4R Operational Diagnosis Protocol

The Abou-Rass 4R Operational Diagnosis Protocol (4ROD) is a valuable clinical diagnostic method primarily designed for endodontics. However, after years of using the protocol in teaching and practice, it has been found that many aspects of the protocol are applicable and most beneficial for general dentistry practitioners doing endodontics associated with prosthodontics and periodontic procedures. Therefore, the value of the protocol is not limited to endodontic diagnostics but to dental diagnostics in general.

The 4ROD was first envisioned when I was an advanced endodontic resident at the University of Pittsburgh in 1968, and it continued for 20 consecutive years in USC’s academic teaching and clinical instruction and publications. In 1999, I introduced it to advanced general dental and endodontic training in the Kingdom of Saudi Arabia.

There have been five revisions to the protocol, the most recent for the Abou-Rass Endodontics Academy (AEA). Operationalism distinguishes the protocol from other methods for evaluating endodontic health diagnostics. It involves physical examination, which includes removing caries and crowns, restorations in non-surgical endodontics, and raising a flap or doing an apical curettage in surgical endodontics. This allows reality findings compared to interpreting radiographs, superficial probing of margins, or a periodontal pocket.

Operationalism is based on what I learned from my mentor, The late Andrew Michanowicz, when I was a graduate student with a periapical radiograph in my hand for an endodontic issue; he looked at it, looked at me, and said, “Marwan, don’t ask. Let’s see what happens when the restoration is removed. Let’s open and see!

“Operationalism” revolves around stepping in, observing, teasing out, and gathering actual data instead of relying on radiographic images or merely looking.

The protocol is an established clinical diagnostic method based on evidence-based guidelines. It integrates clinically accepted biological norms with the physical examination of the dentition, focusing on investigating and evaluating the tooth Endodontium and Periodontium data. It is valuable for the general dentistry practitioner because it applies to a single tooth, a quadrant of teeth, or an entire dentition.