Revascularization Study - Post Treatment Follow-up Findings

This form is for entering information from a follow-up appointment for a case in which you have already submitted the initial information. It is critical that you match the "Case ID" for the original information.

If you are looking to enter a new case exit this form and go to:

http://aae1.Revascularization-Study.sgizmo.com/s3/

Note: Do to page logic do not use your browser's "Back" button. If you need to edit information already entered, contact Dr. Ed Halteman, ed@survey-design-and-analysis.com.

1. Please enter the case ID from the case to which this follow-up relates. The case ID consists of your initials followed by a three-digit number representing which case you are entering:
(your first case was 001, your second 002, etc.) (E.g. ASL001) *This question is required.

2. Please provide the patient's initials for this case. (leave blank if unknown)

First and Last Initials

4. Please indicate the level of spontaneous pain the patient was experiencing for this follow-up?

5. Please indicate whether any of the following were present for this follow-up.
(Select all that apply)

Swelling near or around the tooth
Sinus tract draining infection (stemming from the tooth)
Mobility (> 2mm)
None of these

6. Please indicate the pulp responsiveness for all applicable tests performed for the tooth in question.

Space Cell	Response	No response	Not performed
Cold
Heat
EPT

7. Please indicate the degree to which the patient reported tenderness to percussion.

8. At this point in the recall process with your patient, do you feel that the revascularization procedure performed was successful?

Please indicate which of the following describe why you consider the procedure a success. (Select all that apply)

Periapical healing
Apex closure
Root length increase

Root width increase
Positive vitality
Other (please explain) Please enter an 'other' value for this selection.

Please indicate why you don’t currently consider the procedure to be a success. (Select all that apply)

Patient’s pain
No healing or new apical radiolucency
Presence of sinus tract
Presence of external root resorption

There is a root or crown/root fracture
Apex hasn't closed enough
Other (please explain) Please enter an 'other' value for this selection.

What treatment, if any, have you provided since you determined that the revascularization procedure was not successful?
(Select all that apply)

Extraction
Apexification
Attempted a second regenerative procedure
Monitoring until patient is symptomatic
None
Other (please explain) Please enter an 'other' value for this selection.

Revascularization Study - Post Treatment Follow-up Findings

POST TREATMENT FOLLOW-UP FINDINGS