class 4*)
Anesthesia	No history of anesthesia problems	Vasoconstrictor intolerance	Difficulty achieving and/or maintaining anesthesia
Patient Disposition	Cooperative and compliant	Anxious but cooperative	Uncooperative
Ability to Open Mouth	No limitation	Slight limitation in opening	Significant limitation in opening
Gag Reflex	None	Gags occasionally with radiographs/treatment	Extreme gag reflex which has compromised past dental care
Emergency Condition	Minimum pain or swelling	Moderate pain or sweling	Severe pain or sweling
DIAGNOSTIC AND TREATMENT CONSIDERATIONS
Diagnosis	Sign and symptoms consistent with recognized pulpal and periapical condition	Extensive differential diagnosis of usual signs and sumptoms required	Confusing and complex signs and symptoms: difficult diagnosis History of chronis oral/facial pain
Radiographic Difficulties	Minimal difficulty obtaining/interpreting radiographs	Moderate difficulty obtaining'interpreting radiographs (e.g., high floor of mouth, narrow or low palatal vault, presence of tori)	Extreme difficulty obtaining/interpreting radiographs (e.g., superiomposed anatomical structures)
Position in Arch - Tooth Type	Anterior/premolar	1st molar	2nd or 3rd molar
Position in Arch - Inclination	Slight inclination (<10 degree)	Moderate inclination (10-30 degree)	Extreme inclination (>30 degree)
Position in Arch - Rotation	Slight rotation (<10 degree)	Moderate rotation (10-30 degree)	Extreme rotation (>30 degree)
Tooth Isolation	Routine rubber dam placement	Simple pretreatment modification required for rubber dam isolation	Extensive pretreatment modification
Crown Morphology	Normal original crown morphology	Full coverage restoration Porcelain restoration Bridge abutment Moderate deviation from normal tooth/root form (e.g., taurodontism, microdents) Tooth with extensive coronal destruction	Restoration does not reflect original anatomy/alignment Significant deviation from normal tooth/root form (e.g., fusion, dens in dente)
Canal Morphology	Slight or no curvature (<10 degree)	Moderate curvature (10-30 degree) Crown axis differs moderately from root axis	C-shaped morphology Extreme curvature (>30 degree) S-shaped curve Mandibular premolar or anterior with 2 roots Maxillary premolar with 3 roots Canal devides in middle or apical third Very long tooth (>25mm) Other anomalies such as radix ento/paramolaris
Apex Diameter	Closed apex (<1mm in diameter)	Apical opening 1-1.5mm in diameter	Open apex (>1.5mm in diameter)
Radiographic Appearance	Canal(s) and chamber visible and not reduced in size	Canal(s) and chamber visible but reduced in size Pulp stones	Indistinct canal path Canal(s) and chamber not visible
Proximity of the root apices to vital structures such as the IAN or mental foramen	Vital structures 5 or more milimeters from apices	3-5 milimeters	<3 milimeters
Resorption	No resorption evident	Minimal apical resorption	Extensive apical resorption Internal resorption External resorption
ADDITIONAL CONSIDERATIONS
Trauma History	Uncomplicated crown fracture of mature or immature teeth No history trauma	Complicated crown fracture of mature teeth Subluxation	Complicated crown fracture of immature teeth Horizontal root fracture Alveolar fracture Intrusive, extrusive or lateral luxation Avultion
Endodontic History	No previous treatment	Previous access without complications	Previous access with complications (e.g., perforation, non-negotiated canal, ledge, separated instrument) Previous surgical or non-surgical endodontic treatment completed
Periodontal-Endodontic Condition	None or mild periodontal desease or concurrent moderate periodontal disease	Combined endodontic/periodontic lesion	Concurrent severe periodontal disease Cracked teeth with periodontal complications Root amputation prior to endodontic treatment

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HIGH

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TOTAL

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ENDO CASE

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This case is below 22 points. The case can be treated by a dental student under faculty supervision. The supervision should be tailored to the student's level of experience.

This case is beetween 22 to 23 points. If treated by a dental student, they should be skilled and under very close supervision by an endodontist. Alternatively, the case should be treated by an endodontic resident or endodontist.

This case is above 23 points. The case should not be treated by a predoctoral student. The patient should be referred to an endodontic resident or endodontist.