Factors Affecting Prognosis in Endodontics PDF

Factors Affecting Prognosis in Endodontics Leigh R. Busch, D.D.S. Former Director, Predoctoral Endodontics NYU College of Dentistry Importance of Knowing Prognosis ● Clinicians are expected to be able to advise patients as to the prognosis of available alternatives ● Doc what’s the % of success f...

Factors Affecting Prognosis in Endodontics Leigh R. Busch, D.D.S. Former Director, Predoctoral Endodontics NYU College of Dentistry Importance of Knowing Prognosis ● Clinicians are expected to be able to advise patients as to the prognosis of available alternatives ● Doc what’s the % of success for the procedure? ● Clinicians are expected to maximize prognosis by using best treatment methods ● Nothing is 100% successful Definition of Success for RCT ● Strict definition= Absence of radiolucency and signs and symptoms, Sjogren,et al Factors affecting the long term results of endo tx. J Endo 1990 and many other studies ● Lenient definition= Absence of clinical signs and symptoms, Seltzer, Bender et al Factors affecting successful repair after RCT, JADA 1963 and many other studies ● If the patient has no signs or symptoms but there is a radiolucency present is additional treatment necessary? ● ROOT CANAL THERAPY IS A VERY PREDICTABLE AND HIGHLY SUCCESSFUL TREATMENT WHICH HAS BEEN USED TO HELP PATIENTS RETAIN THEIR TEETH FOR MANY YEARS Salehrabi & Rotstein, JOE 2004 “Endodontic Treatment Outcome in a Large Pt Population” Over 1 Million RCTs 8 Yrs later, 97% still in mouth Does that mean that RCTs are 97% successful? Peri-Implantitis Implant Failure ●Study published that I read last week, Buffalo, ●Higher failure rate for implants on patients taking anti anxiety medications. ●Interferes with bone formation Factors Affecting Prognosis ● Number of Roots and Canals ● Initial Apical Periodontitis (Radiolucency) ● Size of the radiolucent lesion? ● Location of tooth ● Previous treatment history ● Post Treatment Restoration ** ● Periodontal health ● Systemic health ● Age and Gender? ● SKILL OF CLINICIAN Initial Radiolucency ● The most important factor leading to success or failure is the presence or absence of an initial radiolucent lesion? Really? ● Does the size of the lesion influence success or failure of healing ? ● Farzaneh M, et al. Treatment outcome in endodontics: the Toronto Study JOE 2004;30:627-33 size doesn’t matter ● Hoskinson et al 2002—areas 5mm smaller or larger do affect prognosis Does Size Matter? Through and Through Lesion Left Scar Ingle; 6th Edition pg.1164 Apical Scar ● Bhaskar SN. Periaical Lesions-types, incidence, and clinical features. Oral Surg O Med Opath O Rad & Endo 1966 ● Scars comprise 2 % of radiolucent lesions usually after a surgical procedure Systemic Health ● A recent study by Marending et al in the 4x Oral Journal 2005 indicated as expected that diabetic and immune-compromised patients had a poorer outcome ● HOWEVER, The poorer outcome was not significant enough to preclude RCT ● Age and gender to not appear to affect prognosis Previous Treatment History ● Why did the original treatment fail? ● What are the chances of successful retreatment? ● Quality of Obturation ● Perforation ● Ledging ● Broken Instruments Radiographic Interpretation ●Changes in angulation can affect decision ●Radiograph is 2 dimensional ●Bias of clinician CBCT Can Help Diagnosis Advantages of CBCTs ● Designed to produce 3D info of maxillofacial skeleton ● 1st 2D dental radiograph 1896 ● 3D images of teeth and surrounding tissues ● Lower radiation doses than with conventional medical CTs ● PAPs detected sooner than with normal Pas ● True size, extent, nature, position of PA & resorptive lesions better assessed Should a CBCT be used for every case? ●Root fractures and RC anatomy better seen ●Quality of RC fills better 2D that CBCTs ●True nature of alveolar bone topography around teeth ●Assess posterior teeth prior to periapical surgery, thickness of cortical and cancellous bone ●Inclination of roots, relationship to Sometimes They Work For No Known Reason