Evaluation of Endo Outcomes Flashcards
(13 cards)
What is defined as successful endodontic outcome?
3 signs
- Lack of clinical symptoms & radiographic signs of disease, in particular apical periodontitis
- No pathosis should arise after treatment, if there were none pre-operatively
- Pre-operative pathosis should resolve completely with tx
What is defined as endodontic failure?
- Presence of s/s indicative of disease, in particular apical periodontitis
AAE Definitions for Endodontic Outcomes
1. Healing
2. Healed
3. Non-healed
4. Functional
- Healing
- functional, asymptomatic, with radiographic periradicular pathosis OR
- symptomatic, but with intended function not altered. with or without radiographic periradicular pathosis - Healed
- functional, asymptomatic teeth
- no/ minimal radiographic periradicular pathosis - Non-healed
- non-functional, symptomatic
- with/ without radiographic periradicular pathosis - Functional
- treated tooth serving its intended purpose in dentition
What are the criterias for evaluation of endodontic outcomes?
- Patient symptoms
- Clinical examination
- Radiographic examination
- Histologic examination
What are the patient symptoms related to Endo success & failure?
Success: Absence of symptoms
vs
Failure: Presence of symptoms
- Pain upon biting –> PA inflammation
- Pain on release –> crack
- Sensitive to thermal changes: missed canal? adjacent untreated tooth?
- Bad taste –> draining abscess?
What are radiographic signs of success & failure of RCT?
*Radiographs must be taken at the appropriate time, at least 6m post-tx for any radiographic changes. Same angle and exposure
Success:
- When comparison of pre & post-op xray shows resolutions of signs
- PDL space: widened –> normal
- Size reduction/ absence of PARL
- Lamina dura: disrupted –> continuous and intact
Failure:
- Increased size of PARL
-
However,
- Residual PARL does not necessarily indicate failure and specific time intervals alone should not be used to conclude that a lesion will not resolve without intervention. Complete healing can take 10-20 years (Yu et al 2012)
What are the clinical examinations s/s indicative of success & failure of Endo tx?
Success:
- Absence of symptoms (but may be asymp AP, does not necessarily indicate success)
- Tooth restored and in function (considered success)
Failure:
- Presence of s/s
- Swelling, abscess, sinus tract
- TTP, TTPp
- Deep narrow PPD indicative of periodontal breakdown
What evidence shows residual PARL doesnt necessarily indicate failure?
Residual PARL does not necessarily indicate failure and specific time intervals alone should not be used to conclude that a lesion will not resolve without intervention. Complete healing can take 10-20 years (Yu et al 2012)
- Diminished lesion at 6m suggests healing potential but more follow ups required
- Smaller lesions tend to heal completely, larger ones improve over time
Histologic evidence of success and failure of RCT
- Rarely done as need surgery to do biopsy
Success:
- Reconstitution of PA tissues
- Absence of inflammation
Failure:
- persistent inflammation
What are the limitations of radiographic examination to evaluate outcomes?
- Angulation change may yield different appearance of a lesion, subjected to bias
- The correlation btw radiographic changes & histological status of PA tissues unclear
What are the landmark studies in evaluation of outcomes?
- Strindberg 1956: related outcomes to biologic and therapeutic factors
- Bender et al 1966: discussed criteria of endodontic success and failure
Categories of factors affecting endodontic tx outcomes
- Pre-op
- Intra-op
- Post-op
- Microbial
Pre-op factors affecting endo tx outcome
- Patient factors
- Age & medical health: uncontrolled diabetes risk poor healing - Tooth factors
