Prognosis / Outcomes Overview
When should pts be recalled?
- Orstavik – 1 yr; peak incidence of healing / CAP occurred @ 1 yr; may take 4 yrs
- Andreasen – 1 yr; wait 4 yrs for uncertain healing cases
How long doe it take a lesion to heal?
Murphy – Avg. rate is 3.2mm/mo.; >70% require >12mo
What factors may be detrimental to a successful outcome?
- Crump – (POOR PAST): Perforation, Obturation; Overfill, Root canal missed, Perio disease, Another tooth, Split tooth, Trauma
- Friedman – Toronto study: NSRCT – Pre-op lesion
- RETX – Pre-op lesion, perforation, fill quality, restoration
- S RCT – lesion > 5mm quadrupled risk
Do the radiographic healing correlate to histologic healing?
- Byrnolf – No; only 7% demonstrated no inflammation
- Walton – Yes; 74%
Is bacterial culturing indicated? Does it influence healing?
- Sjogren & Sundqvist – 94% success w/ -culture; 68% w/ +culture; regardless, they state modern anaerobic culturing techniques are not readily available, nor are they required
- Peters & Wesselink – found NSD between 1 or 2 visit, or between + and – cultures
What are reasons for failure of NS RCT?
- Intraradicular infection – Nair – main reason for failure is microbes persist in canals
- Extraradicular infection – Siqueira –rare / Nair – Actinomycosis
- Foreign body rxn – Nair – root filling materials
- Cysts – Nair – possibly with cholesterol crystals
Does the level of root canal fill influence success/failure?
- Seltzer & Bender – Overfill decreased success; underfill had no influence
- Ng – meta-anaylsis shows w/in 2mm of apex improved success
Is 1 or 2-visit treatment more successful?
- Peters & Wesselink – NSD
- Weiger, Rosendahl & Lost – NSD for teeth with AP treated in 1 visit or with 1 wk Ca(OH)2
- Toronto (Friedman) 85% healed; 95% functional
- Washington Study (Ingle) 92%
- Toronto (Friedman) 81% healed; 93% functional (with Perforation - 42%)
- Allen, Newton , Brown 73%
Allen, Newton , Brown 47%
- Toronto (Friedman) 74% healed; 91% functional
- Rubinstein, Kim 97% (3-12 mo.); 92% (5-7yrs.)
- Allen, Newton , Brown 60%
2nd S RCT
Peterson & Gutmann 36% healed; 26% uncertain
Bender & Rossman 81%
Jordan, Suzuki & Skinner <50% (11/24 cases)
- Ravn 80% (uninflammed pulps)
- Tronstad <50% (carious exposure - consider IP)
- Cvek 96% (young incisors)
- Mass 91% (young molars)
- Cvek 96% -Ca(OH)2 long term
- Whitherspoon 91-94% -MTA
Pulpotomy (primary teeth)
Formo -84%; FeSO4 -93%; MTA -97%
Implants vs. RCT
- Doyle NSD - 94%
- Kim Meta analysis – NSD
Glockner 98% -pt. subjective success
Who discussed the criteria for success in 1956?
§ The contours, width and structure of the periodontal margin are normal
§ The periodontal contours are widened mainly around the excess filling
§ A decrease in the periradicular infection
§ Unchanged periradicular rarefaction
§ An appearance of new rarefaction or an increase in the initial
Who introduced the PAI?
- Orstavik 1986 – developed the Periapical Index (PAI) which is an ordinal scale of five scores ranging from healthy to severe periodontitis with exacerbating features; the
- PAI is based on reference radiographs verified histologically by Brynolf 1967; 1=healthy; 2-5=disease
(1) normal PA structures
(2) small changes in bone structure
(3) changes in bone structure w/ some mineral loss
(4) periodontitis w/ well-defined radiolucent area
(5) severe periodontitis w/ exacerbating features
Are endodontic teeth more brittle?
Sedgley - Endo treated teeth are NOT
Does the presence of PARL reduce success of NSRCT?
Friedman – Presence of PARL decreases success by 10-25%
If a tooth is perforated, what factors affect outcome?
3 factors affect outcome of perfs
Does radiographic healing correlate to histo?
Brynolf – only 7% histo healing despite 100% radiographic healing
Walton –100% radiographic healing had 74% histo healing (disputes Brynolf’s findings)