November 19, 2013
All teeth considered for treatment without predetermination under the NIHB endodontic policy should meet the following criteria:
- adequate biologic width (i.e., 3 mm or more)
- a crown/root ratio of 1:1 or more
If you have any doubts about a tooth meeting these criteria, you are advised to submit for predetermination.
Health Canada recently announced an extension of a Non-Insured Health Benefits (NIHB) Program trial that assesses the feasibility of removing the predetermination (PD) requirement for standard root canal treatment (RCT) procedures on bicuspids and first molars. The trial, initiated on April 1, 2011, has been extended until March 31, 2016.
A review of the initial trial period found that 25% of bicuspid and first molar teeth that had an RCT did not meet the treatment/restorability criteria of the program. Of these teeth, the main reasons for not meeting the criteria were insufficient biologic width (63.5%) and insufficient periodontal support (11.7%). Teeth with active caries or affected by active periodontal disease also failed to meet the program’s criteria for treatment.
To help measure the program’s success, the NIHB Program has set a target of having 95% of teeth meet the treatment/restorability criteria during the trial’s second phase. The rate of extractions of bicuspid and first molar teeth after RCTs are performed will also be monitored; rates are expected to decrease relative to the first phase of the trial.
Health Canada’s treatment/restorability criteria are detailed in the NIHB endodontic policy. However, it is essential that all teeth considered for treatment without predetermination under this program meet the following two criteria:
- adequate biologic width (i.e., 3 mm or more)
- a crown/root ratio of 1:1 or more
If you have any doubts about a tooth meeting these criteria, you are advised to submit for predetermination.
The NIHB Program will continue to sample randomly selected paid standard RCTs and assess them against NIHB endodontic policy. Dentists participating in the trial must submit supporting documentation for RCTs upon request or be subject to payment reversal. Noncompliant cases are also subject to payment reversal, including instances when a noncompliant RCT is discovered during the course of assessing predetermination submissions for other dental services (e.g., crowns). In addition, in cases where radiographs are sent for preauthorization of a subsequent treatment, all endodontic services apparent on the radiograph will be evaluated for compliance.
For more detailed information on the NIHB endodontic policy, please refer to the endodontics services section of the NIHB Dental Benefits Guide at hc-sc.gc.ca/fniah-spnia/pubs/nihb-ssna/_dent/2012-guide/index-eng.php#a84.
